COVID-19 Update June 11, 2020


MSSNY Press Statement: COVID-19 Has Devastated Physician Practices
“The June 10th Fair Health report—which highlights the fact that community physician practices faced 80% drops in patient visits and revenue—confirms similar MSSNY surveys about the absolutely devastating impact this pandemic has had on community physician offices across New York State.

“MSSNY surveys have demonstrated that the federal CARES Act enacted by Congress in the spring helped to offset some of these enormous deficits, but it has been nowhere near enough to ensure the survival of many physician practices across the state.

“We again urge the New York Congressional delegation to continue its efforts for dedicated grant funding in the next stimulus package for these hard-hit community practices—not only to preserve the hundreds of thousands of jobs physician offices provide across the state, but most importantly to ensure we can continue to treat our patients who depend on our services.”

Notes from Governor Cuomo’s Briefing

– Day 103 of COVID crisis
– Day 18 of civil unrest

– We must pay attention to daily testing as hospitalization rates will be about
2 weeks behind
– Monitor testing results by region and county
– Hospitalizations are down
– 36 deaths as of yesterday (32 in hospitals, 4 in nursing homes)
– Five regions enter phase 3 tomorrow
– Restaurants/food services (Indoor and outdoor)
– Personal care services (Nail salons, massage parlors)
– As we enter summer season, localities are allowed to open public pools and
playgrounds using their judgement while following state guidance
– Governor stated COVID is increasing in 21 states, noting spikes in
California, Florida, Texas, and Arizona.
– Reopening has been successful in NYS, due to phased reopening measures
and the efforts taken by New Yorkers
– We are a more-dense state with more crowding, so we must exercise more
– The effect protests have had on COVID has not yet been determined

– In response to a question regarding visitors in nursing homes, the Governor
stated that not being able to see a loved one is “better than death”. He
continued stating that when the DOH gives the okay, then visitors will
be allowed again
– DeRosa stated that it was understood that special education students have
difficulty with distance learning so it was agreed that they would be able to
have summer school in person at the discretion of localities

Police Reform/Protests:
– In answer to a question on demilitarizing police, Cuomo stated that this is a
moment for reform, but it must be done correctly
– In regards to discipline for officers not wearing masks at protests, the Governor
stated that it’s up to local police departments, however his recommendation is
to wear a mask
– When asked if he was comfortable saying “Black Lives Matter,” the Governor said,
“Of course they matter, all lives matter.” He continued stating that we must
continue to examine the systemic racism and find a solution
– In response to a question about the removal of the Christopher Columbus statue,
the governor stated that the statue has come to represent Italian-American contributions.

FAIR Health Releases Study on COVID-19 Impact on Revenue and Utilization Associated with Healthcare Professionals
Today, FAIR Health released its third COVID-19 study, Healthcare Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization. In this new brief, FAIR Health draws on its repository of private claims data to analyze, on a monthly basis, changes in utilization and estimated in-network reimbursement amounts for healthcare professionals in the first four months of 2020 as compared to the same months in 2019 (adjusted by Consumer Price Index). The second part of the study focuses on seven specialties: cardiology, dermatology, oral surgery, gastroenterology, orthopedics, pediatric primary care, and adult primary care.

Among the findings of the study: In April 2020, in the midst of the COVID-19 pandemic, healthcare professional services declined 68 percent in utilization and 48 percent in revenue based on total estimated in-network amounts compared to April 2019 nationally In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80 percent) and revenue (79 percent) in April 2020.

Of specialties studied, oral surgery had the largest decreases in utilization and revenue in both March and April 2020. In March 2020, oral surgery utilization declined by 80 percent, and revenue based on total estimated in-network amounts dropped 84 percent; in April 2020, oral surgery utilization declined 81 percent and revenue 92 percent. Gastroenterology had the second largest decreases in all four categories.

Of specialties studied, pediatric primary care had the smallest decreases in March 2020 utilization (52 percent), March 2020 revenue based on total estimated in-network amounts (32 percent), April 2020 utilization (58 percent) and April revenue (35 percent).

Across many specialties from January to April 2020, office or other outpatient evaluation and management (E&M) visits became more common relative to other procedures, both by utilization and total estimated in-network amounts. This may have been due in part to the fact that many of these E&M services could be rendered via telehealth, whereas certain other procedures that became less common required in-person visits.

The first brief in FAIR Health’s series on the COVID-19 pandemic examined projected US costs for COVID-19 patients requiring inpatient stays, and the second the impact of the pandemic on hospitals and health systems. For the new brief, click here.

Medicaid Enrollment Could Grow Hundreds of Thousands Enroll
Enrollment in New York’s Medicaid program could grow by hundreds of thousands of beneficiaries as workers lose their job—and their insurance coverage—because of the economic shock waves generated by COVID-19. A new analysis from the United Hospital Fund found the state is better equipped to handle a spike in workers seeking Medicaid benefits than during the Great Recession of 2007–2009.

“The infrastructure that’s in place to connect people to coverage right now is significantly more robust than it was in the Great Recession,” said Nathan Myers, director of UHF’s Medicaid Institute.

The Urban Institute last month estimated changes in insurance status by state based on how many people are unemployed. It projected an increase of 641,000 Medicaid enrollees in New York if the state unemployment rate is 15% and a 1.2 million increase if state unemployment reaches 25%.

