COVID-19 Update June 3, 2020

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News & Highlights from the Governor’s Daily Briefing

GENERAL:
– Day 95 of COVID-19 pandemic; Day 10 of civil unrest after the death of George
Floyd.

PROTESTS:
– Reiterated the difference between protesting and looting, urging protesters
to follow the curfew and remain peaceful.

Q&A:
PROTESTS AND POLICE:
– Gov claimed necessary reforms must be made to address injustice in the
criminal justice system. Hoped 50-a reforms could become law shortly.
– Believes legislature will be coming back “in the next couple of weeks” to
address reforms.


Small Doctor Practices Fear They May Not Survive the Pandemic
Primary care practices focus on the preventive care that keeps patients healthy. Many of them are small but punch above their weight in providing access to services in underserved communities. A series of new surveys by researchers at NYU have found that the city’s primary care practices have been particularly hard hit by the pandemic. Many of them worry they may not come out on the other side.

Initial survey results collected in mid-April yielded responses from nearly 500 primary care practices across the city and revealed that the Covid-19 crisis was having a severe impact on 85% of them, NYU said. The most common sources of stress included shortages of personal protective equipment, which 53% of respondents reported. Nearly half noted strain from large volumes of patient calls, and 42% reported struggles with staff illness. For practices that remained open, more than half of patient visits were completed via video or telephone, the researchers found. However, some providers were unsure whether they would be reimbursed for them.

In the most recent iteration of surveys, completed May 21, more than 120 practices responded, and 72% said that they were detrimentally affected by the crisis. More than 60% of respondents cited decreases in revenue as a severe source of stress.

“It is frustrating because small community clinics are completely forgotten,” one practice from Brooklyn responded. “We don’t get funds, and insurance carriers pay peanuts for televisits—that is, if they choose to pay.”

Though many primary care practices have applied for varying loan and grant programs to help ease some of the financial strain, there is concern they haven’t been a priority for federal relief. “We all understand that the crisis is at the hospital level, but what’s remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other frontline health care workers, and they’re called primary care doctors and nurses,” said Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research.

The Medical Society of the State of New York also noted that more federal funding is needed to support physician practices during the pandemic following its own survey. And even large practices have noted the high costs of obtaining PPE.

Shelley and her colleagues are working with NYU Langone Health as well as the city Health Department on the research. NYC Reach, a program at the Health Department that assists primary care providers in the city, has collaborated with NYU to assess Covid-related challenges and needs. Since the pandemic began, the program has worked with small independent practices on adapting to state and federal regulations for reimbursement of virtual services and utilizing other health care incentive programs.

The goal of the surveys is to gather data on the evolving needs of primary care practices and to put together actionable data that could help support them during and after the pandemic, Shelley of NYU said. Additional support could ensure that they have a greater role should another health crisis emerge. She collectively calls the primary care practices the “silent safety net.”

“If 50% shut their doors, they worry that their patients would have nowhere to go,” Shelley said. One practice responded that members of its staff can speak four African languages, an essential part of providing quality care to the patients it serves.

“Primary care is the foundation of our health care system,” Shelley said. “We have underinvested in it for decades.”


Gov. Cuomo: Erie County Elective Surgeries Can Resume
Governor Cuomo announced today that elective surgeries could resume in Erie County, including in ambulatory surgery centers and office-based surgery locations.  MSSNY worked together with the Erie County Medical Society and the NYS Society of Orthopedic Surgeons in strongly advocating for this resumption, including in communications with the NYS Department of Health and the Governor’s office. It was reported on the Buffalo News yesterday.

Medicaid Enrollment Increased for First 2 Months Of Outbreak, DOH Reports
More than 136,000 New Yorkers enrolled in Medicaid as the coronavirus outbreak surged in the state between the end of February and the end of April, state health officials have reported.

Data released by the state Department of Health found that more than 6.2 million New Yorkers had enrolled in the state’s Medicaid program as of April 30, compared to 6.06 million at the end of February — an increase of 136,498.

Enrollment in Child Health Plus and Qualified Health Plans, meanwhile, dropped a respective 27,563 and 17,283 between March 6 and May 23, DOH reported. More than 16,500 individuals enrolled in the Essential Plan during the same period.

State health officials did not immediately respond to requests for comment on the pre- and post-Covid-19 enrollment data.

Department of Health spokesperson Jonah Bruno said in early May that although the state anticipated some level of new enrollment in public health insurance programs, new enrollment due to the Covid-19 pandemic “may exceed our budget projections.”

Gov. Andrew Cuomo has repeatedly urged Congress to provide more funding to help states like New York rebound from the pandemic. The governor, who recently approved a budget including proposals to curb state Medicaid spending, has cautioned that without federal assistance, additional cuts may be needed. (Politico Pro June 2)


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MSSNY Provides Access to PPE Supply Chain in Collaborative Effort with American Society of Plastic Surgeons
The Medical Society of the State of New York (MSSNY) is pleased to offer members access to purchase PPE supplies through the American Society of Plastic Surgeons (ASPS) PPE supply chain program. ASPS established the program earlier this month to help practices acquire difficult-to-access PPE and other needed supplies as states begin to lift restrictions on elective surgery and office-based procedures.

Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked. Please note that shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times.

To see the available supplies and create an account to purchase items, visit this website.

MSSNY is proud to offer this benefit to our members and grateful to ASPS for extending this opportunity to help medical practices and patients in our state resume practice swiftly and safely.


Hospitals May Face Surge of Rescheduled Surgeries, Reports Predict
HealthDay (6/1) reports, “For months, the coronavirus pandemic forced hospitals to delay elective surgeries as doctors turned their attention to treating COVID-19 patients, but the spigots on non-urgent procedures are about to reopen.” According to “two new reports from Johns Hopkins University researchers,” hospitals may “be stretched to the limit by the oncoming surge of rescheduled surgeries.” According to one study published in the Journal of Bone and Joint Surgery, “it may take between seven and 16 months for orthopedic surgeons to get back to performing 90% of the surgeries completed at pre-pandemic efficiency.” Furthermore, “a second Hopkins report predicts a surge in skin cancer surgeries that could stretch in a six-month backlog.


Opinion: Trauma from COVID-19 Will Define a Generation of Healthcare Workers
In an opinion piece for the Washington Post (6/2), Dr. Craig Spencer, Director of Global Health in Emergency Medicine at New York Presbyterian/Columbia University Medical Center, writes about the impact the COVID-19 outbreak has had on healthcare providers. Spencer writes, “The curve will flatten. The cases will decline. And maybe one day, covid-19 will be an afterthought. But long after that, this trauma will define a generation of health-care workers.” Spencer concludes, “Most of us made it. The best among us didn’t. May they forever rest in peace. For the sacrifice they made. For all of us.”


If Pandemic-Related School Closures Continue to End of 2020, US Childhood Obesity Rate May Increase By 2.4%, Research Indicates
HealthDay (6/1) reports that “new research warns that over one million more American boys and girls” may have obesity “if coronavirus-related school closures continue through the end of the year.” The study author said, “If school closures continue to the end of 2020 – due to unsubdued community transmission of COVID-19 – the childhood obesity rate in the U.S. might further increase by 2.4%.” The research was published in the Journal of Sport and Health Science.


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Surgeon General: Large Protests Could Lead to New Outbreaks of Coronavirus
CNN (6/2) reports Surgeon General Dr. Jerome Adams warned that nationwide protests over the death of George Floyd would likely lead to new outbreaks of coronavirus. Dr. Adams said, “I remain concerned about the public health consequences both of individual and institutional racism [and] people out protesting in a way that is harmful to themselves and to their communities.” Dr. Adams added, “Based on the way the disease spreads, there is every reason to expect that we will see new clusters and potentially new outbreaks moving forward.”



CURFEW PLANNING: The Greater New York Hospital Association advised hospitals to tell their employees to carry hospital identification while New York City has a curfew in effect. Essential workers are exempt from the curfew.


Virus Deaths in NY Approaching Very Low Level, Cuomo Says
For practices that remained open, more than half of patient visits were completed via video or telephone, the researchers found. However, some providers were unsure whether they would be reimbursed for them.

In the most recent iteration of surveys, completed May 21, more than 120 practices responded, and 72% said that they were detrimentally affected by the crisis. More than 60% of respondents cited decreases in revenue as a severe source of stress.

“It is frustrating because small community clinics are completely forgotten,” one practice from Brooklyn responded. “We don’t get funds, and insurance carriers pay peanuts for televisits—that is, if they choose to pay.”

Though many primary care practices have applied for varying loan and grant programs to help ease some of the financial strain, there is concern they have not been a priority for federal relief.

“We all understand that the crisis is at the hospital level, but what’s remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other frontline health care workers, and they’re called primary care doctors and nurses,” said Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research.

The Medical Society of the State of New York also noted that more federal funding is needed to support physician practices during the pandemic following its own survey. And even large practices have noted the high costs of obtaining PPE.

Shelley and her colleagues are working with NYU Langone Health as well as the city Health Department on the research. NYC Reach, a program at the Health Department that assists primary care providers in the city, has collaborated with NYU to assess Covid-related challenges and needs. Since the pandemic began, the program has worked with small independent practices on adapting to state and federal regulations for reimbursement of virtual services and utilizing other health care incentive programs.

The goal of the surveys is to gather data on the evolving needs of primary care practices and to put together actionable data that could help support them during and after the pandemic, Shelley of NYU said. Additional support could ensure that they have a greater role should another health crisis emerge.

She collectively calls the primary care practices the “silent safety net.”

“If 50% shut their doors, they worry that their patients would have nowhere to go,” Shelley said. One practice responded that members of its staff can speak four African languages, an essential part of providing quality care to the patients it serves.

“Primary care is the foundation of our health care system,” Shelley said. “We have underinvested in it for decades.” Crain’s NY Business June 3.