COVID-19 Update April 22, 2020


COVID-19 April 22 Statistics

By the numbers:

* New York reported 15,302 statewide deaths as of Wednesday, including 474 more fatalities in the past day of New Yorkers who have tested positive for COVID-19.

* As of Wednesday, the state reported 10,977 deaths of city residents, or 15,842 deaths if you include “probable” and not just “confirmed” cases.

* As of Wednesday, 15,599 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here.


ALL PHYSICIANS: DO YOU HAVE A STORY TO SHARE? DO YOU HAVE A PHOTO OF YOUR HEALTH CARE HEROES? Email MSSNY at csouthard@mssny.org or call MSSNY at 516-488-6100 ext. 355.


MSSNY President Dr. Art Fougner Holds Up Newsday Centerfold Saluting “HEALTHCARE HEROES.”

MSSNY President Dr. Art Fougner holds up Newsday centerfold saluting “HEALTHCARE HEROES.”


Governor Cuomo’s COVID-19 Briefing Notes

– 15,599 total hospitalizations as of yesterday. “The curve is on the descent.”
– Net change in total hospitalizations and intubations is down
– 1,366 COVID hospitalizations yesterday
– 474 deaths (446 in hospitals, 28 in nursing homes)

White House Visit:

– Visit was productive… was able to put personal politics aside and come to
terms on the federal and state partnership in terms of testing, state
funding, and the state/FEMA match.
– About 40K tests could be done daily if all variables were bought up
to capacity.

Reopening:

– Local leaders are feeling pressure to reopen
– “This is not a time to be stupid.”
– Governor reiterated what happened during the Spanish flu noting that if we
are not prepared a second wave could wreak havoc.
– Governor reiterated that he has no problem taking the blame for any judgements
on the matter.

Q&A:
Reopening:

– Schools will only open if it is known that schools are disinfected and there
are protocols in place for continued disinfecting and social distancing.
– Can’t reopen businesses without reopening schools and transportation.

Nursing Homes:

– Announcement will be made tomorrow on regulations and ensuring safety of staff
– If homes are not providing staff with PPE, they may be put out of business by
the state for noncompliance.

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HealtheConnections Offering COVID-19 Lab Result Data to NYS Physicians
HealtheConnections, a nonprofit organization serving twenty-six counties in New York State, operates our regional health information exchange (HIE). They are offering its free resources tailored to COVID-19 treatment and monitoring to any healthcare provider or public health professional. 

In partnership with the NYS Department of Health, they are offering immediate access to free COVID-19 lab result data and clinical alerting on lab results from anywhere in New York State. Please see this short flyer explaining these services and how to gain access if you feel these might be of benefit to your organization or someone you know working in the healthcare field. 

HealtheConnections is the Regional Health Information Organization (RHIO) for Dutchess County and the entire Hudson Valley region. Their HIE, which creates comprehensive patient medical records from more than 450 care organizations, includes every hospital in our region. 

If you have any additional questions on this data or how to access, please reach out to HealtheConnections directly at support@healtheconnections.org or call 315-671-2241 x5.


DHHS Stimulus Payment Attestation Obligation
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process.


Gov.: Plan for Resuming Elective Surgeries in Certain Parts of Upstate NY
As part of the Governor’s daily press conference yesterday, he announced that elective surgeries could resume in certain “counties and hospitals without significant risk of COVID-19 surge in the near term” across upstate New York. Hospitals will be able to resume performing elective outpatient treatments on April 28, 2020 if

a) the hospital capacity is over 25% for the county and
b) there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days.

If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25% threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease. Further, patients must test negative for COVID-19 prior to any elective outpatient treatment. The State Department of Health will issue guidance on resuming elective surgeries.

Restrictions on elective surgery remain in place in Bronx, Queens, Rockland, Nassau, Clinton, Yates, Westchester, Albany, Richmond, Schuyler, Kings, Suffolk, New York, Dutchess,Sullivan, Ulster, Erie, Orange and Rensselaer counties as the state continues to monitor the rate of new COVID-19 infections in the region.


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MSSNY Survey: Please Complete to Gauge Financial Impact of Outbreak and Availability of Relief
The $2 trillion CARES Act became law on Friday, March 27th and was the third stimulus relief package approved by the federal government in less than two months. Among the issues the bill addresses are the impact on small businesses, as well as the healthcare system, and includes $350 billion in forgivable loans and grants, and advanced payments from Medicare.

These resources are already available, but it is unclear how much physicians know about them and whether they are benefiting. Moreover, as MSSNY continues its aggressive advocacy to ensure physicians can obtain needed financial assistance during this crisis, we need information from our members as to the impact on their practice.

To get an idea if funds are getting into the hands of New York physicians, MSSNY’s Governmental Affairs team distributed a survey on Monday, April 13, to all members and other partners, with questions ranging from how aware physicians are of the financial assistance available through the federal government, difficulty in applying for assistance and whether or not physicians are having to layoff, or furlough, staff. For those MSSNY members who may not have taken the survey, please go to this link.

We will keep you updated on our final survey findings and how we plan to use this information, going forward.


Congress, President Announce Agreement to Provide Needed Additional Funding for Small Business and Health Care Relief Pools
As has been reported in several news articles today, Congress and the Trump Administration have agreed on a package to be voted on this week to provide a “replenishment” to various funding pools enacted in the CARES Act last month.  This includes $310 billion to supplement the depleted fund for the Paycheck Protection Program (PPP) for small businesses; $50 billion for the Economic Injury Disaster Loan (EIDL) program; and an additional $75 billion to supplement the $100 billion health care provider pool (of which an initial $30 billion distribution was made last week).

Moreover, the bill allocates $25 billion to assist in developing a national testing program, including a reported $1.5 billion for New York. The US Senate passed the legislation on Tuesday and the US House is expected to take it up Thursday. Each of these funding streams are absolutely essential towards helping physicians maintain their practices and keeping their practices during this crisis period. MSSNY President Dr. Art Fougner praised the New York Congressional delegation for taking this action.


Upstate Escapes the Worst of COVID-19
As of Sunday, the city proper, along with Long Island and its northern suburbs (Dutchess, Orange, Putnam, Rockland and Westchester counties), had recorded almost 14,000 Covid-19 deaths, which was 97 percent of the statewide total and a third of the nationwide toll. The impact on the other 50 counties has been far less severe, with 410 deaths as of Sunday.


We Thank NY Legislators for Replenishing Pool for Relief
“MSSNY thanks Senators Schumer and Gillibrand, and the New York Congressional delegation for their efforts to advance legislation to replenish the small business and health care provider relief pools initially passed in the CARES Act. This additional funding stream is critically important to maintaining the availability of physicians to their patients as we continue to manage and begin to recover from this horrific outbreak.

This funding stream is also a critically important lifeline to physicians in their efforts to maintain jobs for the hundreds of thousands of New Yorkers they employ. A MSSNY survey released last week finds that 80% of the physician respondents noted that there had been at least a 50% reduction in patient visits since the beginning of the outbreak, and more than a quarter have had to lay off or furlough at least 50% of their staff.

MSSNY looks forward to the U.S. House passage of these relief funds later this week as well as development of the next stimulus package, which we hope will more fully address the enormous financial consequences to New York’s health care and economic infrastructure, as well as providing a mechanism to ensure both office based and hospital based medical staff have the protective equipment they need.”


NYC Healthcare Workers Get Coronavirus Antibody Tests
Teams at Columbia University have pushed hard to boost the sensitivity of their in-house COVID-19 antibody testing and are now offering it to healthcare workers returning to the front lines here. While sensitivity is not perfect and questions remain about the clinical significance of SARS-CoV-2 antibodies, teams are moving ahead with the two-fold purpose of providing healthcare workers some peace of mind and collecting data to ultimately improve testing.

After weeks of tweaking their own ELISA assay, Columbia researchers say they’ve managed to bring its sensitivity to 85% — higher than the 50% to 60% they achieved with a commercial assay, according to Steven Spitalnik, MD, director of clinical laboratories at Columbia University Irving Medical Center and NewYork-Presbyterian.

“We know they’ve been diagnosed with the infection, so the majority [of healthcare workers] should test positive with this assay,” Spitalnik told MedPage Today. “That should give them some comfort and lower their stress levels, though we still expect them to use full personal protective equipment.”

Testing will also give Columbia a “biorepository of well curated samples,” he said.
(Med Page, 4/22)


How Many Times Can You Wash Your Mask?
Steam sterilization may work for decontaminating N95 respirators in short supply during the COVID-19 pandemic, researchers reported. N95 masks retained structural integrity and efficacy after three cycles of sterilization, reported Firas Zabaneh, MT, MBA, of Houston Methodist Research Institute, and colleagues in a research letter in Infection Control & Hospital Epidemiology.

Fit testing of the masks on five test subjects checked out after all three rounds compared with baseline. Chemical and biological indicators for every autoclave cycle confirmed absence of contamination on the masks afterward. Reuse is unavoidable, because “the United States will need 3.5 billion N95 masks for healthcare workers during this pandemic, and currently has about 1% of that necessary volume,” the researchers noted.

Decontamination strategies have varied widely from institution to institution in what has been described as a “Wild, Wild West” phase for infection control, with some just waiting out the 72-hour period the coronavirus can live on plastic, stainless steel, and cardboard surfaces and others taking more active measures. The study used immediate-use steam sterilization with a Steris Amsco Evolution HC1500 PreVac Steam Sterilizer autoclave on masks packed in paper-plastic sterilization peel pouches.

While the CDC hasn’t officially endorsed any method for decontamination, it said ultraviolet germicidal irradiation, vaporized hydrogen peroxide, and moist heat — like used in this study — have shown “the most promise” as methods for decontaminating respirators. Also, the FDA indicated it won’t object to use of disinfectant devices, sterilizers, and other approaches for mask decontamination. Subsequently, a study from the National Institute of Allergy and Infectious Diseases determined that the best strategy was vaporized hydrogen peroxide, which worked fast and maintained mask efficacy for three cycles of sterilization.

