Author: Freddie Sanchez

Alia Paavola

The cost of halting major elective surgery during the pandemic is estimated to be $22.3 billion for U.S. hospitals, according to a new study published in the Annals of Surgery. 

Last spring, many states ordered hospitals to pause elective surgeries to ensure they had staff and capacity to care for an influx of COVID-19 patients. Researchers sought to quantify the financial hit from those cancellations in the U.S. from March 2020 to May 2020. 

For the study, researchers used data from the nationwide inpatient sample to forecast revenue and elective surgery demand. They also conducted a sensitivity analysis to calculate how long it would take to recover the revenue losses.

The researchers found that the median recovery time to recoup lost revenue was 12 to 22 months. They also found that rural and urban nonteaching hospitals may face more financial risk amid the pandemic.

“Strategies to mitigate the predicted revenue loss of $22.3B due to major elective surgery cessation will vary with hospital-specific supply-demand equilibrium. If patient demand is slow to return, hospitals should focus on marketing of services; if hospital capacity is constrained, efficient capacity expansion may be beneficial,” the researchers concluded. 

by Gabrielle Masson 

Temporary loss of smell, known as anosmia, is a commonly reported indicator of COVID-19. 

Losing your sense of smell and taste can be jarring and emotional, and adjusting to the seemingly muted world can be difficult at first. However, research looks promising for COVID-19 patients with anosmia, though scientists say there’s still a lot unknown.

Here’s what we know about anosmia related to COVID-19 thus far:

How does it happen? 

The novel coronavirus likely changes the sense of smell in patients not by directly infecting neurons, but by affecting the function of supporting cells, said Sandeep Robert Datta, MD, PhD, associate professor of neurobiology at Boston-based Harvard Medical School. Dr. Datta co-authored a study published July 31 in Science Advances, and its findings identify the olfactory cell types in the upper nasal cavity as most vulnerable to SARS-CoV-2 infection. 

Justin Turner, MD, PhD, associate professor of Otolaryngology-Head and Neck Surgery and medical director of Nashville-based Vanderbilt University Medical Center’s Smell and Taste Center, said May 21 that the primary cause of smell loss appears to be from an inflammatory reaction inside the nose that can lead to a loss of the olfactory neurons.

Who loses their smell?

Smell loss can be one of the first or only signs of disease and may precede symptoms such as cough and fever, Dr. Turner said, citing spring data from VUMC’s Smell and Taste Center.  

A study published Jan. 5 in the Journal of Internal Medicine found that 86 percent of patients with mild COVID-19 cases experienced anosmia, compared with 4 percent to 7 percent of those with moderate to severe cases. The research analyzed data from 2,581 patients in France, Belgium and Italy.  

Will COVID-19 patients get their sense of smell back? 

Of 2,581 COVID-19 patients studied, 95 percent of patients regained their sense of smell within six months, according to the study in the Journal of Internal Medicine.

For most patients, COVID-19 infection is unlikely to permanently damage olfactory neural circuits and lead to persistent anosmia, Dr. Datta said, adding, “Once the infection clears, olfactory neurons don’t appear to need to be replaced or rebuilt from scratch. But we need more data and a better understanding of the underlying mechanisms to confirm this conclusion.”

If so, when do COVID-19 patients get their sense of smell back? 

The average time of olfactory dysfunction reported by patients was 21.6 days, according to the study in the Journal of Internal Medicine. Nearly a quarter of the 2,581 COVID-19 patients studied didn’t regain smell and taste within 60 days of infection.  

Are there any long-term physical or psychological risks?

“If you have a gas leak, you can’t necessarily smell it,” Nina Shapiro, MD, a pediatric head and neck surgeon at University of California, Los Angeles School of Medicine, told NBC News. “And if people lose their appetites because food tastes like cardboard or even rotting meat, they might develop vitamin deficiencies. What’s more, people might not know when food is, indeed, spoiled or burning.”

“Anosmia seems like a curious phenomenon, but it can be devastating for the small fraction of people in whom it’s persistent,” Dr. Datta said. “It can have serious psychological consequences and could be a major public health problem if we have a growing population with permanent loss of smell.”

by Ayla Ellison

The Trump administration delivered new guidelines Jan. 12 that expand COVID-19 vaccine eligibility to everyone 65 years old and above.

The Trump administration announced the new guidelines, first reported by Axios, at a press conference Jan. 12 with officials from Operation Warp Speed. 

