Tag: 2020

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April 15, 2020 Latest COVID-19 Statistics
10,834 – The number of people who have died of coronavirus in New York state, as of the morning of April 14.

11,568 statewide deaths as of Wednesday morning, including 752 more fatalities in the past day. Statewide and county-by-county totals haven’t yet been updated, which Gov. Andrew Cuomo suggested had to do with new reporting requirements from the Centers for Disease Control and Prevention. New York City, for example, added nearly 4,000 deaths to its total overnight by including “probable” deaths and not just confirmed deaths. As of Tuesday, New York City reported 10,367 deaths from the coronavirus. As of Wednesday, 18,335 New Yorkers were hospitalized with the coronavirus, and 5,205 were in intensive care units. For more numbers, including the latest statewide and borough-by-borough statistics, click here.

Gov. Cuomo’s Daily Press Conference Highlights

COVID-19 GENERAL:

MASKS EXECUTIVE ORDER:

TESTING:

NOTES:

In three days, New Yorkers will be required to wear a mask or face covering when going out in public and unable to maintain six feet of social distancing in order to halt the spread of the coronavirus pandemic, Gov. Andrew Cuomo on Wednesday said. For now, no fines will be issued for not wearing a mask, but local governments will be enforcing the order. 

Masks — either medical grade facemasks or cloth masks that can cover a nose and mouth — will be required to wear in crowded public areas like mass transit. 

Masks will be required in “any situation in public where you cannot maintain social distancing,” Cuomo said.

Interim Guidance on Executive Order 202.16 Requiring Face Coverings for Public
and Private Employees Interacting with the Public During the COVID-19 Outbreak

9,000+ Healthcare Workers Have Contracted COVID-19: 6 CDC Findings
More than 9,000 healthcare employees have contracted COVID-19 in the U.S., according to CDC data released April 14.

CDC researchers analyzed data on 315,531 laboratory-confirmed COVID-19 cases reported nationwide between Feb. 12 and April 9. The agency identified 9,282 cases known to involve healthcare professionals. The CDC noted this figure is likely underestimated, since healthcare employee status was only available for 16 percent of cases reported nationally.

Six report findings:

1. The median age of sickened healthcare professionals was 42, and 73 percent were female.
2. About 38 percent had at least one underlying health condition.
3. Among healthcare professionals with available data on exposure, 55 percent said they only had contact with COVID-19 patients in healthcare settings.
4. Ninety-two percent of healthcare professionals reported having fever, cough or shortness of breath. The remainder did not have these symptoms.
5. A majority (90 percent) did not require hospitalization, but severe illness occurred among all age groups.
6. The CDC received reports of 27 deaths among healthcare professionals during this time period, most commonly occurring in individuals 65 and older.
   Becker’s Hospital Review, April 15)

Practices Report 60% Average Decrease in Patient Volume
Practices report a 60% average decrease in patient volume and a 55% average decrease in revenue since the beginning of the public health emergency, an MGMA survey finds.

Ninety-seven percent of physician practices have experienced a negative financial impact from COVID-19, finds a new Medical Group Management Association survey.

The financial impact is both directly and indirectly related to the outbreak, the survey said. Specifically, practices report a 60% average decrease in patient volume and a 55% average decrease in revenue since the beginning of the public health emergency.

In addition, many practices have started furloughing and laying off employees, and more plan to do so as the weeks and months of crisis drag on, respondents said.

Because of the revenue and volume declines, 48% of respondents have temporarily furloughed staff, and 22% have permanently laid off staff. By May, those numbers are projected to increase to 60% for furloughs and 36% for layoffs, according to MGMA.

Clarification on Attestations for $100 billion CARES Act Health Care Provider Pool
Concerns were raised Friday when the initial HHS Emergency Fund grants were released that, in agreeing to the terms and conditions of the grants, physicians were being required to attest that they diagnose, treat, or test patients for COVID-19. The AMA brought these concerns to the Secretary’s office and HHS committed to posting some clarifying language. HHS has now modified some of the language to make its meaning clearer, as follows, stating that every patient is a possible case of COVID-19.

The website at https://www.hhs.gov/provider-relief/index.html now includes the following statement:

If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

​Also, the second provision of the Terms and Conditions has been changed to no longer say providers attest to “currently” taking care of patients, just that they did so after 1/31/2020:

The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently</a have Medicare billing privileges revoked. (American Medical Association)

CNN: Social Distancing in the US May Have To Be Endured Until 2022 if No Vaccine is Quickly Found, Scientists Predict
“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available,” they wrote in their report. “Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.” The Harvard team’s projections also indicate that the virus would come roaring back fairly quickly once restrictions were lifted. “If intermittent distancing is the approach that’s chosen, it may be necessary to do it for several years, which is obviously a very long time,” Dr. Marc Lipsitch, an author on the study and an epidemiology professor at the Harvard School of Public Health, told reporters. That’s according to researchers from the Harvard T.H. Chan School of Public Health, who published their findings in the journal Science on Tuesday.(CNN 4/15)

New York City’s Death Toll Jumps by More Than 3,700 After Officials Take into Account Probable Cases
“Behind every death is a friend, a family member, a loved one. We are focused on ensuring that every New Yorker who died because of COVID-19 gets counted,” said Health Commissioner Dr. Oxiris Barbot. The revised numbers hint at how much the country has likely under-counted deaths. The U.S. recorded its deadliest day on Tuesday

The US recorded its highest number of coronavirus deaths in a day after several days in which the death toll had fallen or was nearly flat. The daily death toll was 2,405 on Tuesday, according to Johns Hopkins University’s tally of cases, bringing the total number of US deaths to 26,033. At least 609,240 people have been infected with the virus in the US.