In that study, ultraviolet light took longer but also kept masks in good shape through three cycles. Dry heat was slow and degraded mask function after two rounds of decontamination. A 70% alcohol saturation did not make it to the second round.

Zabaneh’s group acknowledged the low numbers in their study “to prevent removing N95 masks from clinical settings and to rapidly translate this finding to the greater clinical community.” Follow-up studies in a significantly larger group are planned at Houston Methodist Hospital, with fit testing each day.

Primary Source

Infection Control & Hospital Epidemiology

Source Reference: Carrillo I, et al “Immediate Use Steam Sterilization (IUSS) Sterilizes N95 Masks Without Mask Damage” Infect Control Hosp Epidemiol 2020; DOI: 10.1017/ice.2020.145.


Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort
On April 19, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families, and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).

This information must be reported in accordance with existing privacy regulations and statute. This measure augments longstanding requirements for reporting infectious disease to state and local health departments. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.

CDC will be providing a reporting tool to nursing homes that will support federal efforts to collect nationwide data to assist in COVID-19 surveillance and response. This joint effort is a result of the CMS-CDC Work Group on Nursing Home Safety. CMS plans to make the data publicly available. This effort builds on recent recommendations from the American Health Care Association and Leading Age, two large nursing home industry associations, that nursing homes quickly report COVID-19 cases.

This data sharing project is only the most recent in the Trump Administration’s rapid and aggressive response to the COVID-19 pandemic. More details are available in the Press Release and Guidance Memo.

COVID-19 Update April 21, 2020


COVID-19 April 21 Statistics


Notes from Governor Cuomo’s COVID-19 Briefing:

Total hospitalizations is “basically flat” and overall curve is decreasing
– Net change in intubations and net hospitalizations is decreasing
– New COVID hospitalizations 1,308 as of yesterday
– Total hospitalizations by region
– 64% in NYC, 21% in Long Island, 8% in Westchester and Rockland County
– 125 hospital deaths in Erie county yesterday
– 481 total deaths in NY yesterday (452 in hospitals, 29 in nursing homes)

Governor reiterated the need to Do No Harm:
 – Be ready to Surge and Flex support to address local clusters by
moving ventilators and equipment from downstate to upstate.

Elective Treatment:

 – Hospitals will allow elective outpatient treatment in counties
and hospitals without significant risk of COVID-19 surge in near term.
– Westchester and Rockland south, Erie, Albany, Dutchess, and
several other counties are excluded.

Testing and Tracing:

 – National private manufactures of lab equipment sell test and treatment
to labs to 211 labs in NY.
– Governor agrees that states should be in charge of testing however the
federal government should aid in providing tests.

Reopening:
– Decisions to open will be made on regional circumstances.

Q&A:
Testing:

– Meeting with the president will focus on testing.

Regional Reopening:
– Will view hospitalization rate and amount of COVID cases in
addition to infection rates and hospital capacity to determine
when and how reopening is possible.


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Cuomo Commits to Reopening New York State Regionally
“We’re going to make reopening decisions on a regional basis based on that region’s facts and circumstances,” he said during his daily briefing. The briefing was held in Buffalo, his first-time venturing west of Schenectady since the pandemic began.

“Just like some states will reopen before other states because they have a different circumstance when it comes to COVID and their status with COVID, it’s also true across the state,” Cuomo said. “[The] North Country has a totally different situation than New York City. Central New York has a different situation. We operate as one state, but we also have to understand variations, and you do want to get this economy open as soon as possible.”

He provided the first taste of how this regional rollout will work by announcing that some hospitals can resume elective surgeries and treatments. “We’re going to allow elective outpatient treatment, which means the number of beds remain available because the number of people are using those beds is still relatively minimal,” he said. “And we’re going to allow it in those hospitals and counties in the state that do not have a COVID issue.” Cuomo said the policy will exclude hospitals in Westchester, Rockland, Erie, Albany and Dutchess Counties, as well as in New York City, where there still is “a real COVID problem.”

“The economic impact … has taken an extraordinary toll on an already struggling Upstate economy,” Unshackle Upstate Executive Director Michael Kracker said in a statement Monday. “A one-size-fits-all strategy is simply not the best fit for Upstate New York.” (Politico, 4/21)


MSSNY Urges NY-Based Health Insurers to Provide Advance Payment Options for Network Physicians
MSSNY President Dr. Art Fougner has written to the CEOs of several regional health insurers operating in New York State urging that they implement a program to provide “advance payment” options to their network physicians similar to what has been undertaken by the Medicare program.

The letters, written to the CEOs of CDPHP, Excellus, Emblem, Empire Blue Cross, Independent Health and MVP, note that “like many businesses across the state, New York physicians are dealing with the devastating impact on their practices as a result of the suspension of all elective procedures, the lack of availability for needed personal protective equipment (PPE), and patients appropriately limiting their trips out of the house, including to their doctor’s offices.”

The letter also thanks the insurers for “working collaboratively…over the past several weeks to help remove barriers to patients being treated via telemedicine, which has been important to maintaining essential continuity of care for our patients and your insureds collaboration”, but notes that far more needs to be done to preserve their networks in the future given the challenges and limitations of the Paycheck Protection Program established under the CARES Act. A similar program was recently advanced by United Healthcare


COVID-19-Related NY Nursing Home Deaths Surpass 1,000
More than 1,100 New York nursing home and adult care facility residents have died from Covid-19 since the outbreak began more than a month ago, state health officials reported Friday. New data released by the Department of Health found that at least 1,135 people died at nursing home and adult care facilities as of Wednesday. That represents about 9 percent of the state’s death toll so far. The bulk of those deaths occurred at facilities in New York City.  (Politico, April 20)


N.Y. Nurses Sue Montefiore, State Over Dangerous COVID-19 Conditions
The New York State Nurses Association on Monday sued the state, Montefiore Medical Center and Westchester Medical Center, alleging their members weren’t given adequate personal protective equipment and were forced to return to work earlier than advised.

Approximately 161 association nurses at the two health systems have tested positive for coronavirus.

“More than seven in ten of our nurses are reporting exposure to COVID-19 and most are still untested. These lawsuits were filed to protect our nurses, our patients and our communities from grossly inadequate and negligent protections,” NYSNA Executive Director Pat Kane said in a statement. “We cannot allow these dangerous practices to continue.” (4/20 Modern Healthcare)


Huntington Hosp Thank you Sign
Huntington Hospital, Long Island


CMS: Facilities May Begin Performing Elective Procedures; Follow Procedures
Healthcare facilities should be able to begin performing elective procedures again if they follow certain protocols, according to guidelines released Sunday by CMS. Although many hospitals and health systems have quickly set up telehealth services to address non-urgent medical issues, “the reality is that not everything can be addressed by telehealth,” CMS administrator Seema Verma said at a briefing held by the White House’s coronavirus task force, citing breast cancer surgery and cataract surgery as two examples of elective procedures that can’t be put off for too long.

With some hospitals around the country seeing a decline in COVID-19 cases and reporting unused capacity, “we’re issuing guidelines today about how we can re-open the healthcare system; these are recommendations around Phase 1,” Verma said, referring to the administration’s “Guidelines for Opening Up America Again.” That guidance outlines a stepped approach to resuming normal activities based on trajectories of syndromic illnesses, diagnosed cases, need for hospital “crisis care,” and testing availability.

“Every state and local official has to assess the situation on the ground,” she said. “They need to be able to screen patients and healthcare workers for the COVID virus, and we need to make sure that patients feel safe when they come in to seek healthcare services by showing they have the appropriate cleaning in place and that they observe social distancing inside the healthcare facilities.” Verma added that this will be a gradual process in which “healthcare systems across the country need to decide what services should be available. We want to make sure systems are reopening so they can stay open and doing that in a very measured way.”

The new CMS guidelines specify that “non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with public health information and in collaboration with state public health authorities.” (Medpage 4/20)


One in Three N.Y. COVID-19 Patients Required a Ventilator
A large study of hospitalized COVID-19 patients in New York City found 1 in 3 were put on breathing machines. That’s a rate more than 10 times higher than seen in China.

The study’s authors say that of the patients studied, 36% were obese, which may have contributed to severe breathing problems and the need for ventilators.

Published online Friday in the New England Journal of Medicine, the report involves 393 patients admitted to two unidentified hospitals from March 5-27. Patients were aged 62 on average and 60% were men. Almost 40% were white but the report had no other racial breakdown. Overall, 6% were health care workers.

Cough, fever and shortness of breath were the main symptoms, but diarrhea, nausea and vomiting were also common.

Dr. Parag Goyal of Weill Cornell Medicine and the report authors say that compared with China, hospitalization for COVID-19 in the U.S. is generally limited to more severely ill patients, another likely reason for the greater use of ventilators.

The authors say 40 patients or 10% died and 260 were discharged from hospitals. (4/17 Modern Healthcare)


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Private Labs in New York Must Prioritize COVID-19 Testing
Private labs across New York were ordered Friday to coordinate with the state’s Department of Health to mandate coronavirus testing takes priority.

Gov. Andrew Cuomo said Friday he would issue an executive order that mandates all labs—public and private—in the state, who are tasked with carrying out coronavirus diagnostic tests, coordinate with the State’s health department going forward.

There are 301 labs in New York licensed to perform virology testing, Cuomo said.

“How do we get 300 private labs and hospitals to become one system statewide to do testing for COVID? And how do we get them all coordinated? This is something that has never been done before and is going to be a tremendous undertaking,” Cuomo said. (Crain’s New York Business 4/20)


MIPS Credit for Sharing Clinical Data
The CMS on Monday encouraged providers to share clinical data in the Quality Payment Program that could help combat the COVID-19 pandemic.

