COVID-19 Update June 4, 2020
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Some PPE Vendors Will Not Sell to Doctors with Smaller Practices; Or, Worse— Sell at Exorbitant Prices
Statement attributable to:
Bonnie Litvack, M.D.
President, Medical Society of the State of New York
“As the acute threat of COVID-19 begins to recede, physicians are anxious to return to providing in-person care to their patients. Telehealth has been essential in this crisis and remains an important and safe way for patients to receive treatment when an in-person visit is difficult or impossible. However, many conditions cannot be diagnosed or treated via telehealth and require a face-to-face visit.
“Masks, gowns, gloves, and other materials prevent the inadvertent transmission of viruses and germs between physicians, medical staff, and patients. As community physicians look forward to re-opening their offices, a major barrier to resuming regular patient care is the shocking shortage of this essential personal protective equipment (PPE).
“The contagious nature of the COVID-19 virus makes it necessary to change PPE frequently. Unfortunately, over the last several months some vendors refused to sell their products to smaller physician practices. Instead, they only contracted with larger institutions or government entities. In instances when suppliers would contract with physicians, there were outrageous price increases or supply limits that prevented physicians from receiving more than a few days’ supply.
“To ensure physicians can continue to serve their communities, these disgraceful business practices must be addressed. Otherwise, patient care will be compromised, as many patients may be unable to be seen and treated by their physicians.
“The State Legislature recently passed a measure to provide greater clarity under the law. Now, vendors who take advantage of a public health crisis to charge grossly inflated prices for needed medical equipment may be prosecuted. This is an important step to prevent price gouging but does not go nearly far enough. Currently, some vendors will not even attempt to sell to community physicians!
“The state and federal governments need to take immediate steps to require medical supply vendors are dealing fairly with physician practices. Should health care institutions receive all the medical supplies they need? Absolutely! However, community physicians play an essential role in treating patients on the front lines. However, without adequate PPE, some will be unable to open their offices and others will unable to stay open.
“We urge the Cuomo Administration and the Trump Administration to take the necessary steps to ensure that New York’s and America’s doctors have the basic tools to, once again, care for their patients and guarantee their safety during their office visits.”
(Dr. Litvack’s statement was featured in today’s Crains’ Health Pulse. See highlighted article below.)
Small Practices Struggle to Obtain PPE
As small physician practices look to bring back more in-person services, they’re having trouble securing the necessary personal protective equipment to do so. The Medical Society of the State of New York has heard from nearly 700 physicians in need of assistance procuring PPE. Though telehealth has been an important part of providing care during the Covid-19 crisis, some conditions can’t be diagnosed or treated virtually, Dr. Bonnie Litvack, president of the medical society, noted in a statement issued Wednesday.
Additionally, reopening offices will be particularly helpful for practices that have been financially strained by lower revenues and higher costs as a result of the pandemic.
“Unfortunately, over the last several months some vendors refused to sell their products to smaller physician practices,” Litvack said. “Instead, they only contracted with larger institutions or government entities. “Other practices saw substantial price increases or supply limits that prevented them from obtaining more than a few days’ supply, she added Litvack applauded the state Legislature for recently passing a measure that will help to prevent price gouging on medical equipment. However, she said, more efforts are needed from the state and the federal government to require vendors to deal fairly with community physicians.
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. The most common sourcesof stress included shortages of equipment, which 53% of respondents reported.
News & Highlights from the Governor’s Daily Briefing
GENERAL:
– Day 96 of COVID-19; Day 11 of aftermath of death of George Floyd.
– Reiterated the division caused by racial and political division brought forth
by both COVID-19 and police brutality.
COVID-19:
– Total hospitalizations down.
– Lives lost 6/3: 52 – 38 in hospitals, 14 in nursing homes. Noted this was a
slight increase but did not think it was anything to worry about.
– NYS conducts an average of 50k tests per day. Testing data has found
positive tests average around 1-2% in LI, NYC, WNY, and the Cap Region.
REOPENING:
– Reiterated need for caution when reopening to avoid a second wave.
– Worried protesters would compound COVID-19, stating there were approx. 30k
protesters statewide, ~20k in NYC.
– Will be expanding testing criteria to all individuals who have joined
recent protests.
-Get a test at www.coronavirus.health.ny.gov
-Said to assume you’ve been exposed to COVID at protests and disclose attendance to relatives and surrounding individuals.
– NYC to enter Phase I on Monday, yet had the highest number of protesters.
– Outdoor dining included in Phase II opening (WESTCHESTER/ROCKLAND/OC reopen next Tuesday).