Trump’s Decision to Cut Off WHO Funding Draws Swift Push Back From AMA
“During the worst public health crisis in a century, halting funding to the World Health Organization is a dangerous step in the wrong direction that will not make defeating COVID-19 easier,” American Medical Association President Patrice Harris said.

New York AG Files Suit Against Dept. of Labor Paid Sick Leave Rule
Yesterday, New York Attorney General Tish James sued the Labor Department, alleging its rule governing emergency family leave and paid sick leave could have “devastating consequences for New York and its residents.”

The final rule, published earlier this month, implements the paid leave and paid sick leave provisions in the Families First Coronavirus Response Act, the second of two bills Congress passed last month to combat the coronavirus pandemic. The bill requires businesses that employ fewer than 500 people to offer employees up to two weeks’ sick leave at full pay and up to 10 weeks’ family leave at two-thirds’ pay to address the pandemic. Employers may offset the costs by suspending employee tax withholding.

DOL’s guidance placed certain restrictions on access to the temporary program, including a requirement that workers first receive a requirement that workers first receive a medical diagnosis or advice from a health care provider. “The paid sick leave and emergency family leave provisions of the FFCRA were enacted to protect public health and to provide economic security to working families,” James said in an emailed statement. “The Trump Administration’s rule makes it harder for New Yorkers and Americans throughout the country to claim these paid benefits, which unnecessarily puts more workers at risk of exposure to COVID-19.”

James also filed a motion for summary judgment in the same court, the U.S. District Court for the Southern District of New York. (Politico)

MLMIC Offers 24/7 Legal Hotline
Due to the minute by minute changes regarding COVID-19, MLMIC is keeping our insureds informed via email blasts, our website, blog, as well as through our social media accounts via Twitter and Linked In.

For those insureds who face challenges to their practice due to COVID-19, MLMIC is offering the following:

• MLMIC’s toll free 24/7 Legal Hotline – (855) FAKS-LAW (1-855-325-7529) can help address many questions or concerns that may arise.
• Our staff remains directly available via phone (800) ASK-MLMIC(1-800-275-6564) and every effort will be made to handle inquiries and answer questions regarding claims, coverages and policies on an immediate basis.
• Blog:  Guidance on Using Telemedicine for Coronavirus – click here

COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid”
CME Webinar on April 29th – Registration Now Open

MSSNY announces a new webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am. Faculty for this program is William Valenti, MD and Craig Katz, MD.

Registration is now open for this webinar.

Educational objectives are:

• Explore the role of office-based physicians during the COVID-19 pandemic
• Describe surge preparedness procedures for infectious disease outbreaks
• Identify wellness and resiliency strategies to use during infectious outbreaks

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020 and Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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April 13, 2020 Latest COVID-19 Statistics
New York reported 10,056 statewide deaths as of Monday morning, including 671 more fatalities in the past day. As of Monday, New York reported 195,031 confirmed cases, including 106,763 cases in New York City alone. As of Monday, the state reported 7,349 deaths of New York City residents.

As of Monday, 18,825 New Yorkers were hospitalized with the coronavirus. As of Friday, 4,903 of those hospitalized were in intensive care units. For more numbers, including the latest statewide and borough-by-borough statistics, click here. Here is the governor’s April 13 presentation.

To apply for SBA Loans (COVID-19 Disaster Loan Application or the Paycheck Protection Program Application), click here.

Providers Begin Receiving First Round of CARES Act Grants
Providers on Friday began receiving $30 billion from the first round of grant funding from Congress’ third stimulus package.

The funds, from the $100 billion provider relief fund in the Coronavirus Aid, Relief, and Economic Security Act, were distributed based on providers’ share of 2019 Medicare fee-for-service reimbursements.

The grants do not have to be repaid, but administration officials said Thursday that grant recipients have to agree not to balance bill patients for out-of-network COVID-19 treatment.

Federation of American Hospitals President and CEO Chip Kahn said he generally supports the administration’s surprise billing ban, though he said important details were unclear including insurer reimbursement for out-of-network services.

“This is in a framework that we support,” Kahn said.

Many providers received direct deposits on Friday morning. HHS said that payment was made through information on file either with UnitedHealth Group or the CMS, and paper checks will be sent out for remaining providers within the next few weeks. Payments for larger medical groups will be sent to the group’s central billing office, according to background materials.

UnitedHealth Group said combined with its affiliates, it has relationships with more than 80% of all U.S. healthcare providers and hospitals. The insurer donated administrative costs in the partnership.

HHS said it is working on how to distribute the remaining $70 billion. The agency said it will prioritize providers in areas with severe COVID-19 outbreaks, rural providers and those who serve the Medicaid population or have a payer mix that’s lighter on Medicare fee-for-service payments in the next round. The Friday announcement also reiterated the department’s intent to use some of the funds to reimburse providers for COVID-19 treatment for the uninsured at Medicare rates.

The NY and NJ congressional delegations have complained that the across-the-board distribution did not provide enough support to hard-hit areas. As of Friday afternoon, New York and New Jersey combined had 45% of confirmed COVID-19 cases in the United States.

Notes from Governor Cuomo’s Briefing:

REOPENING:

Q&A:
HOSPITALS:

REOPENING:

COVID-19:

NYSDOH Issues Evidence-Based Pharma Info
The Department of Health today issued COVID-19 Drug Topics,  which provides prescribers with an evidence-based, non-commercial source of the latest objective information about pharmaceuticals.  The information is provided through our Prescriber Education Program (PEP), which is a partnership between the Department of Health and the State University of New York (SUNY) Medical and Pharmacy institutions.