The agency will give providers credit in the Merit-Based Incentive Payment System if they participate in a clinical trial that uses a drug or biologic to treat COVID-19 and report the data to the CMS. The hope is the increased participation will help improve patient care and find best practices that could curb the virus’ spread.

“The best scientific and medical minds in the world are working night and day to find treatments to combat coronavirus,” CMS Administrator Seema Verma said in a statement. “But without solid data, their efforts are liable to run up against a brick wall.”

Clinical trial participation will earn half of the credit necessary to gain a maximum MIPS improvement activities score, which is 15% of a provider’s total MIPS score.

The CMS highlighted several trials providers could join, including National Institutes of Health trials or a clinical data repository with Oracle.

“Having clinicians use an open source data tool to submit their findings will bring the results of their research to the forefront of healthcare much faster, leading to improvements in care delivery and the ability to treat COVID-19 patients,” the CMS said in a press release. (Modern Healthcare 4/21)


Northwell Awards Front-Line Workers with Cash, Extra PTO
Northwell Health is giving its front-line workers a $2,500 lump-sum payment and a week of paid time off.

The system estimates around 45,000 nurses, physicians, respiratory therapists, housekeepers and other workers are eligible for these benefits.

“Our dedicated staff’s response to the COVID-19 pandemic has been nothing short of heroic. Thanks to the courage and commitment of our front-line caregivers, we answered the call-in service to the patients and communities who entrust us with their care,” said Michael Dowling, Northwell’s CEO. (4/20)


Healthcare Professionals Urge Data re Death among African Americans
Providers are urging the Trump administration to collect more information about what’s causing high rates of COVID-19 infection and death among African Americans and other people of color, according to a joint letter sent Thursday to HHS by three major associations.

The American Hospital Association, American Medical Association and American Nurses Association identified several areas that require more federal attention, including the need for additional information about “comorbidities, the number of patients by race who require ventilators, oxygen support or intubation, and the number who died in their homes.”

“We need the federal government to identify areas where disparities exist and help us immediately address these gaps,” they wrote.

The groups also pushed HHS to work with state and local public health departments to gather and share information to make sure that providers don’t spend valuable time and resources collecting and reporting data that might already be available.

HHS should act to increase access to COVID-19 testing for African Americans by creating testing centers paid for and run by the federal government, according to the letter. Likewise, the Trump administration should make it easier to get a referral for COVID-19 testing since many people of color don’t have health coverage or primary care access.

Hospitals, physicians and nurses also pressed HHS to develop ways to address minority populations’ COVID-19 needs that are culturally relevant.

The Centers for Disease Control and Prevention recently started to collect and report information about COVID-19 patients’ race and ethnicity—including testing, hospitalization and mortality data—after widespread reports that the COVID-19 outbreak was affecting racial and ethnic groups differently. But experts say they need more information to address the problems. Modern Healthcare, April 21)

COVID-19 Update April 20, 2020


COVID-19 April 20 Statistics
New York reported 14,347 statewide deaths as of Monday, including 478 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Saturday, New York City reported 13,240 deaths of city residents, including “probable” and not just “confirmed” cases. As of Monday, 16,103 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. Gov. Andrew Cuomo’s April 19 coronavirus presentation is here.


Notes from Governor Cuomo’s COVID-19 Briefing:

– Total hospitalizations 16,103 as of yesterday
– 1,380 new COVID hospitalizations yesterday
– Net change in hospitalizations and intubations is down
– 478 lives lost yesterday (455 in hospitals, 23 in nursing homes)
– – In terms of reopening, let’s use this situation to learn lessons
and reimagine what we want society to be.
– Antibody testing begins today

Funding:

– Federal government has not funded states to date.
– Federal CARES Act contains zero effort to combat shortfalls
– Renewing bipartisan call for $500 billion in aid to states
– If state government is excluded again schools, local governments,
and hospitals are forecast to be cut by 20% each.
– Hazard pay for frontline workers – they should receive a 50% bonus
(including airline workers)
– 41% of frontline workers are people of color
– 2/3 of front-line workers are women
– 1/3 of front-line workers are from low-income households.

Q&A:
Hospitals:

– Over 20 hospitals were using hydroxychloroquine and will send
results to the FDA and CDC today. The DOH will receive a copy.
— Elective surgeries have been suspended in NY, but bed capacity
has increased since start of COVID-19, so this suspension will be reexamined.
– Policy will be announced tomorrow regarding hospital vacancy rate
and COVID-19

DOL:

– Applications being processed so money should be seen this week.
– People that opt for a debit card instead of direct deposit will wait
longer to receive money.
– DOL launched new form where one application can be filled out to
determine if one is eligible for unemployment insurance and pandemic
unemployment insurance.

NY Physician Practices Struggling to Survive: Survey
Physicians in New York are struggling to stay afloat despite the recent passage of the CARES Act, according to a new survey from the Medical Society of the State of New York.

The bill was meant to address the impact of the Covid-19 pandemic on small businesses, including physician practices, the society said. But more federal support is critical to the survival of those in hard-hit New York.

Some 80% of survey respondents reported that they have suffered a loss of revenue of more than 50% since the Covid-19 outbreak began. And 83% reported they have experienced a reduction of more than 50% in the volume of patients visiting their practices.

Additionally, more than a quarter of respondents said they have had to lay off or furlough more than half their staff, and nearly three-quarters said they have applied for forgivable loans through the Small Business Administration.

Our first priority remains to ensure that our patients through the crisis can continue to receive the care they need, but we need to know if our practices can keep their doors open for patients now and in the future,” said Dr. Art Fougner, president of the medical society, in a statement. “With patients appropriately limiting their trips out of the house, including to their doctor’s offices, along with all elective procedures being suspended, the impact has devastated practices and the hundreds of thousands of New Yorkers they employ.”

Fougner added that one physician commented: “Letting go of my staff, knowing the hardship ahead for them, was one of the most difficult decisions I ever had to make. I pray they will return when this horrible scourge is over.”

The society noted that although the CARES Act provided some funding to make up for deficits, it’s not nearly enough for many physicians across the state.

The group thanked the New York congressional delegation for continued efforts to secure additional relief funds. (Crain’s, April 17)


Survey of Medical Society of State of NY Physicians
A survey of Medical Society of the State of New York members released Thursday found 83 percent of respondents have had a reduction of more than 50 percent in the volume of patients visiting their practices. Also, 80 percent have suffered a loss of revenue of more than 50 percent since the outbreak of COVID-19. More than a quarter have had to layoff, or furlough, more than 50 percent of their staff.

“Very disturbing reports were also received from physician respondents that despite having applied for help as soon as the funds became available, they have received no assistance to date,” the society reported. (Times Union,  April 19)


African Americans Make Up One-Third of All US Coronavirus Cases
As of April 15, African Americans made up about 30 percent of the COVID-19 
cases in the country, according to CDC data.

The CDC released demographic data for coronavirus cases in the U.S. as of April 15 at 4 p.m. CDT. The data is based on 465,995 U.S. cases.

Three insights:

  1. Race is specified for 111,650 of the COVID-19 cases included in the data.
  2. Black people account for about 30 percent of all U.S. COVID-19 cases where race is specified, while white people account for 64 percent and Asians account for 4 percent.
  3. Of the 102,979 cases for which ethnicity was specified, Hispanic/Latinos account for 17 percent of the cases. (Becker’s Hospital Review, April 20)

The Coronavirus Spreads At Least 13 Feet, Travels on Shoes: CDC
The coronavirus can travel through the air at least 13 feet — more than twice as far as social distancing guidelines, according to a report from the Centers for Disease Control and Prevention. Research published in the federal agency’s Emerging Infectious Diseases journal shows the contagion spreading much farther than previous official suggestions — and also getting spread on people’s shoes.

“The aerosol distribution characteristics … indicate that the transmission distance of [COVID-19] might be 4 m,” the report says, translating as more than 13 feet.

“Furthermore, half of the samples from the soles of the ICU medical staff shoes tested positive,” the researchers wrote of samples taken at Huoshenshan Hospital in Wuhan. “Therefore, the soles of medical staff shoes might function as carriers.”

The report, based on research by a team at the Academy of Military Medical Sciences in Beijing, appears to reaffirm fears that the current social distancing guidelines of 6 feet may not be enough.

It also suggests people — especially medical staff on the front lines — could inadvertently be spreading the bug away from its source, recommending stringent disinfecting measures. (WebMD, April 14)


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NY Hospital Leadership Regarding Communication and Strategy
Michael Antoniades, EVP and COO, Maimonides Medical Center (NYC) 

Hold virtual town hall meetings with all staff at least weekly. You cannot communicate enough. Be open and transparent with your team.

Robert J. Corona, DO, MBA, FCAP, FASCP, Chief Executive Officer, SUNY Upstate Medical University and Community Hospitals (Syracuse, N.Y.)

Anticipate the unexpected. You are operating in an uncertain environment, and the cavalry is not coming. Reach out to collaborate with organizations promising to help you, but ultimately you’re on your own. Low expectations will lead to less disappointment. You’ll be disappointed by some you thought were good leaders and pleasantly surprised by others. A crisis reveals the essence of people’s leadership skills and their true nature.

At the same time, there are people on the bench waiting to get into the game. You will be surprised by the talent you have right under your nose. Delegate urgent issues to your team so you can focus on the critical. Keep vigilant to threats. You can’t take the typical time to make decisions. As a neuropathologist, I compare it to making a frozen section diagnosis. Time is critical, and you have to make the call with the data you have. Also, start planning now for a rolling recovery and coming out of this crisis as a more resilient organization. Coming out of this crisis only to be the same organization you were before is a lost opportunity. 

Laura Forese, MD, Executive Vice President and COO, New York-Presbyterian 

There is no such thing as overcommunicating. Communicate to your team members at all levels. Every person needs to know what is happening in your organization, how you are thinking about the evolving strategy and that you care about the team.

Ignore all the superfluous and overly sensationalized media “noise.” It’s way too unproductive. Alternatively, stay the course by driving evidenced-based, science-centric decisions. And if the noise gets too loud — turn up the music. 