PROTESTS:
– Gov thanked protesters last night for remaining “mainly peaceful.” Also
voiced his support for their fight, noting his outrage towards Floyd’s murder.
– Gov noted violence against police officers (i.e. stabbing, shooting) and
requested protesters not take such actions.
– Recommended local DAs should charge looters for their crimes and set bail.
BUSINESSES:
– Directing insurers to expedite claims for looted businesses, provide free
mediation of disputes, and accept photos as reasonable proof of loss so
businesses don’t have to wait for police reports.
– Visit www.dfs.ny.gov if a business is having trouble with their insurance company.
Q&A:
PROTESTS:
– Gov claimed to be “stunned” by the disrespect shown to NYPD in NYC protests
but noted his support for protester’s fight. Argued against violence towards
police officers.
– Gov acknowledged tense political environment getting in the way of
responsible conversation and reform.
– When asked how he addresses racist divide in NYS, “I just tell people what
I think,” answered the Gov. He claimed to make decisions and recommendations
based on facts without political bias.
– Gov named police violence against peaceful protesters a criminal action.
– On a note that Burglary 2 only pertains to personal dwellings, Gov said to
“charge appropriately.” DeRosa clarified that statute allows for
Burglary 2 to be charged and bail set on looters
Study finds scarcity of behavioral health providers will become more pronounced.
COVID-19 Has Exposed Flaws in US Mental Health System
Modern Healthcare reports, “As COVID-19 and nationwide protests bring demand for behavioral health services even higher, the nation’s scarcity of providers likely will become more pronounced.” And although some providers “have been working to integrate behavioral and medical health for a few years, there are a host of organizational, cultural and financial burdens to overcome, many of which are highlighted in a RAND Corp. study published June 1 in the Annals of Internal Medicine.” Patrice A. Harris, M.D., M.A., president of the American Medical Association, said: “The COVID-19 pandemic has exposed and magnified the flaws in our mental health system and the true burden of mental illness in our country. Behavioral health care integration can help save lives and is a proven model that has many advantages over a more divided one.”
Scientists Question Data in Two Prominent Medical Journals
The New York Times (6/2) reports “a group of scientists has questioned the data used in studies in two prominent medical journals.” At issue are a study published in the New England Journal of Medicine on May 1 concerning the impact of blood pressure drugs on patients with coronavirus and a study published in The Lancet on May 22 concerning the use of hydroxychloroquine and chloroquine to treat patients with coronavirus. The studies share some of the same authors and both relied on the same database, which the group of scientists say may not be reliable.
The AP (6/2) reports that on Tuesday, the New England Journal of Medicine issued an “expression of concern” about the study it published that “suggested widely used blood pressure medicines were not raising the risk of death for people with COVID-19.” In its communication, the journal expressed concerns about the reliability of the database. Similarly, The Lancet issued an expression of concern about the study it published that “tied the malaria drugs hydroxychloroquine and chloroquine to a higher risk of death in hospitalized patients with the virus.” The Lancet said questions have been raised about the data used in the study.
IM Resident Takes Time to Deliver Wellness Bags to Healthcare Workers
Internal Medicine intern Gayatri Malhotra-Gupta, daughter of MSSNY member Dr. Sandhya Malhotra (Queens), delivers wellness bags to health care workers across the city. Dr. Malhotra-Gupta is part of the Global Physicians Network Foundation, along with two others (GPNF members has delivered more than 500 bags to 12 hospitals). “I think that the sense of community in New York is what’s going to help us through this really tough time together,” she said.
Americans’ Top 5 COVID-19 Stressors
The most common stressor related to the pandemic for the U.S. public is reading or hearing about the severity and contagiousness of COVID-19, a new survey shows.
The survey was conducted April 7-9 and includes responses from 1,015 U.S. residents 18 years or older. Survey results were published in the Journal of General Internal Medicine.
Five top stressors related to the COVID-19 pandemic:
Note: Respondents could select multiple stressors.
- Reading or hearing about the severity and contagiousness of COVID-19: 96.6 percent
- Uncertainty about length of quarantine and social-distancing requirements: 88.3 percent
- Changes to social routines, such as spending time with friends and loved ones: 83.7 percent
- Changes to daily personal care routines, such as cooking, cleaning, exercise, and relaxation: 80.1 percent
- Cancellation of planned or scheduled celebrations, entertainment, vacations, or trips: 68.7 percent
Mental Wellness Has Crept Our Daily Discourse in Ways That It Never Has Before
While one in five adults has a clinically significant mental or substance use disorder, behavioral health integration into U.S. physician practices is still uncommon. Findings from a new joint study by the RAND Corp., the American Medical Association (AMA) shed light on what physicians say are the barriers to adoption.
