COVID-19 eNews – March 24, 2020 5:30 PM

A List of all New York State resources for Physicians Has Been Compiled by MSSNY and is Available Here.

Gov. Cuomo Demands Supplies from President
Gov. Andrew Cuomo voiced alarm and frustration with the Trump administration’s response to the growing coronavirus crisis Tuesday, estimating that New York is just two weeks away from hitting the apex of its outbreak.  “The president said it’s a war … then act like it,” Cuomo said, raising his voice during a morning news conference at the Javits Center in Manhattan. “They’re doing the supplies? Here’s my question: Where are they?”

New York has procured just 7,000 of the 30,000 ventilators required to treat the expected surge in hospitalized Covid-19 patients. Cuomo repeated his call for the Trump administration to use the federal Defense Production Act to contract with American companies so more of the vital machines can be manufactured in the coming weeks. “There is no other way for us to get these ventilators, we’ve tried everything else,” he said. “The only way we can obtain these ventilators is from the federal government, period. … If we don’t have the ventilators in 14 days it does us no good.”

With nearly 26,000 confirmed cases of coronavirus, New York is the epicenter of the crisis, nationally. The governor said the state is now expected to need 140,000 hospital beds when the virus reaches its peak — which he estimates will occur in the next 14 to 21 days. Cuomo has ordered New York hospitals to increase their total capacity from 53,000 beds to at least 75,000 — with the goal of creating 110,000 beds.

The governor said he “will turn this state upside down to get the number of beds we need.” He said he’s in touch with hotel owners to take over their locations and has no problem turning dorms at state colleges into makeshift hospitals.

But, Cuomo argued, that means nothing if New York does not have the staff or equipment needed to treat those beds. (Politico 3/24)

Notes from Gov. Cuomo’s Press Conference

– Apex is forecasted for 5/1, but the curve is increasing, new apex is forecasted for 14 to 21 days.
– New projected needed beds are at 140k, with 40k ICU beds.
– NYC expected to have a density reduction plan in place by noon today.
– Hydroxychoroquine and Zithromax trials will start today.
– DOH still pursuing Plasma Injection as well as Antibody test.
– Cuomo will speak with all hospital administrators today on increasing capacity.
– Cuomo is speaking with hotel owners to discuss conversion of locations.  He will use SUNY and CUNY dorms, as well.
– Experimenting with splitting ventilators in order to cover two people simultaneously.
Still pushing feds to use of federal Defense Production Act.  Not using power is inexplicable to Cuomo.
– The Governor is urging HHS Secretary Azar to release 20,000 ventilators to the State.
– FEMA is reportedly sending 400 ventilators, but the need is projected to be 30,000.
– The Governor will take personal responsibility for transporting federal stockpile ventilators to the next region where needed, once state crests over apex.
– Governor discussing bringing lower risk people back into the workforce, and recovered people.
-Ramp up the economy with available workers.  Reiterates that the crisis facing the state today is hospital capacity.

FEMA has sent just 400 ventilators to New York — an amount which Cuomo said misses “the magnitude of the problem.”

The federal government could use its authority to provide businesses start-up capital and guaranteed contracts to build more ventilators in 14 days. Companies volunteering services — something the president has pointed to in recent days — is not enough, Cuomo said.

He compared the current push to World War II when the U.S. contracted directly for military supplies.

“When we went to war we didn’t say, ‘Any company out there want to build a battleship?'” he said, mocking the federal government’s current stance.

He argued business would welcome such an order.

“You know what business wants? They want to make money … let them open their factory and make money, help them do that by ordering the supplies you need,” Cuomo said. “That’s what the Defense [Production] Act was all about and at the rate they are going — it is not happening. FEMA says we’re sending 400 ventilators. Really? What am I going to do with 400 ventilators when I need 30,000?”
No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency | Governor Andrew M. Cuomo

No. 202.10. EXECUTIVE ORDER. Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency. WHEREAS, on March 7, 2020, I issued Executive Order Number 202, declaring a State disaster emergency for the entire State of New York; WHEREAS, both travel-related cases and community contact transmission of COVID-19 have been documented in New York State and …

As part of an Executive Order Governor Cuomo announced physicians and other health care practitioners would be “immune from civil liability for any injury or death alleged to have been sustained directly as a result of an act or omission by such medical professional in the course of providing medical services in support of the State’s response to the COVID-19 outbreak, unless it is established that such injury or death was caused by the gross negligence of such medical professional”.  While this is a very welcome development, at the same time, the Executive Order also contains several very concerning short -term waiving of laws, including physician supervision requirements for Certified nurse anesthestists, physician assistants and nurse practitioners.