Bill Lynch, Executive VP/COO, Jamaica Hospital Medical Center (NYC) 

Communicate, communicate and communicate. It’s that critical! Good luck.

fact that decisions need to be made quickly. When doing so, not all decisions will be perfect and the organization needs to be agile enough to adjust quickly.

Another key ingredient in leading through this complex crisis is to ensure that the organization is communicating in a multi-channel way, both internally and externally. Communications need to be built into the organization’s daily rhythm and key messages need to be repeated. As COVID-19 races to adapt to its new environment, so must we. Through courage, cooperation, creativity and most importantly resilience, we will persevere. 

Louis Shapiro, President and CEO, Hospital for Special Surgery (NYC) 

Set up a robust organizational structure as if you were starting a new company at scale. Be forward-looking and think about what you need to do before you need to do it. If you wait, it will be too late. Don’t underestimate the importance of communicating with your workforce. HSS did so in many ways: web-app, daily videos, daily emails, live stream. Visibility, transparency, inspiration and timeliness are all critical. Remember your hidden heroes: environmental services, engineering, supply chain, microbiology. Figure out a way to capture what you learned and make sure you pull it through to the other side. Develop your “return to new normal” plan well before you need it.

Overcommunicate. Make sure communication is timely, transparent, and clearly stated. As the messages are delivered, praise the work for the staff for being flexible, as policies and processes are changing daily. Invite feedback, give them a vehicle with which to respond. Let staff know that you are listening to them because they likely have the answers and you want to know what they are thinking. At no other time have we had the opportunity to connect closer to our frontline staff than now. And it is our responsibility to do so. (Becker’s Hospital Review April 17)


Nearly 60% Of COVID-19 Chest X-Rays Look Normal, Study Shows
Chest X-rays read as “normal” for nearly 60 percent of COVID-19 patients, a new study shows. The study, published in The Journal of Urgent Care Medicine, examined the database of a large urgent care company in the greater New York City area. They examined data for patients with the new coronavirus who also had chest X-rays between March 9 and March 24.

Eleven radiologists reviewed data for 636 chest X-rays among patients with confirmed COVID-19.

Of the 636 chest X-rays, 371, or 58.3 percent, read as normal. Of the 265 chest X-rays that read as abnormal, 195 demonstrated mild disease, 65 demonstrated moderate disease and five demonstrated severe disease. (Becker’s Hospital Review April 17)


NBC/WSJ Poll: People More Concerned About Virus than the Economy
Nearly 60% of Americans say they’re more concerned that loosening stay-at-home measures will cause further spread of the coronavirus than they are about what impact restrictions might have on the US economy, according to a new poll. The NBC News/WSJ poll released Sunday found that 58% of registered voters worry the country will be too quick to lift the restrictions, leading the virus to spread and to more fatalities. By comparison, there was another 32% who are more concerned that the country will take too much time to ease the restrictions, which will take a toll on the economy.

There appeared to be a partisan impact on the responses — with 77% of Democratic respondents and 57% of independents reporting they’re more concerned about the spread of the virus than the economy.

Meanwhile, Republicans were more divided with 39% more worried about the pandemic and 48% reporting that their greatest concern was about the economy, the poll said.

The poll was conducted from April 13 to 15 as some states have begun to talk about how to ease lockdown restrictions.

Pollsters surveyed more than 900 registered voters, more than half of whom were reached by cellphone. (NY Post April 19)


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Coronavirus in Context: Covid-19 Prevalence
WebMD’s Chief Medical Officer, John Whyte, speaks with Justin Silverman, M.D. PhD Assistant Professor, Penn State University Alex Washburne, PhD Research Scientist, Montana State University Nathaniel Hupert M.D. MPH FACP Assistant Professor, Weill Cornell Medicine to discuss Covid-19 Prevalence.

In comparison, as of March 28, the CDC had reported more than 122,000 confirmed cases.

The researchers say their findings are in line with another new study that looked for COVID-19 antibodies in the blood of 3,300 Santa Clara County residents. Based on their tests, researchers estimate that between 2.5% and 4.2% of county residents have antibodies against the virus, a number that translates into 48,000 to 81,000 infections, or 50 to 85 times as high as the number of known cases. That study also has not been peer reviewed.

For their study looking at ILI rates, the researchers looked at several sources of information to determine the infection rate:

  • Every week, about 2,600 U.S. health care providers report the numbers of patients who have ILI to the CDC. These patients have a fever of at least 100 degrees, a sore throat or/or a cough, without a known cause other than flu. Colds, flu, other respiratory viruses, and COVID-19 can all cause these symptoms.
  • The researchers then excluded people who were eventually confirmed to have flu.
  • Of the remaining group, they assumed that those numbers above the season average of the nonflu cases could be attributed to COVID-19.

Study co-author Justin Silverman, MD, PhD, assistant professor of information science and technology at Penn State University, cautions that the data about infection rates needs to be verified yet by other methods, such as testing blood samples and taking swabs. The findings point to the need for more testing, and not just of those showing up at the doctor with symptoms, says Alex Washburne, PhD, co-lead author of the study and a research scientist at Montana State University. What’s needed, he says, is random population testing.

“I would like to see 100 random people in each state on each day” tested, he says, both with swabs and antibody testing. “That would give us a sense of prevalence.”

Ruiyun Li, PhD, a research associate at the Imperial College London, who has studied undocumented COVID-19 infections, agreed that the findings stress the need for more testing. “The finding is important as it indicates the urgent need to improve the testing and detection capability – the more we test, the more cases could be confirmed,” Li says. He also said their approach is interesting because it’s impossible to test everyone. “The estimates based on current ILI surveillance system could help.”

The lack of testing is one of the reasons many countries have employed social distancing measures to prevent the spread of the COVID-19 infection. In the U.S., officials have expressed optimism that ramping up widespread antibody testing may help relax distancing measures. Li echoes the researchers’ caution that the estimates are just that – estimates — and the findings do need to be validated by blood tests to show exactly how many people test positive.

Death Rate Questions

The finding of much more widespread infection suggests the infection to fatality rate from COVID-19 might be less than current estimates, which range from 3% from the World Health Organization to 1.4% reported recently by other experts. But the researchers stop short of estimating a revised death rate from their findings.

Fatality rates also depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. The New York Times reported that China’s estimated death rate was 17% in the first week of January, when Wuhan was in its peak, but only 0.7% by late February.

Washburne says while their findings suggest a lower fatality rate is possible, it’s premature to calculate a death rate from the infection rate the researchers found. Death rate, he says, ”is probably the most important and contentious number for assessing the risk-benefit of costly interventions, such as statewide lockdowns versus more diffuse interventions such as mask wearing.”

One bit of missing information may throw off the estimate of the death rate, Washburne says. “If we’re off by 0.1%, that’s 200,000 deaths.”

Washburne says what they’ve done is added a piece of evidence that suggests the growth rate of the virus is faster but that the number of serious cases is fewer. He hopes he can help guide future models if backed up by other evidence. (WebMD Health News Reviewed by Neha Pathak, MD on April 18, 2020)


Social Distancing May Be Needed Through 2022, Harvard Researchers Say
Social-distancing measures for COVID-19 may need to continue through 2022, according to new projections from Harvard researchers published in Science. 

Researchers from Boston-based Harvard T.H. Chan School of Public Health used mathematical modeling to predict various scenarios for the pandemic.

The researchers projected that the SARS-CoV-2 virus will return every winter, prompting more outbreaks after the initial pandemic wave ends. Prolonged social-distancing strategies could help limit the strain on healthcare systems and make quarantine and contact-tracing a feasible response strategy.

“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available,” the researchers said.

They acknowledged that even intermittent social distancing will have profound economic, social and educational consequences. Even after the “apparent elimination” of COVID-19, viral surveillance should continue through as late as 2024 to prevent an outbreak resurgence, researchers said.

The researchers said their modeling should not be taken as an endorsement of certain response policies, but instead be used to identify helpful interventions and spur new ideas to achieve long-term control of the pandemic.

To view the full study, click here.


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COVID-19 Update April 17, 2019

I hear empty trains a’comin
They’re rollin round the bend
And I ain’t seen a steakhouse
Since I don’t know when.
I’m stuck in COVID prison
And time keeps draggin’ on
But the news scroll keeps a rollin’
On and on and on.
(Apologies to Johnny Cash)

John Donne famously wrote “No man is an island unto himself.” Mr. Donne clearly had not experienced social distancing. Humans are by nature social beings. This trait enabled our distant ancestors to obtain food while avoid being food. We enjoy going to parties, to shows, to restaurants, to sporting events, and yes, even to Grand Rounds. The current pandemic has stolen that all from us. We can no longer attend weddings. We cannot hold funerals for our dead. We can no longer congregate in parks nor play pick-up basketball. Tech can provide some relief, some illusion of sociability but that small comfort is both illusory and fleeting.

In the days when medicine was far more art than science, the most powerful weapon in that black bag was the therapeutic touch. Attending at the bedside to comfort the sick and dying was integral to the calling. Without curative therapies, all physicians really had to offer were moments of humanity. The virus has even deprived us of these moments. Surviving the virus, we have lost much of our humanity.

Now, we may be over the worst. Some curves have flattened. Others are on the downslope. Early reports of treatments are lighting up the financial markets. Our leaders are talking about and planning the recovery phase – society’s parole. This too will no doubt have its glitches, but we should be optimistic and begin to plan. We should realize that nothing will go back to the way things were and, in fact, many should never go back to the way things were. Hearings will be held. Books will be written. Talking heads will drone on.

Let me suggest one principle to help us find our way. We have flattened the curve. We must work to flatten the bureaucracy. Let’s do it together.

Let’s all find those Blue Skies.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


Visit covid19tracker.health.ny.gov to See the Latest NY Data
New York reported 12,822 statewide deaths as of Friday morning, including 630 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Thursday, the state reported 8,893 deaths of New York City residents. As of Thursday, 17,035 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. 