The COVID-19 pandemic has exposed and magnified the flaws in our mental health system and the true burden of mental illness in our country.
- Since 2001, suicide has increased by 31 percent, making it the tenth leading cause of death in the US.
- 60 percent of US counties do not have a practicing psychiatrist.
- one in five adults experience mental illness.
- one in 25 experience serious mental illness.
- In 2018, only 40 percent of adults who experienced mental illness received treatment.
One potential solution to the crisis is integrating behavioral health into medical care. As such, determining barriers to adoption is critical. Published today in the Annals of Internal Medicine, the new RAND-AMA study sheds important insight on motivations and barriers influencing physician practices’ implementation of behavioral health integration.
Obesity May Greatly Increase Odds of Children Getting Severe COVID-19
“If a child is infected with the new coronavirus,” having obesity “appears to greatly raise the odds for developing a severe form of COVID-19, a new study finds.” According to the research, “eleven (22%) of the 50 kids” had obesity, “and six of the nine children who required a ventilator” had obesity. The findings were published in JAMA Pediatrics.
People of Color Have Been Disproportionately Affected By COVID-19
- About 26 percent of COVID-19 patients in the U.S. have been black, while white people account for 52.2 percent and Asian people account for 4.6 percent, according to CDC data updated June 1. The data is based on 718,254 COVID-19 cases in which race was specified. According to U.S. Census estimates from 2019, white people account for 76.5 percent of the nation’s population, while black individuals account for 13.4 percent and Asian people account for 5.9 percent.
- Nationwide, 26 percent of Latino adults said they know someone who has died from COVID-19, compared to just 10 percent of white adults, according to an ABC News-Ipsos survey published May 22. In Maryland, Virginia and Washington, D.C., Latinos represent about 10 percent of the population but account for one-third of cases, according to an analysis by The Washington Post. (Becker’s Hospital Review, June 2)
Providers Want More Telehealth Flexibility and Higher CMS Payments
Rather than stopping telehealth’s momentum when the COVID-19 pandemic ends, provider groups want CMS to press forward by allowing more providers to take part in virtual care and boosting reimbursements for telehealth services. In their comments on CMS’ emergency changes to the Medicare program, provider groups praised the agency for its unprecedented extension of telehealth benefits during the COVID-19 pandemic. But they argued that the federal government should make permanent changes following the tectonic shift in telehealth during the past few months.
“It is imperative that the progress that has been made since March continue when the (public health emergency) ends,” the Association of American Medical Colleges said.
AAMC asked the agency to extend the telehealth flexibilities and waivers for one year beyond the end of the public health emergency to give Congress and federal regulators time to act. Public officials across the board support the long-term expansion of telehealth services, so it’s likely a matter of when, not if the changes will be made permanent.
Hospitals, medical groups and clinicians also want CMS to allow more providers to deliver higher levels of telehealth services to beneficiaries. For instance, there has been an increase in the number of inpatient interprofessional consultations during the COVID-19 pandemic, but CMS limits how often they can occur. Hospitals want the agency to lift the restrictions so that they can respond quickly to the healthcare needs COVID-19 patients without putting other patients, or their finances, at-risk.
Likewise, CMS has said that telehealth visits cannot replace in-person or home health visits under Medicare’s home health benefit, a restriction that’s made it more difficult for providers to deliver care to worried seniors.
“We have heard of instances where patients are refusing in-home care out of fear of contracting COVID-19. In these instances, telehealth may be the only possible avenue to access the patient and provide them with the healthcare they require,” the American Association of Nurse Practitioners said.
Provider groups are asking for increased reimbursement for telephone-only telehealth services too. CMS temporarily approved payment for telephone-only evaluation and management, or E/M, services in March. But providers say the reimbursements are too low because they don’t reflect the level of services that clinicians are delivering during the pandemic. Some patients are unwilling or unable to use video-based telehealth services, especially beneficiaries that are older and poorer.
The National Association of ACOs and eight other groups representing providers in accountable care organizations asked CMS to take several actions in response to the COVID-19 pandemic. They want the agency to give ACOs the option to give up some of their shared savings in exchange for protection against financial losses and extend the deadline for the Medicare Shared Saving Program. ACO providers also want CMS to overturn its decision to cancel the 2021 MSSP application cycle and to make ACO shared savings and Advanced APM bonus payments as soon as possible, according to a joint letter. (Modern Healthcare April 10)