Information regarding Colchicine, Hydroxychloroquine and Ibuprofen is now available on the COVID-19 Guidance for Medicaid Providers webpage.

Telehealth Thursday WEBINAR: Playing Critical Role in Virtual Care in Crisis
DrFirst is offering a webinar this Thursday, April, 16^th at 11AM EDT for physicians to discover how they may leverage HIPAA-compliant video conferencing, secure messaging, file transfer and other communication tools to stay connected with their patients during the pandemic.

Event Highlights and Learning Objectives:

• Find out how healthcare organizations of all types are using telehealth technology to improve communication and care collaboration
• Hear telehealth success stories and learn best practices your practice can utilize in your COVID-19 response
• Learn about key “must-haves” when evaluating telehealth solutions
• Engage with clinical consultants and ask questions about you can better connect with patients and remote providers.

To register for this important webinar, go to this link.

Physicians on the Frontlines and Mortality Rates
Concerns among healthcare professionals are well-founded. The epidemic is horrific, and any loss of human life is a tragedy. In order to investigate this issue, we looked at summaries of physician deaths attributable to COVID-19 through April 10, 2020, in Medscape. I concentrated on physicians rather than all providers because mortality reports appeared more complete.

Through April 10, there were 17 physician deaths in the United States. Sixteen of the 17 deaths occurred among physicians aged 60 or older. The range in age was 37-92: the only death under age 65 was an oral surgery resident. 65% (11 of 17 deaths) occurred in physicians aged 65 or older and 47% where among those older than 70. Obituaries or press releases were available for 16 of the cases. Although it is uncertain from the write-ups, it appeared that about half of the physicians who died were retired or only practicing part-time. Several of the write-ups noted that the deceased physician had serious health problems, including recurrent cancers.

The COVID-19 epidemic is creating legitimate anxiety among healthcare professionals. Media reports focus on young physicians expressing fear for their own safety. One healthcare provider explained that she felt like a sacrificial lamb being sent off to slaughter. But are healthcare providers at significantly greater risk of death than the general population?

In order to put the 17 deaths in perspective, I compared the COVID-19 death rate among physicians to that in the general population. There are approximately 1.1 million physicians in the U.S. population of 330 million people. In other words, there is approximately one physician for each 300 persons in the population. By April 10, there were approximately 20,000 COVID-19 deaths in the US.

If physicians are dying at the same rate as people in the general population, we would expect about 66 physician deaths. If the data are accurate, physician deaths are about 75% lower than expected. And, the risk from exposure to sick patients may be an overestimate because in nearly half of cases the physicians appeared to have retired or reduced clinical practice. Medscape by Robert M. Kaplan, PhD, is a faculty member at Stanford University’s Clinical Excellence Research Center, former associate director of the National Institutes of Health, former chief science officer for the U.S. Agency for Healthcare Research and Quality.

GNYHA Pres/CEO Kenneth Raske Spoke with WH Senior Adviser Jared Kushner
“This distribution methodology is woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in hot spot areas such as the New York City region,” Raske wrote in a letter to GNYHA members.

The largest recipients by state were California with $2.9 billion, Florida with $2.2 billion, Texas with $2.1 billion, New York with $1.9 billion and Pennsylvania with $1.2 billion.

Republicans on the House Ways & Means Committee acknowledged concerns with the initial allocation.

“While this distribution system is not perfect, the administration should be commended for developing a system that delivers support to key healthcare facilities quickly,” members wrote in a statement Friday.

Providers receiving grant funding will have to certify that they will only use the funds for coronavirus-related costs and cannot use the funds for expenses reimbursed from other sources. Providers receiving more than $150,000 from the federal government will have to file quarterly reports detailing how the funds were spent. Providers must within 30 days confirm receipt of the grant payments and agree to the terms in an online HHS portal opening April 13 or refund the money.

The CARES Act requires the HHS Office of Inspector General to send a report to Congress on audit findings for the $100 billion grant program within three years of when final payments from the fund are made.

GNYHA Ensuring the Safety of Our Direct Caregivers
GNYHA and the Healthcare Association of New York State (HANYS) continue to work with Governor Andrew Cuomo and the New York State Department of Health (DOH) to help you achieve your number one priority during the COVID-19 crisis—ensuring that direct caregivers at your institutions have safe, adequate levels of personal protective equipment. At the Governor’s request, GNYHA and HANYS are asking all hospitals across the State to adhere to the following policy: When a direct caregiver in a hospital asks for a new N95 mask, they will receive one at least once a day.

As has been stated on Governor Cuomo’s calls with hospital chief executive officers, any hospital whose N95 inventory is low should call Larry Schwartz at 914-393-8254 or Jim Malatras at 518-281-1754. We will continue to do everything we can to support your heroic response to the COVID-19 crisis.

New COVID-19 Resources from the AMA

• The AMA just released a resource to help physicians and practice staff track the rapidly evolving prior authorization policy changes health plans and PBMs are making in response to COVID-19. They will be regularly updating this resource to stay current with payers’ policy chanhttps://www.ama-assn.org/system/files/2020-04/prior-auth-policy-covid-19.pdfges.
• The AMA has updated its COVID-19 coding guidance document to reflect the most recent information released by CMS. The document has been expanded to now outline 18 different treatment scenarios and recommended coding for each.