Gov. Cuomo: What You Need to Know

  • “New York on PAUSE” will be extended until May 15th. This action is taken in consultation with other regional states. Non-essential workers must continue to stay home and social distancing rules remain in place. We will re-evaluate after this additional closure period. I know this is hard, but we must stay the course.
  • Cuomo outlined a blueprint to get New Yorkers back to work and ease social isolation without triggering a renewed spread of the virus.The blueprint operates under one overarching principle — do no harm. As part of the strategy to reopen, we will strengthen the healthcare system; use diagnostic testing, antibody testing and contact tracing to limit the spread of the virus; and implement a phased return to a “new normal” — which will include evaluating risk by industry, starting with the most essential businesses that present the lowest risk, rethinking the workplace to make it safer, and implementing protocols for response if a worker develops COVID-19 symptoms. Real the full plan here.
  • New Yorkers MUST wear masks or face coverings on public transportation systems and while taking private transportation or riding in for-hire vehicles.Additionally, all operators of public systems, private carriers and for-hire vehicles must always wear a mask or face covering while working. These directives expand on the Executive Order announced yesterday requiring everyone in New York to wear a mask or a face covering when out in public and in situations where social distancing cannot be maintained. The order will go into effect on TODAY at 8 PM.
  • The number of hospitalizations continue to fall but we are not out of the woods yet. Yesterday, total hospitalizations fell to 17,735, the third straight day of declines. However, infections remain high and the virus is still spreading. Visit health.ny.gov to see the latest data.


For more information, click here.


Urge the NY Congressional Delegation to Support Additional Stimulus to Assist Physician Practices
All physicians are urged to contact Senators Schumer and Gillibrand, as well as their respective US Representative, to urge that they fight for needed funding to assist physician practices across the state of New York to be able to keep their doors for their patients, as Congress discusses the creation of a fourth stimulus bill.  A letter can be sent from here.


MSSNY Survey Results re COVID-19 Impact on Their Practices
This week, MSSNY issued a press release announcing the results of a physician survey that showed that, like many businesses across the state, New York physicians have faced a devastating impact on their practices as a result of the coronavirus outbreak.  The survey results were reported in several media outlets including the Syracuse Post-Standard , Buffalo News and Crain’s Health Pulse.

The survey results make clear that while the CARES Act funding pools (including the SBA funding and other health care distribution pools) provided some funding to make up these enormous deficits, it is not nearly enough to ensure the survival of many physician practices across the State of New York.  MSSNY President Dr. Art Fougner thanked the New York Congressional delegation for their efforts to fight for relief funds for New Yorkers, but also noted how is imperative they fight in the next relief package to preserve the viability of New York’s health care system, including physician practices. This is not only critically important for doctors and their patients, but also for their hundreds of thousands of dedicated employees—many of whom have been laid off or furloughed during this crisis.

Among the key findings of the MSSNY survey were that: 83% of respondents have had a reduction of more than 50% in the volume of patients visiting their practices; 80% have suffered a loss of revenue of more than 50% since the outbreak of COVID19; and more than a quarter have had to layoff, or furlough, more than 50% of their staff.

In addition to fighting for an expansion of the small business loan/grant funding pool, the grassroots letter also urges funding for tuition relief and loan forgiveness for physicians, residents and medical students treating patients on the front lines.


DHHS Stimulus Payment
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process: https://covid19.linkhealth.com/#/step/1


Please Continue to Let MSSNY Know if Your Hospital or Office Cannot Receive Adequate PPE
Pursuant to Executive Order 202.16 issued this past Monday, all businesses must provide face coverings, at their expense, for all their employees who are in direct contact with the public.  However, we continue to hear concerns from physicians that, in some hospitals, physicians and other health care staff are not receiving the personal protective equipment (PPE) they need when delivering patient care.

MSSNY has been sharing these reports with the New York State Department of Health for further investigation.  It is our hope that with the new Executive Order, and a briefing notice from the Greater New York Hospital Association and the Healthcare Association of New York State to their members calling for compliance with this requirement, that these concerns will be addressed.  However, please let us know (mauster@mssny.org) if these concerns continue, and we will continue to bring them to the attention of the NYSDOH.


New Clarifications on Emergency Funds
As you know, 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 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 have Medicare billing privileges revoked.


NEJM: Clinical Characteristics of COVID-19 in New York City
NYC physicians published a paper today in NEJM.


Garfunkel Wild Webinar: Employer’s Practical Guide to Facing Day-To-Day Coronavirus Challenges on April 20, 2020 | 12:00 pm – 1:00 pm
In the last several weeks, myriad laws and protocols have been issued by Federal and local governments in response to the outbreak of the global COVID-19 virus and to dissipate the profound economic and health and safety impacts of the virus. Examples of this are the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, which are part of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act (CARES Act).

At this juncture, while most employers are familiar with the eligibility requirements and magnitude of the leave benefits under these new statutes, they are lacking practical information and guidance on how to implement these requirements.  The webinar will address such issues as:

  • How to deal with COVID-related health issues in the workplace
  • What measures can employers take to determine if employees coming into the workplace have COVID-19 or related symptoms?
  • Can employers tell their employees if a co-worker contracts COVID-19?
  • What types of accommodations must an employer consider related to COVID-19?

Planning for your PPP Loan

  • Can employers furlough employees until the PPP loan comes in?
  • How can employers apply for a PPP loan?
  • How can employers deal with reductions in force and salary reductions in light of a PPP Loan?

Addressing Unemployment Insurance Issues

  • How do the new federal unemployment provisions work?
  • What is the interplay between State and Federal Standards?
  • What are the rates of unemployment under the new rules?
  • What to do with employees who don’t want to return to work?

REGISTER NOW


COVID-19 & Healthcare Professionals: What the Latest CDC Data Shows
Federal data released this week showed that healthcare professionals account for 9,282 of the 315,531 COVID-19 cases nationwide, their median age is 42, and 73 percent of them are female. The tally came from the CDC April 14 and was representative of laboratory-confirmed COVID-19 cases voluntarily reported to the agency from 50 states, four U.S. territories and affiliated islands and the District of Columbia, from Feb. 12 to April 9.


Dr. Erick Eiting’s Video Diary from the ED Featured on ABCNY7
Dr. Erick Eiting, an Emergency Room physician at Mt. Sinai Beth Israel, is featured in a short film about last Friday’s night shift at the hospital treating COVID-19 patients.
Dr. Eiting, a MSSNY member since he left medical school, is currently Vice Chair of Preventive Medicine Family Health Committee, a Member of Task Force on End of Life Care, and Co-Vice Chair of Committee to Eliminate Health Disparities.


Staten Island Launched 10,000 Calls’ to Help Curb Spread of Coronavirus
Borough President James Oddo announced that his office has teamed up with several healthcare organizations on Staten Island, including Richmond County Medical Society (RCMS), Community Health Action of Staten Island (CHASI) and New York Chapter of the American College of Physicians (NY ACP) to launch “10,000 Calls.”

The initiative is meant to tackle the coronavirus pandemic through local physicians conducting outreach to patients, or their caregivers in order to provide a quick “wellbeing/social check-in” phone call. Patients who are 65 years old or older, who are more susceptible to the coronavirus, will be prioritized by physicians.

The Initiative gives physician offices and their staff questions to ask patients, and/or their caregivers, that are related to critical areas of the coronavirus outbreak.

Physician staff members will ask patients questions about their overall health and whether they have any pressing health concerns. Staff members will also ask patients about whether they need medication assistance, have concerns related to the pandemic and will offer concrete help related to social support during the pandemic.


 

MLMIC COVID Banner


CME COURSES

COVID-19 Resources and Free CME Available from MSSNY
The MSSNY website has myriad resources available in response to the current pandemic.  Go to www.mssny.org and click on the COVID-19 Update link or the banner with COVID-19 Resources for Physicians to find out more.

You can also go to https://cme.mssny.org and get free CME credits for the Medical Matters and Emergency Preparedness courses posted there.  Courses of relevance to the current pandemic include, but are not limited to:

Medical Matters Courses:

  • Psychosocial Dimensions of Infectious Outbreaks
  • Coronaviruses 2020: COVID-19 An Evolving Story
  • Disaster Medicine Every Physician’s Second Specialty
  • Doctor Are You Ready?
  • The Importance of Resilience After a Disaster
  • Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
  • Public Health Preparedness 101
  • Virtual Drill: Incident Command System & Crisis Communications

Emergency Preparedness:

  • Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)

Resources:

  • Psychological Impact of Disaster and Terrorism Reference Card

Please note, if you do not already have an account there, you will need to create one, this is separate from MSSNY’s home page.

You are also encouraged to listen to the podcasts MSSNY has produced about COVID-19 by clicking on the links below:


April 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
“COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid”

Register now for MSSNY’s next 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.


Pain Management, Palliative Care and Addiction Online Programs Now Available at MSSNY CME Website
The Medical Society of the State of New York updated 2020 Pain Management, Palliative Care and Addiction modules are now available on-line here.

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.

These online programs cover all eight topics required in the New York State statute:

  • New York State and federal requirements for prescribing controlled substances
  • Pain management
  • Appropriate prescribing
  • Managing acute pain
  • Palliative medicine
  • Prevention, screening and signs of addiction
  • Responses to abuse and addiction
  • End of life care

MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement. 

These courses are entitled:

  • PM, PC & A 2020: Understanding the Current Legal Landscape in New York State
  • PM, PC & A 2020: When to Consider Opioid Therapy for Chronic Non-Cancer Pain and in Palliative Care
  • PM, PC & A 2020: Patients with Opioid Use Disorders 

Additional information or technical support may be obtained by contacting cme@mssny.org

Attestation Process for Mandatory Prescribers
Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics.

A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application. Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

  1. Log into the HCS at https://commerce.health.state.ny.us
  2. . Under “My Content” click on “All Applications”
  3. Click on “N”
  4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.