HHS Secretary Alex Azar said states are being told to immediately expand vaccine eligibility to those 65 and older as well as people under 65 with comorbid conditions. He said vaccine doses will be released based on each state’s pace of administration and the size of their population age 65 and older. 

The new guidelines will also expand the venues where people can get vaccinated and get all available doses distributed now instead of holding back doses for the second shot. 

The new guidelines are similar to steps some states have already taken to accelerate the vaccination process. President-elect Joe Biden said his administration will not hold back COVID-19 vaccine doses and would release those needed for people’s second shots. The president-elect is expected to release more details on the vaccine distribution plan Jan. 14, according to Politico. 

As of Jan. 11 at 8 a.m. CST, nearly 9 million people had received shots of Pfizer and Moderna’s COVID-19 vaccines, according to CNBC. The federal government had initially estimated that 20 million shots would be given by the end of last month. 

December 16, 2020

Today, the Trump Administration, through the Health Resources and Services Administration (HRSA) is announcing it has completed review of Phase 3 applications from the Provider Relief Fund (PRF) program and will distribute $24.5 billion to over 70,000 providers. Up from the $20 billion originally planned, the addition of another $4.5 billion in funding is being used to satisfy close to 90 percent of each applicant’s reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020. The U.S. Department of Health and Human Services (HHS) recognizes this pandemic has upended the health care system and caused significant financial hardships. These resources, along with previous distributions, have provided much needed relief. Payment distribution started today and will continue through January, 2021.

“HHS is providing more than $24 billion in new relief to more than 70,000 healthcare providers, meeting close to 90 percent of the losses they’ve reported from the COVID-19 pandemic in the first half of the year,” said HHS Secretary Alex Azar. “With the Provider Relief Fund, we’ve been able to support providers hardest hit by COVID-19, including safety net hospitals, rural providers, and nursing homes, helping ensure they can continue serving their communities during and beyond the pandemic.”

HHS has designed the PRF program to be agile and responsive to the shifting dynamics of this pandemic. As with other General Distributions, applicants that have not already received a baseline payment of 2 percent of annual revenue from patient care were eligible to do so. Recognizing the ongoing challenges for providers, HHS enhanced the Phase 3 distribution to consider the actual revenue losses and expenses experienced by providers that were attributable to COVID-19. With this opportunity, previously eligible PRF applicants were invited to apply for additional funding, along with first time applicants.

As HHS began analyzing applications, it realized the submissions for lost revenues and net changes in expenses would exceed the $20 billion budgeted for the Phase 3 allocation. In an effort to meet the demand, HHS worked to add another $4 billion to the allocation bringing the new total to over $24 billion. This funding will distribute to providers up to 88 percent of their reported losses. It is worth noting that over 35,000 applicants will not receive an additional payment either because they experienced no change in revenues or net expenses attributable to COVID-19, or because they have already received funds that equal or exceed reimbursement of 88 percent of reported losses.

HHS was pleased to find in its analysis that providers disproportionately impacted by this pandemic applied and will be receiving another infusion of financial relief. Nursing homes for example, will be receiving another $1.10 billion in Phase 3 funding. This builds on the half billon in incentive payments HHS recently announced and the over $15 billion in aggregate funding already distributed. Ambulance, or transportation services providers, will be receiving $1.48 billion in Phase 3 funding.

As the nation celebrates the historic arrival of COVID-19 vaccines, equipping providers with resources to address personal protective equipment needs, expand capacity and explore other responses to combat this pandemic remains an urgent and present priority. The PRF program will continue to support providers in addressing these immediate needs as demonstrated by today’s announcement and through future funding opportunities.

Payments to Phase 3 applicants will begin today and continue as application quality reviews and recipient payment set up are completed before payment can be made. A state-by-state breakdown on the first batch of Phase 3 payments can be found here – PDF. This data will be updated through January as Phase 3 payments are completed. It is important to note this state-by-state data is tied to the state in which a recipient’s IRS Tax Identification Number (TIN) is registered. It is possible recipients render health care services in states other than their listed TIN. After recipients attest to the terms and conditions for funding, they will be listed in the PRF public dataset.

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Alia Paavola

Twenty-seven senators are urging Senate leaders to include a measure to ban surprise billing in a year-end government funding package, according to The Hill. 

Democratic and Republican leaders of four committees in the House and Senate reached a deal to end surprise medical billing Dec. 11. 