NY Hospital Systems Losing Money as They Respond to Coronavirus
The Wall Street Journal (4/12) reports New York City’s academic hospital systems are each losing $350 million to $450 million a month as they respond to a surge of COVID-19 patients. Meanwhile, independent and smaller hospital systems are facing dire financial pressures and could be unable to make payroll soon.

Report: New York Getting Less Coronavirus Funding Than Other States. Some states “are getting significantly more funding to fight the coronavirus per case compared to other, harder-hit states, according to a new analysis released Friday,” The Hill (4/11, Axelrod) reported. Analysis from Kaiser Health “found that states like Minnesota, Nebraska and Montana are getting more than $300,000 per reported COVID-19 case, while New York, the hardest-hit state, is receiving roughly $12,000 per case.” Florida, “which is also grappling with a serious outbreak, is getting $132,000 per case.”

Health Care Workers Needed to Volunteer in NYC!

NY Statistics for COVID-19
New York State accounts for 36% of the country’s 337,971 COVID-19 cases, according to data as of Monday morning from Johns Hopkins University. About three-quarters of New York State residents are concerned the coronavirus crisis will cause them serious financial problems, according to a new poll released Monday.

The virus has led to closure of nonessential businesses in the state. The state’s Department of Labor processed more than 369,000 initial unemployment applications in the week that ended March 28, representing a 2,674% increase compared with the same week last year. (WSJ, April 8)

Notes from Governor Cuomo’s COVID-19 Briefing:

-NY PAUSE and social distancing have been working to flatten the curve for the
moment. The Governor said stopping such measures could change numbers
and result in an increase in cases.
– Number of patients hospitalized is down, 3-day average trend down, large
hospital systems reporting higher levels of releases than intakes.
– Have managed to increase capacity and share equipment among hospitals.
The Governor said if hospitalization rate continues to decrease, the system
should be able to stabilize over the next couple of weeks and reduce the need
for overflow systems.
– Must continue social distancing to achieve this.
– BAD NEWS: Highest single death toll, 779 people, seen overnight. Number
of deaths will continue to rise as those hospitalized for a longer amount of time
pass.
– For perspective, the Governor said 2,753 lives were lost in 9/11 and 6,268
have passed from COVID-19.
– Flags will be set at half-staff in honor of the lives lost.
– Need to learn and develop a “new normal” through public health preparedness
and increasing hospital capacity. Additionally, have found new ways of using
technology (celebrated the development of a virtual court system, telehealth,
working from home, and online education).
– Still have to develop a testing capacity. Those who are negative or developed
antibodies will be able to return to work from this testing.
– Will be conducting more testing in minority populations to better understand
disparities. Research and testing to be conducted by SUNY Albany’s Dr. Havidan
Rodriguez and DOH/Northwell Health. The Governor said this will begin soon.
– Will be issuing an additional $600 payment to all unemployed NYers; the State
expects to be reimbursed by the Federal government at some point.
– Unemployment benefits will be expanded for an additional 13 weeks
(totaling 39 weeks).
– By executive order, absentee ballots will be allowed for the June 23rd primaries.
– Mercury Medical donated 2,400 BiPap machines, which were flown to NY from
Florida for free courtesy of Jet Blue. He also thanked Oregon, Washington, and
California for helping with ventilators.
– Commended the efforts of public health workers and first responders.
– Will be starting new social media campaign, “Who Are You Staying Home For?”
– Examples include healthcare workers, public health, family members.
– Social distancing violation fines have been doubled, as previously mentioned.
– PASSOVER: Wished the Jewish community a Happy Passover,
noted previous anti-Semitic events from earlier in the year. Used Passover
as an example for how to improve, explaining that it is based on analyzing the past
and determining the future.

1. President Donald Trump said the U.S. may end funding to the World Health Organization. Trump later clarified that his administration has not yet decided to end funding for the agency but will be looking into it. The U.S. has provided $893 million during WHO’s current two-year funding period, nearly 15 percent of its total funding, according to the organization’s website, cited by STAT. 

2. Black people appear to be dying from COVID-19 at disproportionately high rates across the U.S., though many states and officials haven’t been tracking or reporting racial data, USA Today reports. Emerging studies found that black people accounted for 29 percent of confirmed cases and 41 percent of deaths in Illinois as of April 6, despite only making up 15 percent of Illinois’ population, according to STAT. Similar trends appear in Michigan and Wisconsin.

The White House, civil rights groups and lawmakers have urged federal health officials to publish racial data as deaths soar in cities with significant black populations, such as Detroit, New Orleans and New York, according to USA Today.

3. Ventilators may be being overused for COVID-19 patients, some physicians say, according to STAT. Many critical care physicians are reevaluating the widespread use of ventilators after observing that some COVID-19 patients with fatally low blood oxygen levels aren’t gasping for air. That, as well as noting that these patients’ hearts are not racing and their brains don’t show signs of oxygen deficiency, is making some physicians suspect that blood oxygen levels might be misleading care for COVID-19 patients and perhaps numerous patients could instead be treated with less intensive respiratory support.

4. The Drug Enforcement Administration will increase production quotas for several drugs in high demand amid the pandemic, according to an April 7 announcement. The agency is increasing quotas for pharmaceutical manufacturers producing medications in high demand, as well as increasing imports of necessary medications for patients on ventilators.

5. New York City reported 731 COVID-19 deaths in one day, along with an ‘unusually high’ increase in related cases and hospitalizations between April 6-7. The spike is due to both a lag in reports from labs and a large transfer of data from patients hospitalized before April 6. New data from New York state also revealed that 61 percent of 5,489 COVID-19 deaths in the state were among men, and 86 percent of the deaths were among individuals with underlying illnesses. Additionally, 63 percent of deaths were among those 70 years and older.