Complete the steps to ATTEST to the completion of the education requirement.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form.

Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov

Or at https://www.health.ny.gov/professionals/narcotic/mandatory_prescriber_education/


This Week’s Legislative Podcast


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COVID-19 Update – April 16, 2020


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April 16, 2020 Latest COVID-19 Statistics
By the numbers:

New York reported 12,192 statewide deaths as of Thursday morning, including 606 more fatalities in the past day of people who have tested positive for COVID-19. As of Thursday, the state reported 8,893 deaths of New York City residents. As of Thursday, 17,035 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. Gov. Andrew Cuomo’s April 16 coronavirus presentation is here.


MSSNY Member Survey Shows New York Physicians Struggling Despite Recent Passage of CARES Act
Like many businesses across the state, New York physicians have faced a devastating impact on their practices as a result of the coronavirus outbreak, according to physician survey results announced by The Medical Society of the State of New York (MSSNY).

A survey of its members confirms the significant impact of the COVID19 crisis on New York physicians and whether they are able to avail various relief funds available through the recently passed CARES Act approved by Congress. The bill was supposed to address the impact on small businesses, including physician practices.

“Our first priority remains to ensure that our patients, through the crisis, can continue to receive the care they need, but we need to know if our practices can keep their doors open for patients now and in the future.  With patients appropriately limiting their trips out of the house including to their doctor’s offices along with all elective procedures being suspended, the impact has devastated practices and the hundreds of thousands of the New Yorkers they employ,” said Art Fougner, MD, President of the Medical Society of the State of New York.  “Many doctors are working alone or with a skeleton staff.  One physician wrote, ’letting go of my staff knowing the hardship ahead for them, was one of the most difficult decisions I ever had to make. I pray they will return when this horrible scourge is over.’”

Key Takeaways from the Survey Include:
83% of respondents have had a reduction of more than 50% in the volume of patients visiting their practices.

  • 80% have suffered a loss of revenue of more than 50% since the outbreak of COVID19.
  • More than a quarter have had to layoff, or furlough, more than 50% of their staff.
  • 73% have applied for forgivable loans through the Small Business Administration’s (SBA) 7(a) Loan Program.

Very disturbing reports were also received from physician respondents that despite having applied for help as soon as the funds became available, they have received no assistance to date.

“New York’s health care system, including physicians, shouldn’t have to face financial ruin, while working around the clock to save lives. The next package coming out of Congress must include specific funding to help preserve New York’s health care infrastructure, including physician practices,” Dr. Fougner continued, “We thank New York’s Congressional delegation for all their efforts and urge them to continue to fight for a fair share of relief funds for New Yorkers. New York has shouldered the brunt of this crisis and we desperately need the fiscal attention we deserve.”

The survey results make clear that while the CARES Act provided some funding to make up these enormous deficits, it is not nearly enough to ensure the survival of many physician practices across the State of New York.  MSSNY thanks the New York Congressional delegation for their efforts to fight for relief funds for New Yorkers, but it is imperative they fight in the next relief package to preserve the viability of New York’s health care system, including physician practices. This is not only critically important for doctors and their patients, but also for their dedicated employees—most of whom have been laid off, or furloughed, during this crisis. – MSSNY Press Statement April 16


SECOND CHANCE: Please Complete MSSNY Survey to Gauge Financial Impact of Outbreak and Availability of Relief
The $2 trillion CARES Act became law on Friday, March 27th and was the third stimulus relief package approved by the federal government in less than two months. Among the issues the bill addresses is the impact on small businesses, as well as the healthcare system, and includes $350 billion in forgivable loans and grants, and advanced payments from Medicare.

These resources are already available, but it is unclear how much physicians know about them and whether they are benefiting. Moreover, as MSSNY continues its aggressive advocacy to ensure physicians are able to obtain needed financial assistance during this crisis, we need information from our members as to the impact on their practice.

To get an idea if funds are getting into the hands of New York physicians, MSSNY’s Governmental Affairs team distributed a survey on Monday, April 13th, to all members and other partners, with questions ranging from how aware physicians are of the financial assistance available through the federal government, difficulty in applying for assistance and whether or not physicians are having to layoff, or furlough, staff. For those MSSNY members who may not have taken the survey, please use the following this link.

We will keep you updated on our final survey findings and how we plan to use this information, going forward.


Notes from Governor Cuomo’s COVID-19 Briefing:

– Hospitalization rate is down 1k (from 18k to 17k). Total hospitalizations
also down. Also, net change down more significantly than before.
– ICU admission number down.
– Intubations down.
– New hospitalizations remains at about 2k, same as yesterday.
– Deaths since April 15: 606. 577 deaths from hospitals, 29 from nursing
homes.
– Governor says this will be over once a vaccine and/or medical treatments are
made. For the moment, need to continue controlling the rate of infection and
strengthen the healthcare system through increased capacities. Need to also
increase testing with Federal help then conduct reopening in a phase-in matter.
– Reiterated that we must determine the next wave of essential businesses
and figure out what businesses are “safer.” Then must develop reopening plan.
Explained businesses would be phased-up via percentages based on whether
they are considered low- or high-risk for infection.
– The Governor again explained that businesses must “reimagine” the workplace
to increase ability to telecommute, ability to socially distance, and
restructure customer interactions. Additionally, businesses must be able to
determine a proactive infection plan in case of a second wave.
– Testing will be the best tool to make decisions on reopening.
– Governor says NYS has conducted 500k tests in 30 days, more than any other
state.
– Still need to increase testing capacity; need to figure out a way
of increasing testing sites, supplies, lab capacity, acquisition of chemicals,
and create a “tracing army” for investigations.
– Reiterated argument that Federal government should play a role and
assist in obtaining resources.
– STRENGTHENING THE HEALTHCARE SYSTEM: Need to continue surge and
flex procedures, as well as build out a strategic stockpile of PPE.
– – Need to determine how fast the virus spreads from one person to another,
until it is determined we need to limit the spread rate.
– After mitigation efforts, we were able to decrease the infection
spread rate to 0.9 (one person spreads it to 0.9 people).
– However, 1.2 would take us to the high projection rates,
so Governor urges caution with reopening.
– NY Pause will be extended in coordination with other states to May 15.
– Must wear a mask when riding:
– Public transportation
– Private transportation carriers and for-hire vehicles
– This will become effective Friday at 8:00 p.m.

Gov. Cuomo’s Quote of the Day: The policies I communicated aren’t worth the paper they are presented on unless people decide to follow them,“.

ECONOMIC TOLL:

Governor says we cannot overcome the economic strain without Federal
assistance. Again, emphasized the importance of funding state and local
governments.

Gov. Cuomo Extends Closing of Non-Essential Businesses to May 15
Gov. Andrew M. Cuomo extended until May 15 the closing of nonessential businesses and schools across the state as well as a stay-at-home mandate to prevent further coronavirus spread, as he vowed to protect progress resulting from those preventive measures.

New York saw another day of hospitalizations trending down, intensive care unit admissions decreasing and fewer people needing to be intubated due to severe illness, Cuomo said during his daily briefing.

“That rate came down because people changed their behavior,” Cuomo said.


Please Continue to Let MSSNY Know if Your Hospital or Office Cannot Receive Adequate PPE
Pursuant to Executive Order 202.16 issued this past Monday, all businesses must provide face coverings, at their expense, for all their employees who are in direct contact with the public. However, we continue to hear concerns from physicians that, in some hospitals, physicians and other health care staff are not receiving the personal protective equipment (PPE) they need when delivering patient care.  MSSNY has been sharing these reports with the New York State Department of Health for further investigation.

It is our hope that with the new Executive Order, and a briefing notice from the Greater New York Hospital Association and the Healthcare Association of New York State to their members calling for compliance with this requirement, that these concerns will be addressed.  However, please let us know (mauster@mssny.org) if these concerns continue, and we will continue to bring them to the attention of the NYSDOH.


Physician Guidance Re Rise in Cyber Threats Exploiting the COVID-19 Pandemic
The Federal Bureau of Investigations (FBI) released a recent public advisory noting that more than 1,200 complaints related to COVID-19 scams were received at its Internet Crime Complaint Center. According to the FBI, “in recent weeks, cyber actors have engaged in phishing campaigns against first responders…deployed ransomware at medical facilities and created fake COVID-19 websites that quietly download malware to victim devices.

Based on recent trends, the FBI assesses these same groups will target businesses and individuals working from home via telework software vulnerabilities, education technology platforms, and new Business Email Compromise schemes.” Responding to a spike in cyber threats that exploit telework technologies during the COVID-19 pandemic, the American Medical Association (AMA) and the American Hospital Association (AHA) have teamed to provide physicians and hospitals with guidance on protecting a remote work environment from cybercriminals. 


CMS “Lessons from the Front Lines: COVID-19”— Friday, April 17
This call series is an opportunity to hear physicians and other clinical leaders share their experiences, best practices, strategies, and insights related to COVID-19. “Lessons from The Front Lines” calls are held weekly on Fridays at 12:30 PM Eastern and specific topics vary. Dial in details are below.

CMS Lessons from the Front Lines: COVID-19
Friday, April 17th, 12:30 – 2:00 PM Eastern

Participant Dial-In: (877) 251-0301
Access Code: 8672948

Webcast Streaming: https://protect2.fireeye.com/url?k=6fb83c6b-33ed3578-6fb80d54-0cc47adb5650-cdbb9430fa7bc190&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1924

COVID-19 Update – April 14, 2020


.
April 14, 2020 Latest COVID-19 Statistics
By the Numbers:

· New York reported 10,834 statewide deaths as of Tuesday morning, including 778 more fatalities in the past day. As of Tuesday, New York reported 202,208 confirmed cases, including 110,465 cases in New York City alone. As of Tuesday, the state reported 7,905 deaths of New York City residents. As of Tuesday, 18,697 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.