The committees decided that the best approach would be banning physicians and hospitals from charging patients fees their insurer will not cover and holding patients harmless when they receive emergency care from out-of-network providers. Payment rates would be based on the median amount insurers in a given area pay in-network providers and also allows providers to enter into arbitration to gain higher reimbursements.

But the fate of the bill is undecided because it is unclear whether Senate Majority Leader Mitch McConnell, R-Ky., will agree to include it in the funding package. 

“There will never be a broader bipartisan, bicameral solution to ending surprise medical billing, and we should deal with it now,” the 27 senators wrote to Mr. McConnell and Senate Minority Leader Chuck Schumer, D-N.Y.,  according to The Hill. “Patients cannot wait any longer.”

The deal reached Dec. 11 has support from unions, insurers and consumer groups. The White House has also expressed support. 

But the American Medical Association and American Hospital Association expressed concerns about the legislation. 

The AMA said it is worried that small physician practices might not be able to receive fair compensation under the arbitration process outlined in the bill. The AHA said it wants to see penalties for health plans that fail to reimburse providers for out-of-network care and clarification that out-of-network providers are responsible for managing their own notice and consent process with patients.

beckershospitalreview.com

Morgan Haefner

In several states, hospital CEOs have been among the first to receive the COVID-19 vaccine. Many leaders hope the move will help their communities see the vaccine as safe and increase adoption.

On Dec. 11, the FDA authorized Pfizer-BioNTech’s vaccine for emergency use in the U.S. At Providence, R.I.-based Care New England, President and CEO James Fanale, MD, was the first in line at the health system for the vaccine on Dec. 15. Dr. Fanale is a practicing geriatrician, and wanted to send a strong public message that the vaccine is safe, according to The Providence Journal.

In Washington, D.C., Anita Jenkins, the CEO of Howard University Hospital, was among the first to be vaccinated in a move she hopes would address doubts that Black Americans may have about the vaccine. Black Americans have been disproportionately affected by the pandemic.

“Healthcare disparities, research, all of that has not necessarily been a smooth ride for Black and brown people in the United States,” Ms. Jenkins told WUSA 9. “That’s why this COVID vaccine is met with skepticism. But let’s please understand, we are losing the battle with COVID. Black and brown people are dying about three times more from this disease than others.”

In addition to being among the first to get the COVID-19 vaccine, hospital CEOs are also using the stories of their front-line workers as a symbol for their communities. Maritza Beniquez, an emergency room nurse at University Hospital in Newark, N.J., was the state’s first person to receive the vaccine, according to ROI-NJ.

University Hospital CEO Shereef Elnahal, MD, said Ms. Beniquez’s, and other healthcare workers’ “adoption of this vaccine will be key to convince community members to vaccinate later. Our healthcare heroes have been, and continue to be, trusted voices for healthcare in our community, and we hope that they will carry the message that these vaccines are safe and effective,” he told ROI-NJ.

beckershospitalreview.com

Kelly Gooch

The U.S. Supreme Court is set to hear a case questioning the legality of the ACA on Nov. 10.

Five things to know:

1. At the center of the case is whether the health law should be struck down. In a brief filed June 25 in Texas v. United States, the Trump administration argues the entire ACA is invalid because in December 2017, Congress eliminated the ACA’s tax penalty for failing to purchase health insurance. The administration argues the individual mandate is inseverable from the rest of the law and became unconstitutional when the tax penalty was eliminated; therefore, the entire health law should be struck down.

2. The administration’s brief was filed in support of a group of Republican-led states seeking to undo the ACA. Meanwhile, California Attorney General Xavier Becerra is leading a coalition of more Democratic states to defend the ACA before the Supreme Court. 

3. The case goes before the Supreme Court days after media outlets projected Joe Biden as the next president of the U.S. President-elect Biden has said he seeks to expand government-subsidized insurance coverage and wants to the bring back the ACA’s tax penalty for failing to purchase health insurance, according to The Wall Street Journal. If a change regarding the tax penalty did occur, the publication notes that Republicans’ argument on severability would no longer apply.

4. The case also goes before the Supreme Court about two weeks after the Senate voted Oct. 26 to confirm Amy Coney Barrett to the Supreme Court. Ms. Barrett previously criticized Chief Justice John Roberts’ 2012 opinion sustaining the law’s individual mandate, The New York Times reported, but she said during her confirmation hearings in October that “the issue in the case is this doctrine of severability, and that’s not something that I have ever talked about with respect to the Affordable Care Act.”

