IHA Daily Briefing: Sept. 8

Tuesday, September 8, 2020
CMS Issues FY2021 IPPS Final Rule
Dr. Birx Meets with State, Local Health & Hospital Officials
IDPH COVID-19 Warning List – 29 Counties
State, National, Global COVID-19 Updates
BioPharma CEOs Issue COVID-19 Vaccine Pledge
State Announces $36M in Federal Opioid Grants
Suicide Prevention Awareness This Month
Briefly Noted

CMS Issues FY2021 IPPS Final Rule
Last Wednesday (Sept. 2), the Centers for Medicare & Medicaid Services (CMS) issued the Inpatient Prospective Payment System (IPPS) final rule for Fiscal Year (FY) 2021 for acute care and long-term care hospitals (LTCH), which includes a 2.9% increase in inpatient hospital reimbursement rates for facilities meeting quality reporting and meaningful use requirements. In total, CMS expects Medicare spending on acute care inpatient hospital services to increase by about $3.5 billion next year, a 2.7% increase compared to FY 2020.

CMS finalized an LTCH PPS standard rate increase of 2.3% in FFY 2021 compared to FFY 2020. CMS also finalized a permanent budget neutrality adjustment factor of 0.991249, which accounts for the cost of eliminating the 25% threshold policy for FFY 2021 and subsequent years, and a FFY 2021 area wage index budget neutrality factor of 1.0016837.

The final rule includes other policies that are opposed by IHA and AHA, including the collection of median payer-specific negotiated charges for Medicare Advantage organizations on the Medicare cost report for the cost reporting periods ending on or after Jan. 1, 2021. Starting in FY 2024, CMS will use the data in a new market-based methodology to set MS-DRG relative weights, which are used for calculating Medicare payment rates for inpatient hospital stays.

The final rule will make changes to the distribution of uncompensated care payments to hospitals participating in Medicare, decreasing Medicare uncompensated care payments by about $60 million compared to FY 2020. The rule also includes the use of audited Worksheet S-10 data for uncompensated care payment distribution.

The FY 2021 IPPS final rule, which will go into effect on Oct.1, 2020, is scheduled to be published in the Federal Register on Sept. 18. IHA will be providing more information to members about the final rule in fact sheets and hospital impact reports.

Dr. Birx Meets with State, Local Health & Hospital Officials
Last week (Sept. 1), IHA President & CEO AJ Wilhelmi participated in an in-person meeting with Dr. Deborah Birx, Coronavirus Response Coordinator for the White House Coronavirus Task Force. The meeting was organized by the U.S. Dept. of Health and Human Services and hosted by Rush University Medical Center in Chicago. In attendance, either in-person or by Webex video, were representatives of several healthcare associations and providers including hospitals, nursing homes and FQHCs as well as representatives from county health departments in the Chicago metropolitan area and other public health stakeholders. Dr. Birx is on a multi-state tour to discuss COVID-19 response issues with local officials and was in Chicago to get a better understanding of what she characterized as an effective response to date in the City of Chicago that has seen test positivity rates trend flat at around 5% throughout the summer months.

Participants attributed Illinois’ success to many factors, but most prominently to the unique communication and collaboration among hospitals, healthcare providers and government officials at the height of the pandemic. It was also noted that establishing and maintaining trust between the provider community and our government public health agencies has been critical. Meeting participants discussed various issues including availability of testing supplies and testing capacity, insurance coverage for COVID-19 testing, the extensive reporting requirements being imposed on hospitals and other healthcare providers, and Dr. Birx’s views on what may lie ahead.

Dr. Birx expressed concern about a possible autumn resurgence of COVID-19 infections and warned that a second surge could be more challenging due to the virus being more widespread, affecting all states, and now impacting rural as well as urban communities. Dr. Birx urged all stakeholders to be prepared for another wave of infection, to maximize community testing options, and to further strengthen the collaboration between medical providers and community organizations.

IDPH COVID-19 Warning List – 29 Counties
The Illinois Dept. of Public Health (IDPH) Friday (Sept. 4) reported 29 counties are considered to be at a warning level for COVID-19. The counties include: Boone, Bureau, Clinton, Coles, Cumberland, Edgar, Effingham, Fayette, Greene, Henry, Jasper, Jefferson, Jersey, Lake, Lawrence, Madison, McLean, Monroe, Pulaski, Randolph, Rock Island, Shelby, Stark, St. Clair, Union, Wabash, Warren, Williamson, and Will.

IDPH says that although the reasons for counties reaching a warning level varies, some of the common factors for an increase in cases and outbreaks are associated with college parties, weddings, large gatherings, bars and clubs, long-term care facilities and other congregate settings, travel to neighboring states, and spread among members of the same household who are not isolating at home. Cases connected to schools are beginning to be reported. General transmission of the virus in the community is also increasing.

State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) announced today 1,392 new COVID-19 cases and seven deaths. The total number of cases in the state is 252,353 in 102 counties, with a total of 8,186 deaths. IDPH says that in the past 24 hours, 31,363 test specimens have been processed, with a positivity rate of 4.4%. The preliminary seven-day statewide positivity rate from September 1 to September 7 is 4.0%. Statewide COVID-19 hospitalizations in the past 24 hours increased from 1,484 patients to 1,504 patients. Of that figure, 343 patients were in the ICU, with 133 patients on ventilators.

