IHA Daily Briefing: July 27

Monday, July 27, 2020
Guv Issues New Disaster Proclamation, Exec Orders
State, National, Global COVID-19 Updates
Latest CDC Findings on COVID-19
HHS/ASPR COVID-19 Clinical Rounds
IHA, Other Associations File Brief on Negotiated Charges
LaHood Introduces ACO Legislation

Guv Issues New Disaster Proclamation, Exec Orders
Late Friday (July 24), Governor J.B. Pritzker issued a new 30-day COVID-19 disaster proclamationExecutive Order #47 (on pre-K-12 schools reopening) and Executive Order #48 (reissuing many existing executive orders and extending them to Aug. 22).

Among the reissued Executive Orders are #9, requiring all commercial health insurers regulated by the Dept. of Insurance to cover clinically appropriate, medically necessary telehealth services and reimburse providers at the same rate as in-person visits and prohibiting them from imposing any cost-sharing for in-network providers unless a deductible has not been met for a high-deductible health plan; #23, giving the Dept. of Financial and Professional Regulation the flexibility to waive certain requirements in order to increase the number of licensed professionals responding to the disaster; and #26, extending many of the waivers from the Hospital Licensing Act to increase hospital capacity.

State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) announced today 1,231 new COVID-19 cases and 18 deaths. The total number of cases in the state is 172,655 in 102 counties, with a total of 7,416 deaths. IDPH says that in the past 24 hours, 30,567 test specimens have been processed, with a positivity rate of 4.0%. The preliminary seven-day statewide positivity rate from July 20 to July 26 is 3.8%. Statewide COVID-19 hospitalizations in the past 24 hours increased from 1,394 patients to 1,417 patients. Of that figure, 350 patients were in the ICU, with 124 patients on ventilators.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 4.2 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 146,546 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 16 million COVID-19 cases globally, with more than 646,000 deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 8.6 million cases and more than 337,000 deaths.

Latest CDC Findings on COVID-19
The Centers for Disease Control and Prevention (CDC) has released new findings about COVID-19 in Morbidity and Mortality Weekly Reports (MMWRs) issued on Friday. In a July 24 MMWR, CDC said a multistate telephone survey of symptomatic adults who had a positive outpatient COVID-19 test result found that 35% had not returned to their usual state of health when interviewed two to three weeks after testing. Among persons aged 18-34 years with no chronic medical conditions, one in five had not returned to their usual state of health. COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions.

In a separate July 24 MMWR, CDC indicates older adults and those with chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease and obesity are at higher risk for severe COVID-19-associated illness. CDC estimates that the prevalence of any of the five underlying medical conditions is 47.2% among 3,142 U.S. counties, with a higher prevalence in more rural counties.

HHS/ASPR COVID-19 Clinical Rounds
The U.S. Dept. of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR) will hold interactive virtual learning sessions this week to create a peer-to-peer learning network where clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes. Sessions include:

Critical Care: Lifesaving Treatment and Clinical Operations
Tues., July 28, 11 a.m. - 12 p.m. CDT
This resource webinar is intended for consultant physicians involved in critical care practice, fellows, residents, pharmacists, nursing staff, nurse practitioners, physician assistants, respiratory therapists, and allied health staff. Click here to register.

Emergency Department: Patient Care and Clinical Operations
Thurs., July 30, 11 a.m. - 12 p.m. CDT
Join presenters to discuss emergency management resources and information that can be utilized to improve effective hospital and emergency department function during the COVID-19 pandemic. Click here to register.

If you miss a session, find the recordings on the University of New Mexico’s Project ECHO website. Click here to join the HHS/ASPR COVID-19 Clinical Rounds email list.

IHA, Other Associations File Brief on Negotiated Charges
On Friday, in a friend-of-the-court brief supporting an appeal by the American Hospital Association (AHA) and other hospital groups, 40 state and regional hospital associations – including IHA – urged the federal appeals court in Washington, D.C., to reverse a lower court’s decision and void the U.S. Dept. of Health and Human Services (HHS) final rule requiring hospitals to disclose their confidential privately negotiated charges with insurers. In the brief, the associations say their member hospitals “know better than anyone how important it is for patients to make informed health care choices” and “strongly support meaningful price transparency” for that reason. “But this Court need not decide whether the Final Rule is ‘sound polic[y].’ The only question for this Court is one of administrative law, i.e. ‘whether the agency appreciated the scope of its discretion or exercised that discretion in a reasonable manner.’ HHS did not do so here. It instead chose to achieve its laudable goals in unlawful ways.”

In June, the U.S. District Court for the District of Columbia ruled hospitals must comply with a 2019 price transparency final rule from HHS requiring them to publicly disclose privately negotiated rates with third-party payers, among other mandates. AHA and other hospital groups filed a lawsuit challenging the rule, arguing that the rule exceeds the agency's authority, violates the First Amendment, and is arbitrary and capricious under the Administrative Procedures Act.

LaHood Introduces ACO Legislation
Late Friday, U.S. Rep. Darin LaHood (R-IL-18) introduced the Value in Health Care Act, bipartisan legislation aimed at increasing participation in Accountable Care Organizations (ACOs). The Act would adjust the calculations for how Medicare savings are measured and the amount physicians, hospitals and their business partners are permitted to keep as Qualified Providers in an approved ACO.

“The Value in Healthcare Act is a commonsense proposal that includes substantive reforms to encourage and support greater participation by healthcare providers in ACOs, particularly in our rural communities in central and west-central Illinois,” said Rep. LaHood. “By incentivizing the use of these value-based health programs that support coordinated care between doctors, hospitals, and other healthcare providers, this legislation will improve healthcare access and the quality of care for our seniors, which is critical now in our fight against COVID-19. As we continue to battle this virus, I am committed to working with my colleagues to get this bill passed to support our communities and seniors in IL-18.”

According to the Representative’s press release, the legislation includes the following changes to ACOs:

  • Encourages participation by increasing the percent of shared savings beginner participants receive. Recent program changes decreased shared savings, making the program less attractive.   
  • Modifies risk adjustment to be more realistic and better reflect factors participants encounter like health and other risk variables in their communities.   
  • Removes barriers to participation by eliminating arbitrary program distinctions so all participants are playing on a level playing field.   
  • Supports fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care.   
  • Provides greater technical support to participants to cover the significant startup costs associated with program participation.   
  • Addresses overlap in value-based care programs so that alternative payment models overlap within markets complement each other rather than cause confusion.

Reps. Peter Welch (D-VT) and Susan DelBene (R-WA) joined Rep. LaHood in introducing the legislation. The legislation is supported by numerous stakeholders, including the American Hospital Association, American Medical Association, America's Essential Hospitals, Association of American Medical Colleges, Federation of American Hospitals and the American Academy of Family Physicians.