· Johns Hopkins Corona Virus Map 


Notes from Governor Cuomo’s COVID-19 Briefing:

-Total hospitalizations is basically flat, “technically” down. Governor
believes we are at the apex.
– Net change in hospitalizations is down. The 3-day average is
also down.
– Net change in ICU admissions is down.
– New COVID hospitalizations down. However, 1,600 new COVID cases came in
yesterday. The Governor reiterated that though volume is still high,
net changes reflect discharges as well as new entries.
– Total hospitalizations by region has remained relatively flat. Hot spots
have been isolated and traced as they pop up.
– Deaths since April 13: 778. This is higher than recent numbers but
reflects a current flattening of the curve. Total deaths: 10,834.
– Celebrated changes made to projected infection rates through distancing
protocols.
– REOPENING: Seven states have joined the multi-state council for reopening
(DE, MA, PA, CT, NJ, NY, RI).
– President has said he has “total authority” on reopening, but the
Governor disagrees. He says the Federal government was created by states
thus states should hold more power over the Federal government.
– Comment on the President’s briefing last night: Says the President is
“clearly unhappy” with Governors and is “spoiling for a fight.” The Governor
hopes to stray from political division and will be walking away from said
fight. Says a fight is not worth the risk of a second wave.

Q & A

– When asked on whether his staff is preparing to battle with the President,
Governor Cuomo again said he was not interested in fighting with him.
The Governor said he will fight for New Yorkers if it comes to it
but he doesn’t believe such actions will be necessary.

TESTING:

– The Governor explained that only a handful of private companies produce
tests, thus creating competition between states. He argued FEMA should hold
control over testing to stray from multi-state competition and issue them
on a need basis.
– DOH Commissioner Dr. Zucker said the state is looking for tests with over 95% accuracy. He
also said the DOH is looking into false positive issues.
– When asked how many antibody tests could be done, Zucker said 2k tests
will be held daily next week. Additionally, he said DOH was working with
private sector companies and hospitals to develop 100k tests per day.

MSSNY Survey: Please Complete to Gauge Financial Impact of Outbreak and Availability of Relief
The $2 trillion CARES Act became law on Friday, March 27th and was the third stimulus relief package approved by the federal government in less than two months. Among the issues the bill addresses are the impact on small businesses, as well as the healthcare system, and includes $350 billion in forgivable loans and grants, and advanced payments from Medicare.

These resources are already available, but it is unclear how much physicians know about them and whether they are benefiting. Moreover, as MSSNY continues its aggressive advocacy to ensure physicians can obtain needed financial assistance during this crisis, we need information from our members as to the impact on their practice.

To get an idea if funds are getting into the hands of New York physicians, MSSNY’s Governmental Affairs team distributed a survey on Monday, April 13, to all members and other partners, with questions ranging from how aware physicians are of the financial assistance available through the federal government, difficulty in applying for assistance and whether or not physicians are having to layoff, or furlough, staff. For those MSSNY members who may not have taken the survey, please go to this link.

We will keep you updated on our final survey findings and how we plan to use this information, going forward.


STILL NOT PRACTICING TELEHEALTH? Four quick lessons: www.mssny.org


MLMIC Announces Coverage Continuation without Requiring New Premium
As part of our ongoing support of the medical community as it takes on COVID-19, any retired physician returning to volunteer and aide in the COVID-19 efforts who was last insured by MLMIC prior to their retirement will have access to professional liability coverage without requiring any new premium. The same policy benefits and coverages will be provided as when the volunteering physician was actively practicing medicine and last insured with MLMIC.

Retired physicians who were last insured by MLMIC and choose to volunteer should simply call (800) ASK-MLMIC or go click here.


Opportunity to Request Relief from Medical Liability Costs
Physicians are reminded that, pursuant to a recent Governor’s Executive Order, that they are able to request a 60-day “grace period” for paying their medical liability insurance premiums based if they are experiencing “financial hardship”.  Moreover, medical liability insurance companies including MLMIC have provided the opportunity for physicians to request alterations in their premiums.

For example, MLMIC’s website notes that “to alleviate some of the adverse impact caused by COVID-19, premium installment due dates and potential policy cancellations due to non-payment of premium can be adjusted if your practice is encountering a demonstrated financial hardship due to COVID-19. To discuss these forms of potential accommodation, please contact us at (800) ASK-MLMIC (1-800-275-6564).”


Hospital CEOs Blast Distributing Stimulus Funds Based on Medicare Revenue
Hospital CEOs are blasting HHS’ decision to distribute the first $30 billion in emergency funding based on Medicare fee-for-service revenue, according to Kaiser Health News.

HHS said April 10 it would allocate money to hospitals and providers based on their historical share of revenue from the Medicare program, rather than the burden caused by the coronavirus or number of uninsured patients treated.

Kenneth Raske, CEO of the Greater New York Hospital Association, wrote in a memo to association members that the method 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.”

Another CEO, Carlos Migoya of Jackson Health, said that the way the bailout money is being distributed “could jeopardize the very existence” of the hospital. Jackson Health is a safety-net hospital in Miami, one of the harder-hit cities in the U.S.

America’s Essential Hospitals represent more than 300 safety-net hospitals in the U.S., which care for large numbers of uninsured and Medicaid patients.

An HHS spokesperson told Kaiser Health News the agency decided to use Medicare revenue as the basis of distribution because it “allowed us to make initial payments to providers as quickly as possible.”

The $30 billion is part of $100 billion in emergency stimulus funding earmarked for hospitals from the Coronavirus Aid, Relief, and Economic Security Act. (Becker’s Hospital Review, April 14)


Deadline for Cycle VII DANY Grant Applications Extended
Doctors Across New York is a state funded initiative enacted in 2008 to help train and place physicians in underserved communities in a variety of settings and specialties to care for New York’s diverse population.

Due to the COVID-19 epidemic in New York State and the response required by physicians, the deadline for Cycle VII applications has been extended to June 4th, 2020. Applications must be received by 4:00 PM on that day. For more information, visit the NYS Grants Gateway website.


CMS COVID-19 Office Hours—Tonight, April 14
Physicians are invited to join CMS “Office Hours” on COVID-19, Tuesday, April 14th 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

Dial-in details below. Conference lines are limited, so you are highly encouraged you to join via audio webcast, either on your computer or smartphone web browser.

Toll-Free Attendee Dial In: 833-614-0820
Event Plus Passcode: 2395745

Audio Webcast link


Early Results of Remdesivir for COVID-19 Published
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

About two-thirds of novel coronavirus disease (COVID-19) patients given the antiviral remdesivir on a compassionate-use basis showed signs of clinical improvement, according to a small, industry-conducted study in the New England Journal of Medicine. However, the study had no control arm.

Researchers studied 61 patients hospitalized with confirmed SARS-CoV-2 infection who required oxygen support or had an oxygen saturation level of 94% or less. At baseline, 57% of patients were receiving mechanical ventilation, and 8% were receiving extracorporeal membrane oxygenation. Patients were given up to 10 days of remdesivir. Eight patients were excluded from the final analysis, largely because of missing data.

During a median of 18 days of follow-up, 68% of the 53 remaining patients had an improvement in oxygen support requirements. After finishing treatment, 13% overall had died. Some 60% reported adverse events, including elevated hepatic enzymes, diarrhea, rash, renal impairment, and hypotension.

The authors write: “Although data from several ongoing randomized, controlled trials will soon provide more informative evidence regarding the safety and efficacy of remdesivir for Covid-19, the outcomes observed in this compassionate-use program are the best currently available data.”

NEJM article; NEJM Journal Watch COVID-19 page

 

COVID-19 Update April 15, 2020


.
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:

– Gov reiterates that he’s not interested in retrospectives at this point.
– Gov did state that if he could, he’d go back to December/January.
– On NY specific, “There is no state that moved faster.” From time of
first case to total shut-down, NYS was the quickest –9-day period.

MASKS EXECUTIVE ORDER:

– Any situation in public where you cannot maintain social distancing (6
ft.): public transit, crowded streets
– Possibility for a civil penalty, local gov’ts would enforce, but doesn’t
want to get to a penalty, yet. If people don’t follow, there might be a
penalty in the future.  Looking for self-enforcement from public.
– Any coordination with the City?  Coordinate as much as possible with
local gov’ts and partner states.  Local gov’ts can have their own rules,
but they can’t conflict with the state.  If there’s a conflict, state laws
govern.
– Question on forceful removal from public transport if mask refused to be
worn. Gov states that we’re not there yet and transitioned into
compliance with stay at home initiative.  “How can you not wear a mask?”
given the facts.

TESTING:

– Coordination with the City?  DeRosa – City is looking to acquire swabs and
vials, etc.  Gov is looking to increase testing capacity in labs, all
aspects, hoping to reduce competition between purchasers and organize
efforts of gov’ts, and companies.
– How do we get the supply chain up – Fed Govt.

NOTES:

– State will begin reporting all categories of fatalities pursuant to new
CDC guidelines.  “Probable deaths” will be included.  State contacting
facilities to get updated numbers.
– State looking to get reports of COVID deaths outside of hospitals
and nursing homes.

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 WEBINAR

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.

 

 

 

COVID-19 Update – April 13, 2020


.
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:

– Curve continues to flatten. We are seeing a plateau, unsure of how long
this “apex” will last. The Governor says the curve is “still going up a
little bit” but is overall flat.
– Net downturn in hospitalizations. The 3-day rolling average is also down.
– Net change in ICU admissions down as well.
– Net change in intubations 3-day rolling average is down.
– Stabilization in spread. Have been reacting to clusters.
– New COVID hospitalizations per day is down. The Governor clarified that
though hospitals see about 2k new cases per day, many are discharged as well.
– Death toll for April 12: 671. Total lives lost: 10,056.
– The Governor explained the spread has been great because of the density
that exists in NYC, as well as other cities throughout the country. He also
added that physical environment is not the only problem, dense gatherings
can also be problematic.