5. According to the Journal, the Supreme Court is not expected to make a decision in the case until the end of June.

Katie Adams

Clinical trial data for the COVID-19 vaccine Pfizer is developing  with BioNTech shows the candidate can prevent more than 90 percent of infections, the drugmaker said Nov. 9.

The results are based on an interim analysis of a trial in which 94 participants, half of whom received a placebo and half of whom received a vaccine, contracted COVID-19. Pfizer will continue the trial until 164 COVID-19 cases occur in order to gather more data and determine the candidate’s performance against other study endpoints.

Pfizer plans to collect two months of safety follow-up data, a key requirement laid out by the FDA before it grants emergency use authorization. That data is expected to be gathered by the third week of November, and if it raises no concerns, the drugmaker could apply for emergency use authorization by the end of the month. An accelerated review of the vaccine is underway in the U.K.

“This is about the best the news could possibly be for the world and for the United States and for public health,” William Gruber, Pfizer’s senior vice president for vaccine clinical research and development, told Bloomberg, saying the findings were better than even the best result he had wished for.

Analysis has not yet been conducted on the vaccine’s efficacy among key subgroups, such as older patients. Pfizer also has not yet studied how the vaccine  prevents severe cases of COVID-19.

Associated Press

WASHINGTON (AP) — Federal health officials on Friday unveiled a plan to get approved coronavirus vaccines to nursing home residents free of cost, with the aid of two national pharmacy chains.

No vaccine has yet been approved by the Food and Drug Administration, and the distribution program is contingent on that happening first.

Under the plan, trained staff from CVS and Walgreens will deliver the vaccines to each nursing home and administer shots. Assisted-living facilities and residential group homes can also participate in the voluntary program. Nursing home staffers can be vaccinated too, if they have not already received their shots. Needles, syringes and other necessary equipment will be included.

The idea is to give hard-pressed states an all-inclusive system for vaccinating their most vulnerable residents, said Paul Mango, a senior policy adviser at the Department of Health and Human Services. “We are trying to eliminate all potential barriers to getting folks safe and effective vaccines,” Mango said.

People in nursing homes and other long-term care facilities account for less than 1% of the U.S. population, but they account for about 40% of the deaths from COVID-19, with more than 83,600 fatalities logged by the COVID Tracking Project.

The Trump administration’s initial attempts to promote coronavirus testing in nursing homes and to ensure sufficient supplies of protective gear were hampered by missteps and led to widespread complaints from nursing home operators and advocates for older people. The vaccine program seems designed to prevent a repeat at a time when President Donald Trump is battling to hang on to support from older voters.

Vaccines will be on their way to nursing homes within 24 to 48 hours after the FDA approves their use, Mango said.

The effort is taking place under the auspices of Operation Warp Speed, a White House-backed effort to quickly produce and distribute hundreds of millions of doses of approved vaccines, enough for every American.

Mango said he anticipates that if a vaccine is approved this year, initial supplies would be limited. Availability will improve markedly in the first three months of 2021, he said.

HHS is fielding an online survey for nursing homes to assess their interest in the program, but the allocation of vaccines will be done through state and territorial governments.

Nursing homes and long-term care facilities will not be charged for the program. CVS and Walgreens will be reimbursed for administering the shots at standard Medicare rates, officials said.

Morgan Haefner, Becker’s Healthcare

Llano (Texas) County Memorial Hospital is applying for a critical access designation that would allow the rural hospital to reduce its financial vulnerability through increased Medicare reimbursement, according to DailyTrib.com.

The application comes as Llano County Memorial prepares to part ways with Dallas-based Baylor Scott & White. An operating agreement between the two organizations expires at the end of 2020, with no renewal planned. Baylor Scott & White has managed Llano County Memorial for the past 10 years, according to the news site.

Part of the reason the contract isn’t being renewed is due to the rural hospital’s finances, according to the news site. El Campo, Texas-based MidCoast Health System is vying to take over management of Llano County Memorial.

Llano County Memorial is working with a tight deadline for its critical access application as the operating contract deadline approaches. Under the designation process, a third-party contractor helping the hospital has up to 45 days to review the application, followed by an up to 45-day state review and another up to 60-day review from CMS.

“We’re still pressing against that December 31 deadline. Hopefully, we can have some sort of determination before that,” Brett Fuller, an accountant working with LCHA, told DailyTrib.com. “I do know that at least the communications with CMS have been positive at least in expediting their review.”

Read the full report here.