IHA Daily Briefing: Sept 9

Wednesday, September 9, 2020 
Urge Your Rep. to Sign 340B Support Letter
U.S. Senate to Vote on Narrow COVID-19 Bill
Nature Publishes Overview of COVID-19 Vaccine R & D
CMS Updates COVID-19 Medicare Impact Data
Chicago Adds Kentucky to Travel Quarantine Order
COVID-19 and Racial/Ethnic Minority Communities
IDPH COVID-19 Update Webinar for EMS This Thursday
State, National, Global COVID-19 Updates
Improving Diagnosis: FHN Memorial Hospital’s Story

Urge Your Rep. to Sign 340B Support Letter
In response to recent actions taken by numerous drug companies to limit the distribution of certain 340B drugs, a bipartisan “Dear Colleague” letter is being circulated in the U.S. House of Representatives. The letter urges the U.S. Dept. of Health and Human Services (HHS) to use its authority to address these harmful actions by drug makers, which range from interfering with 340B discounts for drugs distributed through contract pharmacy arrangements and making superfluous requests for claims data from hospitals and health systems.
Members are urged to contact their U.S. Representatives and ask them to co-sign the letter to support the 340B Drug Pricing Program. The deadline for signatures is noon this Friday, Sept. 11.

For more information, see a recent letter from the American Hospital Association to HHS here. To look up your Representative’s contact information click here.

U.S. Senate to Vote on Narrow COVID-19 Bill
U.S. Senate Majority Leader Mitch McConnell announced Tuesday that the chamber will vote later this week on a targeted COVID-19 relief legislation released by Republicans. The bill does not include new funding for the Provider Relief Fund nor changes to the Medicare Accelerated and Advance Payment Program, two key priorities for hospitals and health systems. According to a summary, the legislation includes:

  • Liability protections for healthcare providers, businesses, schools through 2024;
  • Support for on-shore manufacturing of healthcare supplies and new investment in strategic stockpiles, contact tracing and vaccines;
  • An additional $300/week in extra, federally-funded unemployment benefits through Dec. 27;
  • Additional funding for the Paycheck Protection Program to allow small businesses meeting certain criteria to apply for a second loan;
  • Assistance to the U.S. Postal Service; and
  • Financial support for education and childcare.

The measure is not expected to receive the 60 votes needed to pass the Senate. Democrats have been united in their opposition to a pandemic response package of less than $2.2 trillion, which they say is a compromise from the more than $3 trillion Democratic HEROES Act that passed the House in May.

Nature Publishes Overview of COVID-19 Vaccine R & D
On Friday (Sept. 4), Nature published a paper, “Evolution of the COVID-19 vaccine development landscape,” which provides extensive data about COVID-19 vaccine research and development and input on what should be expected from COVID-19 vaccine development and what to look for in upcoming vaccine data.
The researchers who compiled the data indicate that as of Sept. 2, 321 vaccine candidates are in development, compared to 112 in April. Of those, 32 vaccine candidates are in clinical trials and will enroll more than 280,000 participants from 470 sites in 34 different countries. The most advanced clinical candidates are now in phase III trials, and data to support licensure are anticipated to be available later this year.

CMS Updates COVID-19 Medicaid Impact Data
Late last week, the Centers for Medicare & Medicaid Services (CMS) released its monthly update on the impact of COVID-19 on the Medicare population. The updated data show over 773,000 COVID-19 cases among the Medicare population and nearly 215,000 COVID-19 hospitalizations. Other key findings include:

  • The rate of COVID-19 cases among Medicare beneficiaries grew 40% since the July release to 1,208 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 33% since the July release to 338 hospitalizations per 100,000 beneficiaries.
  • Weekly counts of COVID-19 cases and hospitalizations reached the lowest point to date in late June and began to increase in July.
  • The rate of COVID-19 cases and hospitalizations grew the most among disabled beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $3.5 billion or just over $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the July release. 29% of beneficiaries went home at the end of their hospital stay and 24% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.

The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to July 18, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by August 14, 2020.

Chicago Adds Kentucky to Travel Quarantine Order
On Tuesday, the city of Chicago added Kentucky to its emergency travel quarantine order and removed California and Puerto Rico. Indiana, which had crossed the order’s threshold of more than 15 new daily COVID-19 cases per 100,000 residents last week, has gone below the threshold and was not added to the list. The addition to the updated list, covering 21 states, will be effective this Friday.

COVID-19 and Racial/Ethnic Minority Communities
On Sept. 17, the U.S. Dept. of Health and Human Services Office of Minority Health (OMH) is hosting Advancing the Response to COVID-19: Sharing Promising Programs and Practices for Racial and Ethnic Minority Communities, a virtual symposium highlighting state, tribal, territorial and community-based efforts to address COVID-19 among racial and ethnic minority and American Indian and Alaska Native populations.

The symposium, which begins at 11 a.m. CDT, will disseminate promising practices, programs and strategies for combating COVID-19 in communities that have suffered historic systemic health and social inequities. These inequities put racial and ethnic minority groups at elevated risk of contracting COVID-19 or experiencing severe illness. For more information and to register, go to the OMH website.

IDPH COVID-19 Update Webinar for EMS This Thursday
IDPH will hold a webinar this Thursday, Sept. 10 at 2 p.m., to provide updates as they related to care, transport and infection control practices for EMS. Register here.

State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) announced today 1,337 new COVID-19 cases and 30 deaths. The total number of cases in the state is 253,690 in 102 counties, with a total of 8,214 deaths. IDPH says that in the past 24 hours, 48,029 test specimens have been processed, with a positivity rate of 2.78%. The preliminary seven-day statewide positivity rate from September 2 to September 8 is 3.7%. Statewide COVID-19 hospitalizations in the past 24 hours increased from 1,504 patients to 1,580 patients. Of that figure, 357 patients were in the ICU, with 133 patients on ventilators.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 6.3 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 189,147 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 27.4 million COVID-19 cases globally, with more than 894,000 deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 14.2 million cases and more than 495,000 deaths.

Improving Diagnosis: FHN Memorial Hospital’s Story
In the span of seven months, leaders and staff at FHN Memorial Hospital in Freeport achieved the following as they worked to improve the diagnostic process:

  • Improved engagement and information exchange during multidisciplinary rounds;
  • Built an early warning system for sepsis in its electronic medical records;
  • Adopted The Joint Commission's Speak Up campaign; and
  • Implemented a safe table approach for adverse event review.

FHN’s efforts to improve quality care accelerated when the Illinois Provider Trust (IPT)—professional liability services through IHA—presented its annual Risk Exposure Adjustment Program to member hospitals in 2019. IPT provided a detailed list of improvement activities and best practices to get members started. That work continues this year.

FHN’s Speak Up campaign pushed the message of patients’ active engagement in their own care. FHN utilized postings throughout the hospital and in radio broadcasts, newspaper advertising and a column in the Journal Standard.

“We are very quality-and-safety focused,” said Cheryl Rife, FHN’s former director of clinical quality, who recently retired. “Over the years, IPT’s REAP criteria has been an important part of our patient safety and quality committee work.”

As an independent hospital serving rural northern Illinois, FHN welcomes recommendations on quality improvement activities. “This was a robust and a new category for us to engage in," Rife said. “Diagnostic error was not a term we used freely.”

FHN leaders and staff are now identifying more potential diagnostic issues in their peer review process and having more challenging conversations on how to address causal factors and improve care.

“It doesn’t mean we're looking for blame,” Rife said. “It just means we’re trying to strengthen the system.”

Learn more about how IPT supports its members in quality improvement and risk reduction.