6. General Motors will build 30,000 ventilators for the national stockpile under a $489.4 million contract with the federal government. The company will deliver the first 6,123 ventilators by June 1, according to the contract invoked under the Defense Production Act.

(Becker’s Hospital Review, April 8)

Worldwide, 1,446,242 COVID-19 cases and 83,424 deaths have been reported, while 308,146 people have recovered from the illness as of 8:30 a.m. CDT April 8.

A Breakdown of Six of the Most Promising COVID-19 Treatments
Hundreds of drugs are being tested to treat COVID-19, the disease caused by the novel coronavirus. Below are six of the most promising treatments, according to Business Insider:

1. Remdesivir— Gilead’s drug, already tested on other viruses, remdesivir has been a front-runner as a possible COVID-19 treatment. The World Health Organization has called it “the most promising candidate,” and there are five active clinical trials testing its effectiveness against COVID-19 taking place in China, the U.S. and South Korea, according to Business Insider.
2. Kaletra— Kaletra is an HIV drug made by AbbVie. Although a study published March 18 in the New England Journal of Medicine said Kaletra didn’t show benefits in COVID-19 patients, the WHO said it will conduct a global study on four experimental treatments, including Kaletra, according to Business Insider.
3. Actemra and Kevzara— Actemra, made by Roche, and Kevzara, made by Regeneron and Sanofi, are both classified as IL-6 inhibitors and may work by stopping a biological mechanism that causes overactive inflammatory responses in patients’ lungs, according to Business Insider. Both drugs are being tested in late-stage clinical trials.
4. Convalescent plasma— Convalescent plasma is blood plasma taken from COVID-19 patients who have recovered from the disease. That plasma contains antibodies that could help sick patients and boost their immune response, according to Business Insider. So far, two trials have shown promising results.
5. Chloroquine and hydroxychloroquine— Chloroquine and hydroxychloroquine are both antimalarial drugs. President Donald Trump has expressed hope for chloroquine’s potential in treating COVID-19. The scientific community has not yet definitively confirmed its clinical effectiveness for this virus.
6. Avigan— Avigan is a flu drug made by Japan-based Fujifilm Toyama Chemical. A trial conducted in China showed Avigan helped patients recover seven days faster than patients on another antiviral drug called arbidol, and it also reduced the frequency of symptoms like coughing and fever, according to Business Insider. However, the drug is not approved in the U.S.  Read the full article here. (Becker’s Hospital Review, April 8)

Worldwide, 1,446,242 COVID-19 cases and 83,424 deaths have been reported, while 308,146 people have recovered from the illness as of 8:30 a.m. CDT April 8. (Becker’s Hospital Review, April 8)

The Four Benchmarks Needed to End Social Distancing
Until there is a vaccine or effective treatment against COVID-19, states should direct efforts toward four major criteria that will help determine local progress, according to a report cited by The New York Times.

The report was written by Scott Gottlieb, MD, former FDA commissioner; Caitlin Rivers, PhD, assistant professor at Baltimore-based Johns Hopkins Center for Health Security; Mark McClellan, MD, PhD, director of the Robert J. Margolis Center for Health Policy and professor at Durham, N.C.-based Duke University; Lauren Silvis, former FDA chief of staff; and Dr. Crystal Watson, senior scholar and assistant professor at Johns Hopkins Center for Health Security. 

Criteria that will determine if and when areas can come out of lockdown:

1. Hospitals must be able to safely treat all patients needing hospitalization without resorting to crisis standards of care. This is the first standard to meet and the focus of most health officials, according to the authors. Currently, there’s no reason to believe any area meets this criteria, and many local outbreaks aren’t predicted to peak for weeks.
2. A state needs to be able to test at least everyone with symptoms. Nationwide, about 750,000 tests would be needed a week, and that’s not including areas with major outbreaks. On a smaller scale, states would need to test every person who may be infected and receive the results in a timely manner. The third requirement cannot be achieved until the second occurs.
3. The state can monitor confirmed cases and contacts. A robust system of contact-tracing and isolation is the only thing that can prevent outbreaks and sequential lockdowns, the authors write. Scaling up some areas’ public health systems to handle such a task would take significant time and money, NYT notes. Other countries have used cellphone-tracking technology to determine who people have been near, but it’s unclear if the U.S. would allow such a tactic.
4. Cases must continue to decrease for 14 days. It can take up to two weeks for COVID-19 symptoms to emerge, so if the number of cases drops steadily for that much time, officials can be reasonably sure suppression has been achieved, or that every infected person is infecting fewer than one other. (Becker’s Hospital Review, April 8)
   

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NYC First Responders: Dwindling PPE and Many Out Sick
New York City’s first responders — paramedics, EMTs, firefighters, and police officers — continue to man the front lines of the COVID-19 epidemic, despite dwindling amounts of protective equipment and an increasing proportion of their workforce out sick. They are struggling to avoid getting sick, while working increasingly demanding shifts and managing call volume surges. Vincent Variale, president of the Uniformed EMS Union Local 3261 in New York, said that normal medical call volume is about 4,000 calls a day. Now, EMS providers are responding to more than 6,500 calls daily. They’re also managing longer workdays, rationing protective gear, and following guidelines that continue to change as hospitals overcrowd with patients.