REOPENING:

– Wants to learn from countries currently undergoing reopening
procedures to see what works and what doesn’t to avoid a second wave. Says
actions will be based on public health and economic experts’ recommendations
and data.
– Want to ease isolation, increase economic activity, recalibrate
“essential worker” economy, apply more testing and precautions, and to keep
infection rate low. Governor says we need to watch the infection rate
throughout reopening. “It’s a delicate balance,” he explained.
– Made points that the economy has not been shut down, however, must
be recalibrated in reopening procedures.
– Would like to reopen with a regional design and systems must
coordinate (economic, transportation, schools, etc.).
– Again said reopening would need Federal support.
– Precautions to be continued (masks, gloves, temperature taking).
– Have been talking with RI, CT, NJ, DE, and PA on working together
for reopening plan. Announcement to come later this afternoon. No time was
specified.
– The Governor claims he doesn’t believe a uniform plan can be made
unless they recognize state by state distinctions.
– The Governor says that there will be no short-term point to declare as
the end, but there will be points of resolution over time. These will be
incremental and based on control of spread of infection.
– Celebrated accomplishments made in controlling the spread and
keeping “the tide from overwhelming [hospitals].”
– Hopefully, within 12-18 months a vaccine will be produced. But the
Governor promised that there will be points within this time span that will
help lessen the burden.
– Must continue distancing protocols.

Q&A:
HOSPITALS:

– Malatras also mentioned that 200 test kits to NYC’s Med Assist
Network Hospital, and many hospitals often report having a 20-30 day supply
of PPE.
– When asked if Buffalo was considered a hot spot for the virus, Malatras
said there has been a recent stabilization in cases.

REOPENING:

– There is a possibility that areas with lower infection rates may open
sooner, though the Governor continued pushing for a coordinated effort
between states.
– The Governor says schools must be opened in coordination with other
systems. He mentioned mixing populations between outer-city areas and issues
with childcare as barriers.

COVID-19:

– The Governor reiterated that though the worst is currently behind us,
people must continue distancing protocols to avoid a second wave of
infection. He explained that facts will continue un-biased.
– When questioned on why nursing homes were unable to report infection rates,
the Governor explained that they are protected under privacy laws. Zucker
added that these protections apply due to these institutions being people’s
homes.

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, 16th 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.”


 

 

COVID-19 Update April 9, 2020


.
April 9, 2020 Latest COVID-19 Statistics

• 799 – The number of deaths from the coronavirus in New York on April 8 – the highest daily total yet.
• 63% – The percentage of victims statewide who are 70 years old or older.
• 159,937 – People who have tested positive for the coronavirus in New York, as of the morning of April 9.
• 18,279 – The number of people currently hospitalized with the coronavirus in New York, as of April 9, with 4,925 in intensive care units. “We’re projecting that we’re reaching a plateau,” Gov. Andrew Cuomo said on April 7.
• 200 – The total number of new hospitalizations, on April 8, the lowest in weeks.
• 84 – The total number of new intensive care patients on April 8, part of a broad downward trend.
• 13,366 – The number of COVID-19 patients who have since been discharged from New York hospitals, as of April 6.
• 391,549 – The number of people who have been tested for coronavirus in New York, as of the morning of April 9.43% of the tests, or 170,826, have been conducted in New York City.
• 62 – The number of counties in New York that have a positive test for COVID-19 – all of them. Seneca County, the last to report a case, had its first case on March 30.
• 40 – The number of days that New York expects its New York State on PAUSE executive order to be into effect – for now. Cuomo enacted the order limiting events, mandating social distancing and closing nonessential business on March 20, and has extended it until at least April 29.
• $1,000 – The maximum fine for violating the state’s protocol of keeping a 6-foot distance from people while in public, raised on April 6 up from $500.

Notes from the Governor’s briefing:

• 18 days of NY PAUSE / 39 days since first COVID case in NY / 80 days
since first COVID case in US
• Current trend is below all projected models: 90,000 bed capacity,
18,279 beds occupied, currently.
• Numbers showing that the social distancing measures are flattening the
curve, so far.
• Hospitalizations, ICU admissions and intubations is continuing to
decrease.
• “We are flattening the curve by our efforts and actions.”
• 799 lives lost yesterday, according to state. Media reports that NYC
issued 824 as the total numbers for NYC-only deaths yesterday.
• State total, according to state is 7,067 deaths.
• State bringing in additional funeral directors to help.
• State plans to open more testing sites in downstate minority
communities (SUNY Albany, DOH and Northwell collaborative effort).
• Governor on past Federal legislation:
– Not $6B in Medicaid funding, actual about $1.3B, and disqualified
about 1.3 of NYS Medicaid recipients.
• Mental Health is a growing problem (domestic violence cases rising)
• State watching Rockland, Nassau, and Suffolk as new hotspots.


Racial Disparities in Deaths from COVID-19
Gov. Cuomo on Wednesday vowed to ramp up coronavirus testing in minority communities and investigate the racial disparities in deaths from COVID-19, the disease caused by the virus. He noted that black New Yorkers comprise 28 percent of deaths in New York City and 18 percent of deaths in New York state, despite being 22 percent and 9 percent of the population, respectively.

Hispanics, meanwhile, are 29 percent of the population in New York City and 11 percent of the population statewide, but represent 34 percent and 14 percent of deaths, respectively.

Experts have pointed to underlying conditions that are more likely to affect minority communities and lack of access to medical care has factors which account for the differences. Cuomo vowed to step up testing in majority-nonwhite communities, adding that there should also be more research into whether the number of Latino and African American public workers “who don’t have a choice but to go out every day and drive the train” were putting those communities at particular risk.

Cuomo said he would ask Havidan Rodriguez, president of the University of Albany SUNY, to head an effort to collect more comprehensive data on the spread of the virus in minority communities.


CMS OKs $34B for Providers with Accelerated/Advance Payment Program 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.


UnitedHealth Group Accelerates Nearly $2 Billion in Payments and Support to Health Care Providers to Help with COVID-19 Financial Challenges
UnitedHealth Group, through UnitedHealthcare and Optum, has announced it is taking steps immediately to accelerate payments and other financial support to health care providers in the U.S. to help address the short-term financial pressure caused by the COVID-19 emergency.

UnitedHealth Group’s move to accelerate claim payments to medical and behavioral care providers applies to UnitedHealthcare’s fully insured commercial, Medicare Advantage and Medicaid businesses. Other financial support currently includes the provision for up to $125 million in small business loans to clinical operators with whom OptumHealth is partnered.

The decision to accelerate claims and incentive payments builds on previously adopted measures taken by the company to streamline processes for health care professionals and facilities, as well as to help members more easily access the care they need. This includes:

·       Suspension of prior authorization requirements to a post-acute care setting

·       Suspension of prior authorization requirements when a member transfers to a new provider

·       Extension of timely filing deadlines for claims during the COVID-19 public health emergency period for Medicare Advantage, Medicaid, and Individual and Group Market health plans

·       Implementation of provisional credentialing to make it easier for out-of-network care providers who are licensed independent practitioners to participate in one or more of our networks

Physicians should go to www.UHCprovider.com for specifics on UnitedHealthcare policies and guidelines.


Communities of Color at Higher Risk for Health and Economic Challenges Due to COVID-19
The COVID-19 outbreak presents potential health and financial challenges for families, which may disproportionately affect communities of color and compound underlying health and economic disparities. A new KFF brief analyzes data on underlying health conditions, health coverage and health care access, and social and economic factors by race and ethnicity to provide insight into how the health and financial impacts of COVID-19 may vary across racial/ethnic groups. (KFF news release)


Nursing Homes Have Ventilators That Hospitals Desperately Need
As the number of COVID-19 patients climbs and health officials hunt for ventilators to treat them, nursing homes across the  U.S. have a cache ― about 8,200 of the lifesaving machines, according to data from CMS. Most of the machines are in use, often by people who’ve suffered a brain injury or stroke. Some of those residents are in a vegetative state and have remained on a ventilator for years. State officials are working to consolidate ventilators where they are most urgently needed. But so far, the supply in nursing homes has not drawn the same attention. (KHN, Los Angeles Times)


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.

The findings are similar to data from China, which indicated more severe COVID-19 cases, or those requiring hospitalization, tended to be in younger children, and prevalence decreased as children got older.

Of the pediatric cases, over half were from New York, 15% from New Jersey, and just under 30% from other jurisdictions. They added the first pediatric U.S. case was reported to CDC on March 2. Median age of patients was 11, and nearly a third of cases occurred in teens ages 15-17, with 27% of cases among children ages 10-14, and 15% apiece among children ages 5 to 9, and infants younger than age 1.

Data on hospitalizations was available for 745 pediatric cases, with the authors estimating a range of 5.7% to 20% of cases were hospitalized, with an estimated range of 0.58% to 2% admitted to an ICU. These figures were lower than adults ages 18-64, who had an estimated 10%-33% of patients hospitalized.

Infants accounted for the largest proportion of hospitalized children, ranging from 15% to 62% of pediatric COVID-19 admissions. Of 95 children younger than age 1, 59 were hospitalized and 5 were admitted to an ICU. Children ages 1-17 had a lower estimated range of hospitalization, from 4.1%-14%.

They added, clinicians should “maintain a high degree of suspicion” for infection in children and monitor the progression of illness, especially among those with underlying conditions.

“Because persons with asymptomatic and mild disease, including children, are likely playing a role in transmission and spread of COVID-19 in the community, social distancing and everyday preventive behaviors are recommended for persons of all ages to slow the spread of the virus,” McNamara and colleagues wrote. Morbidity and Mortality Weekly Report Source Reference: CDC COVID-19 Response Team “Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020″ MMWR 2020; Published April 6, 2020.


 

 

COVID-19 Update – April 8, 2020

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.

NEWS SUMMARY

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)

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.”


MEDICAL ECONOMICS

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


 

 

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