The Executive Order also contains provisions that directs the Health Commissioner to cancel all elective surgeries and procedures, in “all general hospitals, ambulatory surgery centers, office-based surgery practices and diagnostic and treatment centers to increase the number of beds available to patients”.

Medicaid Guide re Use of Telehealth
An updated version of the Medicaid Update Special Edition – Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency, which now includes clarifications for FQHC billing as well as billing for home care providers, has been posted. This guidance was originally issued on March 21, 2020. The Department will be scheduling a webinar shortly to walk through this guidance and a set of FAQs for Medicaid telehealth are under development.

This document will be updated frequently so please continue to check the COVID-19 Guidance for Medicaid Providers webpage and the Medicaid Update webpage for updates and amendments.

PODCAST ”The Psychosocial Impact of COVID-19″
Available at :

The COVID-19 physician and practice resources released by the AMA include:

  • A Physicians Guide to COVID-19, to help physicians prepare their practices, address patient concerns, and provide answers to physicians’ top questions;
  • An AMA COVID-19 online resource center, and a COVID-19 FAQ that are updated each day with the latest information on the COVID-19 epidemic;
  • A Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care which can help achieve a dramatic increase in the nation’s telemedicine capacity;
  • The AMA Journal of Medical Ethics published ethical guidance for physicians to help them in making determinations about how to combat COVID-19;
  • The JAMA Network COVID-19 Resource Center for evidence-based, actionable resources, plus videos of firsthand accounts from physicians on the front lines;
  • CME for physicians through the JAMA Network’s JN Learning website, including COVID-19 epidemiology, infection control and prevention recommendations

Guidance on How to Protect Yourself and Your Family from COVID-19 When Enjoying the Outdoors

NYS has a Coronavirus Hotline at 1-888-364-3065.
The New York State Department of Health has established a provider email account for physicians to ask questions about COVID-19:

Chloroquine in Short Supply As Hospitals Buy in Bulk
Providers have been purchasing significant amounts of chloroquine and hydroxychloroquine in anticipation that they will be used to treat COVID-19, drastically depleting available supply, according to a new report from Premier.

While the U.S. Food and Drug Administration is still investigating whether the inexpensive, old anti-malaria drugs can tame symptoms and limit the spread of the highly contagious virus, hospitals have responded to clinical trials in other countries that have shown promising results.

Orders of chloroquine spiked 3,000% in March, according to data from Premier, the group purchasing and consulting organization. From January 2019 through February 2020, hospitals ordered an average of 149 units a month. More than 2,300 units were ordered through March thus far.

Its variant hydroxychloroquine experienced a 260% surge in demand, Premier data show. Hospitals typically used about 8,800 units a month, jumping to 16,110 units ordered in March. Chloroquine phosphate tables and hydroxychloroquine sulfate tablets went into shortage on March 9 and March 19, respectively, according to the American Society of Health System Pharmacists.

All major wholesale distributors put hydroxychloroquine and chloroquine on allocation this week, which limits ordering to prevent hoarding, Premier said.

Chloroquine, which is also used to treat lupus and rheumatoid arthritis, isn’t typically well stocked by hospitals, if at all, said Erin Fox, a drug shortage expert and senior director of drug information and support services at University of Utah Health.

Some of the manufacturers of chloroquine and related products have lowered prices and donated millions of doses to the U.S. government.

Last month, the National Institutes of Health began a randomized controlled trial for the treatment of COVID-19 patients with Gilead Sciences’ antiviral drug remdesivir. It is one of several drugs that are being tested for COVID-19 treatment, but quality and pricing questions remain.

“We understand and recognize the urgency with which we are all seeking prevention and treatment options for COVID-19. FDA staff are working expeditiously on that front,” FDA Commissioner Dr. Stephen Hahn, said in prepared remarks. “We also must ensure these products are effective; otherwise we risk treating patients with a product that might not work when they could have pursued other, more appropriate, treatments.”

The drug supply chain is already working around restricted access to pharmaceutical ingredients. The Indian government is limiting the export of 26 ingredients, some of which are used in widely used antibiotics, to protect its domestic supply amid the pandemic.

Much of the world’s supply of generic drugs comes from India, which relies heavily on China for their active pharmaceutical ingredients. (Modern Healthcare Mar. 23)

Florida Governor Orders New York Travelers to Quarantine
Florida Gov. Ron DeSantis said Monday he is issuing an executive order mandating that anyone arriving on a flight from New York City and the surrounding area submit to self-quarantine for two weeks. DeSantis said in an address from his Tallahassee office that more than 100 such flights arrive daily in the state and he believes each contains at least one person infected with the new coronavirus.