Last week, for instance, New York City enacted new guidelines for patients in cardiac arrest. If paramedics and EMTs cannot save a patient who is in cardiac arrest in the field, they are being instructed not to take them to the hospital. In New York, this shortage of masks has prompted instructions to firefighters that they use N95 masks only during procedures that might generate aerosols, including intubation, asthma treatment, and cardiac arrest care. (Medpage, April 8)

Comfort Will Be Able to Treat 500 COVID-19 Patients
Gov. Cuomo told reporters on Tuesday the Comfort will be able to treat up to 500 COVID-19 patients, about half of its original expected capacity. The governor said the shift from non-COVID-19 patients to coronavirus cases led to the elimination of 500 beds. The military-run hospitals at the Javits Center and onboard the USNS Comfort remain mostly empty — so far treating only 110 patients between them.

Hospitals: “Fed Gov. Seizing Medical Supplies, Leaving Doctors in Dark”
The Los Angeles Times (4/7) reports that although the President “has directed states and hospitals to secure what supplies they can, the federal government is quietly seizing orders, leaving medical providers across the country in the dark about where the material is going and how they can get what they need to deal with the coronavirus pandemic.” Hospital and clinic officials in seven states “described the seizures in interviews over the past week.”

The Federal Emergency Management Agency “is not publicly reporting the acquisitions, despite the outlay of millions of dollars of taxpayer money, nor has the administration detailed how it decides which supplies to seize and where to reroute them.”

Researchers Say Diabetes Does Not Increase Risk of Coronavirus Infection but is Tied to Higher Mortality Among the Infected
Healio (4/7) reports researchers examined data from China and Italy and concluded that while “adults with diabetes are no more likely to contract” coronavirus “than people without diabetes,” they “could be up to twice as likely to die from complications” tied to the infection.

The researchers wrote a letter to the Journal of Endocrinological Investigation sharing their findings. Gian P. Fadini, MD, PhD, an associate professor of endocrinology at the University of Padova in Italy and one of the letter’s authors, said, “Diabetes does not increase the risk of new coronavirus infection, but it can worsen the outcome of COVID-19. People with diabetes can be reassured they are not at higher risk for becoming infected, but they have to pay additional attention to symptoms and signs of disease progression.”

WC Board Extends Formulary Deadline for Prescription Renewals to Jan 1, 2021
In response to widespread health care industry challenges due to COVID-19, the Chair of the New York State Workers’ Compensation Board (Board) has modified the New York Workers’ Compensation Drug Formulary (NY WC Formulary) regulation (12 NYCRR 441.3(a)(2)) to extend the deadline by which all health care providers must obtain prior authorization for renewals of non-formulary medications from June 5, 2020, to January 1, 2021.

The six-month extension to January 1, 2021 will:

· Reduce the impact that the COVID-19 emergency may have on health care providers’ ability to implement the requirement.

· Provide more time to health care providers to ensure that prescription renewals are consistent with the NY WC Formulary.

· Ensure that the current health crisis does not negatively affect injured workers, especially those who are on certain medications that are non-formulary agents.

This extension also aligns with the expected implementation of the first phase of the Board’s Business Information System (BIS) Project. In the first phase, the Board will roll out a new web-based portal through which providers can request and manage prior authorization and variance requests related to treating injured workers, taking common forms (MG-1, MG-2, and C4-Auths) and related processes online.

The new portal will promote greater access for health care providers, quicker response times for prior authorization requests, and greater system reliability – resulting in the improved delivery of care to injured workers. For more information, please visit the Board’s website at wcb.ny.gov.

CMS OKs $34B for Providers with Accelerated/Advance Payment in One Week
CMS has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks.  In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how healthcare providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet Providers can also contact their Medicare Administrative Contractor for any questions.

CMS Office Hours on COVID-19
You are invited to CMS “Office Hours” on COVID-19, Thursday, April 9th from 5:00 – 6:00 PM EST, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

·        Increase Hospital Capacity – CMS Hospitals Without Walls;

·        Rapidly Expand the Healthcare Workforce;

·        Put Patients Over Paperwork; and

·        Further Promote Telehealth in Medicare

We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A.

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 1881716

Latest COVID-19 Statistics
NYS Health COVID-19 Tracker
https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Map?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n

Dr. Fauci: “Good Signs from New York”
While Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was quick to caution that the U.S. still has much work to do amid this public health emergency, he pointed to “good signs” from New York, citing data saying the numbers of hospitalizations, ICU admissions and requirements for intubations over the last three days have started to level off. “You never even begin to think about claiming victory prematurely, but that’s the first thing you see when you start to see the turnaround.” Dr. Fauci stressed the importance of continued mitigation and social distancing.

NYS DOH Deaths: Majority of 4700 Deaths Were Males with Underlying Illnesses
The majority of New York’s more than 4,700 deaths due to coronavirus were among men, and 86% of all deaths were among people who had underlying illnesses, such as hypertension and diabetes, new state data showed.

The statistics released late Monday offered the latest glimpse into how the rapidly spreading virus has impacted New Yorkers and made the state the epicenter for COVID-19 in the nation.

• Of the 4,758 deaths in New York since the first one March 14, 61% were men and 39% were women, the state Department of Health reported on its new data portal.
• In addition, 63% of the deaths were among those age 70 and older. Just 7% of the cases were those who were 49 and younger.
• And 4,089 of those who died had at least one other chronic disease, the records showed:
• The leading underlying illness was hypertension, which showed up in 55% of the deaths. Next was diabetes, which was diagnosed in 1,755 deaths, or about 37% of the cases. Other top illnesses found in those who died from coronavirus were hyperlipidemia; coronary artery disease; renal disease and dementia, which was apparent in about 16% of cases.