On Friday (Sept. 4), IDPH said it cleared up a backlog of tests from a slowdown in its data processing systems that affected reporting of tests due to the large volume of testing occurring in Illinois. Resources were deployed to improve and upgrade the data systems, which are now fixed with significantly faster processing capacity. Although the slowdown delayed the reporting of some aggregate numbers (resulting in unusually large case and test numbers on Friday), it did not affect the reporting of positive or negative results to individuals in any way.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 6.2 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 188,688 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 27.2 million COVID-19 cases globally, with more than 891,000 deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 14.1 million cases and more than 494,000 deaths.

BioPharma CEOs Issue COVID-19 Vaccine Pledge
The CEOs of nine major biopharmaceutical firms today issued a pledge to continue to make the safety and well-being of vaccinated individuals the top priority in the development of the first COVID-19 vaccines, saying they are committed to uphold the integrity of the scientific processes. In part, their statement reads:

“Following guidance from expert regulatory authorities such as FDA regarding the development of COVID-19 vaccines, consistent with existing standards and practices, and in the interest of public health, we pledge to:

  • Always make the safety and well-being of vaccinated individuals our top priority.   
  • Continue to adhere to high scientific and ethical standards regarding the conduct of clinical trials and the rigor of manufacturing processes.·   
  • Only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.·   
  • Work to ensure a sufficient supply and range of vaccine options, including those suitable for global access.

We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which COVID-19 vaccines are evaluated and may ultimately be approved.”

State Announces $36.7M in Federal Opioid Grants
Late last week, Governor J.B. Pritzker and the Illinois Dept. of Human Services (IDHS) announced the state has received $36.7 million in funding from the Substance Abuse and Mental Health Services Administration to fight the opioid crisis. This funding will expand prevention, treatment, recovery and overdose response initiatives across the state, including:

  • Increased access to Medication-Assisted Recovery (MAR) services for persons with opioid use disorders, including those in the criminal justice system;   
  • Hospital screenings and linkage to community treatment programs for their patients; supportive housing and digital resources for persons in recovery from opioid use disorder;   
  • Access to MAR for patients at federally qualified health centers;   
  • Recovery support services for pregnant and postpartum women with opioid use disorders; mentoring and coaching for medical professionals prescribing medications for opioid use disorder; and a toll-free helpline for opioids and other substances; and   
  • Expansion this year for treatment of persons with stimulant use disorder, in response to rising rates of methamphetamine and cocaine use

“Substance use disorder is a disease – and we must do all that we can to ensure the road to recovery is widely available and accessible,” said Governor Pritzker. “This funding will build on the work of the Department of Human Services and the Department of Public Health in our effort to end the opioid epidemic in Illinois. Nobody is a lost cause, and Illinois won't stop fighting until all of our residents have the opportunity to live their most fulfilling lives.”

Last week, IDHS also announced the #RecoveryBelongs social media campaign to increase awareness and recognize the month of September as Recovery Month.

Suicide Prevention Awareness This Month
September is Suicide Prevention Awareness Month, Sept. 6-12 is Suicide Prevention Week, and Sept. 10 is World Suicide Prevention Day, providing dedicated time to offer support, raise awareness, and reduce stigma around a difficult topic. We know that health and societal effects continue to increase suicide rates and affect communities in disproportionate ways.

Suicide Prevention Awareness Month resources for community engagement and education can be found here.

The Illinois Dept. of Human Services (IDHS) has resources for individuals seeking emotional support on the Help is Here: Talk to Someone webpage that can be distributed for staff, patients and community needs.

Suicide Prevention Resource Center (SPRC) has two new resources for the COVID-19 pandemic crisis response, offering practical guidance modeled on the National Organization for Victim Assistance Crisis Response Program:

Also see a complete list of SPRC resources, including hospital initiatives, here.

In April, the city of Chicago announced the launch of a microsite, offering a variety of free resources and supports for healthcare workers and first responders during the COVID-19 pandemic. These resources and supports are offered under a partnership between the Chicago Department of Public Health, Illinois Health and Hospital Association, Illinois Primary Health Care Association, and NAMI-Chicago. Mental health resources include:

  • Free virtual support groups;            
  • Free individual and group psychotherapy; and      
  • A mental health resource dashboard featuring free apps, self-assessments, hotline supports, video tutorials, and fact sheets.

Briefly Noted
The Louisiana Hospital Association Research and Education Foundation has established the Louisiana Care Fund who experienced significant property loss or personal hardship but continued to care for patients before, during and after Hurricane Laura. To contribute to this fund, visit www.LouisianaCareFund.org. For more information, email LouisianaCareFund@lhaonline.org or call 225-928-0026.

The U.S. economy added nearly 1.4 million jobs in August and the unemployment rate declined to 8.4%, according to the U.S. Bureau of Labor Statistics. Healthcare employment increased by 75,000 over the month, with gains in offices of physicians (+27,000), offices of dentists (+22,000), hospitals (+14,000), and home healthcare (+12,000). Job losses continued in nursing and residential care facilities (-14,000).