IHA Daily Briefing: Oct. 16

Friday, October 16, 2020
Illinois COVID-19 Cases Spike to Record High, Again
Rep. Rush: Reverse Restrictions on PRF Payments
COVID-19 Response: Collaboration Across the Continuum
CDC on Elderly, Minorities and COVID-19 Deaths
CMS Data on COVID-19 Impact on Medicare Beneficiaries
Estimated Economic Cost of COVID-19: $16 Trillion
HFS Update on Integrated Health Home Program

Illinois COVID-19 Cases Spike to Record High, Again
For the second straight day, the number of new COVID-19 cases in Illinois increased to a record high. The Illinois Dept. of Public Health (IDPH) today announced 4,554 new COVID-19 cases (surpassing yesterday’s previous record of 4,015) and 38 deaths. The total number of cases in the state is 336,174 in 102 counties, with a total of 9,165 deaths.

IDPH says that in the past 24 hours, 87,759 test specimens have been processed (a new record number), with a positivity rate of 5.19%. The preliminary seven-day statewide positivity rate from October 9 to October 15 is 5.1%. (The World Health Organization and public health experts consider 5% as one threshold for the percent positivity rate as being “too high.”)

Statewide COVID-19 hospitalizations in the past 24 hours increased from 1,932 patients to 2,016 patients (highest level since June 12). Of that figure, 410 patients were in the ICU, with 151 patients on ventilators.

IDPH today also reported 34 counties on its COVID-19 warning list: Adams, Alexander, Boone, Cass, Christian, Clay, Clinton, Crawford, DeKalb, DeWitt, Jasper, Jefferson, Jo Daviess, Johnson, Kane, Lee, Macon, McDonough, McHenry Mercer, Monroe, Pike, Pulaski, Randolph, Saline, Stephenson, Union, Vermilion, Warren, Washington, Wayne, Whiteside, Will, and Winnebago. That’s an increase from 26 counties on the list last week.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 7.95 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 216,917 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 38.7 million COVID-19 cases globally, with more than 1.095 million deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 18.3 million cases and more than 599,000 deaths.

Rep. Rush: Reverse Restrictions on PRF Payments
U.S. Rep. Bobby Rush (IL-1) sent a letter yesterday to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar urging the agency to quickly reverse recent guidance that would limit how hospitals may use Provider Relief Fund (PRF) payments for purposes of offsetting lost revenue due to coronavirus. Rush said he is specifically concerned the new restrictions would harm safety-net hospitals and that the restrictions are out of line with how Congress intended the money to be used when it appropriated $175 billion to the relief fund.

On Sept. 19, HHS released guidance (IHA memo available here) that provides a drastically different definition of “lost revenues” than used in prior guidance. The September guidance states that “lost revenue” is represented as a negative change in year-over-year net patient care operating income (i.e., patient care revenue less patient care related expenses). This definition changes from one that applies to revenue, to one that looks at net income.

"I am especially concerned about the effect of this policy on safety net hospitals in our state, many of which are struggling to keep their doors open and which serve the very communities who are most affected by the pandemic. As you are well aware, safety net hospitals provide healthcare access to vulnerable communities and serve as economic engines, generating significant economic activity and access to well-paying jobs.

"Hospitals in Illinois and around the country are working tirelessly to respond to the pandemic and prepare for future outbreaks, even as they struggle to rebound from unprecedented losses. According to the Illinois Health and Hospital Association, Illinois hospitals lost an estimated $1.4 billion monthly due to COVID-19-related cancellations and delays during the early months of the pandemic. Congress provided $175 billion to the relief fund in order to assist hospitals and other providers with lost revenue and higher expenses due to the pandemic. HHS’s recent action to drastically limit use of these funds does not align with Congressional intent.”

IHA has been working with state and national partners, including the American Hospital Association, to reverse the Sept. 19 guidance. An IHA Advocacy Alert is available here.

COVID-19 Response: Collaboration Across the Continuum
Join IHA and LeadingAge Illinois for a three-part webinar series on Oct. 20, Nov. 4 and Nov. 13 with hospital and long-term care partners to hear how they worked together to overcome care coordination challenges as well as collaborative successes and lessons learned to support their patients and community during the COVID-19 pandemic.

Presenters will focus on strategies and give attendees an opportunity to engage in discussion around:

  • Infection Prevention Best Practices: how hospitals and long-term care facilities shared infection prevention knowledge/expertise/support between facilities;   
  • Personal Protective Equipment: how facilities worked together to overcome PPE challenges;   
  • Testing: how organizations worked together to facilitate testing of patients;   
  • Patient Transfer: how organizations worked together to successfully transfer patients; and   
  • Staff Morale: how organizations worked on addressing staff morale.

The webinar series is open to all IHA and LeadingAge Illinois members. We invite your staff to join this series – including discharge planners, care coordinators, hospital leadership, frontline staff, quality and patient safety leaders, and other related disciplines.