Less Than 2% of COVID-19 Cases Involve Children
Less than 2% of U.S. COVID-19 coronavirus cases have been in children, with infants more likely to be hospitalized than older children, researchers found.

From February 12 to April 2, individuals under age 18 accounted for 1.7% of the nearly 150,000 overall U.S. COVID-19 cases with data on age — far fewer than might be expected from their representation in the population as a whole (24%), reported Lucy McNamara, PhD, of the CDC’s COVID-19 Response Team, and colleagues in an early Morbidity and Mortality Weekly Report release.

Fewer children reported “typical” symptoms of fever, cough, or shortness of breath compared to adults, the analysis also found.

As well, hospitalization rates among children were much lower than in adults, though hospitalization was more common among both infants and children with underlying conditions, such as asthma.

Statistics from Health Metrics: April 9 Will Be High Point for Deaths in NY
According to the University of Washington’s Institute for Health Metrics and Evaluation, “New York’s high point for deaths in a single day of 878 will arrive April 9,” daily deaths will return to zero by May 8, and the state’s total death toll will be 15,618. New York’s high point for deaths in a single day of 878 will arrive April 9, according to the university’s Institute for Health Metrics and Evaluation, which is funded by the Bill & Melinda Gates Foundation. Deaths in the state will total 873 on April 12 before beginning a steady decline.

Getting Paid for Virtual Encounters
CMS previously only reimbursed for virtual encounters in designated rural environments and the patients had to be physically present in a healthcare facility during the interaction. With the COVID-19 pandemic impact, CMS re-emphasized the programs initiated during the 2019 and 2020 Medicare Physician Fee Schedule Final Rules and expanded its prior telehealth reimbursement rules. For a straightforward three-minute read, the following is a good guide to getting paid.

SBA Loans Available for Physicians
Here is a link to an AMA Q&A on the SBA loan/grant program and other pools of funds potentially available for physicians under the recent CARES Act.

MSSNY Joins Others: Urges HHS to Fund One Month of Physician Payments
MSSNY joined AMA, State and Specialties Sign on to HHS Urging CARES Act fund to cover at least one month of payments to physician practices.

MSSNY Quick Chat: Paycheck Protection Program, Economic Injury Disaster Loans and Emergency Grants, and Small Business Debt Relief
PPP is just getting started and has limits. Important to make application ASAP! The landscape is changing daily. Latest info here.

New Video Available on Medicare Coverage and Payment of Virtual Services
CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Five Takeaways: OIG’s New Report on Hospitals’ COVID-19 Challenges
HS’ Office of Inspector General released a report April 6 that details the challenges hospitals are confronting due to COVID-19, how they are responding, and what they are asking of the government to better meet their needs during the coronavirus crisis.

The OIG conducted brief telephone interviews March 23-27 with administrators from 323 hospitals across 46 states, the District of Columbia and Puerto Rico, which were part of a random sample. Hospital administrators shared the following challenges their organizations face in response to COVID-19, as well as how they would like the government to respond:

1. Challenge: Severe shortages of testing supplies and extended waits for results.Hospitals reported frequently waiting seven days or longer for test results, which results in several “rule-out” cases that strain existing challenges with staffing, bed availability and shortages of personal protective equipment. According to one hospital, 24 hours is typically considered a long turnaround time for virus testing.

Hospitals’ ask: Hospitals expressed a need for greater coordination from the federal government around testing kits and supplies to provide “equitable distribution of supplies throughout the country,” according to the report. Hospitals also asked for the government to provide testing kits, take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests, and expedite results by allowing more entities to produce and conduct tests.

2. Challenge: Widespread shortages of PPE.Hospital administrators reported higher than normal use of PPE contributed to shortages, as well as a disrupted supply chain. One administrator said their hospital’s purchaser reported delays of three to six months for key supplies, including N95 masks. At the time of their interview, some hospital administrators noted that they had not received supplies from the federal stockpile, or that the supplies they had received were insufficient in quantity or quality. Several hospitals reported sharp price increases for supplies, including one administrator who cited a mask that previously cost 50 cents is now $6.

Some hospitals have turned to nontraditional sources of medical equipment and supplies, such as online retailers, home supply stores, paint stores, auto body shops and beauty salons. Staff have even assembled their own equipment from office supplies. Hospitals have also implemented conservation strategies, including reusing PPE (which is typically intended for single use) and limiting provider-patient interactions. As one administrator told the OIG: “We are throwing all of our PPE best practices out the window.”

Hospitals’ ask: Hospitals asked for the government’s support in obtaining a range of supplies and equipment, noting that they were in competition with other providers for limited supplies. Government intervention and coordination, they said, could help reconcile this problem. They also want the government to loosen restrictions around the transfer or gifting of equipment and supplies.

3. Challenge: Difficulty maintaining adequate staffing and supporting staff. Hospitals cited need for specialized staff, concerns that staff exposure to the virus will exacerbate shortages and overwork, and concerns about the emotional toll that staff face.

Some administrators said their hospitals were training certain medical staff, like anesthesiologists, hospitalists and nurses, to help care for patients on ventilators. Those with partnerships with large health systems also said they can deploy medical staff to other hospitals in the system that may be experiencing a shortage. Hospitals are also offering support to staff, including childcare, grocery services, hotel accommodations and mental health services.

Hospitals’ ask: Hospitals want the government to enable reassignment of licensed professionals and realignment of duties within the hospital and throughout their healthcare networks; provide flexibility with respect to licensed professionals practicing across state lines; and provide relief from regulations that restrict the practice of contracted staff or physicians based on business relationships.

