COVID-19: Caring for Patients and Communities

COVID-19: Caring for Patients and Communities / en Sat, 26 Apr 2025 07:41:02 -0500 Thu, 04 Apr 24 10:22:45 -0500 Assessing the Impact of COVID-19 on Rural Hospitals /guidesreports/2024-04-04-assessing-impact-covid-19-rural-hospitals <div class="container"><div class="row"><div class="col-md-8"><div class="panel module-typeC"><div class="panel-heading"><h2 class="panel-title">Key Findings</h2></div><div class="panel-body"><ul class="red"><li class="red">Approximately half (48%) of rural hospitals consistently experienced negative operating margins from patient services prior to and during the COVID-19 pandemic.</li><li class="red">A small minority (12%) of rural hospitals consistently experienced positive operating margins prior to and during the COVID-19 pandemic.</li><li class="red">The COVID-19 provider relief funds benefited all rural hospitals, however rural hospitals with negative total margins had the greatest benefit, with overall increases to profitability.</li><li class="red">In 2021, COVID-19 provider relief funds masked long-standing financial challenges experienced by many rural hospitals.</li><li class="red">System membership may provide benefits to rural hospitals in terms of supporting operations and navigating regulatory and financial challenges during the COVID-19 pandemic.</li></ul></div></div> ul.red { list-style: none; } ul.red li.red::before { content: "\2022"; color: #9d2235; font-weight: bold; display: inline-block; width: 1em; margin-left: -1em; } <h2>Purpose</h2>The purpose of this research is to examine the impact of the COVID-19 pandemic on rural hospital financial performance. The results of this study will provide rural hospital leaders a better understanding of the impact of the COVID-19 pandemic on rural hospital operational and financial performance. Results will also assist policy makers seeking to understand the impact of provider relief funds on rural hospital financial performance.<h2>Background</h2>The COVID-19 pandemic created financial and operating challenges for hospitals across the country. These challenges may have been particularly severe for rural hospitals since, prior to COVID-19, rural hospitals were already struggling with shrinking margins, declining volumes, workforce challenges and other barriers to providing care. The COVID-19 pandemic caused a rapid series of changes for rural hospitals, with the potential to cause drastic swings in the ways rural hospitals provide care to their communities. Moreover, the effects of these changes are likely to shift over time since the intensity of revenue pressures (like limits on elective surgeries) and expense pressures (like unusually high staffing costs) changed throughout the course of the pandemic. The availability of financial aid varied throughout the course of the pandemic as well. Most provider relief funds and other financial support were available to hospitals between 2020 and 2021 and have not continued beyond that time. COVID-19’s effects are also unlikely uniform given the variation in rural hospitals’ revenue sources (i.e., the degree to which they depend on revenues from patient care, investment returns or special COVID-19 pandemic funding), variation in prior financial performance and other determinants. Rural hospital financial performance is multifaceted and is influenced by both hospital and community characteristics. Hospital characteristics such as ownership, size and system affiliation may be important determinants of financial performance. System membership in particular may benefit rural hospitals in a variety of ways, by supporting rural hospitals in maintaining efficient operations and by helping rural hospitals navigate the particular regulatory and financial challenges that COVID-19 posed.<h2>Data and Methods</h2>This study used hospital-level data from 2017 to 2022. Data were obtained from the Medicare Hospital Cost Reports, the AHA Annual Survey, the Area Health Resource File, the Center for Disease Control and Prevention and the Kaiser Family Foundation. Data were merged using a unique hospital provider ID and a year identifier. Hospitals differed in the annual start and end dates of their reporting years. Some hospitals’ start and end dates aligned with the calendar year while other hospitals used a different fiscal year. We recorded hospital financial observations based on cost reporting year of the hospital’s data. For instance, hospital data appearing on the 2020 cost report file were recorded as 2020, even if the hospital’s reporting year ran from March 1, 2020, to Feb. 28, 2021.Rural hospitals were defined as acute care general hospitals located in non-metropolitan counties (micropolitan and non-care-based counties) and Eligible Census Tracts in Metropolitan Counties. The sample consisted of 2,246 rural hospitals (12,256 rural hospital years). Rural hospitals with profitability margins in less than the 1st percentile and greater than the 99th percentile were excluded from the analysis and rural hospitals with reporting periods of less than 360 days were also excluded from the analysis.We identified four measures of operating margin which differed according to the revenue types included in each. These measures were:<ul><li>Patient care margin, which only includes revenues from patient care activities.</li><li>Operating margin, which includes revenue from patient care activities as well as other operating revenue (e.g., gift shop, cafeteria, tuition).</li><li>Total margin, which includes all operating sources of revenue plus investment returns, donations and non-COVID-19 related government appropriations.</li><li>Total margin with public health emergency (PHE) funds, includes all sources of revenue and PHE funds.</li></ul>To understand the variation in hospitals’ financial performance, we created three groups of hospitals based on their financial strength as measured by patient care margins from 2017- 2022. These groups include:<ul><li>Hospitals with positive margins in each year of the study period.</li><li>Hospitals with negative margins in each year of the study period.</li><li>Hospitals with a mix of positive and negative margins during the study period.