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.


– 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
– 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.


– 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.


– 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.


– 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

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 chan
  • 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.”