4. Challenge: Decreased revenue, increased costs and gaps in reimbursement. Hospitals have essentially stopped elective procedures and many other services, which accounts for a substantial portion of hospitals’ revenue. At the same time, costs have increased as hospitals prepare for a potential surge of patients by purchasing extra equipment, remodeling rooms for negative pressure, or setting up drive-thru clinics and tents. Furthering this problem is gaps in reimbursement, such as reimbursement for telehealth services that doesn’t cover the hospitals’ costs. Hospitals also reported difficulty in getting reimbursed for treating patients in nontraditional spaces due to a lack of qualifying billing codes for care in these locations.

Hospitals’ ask: Hospitals of all types reported need for financial assistance, with some expressing need for assistance in a matter of weeks to avoid insolvency. Hospitals told the OIG they want the government to expedite Medicare payments by dropping the 14-day wait period and to offer loans and grants. [Editor’s note: CMS has adjusted Medicare payment policies to expedite payment and extend 100 percent reimbursement for six months, among other changes, which are detailed here.]

5. Challenge: Changing and/or inconsistent guidance from authorities.Hospitals said fluctuating guidance from officials and agencies at the federal, state and local level has contributed to confusion, fear and distrust among staff and the public. One administrator pointed to CDC guidance on the use of face masks, which differed from the guidance issued at the state level. “It’s difficult when a doctor or nurse shows you legitimate information from legitimate sources and they’re contradictory,” one administrator told the OIG.

Hospitals’ ask: Hospitals said the federal government could play a central role in messaging and communications to mitigate what they perceive as conflicting or inconsistent guidance across levels of government. Specifically, hospitals want the government to provide evidence-based guidance, reliable predictive models and data, and a single place to find information they need. (Becker’s Hospital Review, 4/7)

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As New York physicians continue to fight on the front lines of the COVID-19 pandemic, our first priority is–and always has been–the health and well-being of our patients. But we can’t be thrown into this war zone without adequate tools. It is imperative that we are provided with the best available defense, including Personal Protection Equipment (PPE) and workplace practices and policies to reduce disease transmission. Unfortunately, despite everyone’s best efforts to facilitate the availability, we continue to hear far too many disturbing reports from physicians about inadequate PPE availability in the hospitals and office settings where they are delivering patient care.  This is shameful and must be addressed.

“In addition, physicians must retain the right to speak out about conditions that we perceive as endangering ourselves, our patients, and our colleagues’ well-being without fear of repercussion. Our patients’ welfare is our priority and we must retain our freedom to advocate for them, including expressing concerns regarding conditions and safety.”

Art Fougner, MD
President, Medical Society of the State of New York

New York State Statistics April 1, 2020
The coronavirus has infected more than 76,000 people in the New York State as of Wednesday morning.

The state’s new cases on Tuesday made New York the coronavirus epicenter of the world, surpassing China’s Hubei province, which reported 67,801 confirmed cases since the virus emerged there in December. Gov. Cuomo said 10,929 people have been hospitalized with the coronavirus, including 2,710 ICU patients.

Globally, the coronavirus has infected more than 873,767 and has killed at least 43,288 people, according to Johns Hopkins University data. In the U.S., the coronavirus has infected at least 189,633 people and has killed at least 4,081.

With 43,139 confirmed cases, New York City accounts for more than half of all cases in New York state.

Physicians, Share Your Experiences with MSSNY!
Do you have a story re your COVID-19 experiences to share with other New York physicians? We want to hear from you! Email to csouthard@mssny.org

NYSDOH Webinar Update for Healthcare Workers TOMORROW, April 2 @ 1-2 PM
Please join the NYS Department of Health Thursday, April 2nd at 1-2 PM for a COVID-19 update for healthcare providers. To accommodate the large number of participants, our webinar will be streaming via YouTube Live. For audio only, please dial in 844-512-2950.

Paycheck Protection Program (PPP) Information Sheet: Borrowers
The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. The loan amounts will be forgiven as long as:

• The loan proceeds are used to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8-week period after the loan is made; and

• Employee and compensation levels are maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for 6 months.

What do I need to apply? You will need to complete the Paycheck Protection Program loan application and submit the application with the required documentation to an approved lender that is available to process your application by June 30, 2020.

Click here for the application.

10 K Disaster Grant: Does Not Impact Qualification for Forgivable Loan) 75% Reserved; File Now! Do NOT Wait

Apply for a COVID-19 Economic Injury Disaster Loan NOW! 

In response to the Coronavirus (COVID-19) pandemic, small business owners in all U.S. states, Washington D.C., and territories are eligible to apply for an Economic Injury Disaster Loan advance of up to $10,000. To apply for a COVID-19 Economic Injury Disaster Loan, https://covid19relief.sba.gov/#/

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. The loan advance will provide economic relief to businesses that are currently experiencing a temporary loss of revenue. Funds will be made available within three days of a successful application, and this loan advance will not have to be repaid.  DO NOT WAIT!

Use of Telehealth Including Telephonic Services During State of Emergency
The intent of this document is to provide additional information regarding the broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent it is appropriate for the care of the member. This document is intended to accompany previously issued guidance regarding telehealth and telephonic communication services during the COVID-19 State of Emergency issued via Medicaid Updates beginning in March 2020, which are available on the Department of Health website here.

The New York Mets & Dunkin Donuts delivered coffee and donuts to the
staff at North Shore University Hospital (Photo by The New York Mets).