He said he has been in contact with federal officials about curtailing such flights, but has not yet received a response. He said people will be screened when they arrived and told they must self-quarantine. He said those travelers will not be allowed to stay with family or friends, because that is one way the virus is spread.

He did not say specifically how the self-quarantine would be enforced, but said “it is actually a criminal offense if you violate the quarantine order.” Florida law says it is a second-degree misdemeanor to violate a quarantine order that could result in a 60-day jail sentence.

Update on President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak; CMS Outlines New Flexibilities Available to People with Medicare

On March 17, 2020,  CMS announced that Fee For Service (FFS) Medicare is expanding coverage for Telehealth services, with an effective date of March 6, 2020. MLN Connects® Special Edition for Tuesday, March 17, 2020. Previously covered Telehealth services are now available to beneficiaries in their home environments, regardless of geographic location.

Our sole intent is to make the claim process as seamless as possible for the providers we serve. While we do not anticipate claim rejections and denials relative to these Telehealth claims, we urge providers to notify us immediately if any such problems are identified. We also advise providers that the NGS Provider Call Center does not have any further information on this issue at present.

NGS keenly recognizes the challenges providers are facing as the country deals with this current emergency and we assure you of our full support as we navigate through this time.

NGS remains fully committed to a prompt and successful implementation of the telehealth benefits as a result of these changes.  Please continue to monitor this website ( for additional information from CMS or NGS as it becomes available.

CMS Eliminated Reporting for Jan. to June of 2020
CMS eliminated much of the need for reporting in the first six months of 2020. For the Merit-based Incentive Payment System, eligible clinicians who have not submitted any MIPS data by April 30, 2020 will receive a neutral payment adjustment for the 2021 MIPS payment year, according to the press release.

For the Ambulatory Surgical Center Quality Reporting Program, any data from January 1, 2020 through March 31, 2020 submitted will be used for scoring in the program.

Programs with data submission deadlines in April and May 2020 will be given exemptions based on the facility’s choice to report.

The CMS stated in the press release that it “recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.”

Modern Healthcare Mar 23

University of Washington Doctors Share Findings of COVID-19 Cases
In a research letter published in JAMA on Thursday, doctors at the University of Washington revealed what they called “the first description of critically ill patients infected with COVID-19 in the U.S.,” describing them as having a high rate of acute respiratory distress syndrome and a high risk of death.

The research shows “poor short-term outcomes among patients requiring mechanical ventilation.”
A total of 21 cases, ranging in age from 43 to 92, with 52% of them male were admitted to the ICU at Evergreen Hospital between February 20, 2020, and March 5, 2020, were included. Evergreen Hospital is a 318-bed public hospital with a 20-bed ICU serving approximately 850 000 residents of King and Snohomish counties in Washington State.

Comorbidities were identified in 18 cases, with chronic kidney disease and congestive heart failure being the most common. (7:40 PM CT on 3/19/2020 Modern Healthcare 3/19)

AMA: Ethical Challenges in a Pandemic
The COVID-19 pandemic poses ethical challenges and exceptional demands for physicians in the United States.

While caring for the anticipated surge of seriously ill COVID-19 patients, physicians are very likely to encounter heart-wrenching decisions. Meanwhile, physicians face having to balance the obligation to provide urgent medical care during emergencies, with risks to their own safety, health or life. The current pandemic offers each member of the medical profession a unique opportunity to reflect anew on medical ethical dilemmas that arise in the face of adversity.

During the COVID-19 pandemic, some of these ethical challenges will include:

  • Allocation of limited resource
  • Caring for patients in the face of personal risk
  • Use of quarantine and restrictions of personal liberty

The Code of Medical Ethics offers detailed ethical guidance to physicians on these issues that will help physicians approach the difficult decisions in the days ahead.
For more information, please see the AMA’s list of newly released resources on ethical challenges that arise during pandemics

Scientists Warned re China as a “Time Bomb” for Viruses 13 years Ago
In a 2007 study published by Clinical Microbiology Reviews.scientists warned that a penchant for eating exotic mammals in southern China was a “time bomb” waiting to happen.

Lack of hygienic environments and crowded, wet markets selling wild game plus the common presence of coronaviruses in China was a “time bomb” for a dangerous virus outbreak.

“The small reemergence of SARS in late 2003 after the resumption of the wildlife market in southern China and the recent discovery of a very similar virus in horseshoe bats, bat SARS-CoV, suggested that SARS can return if conditions are fit for the introduction, mutation, amplification, and transmission of this dangerous virus,” the authors said. 6:09 PM CT on 3/23/2020 Modern Healthcare, 323

MLMIC: Offering 24/7 Legal Hotline for Insureds
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