The state’s unemployment rate reached 15% in April, compared with 3.6% in the same month last year. More businesses are operating this week, as New York City entered phase one of the state’s reopening plan and Long Island and Westchester County prepared to move to phase two. The second phase allows for more office-based businesses to open, as well as real estate services. But the state’s hard-hit hospitality sector, which shed about two-thirds of its jobs in April, will remain closed for a while.

New York already covers about 6 million people under Medicaid, which is about 2 million more than enrollment in December 2007. That number is expected to grow. During the Great Recession, Medicaid enrollment grew by more than 400,000.

Between February and April this year alone, New York’s Medicaid enrollment had a net gain of 136,000. That monthly growth rate would be four times as large as the monthly rate during the first 12 months of the Great Recession. Enrollment also tended to lag behind spikes in unemployment.

Since the recession, New York created its State of Health marketplace to allow people to sign up for Medicaid, Child Health Plus, Essential Plan and commercial insurance coverage. In addition to Medicaid sign-ups, health plans are expecting more customers to look for coverage for themselves after losing their job. Some consumers who are thinking they might have to shell out more than $1,000 per month for a family plan might find they qualify for subsidized products. The Essential Plan debuted in 2016 as an option for New Yorkers who aren’t eligible for Medicaid because of their income or immigration status. It’s an insurance product heavily subsidized by the federal government, and it could make coverage accessible to more people during the economic downturn.

The downturn comes as New York was already struggling to keep up with the costs of its $70 billion Medicaid program, in which it shares cost with the federal and local governments. It implemented a $2.2 billion savings program, reducing funding for hospitals and long-term-care providers, as part of the budget passed in April.

Gov. Andrew Cuomo has warned that the state could need to reduce spending by an additional 20% if it doesn’t receive additional federal support.

The state is getting some federal support. One of Congress’ earliest coronavirus relief packages included a 6.2 percentage point increase in the federal government’s contribution to Medicaid costs. This article originally appeared in Crain’s New York Business.

MLMIC Banner

Metrics of Opening New York
Each region must meet seven metrics before reopening: 14-day decline in hospitalizations; 14-day decline in hospital deaths; fewer than 2 new hospitalizations per 100,000 residents; at least 30% of total beds available; at least 30% of ICU beds available; monthly testing rate of 30 per 1,000 residents; 30 contact tracers per 100,000 residents. (Medpage June 11)

U.S. Coronavirus Cases Surpass 2 Million
It took the U.S. nearly three months to officially hit 1 million confirmed cases on April 28, but just six weeks to double it. Reporting of Covid-19 cases got off to a slow start amid the Trump administration’s delays in rolling out widespread testing capacity. Testing has now ramped up significantly, from nearly 6 million conducted in late April to over 21 million as of this week. But there are also signs of increased spread, as numerous states have started to see a spike in cases. (Politico 6/11)

Autopsies Turn Up Strange Feature of COVID-19 Lungs
A close look at the body after death from COVID-19 turned up some potentially novel differences in the lungs.

Histology showed the same diffuse alveolar damage with perivascular T-cell infiltration in the lungs of seven people who died with acute respiratory distress syndrome (ARDS) from COVID-19 as in those from seven decedents with ARDS from influenza A (H1N1).However, the vascular damage was different, Steven Mentzer, MD, of Brigham and Women’s Hospital in Boston, and colleagues reported in the New England Journal of Medicine.

NYEC Banner

Are Genetics Tied to Your COVID-19 Risk?
Researchers already have determined that a person’s age and whether they have certain underlying health conditions can affect their risk of developing a severe case of COVID-19, the disease caused by the new coronavirus. But now, some research suggests a person’s blood type may be another factor in whether they have a higher risk of developing a severe case of the disease.

For example, a preprint study published Tuesday that has not been peer-reviewed examined blood samples from 1,610 COVID-19 patients who developed severe cases of Covid-19, which the researchers classified as needing oxygen or a ventilator as part of their treatment. The researchers sequenced part of each those patients’ genomes, and then performed the same analysis on samples from 2,205 blood donors who did not have Covid-19 and compared the results.

The researchers found that many of the patients who had severe cases of Covid-19 possessed the same variant on a gene that determines a person’s blood type. Specifically, the researchers found that having blood type A was linked with a 50% increase in the likelihood a patient would develop a severe case of COVID-19.

According to the New York Times, a separate preprint study conducted by researchers in China that hasn’t yet been peer-reviewed found similar results. The study found that, out of 2,173 Covid-19 patients with different blood types, blood type A was associated with a higher risk of death from Covid-19 when compared with other blood types. The study also found that people with blood type A appeared more likely to contract the new coronavirus, whereas those with blood type O appeared to be the least likely to contract the virus.

Andre Franke, a molecular geneticist at the University of Kiel in Germany, who led the first study said he and his colleagues also identified another locus on Chromosome 3 that appeared to be linked with COVID-19. However, the researchers noted that locus hosts six different genes, and they’ve yet to determine which of those genes influences how Covid-19 develops. Despite the findings, Franke said researchers are still unsure exactly how a person’s blood type plays a part in how COVID-19 affects them. “That is haunting me, quite honestly,” he said.

Franke said the locus that hosts the blood-type gene also contains a portion of a person’s DNA that controls a gene that makes a protein that generates robust immune responses, the Times reports. According to the Times, researchers and providers have found that the new coronavirus can trigger a so-called “cytokine storm” in some patients, which occurs when a patient’s immune system overreacts to a pathogen and damages a patient’s organs, and it’s “theoretically possible that genetic variations influence that response.”

NY Docs Rock Banner