Series Overview:

  • Tues., Oct. 20, 12:00-1:00 p.m. Silver Cross Hospital, Victorian Village, Ferrell Hospital, and Wabash Christian Village will share their experiences with partnership among other area facilities, infection prevention support in urban and rural facilities, and support with personal protective equipment.   
  • Wed., Nov. 4, 12:00-1:00 p.m. Northwestern Memorial Healthcare and Marianjoy Rehabilitation Hospital will share their experiences with managing a pandemic response across a large healthcare system and strategies for dedicated rehabilitation services to care for patients recovering from COVID-19.   
  • Fri., Nov. 13, 10:00-11:00 a.m. University of Chicago Hospital and Clark-Lindsey Village will share their experiences supporting robust testing and addressing staff morale amidst the COVID-19 pandemic.

To participate in one or more of the webinars, click here to register.

Continuing education credits will be provided for: nursing home administrators, nurses, clinical social workers/social workers, registered and certified public accountants, physical therapists/physical therapy assistants, occupational therapists/occupational therapy assistants, professional counselors/clinical counselors, with up to 1.0 hour CE for each webinar.

For questions, contact the IHA Institute for Innovations in Care and Quality team.

CDC on Elderly, Minorities and COVID-19 Deaths
A new Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC) indicates that persons older than 65 and members of minority racial and ethnic groups are disproportionately represented among COVID-19-associated deaths.

An analysis of more than 114,000 COVID-19-associated deaths reported to the National Vital Statistics System during May–August 2020 found that 78.2% of decedents were older than 65; 51.3% non-Hispanic White; 24.2% Hispanic or Latino; and 18.7% non-Hispanic Black. The percentage of Hispanic decedents increased from 16.3% in May to 26.4% in August.

The CDC says these results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups to minimize subsequent mortality.

CMS Data on COVID-19 Impact on Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) today released data showing that 21% of Medicare beneficiaries reported forgoing non-COVID-19 care due to the pandemic, and nearly all – 98% – of beneficiaries have taken preventative measures to keep themselves safe from the virus.

According to the survey of more than 11,000 beneficiaries conducted in June and July, the most common types of forgone care because of the pandemic were dental care (43%), regular check-up (36%), treatment for ongoing condition (36%), and diagnostic or medical screening test (32%). The most common reason cited for forgoing care was not wanting to risk being at a medical facility (45%).

Regarding COVID-19 preventative health behaviors, nearly all beneficiaries cited at least one or more actions they have taken to protect themselves, with regular handwashing/hand sanitizer use topping the list (98%), followed by social distancing and wearing facemasks (each at 93%).

The survey also asked beneficiaries about the impact of the pandemic on daily life and well-being, availability of telemedicine appointments, access to technology, and sources of information about the pandemic. Key findings included:

  • Of beneficiaries who have a usual healthcare provider, 60% reported that this provider currently offers telephone or video appointments;   
  • 92% of beneficiaries with a total household income of $25,000 or more have access to the Internet compared to 65% of beneficiaries with a total household income of less than $25,000;    23% reported feeling more lonely or sad; and   
  • 46% reported feeling more stressed or anxious.

An infographic with a snapshot of the survey results is here, and the public use file detailing the survey results is here.

Estimated Economic Cost of COVID-19: $16 Trillion
The economic cost of the COVID-19 pandemic in the U.S. will be more than $16 trillion, according to a study published in the Journal of the American Medical Association. The estimated cost is based on a theoretical estimate for the value of a human life ($7 million), and is spread out over the next decade. The estimate includes:

  • $4.4 trillion will be due to the economic cost of 625,000 premature deaths by the end of 2021;   
  • $2.6 trillion will be spent treating those who survived COVID-19 but have long-term complications and damage;   
  • $1.6 trillion for mental health treatment for those dealing with the loss of a loved one or feelings of isolation; and   
  • $7.6 trillion will be due to the economic toll of lost jobs and those filing new unemployment claims.

While the study does not say whether another government stimulus package is needed, it does say if the government were to pass more stimulus the highest return would be on testing. The authors estimate that it would cost the government about $100 billion dollars to test and contract trace 30 million Americans a week for the next year, which would save 233,000 lives and reduce the economic cost of the pandemic by nearly $3 trillion.

The study was co-authored by former Treasury Secretary and Harvard President Lawrence Summers and Harvard University economist David Cutler.

HFS Update on Integrated Health Home Program
On Thursday, the Dept. of Healthcare and Family Services issued a Provider Notice providing updates on Medicaid behavioral health service reimbursement and care coordination plans for 2021. These updates include implementation of a comprehensive array of community-based services for children with complex behavioral health needs and a further delay of the Integrated Health Home (IHH) Program. For more information, see an IHA memo.