</li></ul><h2>Results</h2><h3>Profitability Trends from 2017-2022: 2021 Was a Positive Outlier for Most Rural Hospitals</h3><img src="/sites/default/files/inline-images/Figure-1-Rural-Hospital-Profitability.png" data-entity-uuid="3fdebece-d832-4cd6-8969-7eb6952c7b72" data-entity-type="file" alt="Figure 1: Rural Hospital Profitable." width="732" height="502" class="align-left">Figure 1 shows mean hospital margins for the three years prior to the COVID-19 pandemic through 2022. Prior to the pandemic, the cost of providing care to rural patients exceeded reimbursement rates, resulting in negative patient care margins. However, rural hospitals lost money on patient care, but relied on other sources of income, including donations, non-COVID-19 government appropriations, and revenue from cafeteria and gift shop sales, to earn small, positive total margins on average. In 2020, hospital total, operating and patient care margins declined. Hospital financial margins in 2021 saw increases in all measures. However, these were followed by steep declines in 2022 as all margin measures fell below pre-pandemic levels.In addition to the variation from year to year, hospital financial performance showed notable variation from the average levels shown in Figure 1. To investigate this variation, we divided hospitals into three groups based on their patient care margins over the course of the study period. These groups included a “positive margin” group of hospitals whose patient care margins were positive in each year of the study period, a “negative margin” group of hospitals whose patient care margins were negative in each year of the study period, and a “mixed” group whose patient care margins were positive in some years and negative in others. Notably, 48% of the organizations in our sample (1,078 hospitals) had negative margins from patient care every year. Forty-percent of the sample (907 hospitals) had a mix of positive and negative margins throughout the study period. Only 12% of our sample of rural hospitals (261 organizations) had positive patient care margins each year of the sample.<img src="/sites/default/files/inline-images/Figure-2-Patient-Care-Margin_0.png" data-entity-uuid="5077e501-7cfb-45dc-8b57-f8fa8f08143c" data-entity-type="file" alt="Figure 2: Patient Care Margin." width="1047" height="735" class="align-left">Figure 2 presents the performance of each group of hospitals by year. The operating margins from patient services for both the persistent negative margin group and the group with mixed performance were consistently negative. Interestingly, even though the group with mixed performance contained hospitals with positive margins in some years and negative margins in others. The frequency and magnitude of the negative margins in this group were large enough to give the group as a whole a negative average operating margin from patient services in all years of the sample. A small number of rural hospitals experienced positive operating margins from patient services.<h3>Characteristics of Hospitals with Consistent Positive Margins from Patient Care</h3>Our analysis identified several ways that hospitals with persistent positive margins differed from hospitals in the mixed and negative margin groups (Table 1). Hospitals in the positive margin group had a smaller share of discharges coming from Medicare and Medicaid patients. Hospitals in the positive margin group were also more likely to be affiliated with systems — 83% of hospitals in the positive margin group were system members compared to 60% and 37% of the mixed and negative margin groups respectively. Finally, positive margin hospitals were more likely to be for-profit, have a larger average bed size, have lower average length of stay and have lower operating expenses. h2 { color: #003087; } h3 { color: #9d2235; } table, th, td { border: black 1px solid; } th { empty-cells: hide; } td.cellcenter { text-align: center; vertical-align: bottom; } <h3>Table 1: Rural Hospital Characteristics by Financial Performance Group</h3><table><thead><tr><th>&nbsp;</th><th>Always negative patient care margins</th><th>Mixed patient care margins</th><th>Always positive patient care margins</th></tr></thead><tbody><tr><td>Percent of sample</td><td class="cellcenter">48%</td><td class="cellcenter">40%</td><td class="cellcenter">12%</td></tr><tr><td>Percent Medicare discharges</td><td class="cellcenter">50.5%</td><td class="cellcenter">45.2%</td><td class="cellcenter">40.3%</td></tr><tr><td>Percent Medicaid discharges</td><td class="cellcenter">9.1%</td><td class="cellcenter">9.3%</td><td class="cellcenter">8.6%</td></tr><tr><td>Percent of group hospitals affiliated with a system</td><td class="cellcenter">36.6%</td><td class="cellcenter">60.3%</td><td class="cellcenter">82.8%</td></tr><tr><td>Percent of group hospitals with for-profit ownership</td><td class="cellcenter">6.1%</td><td class="cellcenter">10.1%</td><td class="cellcenter">23.8%</td></tr><tr><td>Mean bed size</td><td class="cellcenter">39.6</td><td class="cellcenter">46.2</td><td class="cellcenter">63.5</td></tr><tr><td>Average length of stay (days)</td><td class="cellcenter">15.0</td><td class="cellcenter">18.5</td><td class="cellcenter">7.1</td></tr><tr><td>Mean operating expense per inpatient day</td><td class="cellcenter">$14,424</td><td class="cellcenter">$21,581</td><td class="cellcenter">$13,098</td></tr></tbody></table><h3>COVID-19 Relief Funds Contributed to Positive Margins in Many, but Not All, Rural Hospitals</h3><img src="/sites/default/files/inline-images/Figure-3-Percent-of-Rural-Hospitals-with-Negative-Total-Margins-with-and-without-COVID-funds.png" data-entity-uuid="d73932fb-6157-47a3-9c6a-9ebfd681d994" data-entity-type="file" alt="Figure 3: Percent of Rural Hospitals with Negative Total Margins (with and without COVID funds." width="733" height="538" class="align-left">Figure 3 shows the percent of rural hospitals in our sample with negative total margins, annually, from 2017-2022. The bars represent the percent of hospitals with negative total margins, both with and without COVID-19 relief funds.Prior to the pandemic, COVID-19 relief funds were clearly unavailable, so the two bars are equal. However, it is notable that even in the pre-pandemic period, between 35% and 40% of rural hospitals had negative total margins. During the pandemic, COVID-19 relief funds were successful in providing financial support to help hospitals cope with declining volumes and other financial challenges. For instance, in 2020, excluding relief funds, 41% of rural hospitals would have reported negative total margins. However, 26% of rural hospitals incurred losses after accounting for the supplemental COVID-19 relief funds. Relief funds continued to supplement hospital financial margins through 2022.<h3>COVID-19 Relief Funds Caused the Largest Increases in Total Margin for Hospitals That Would Have Experienced Losses</h3>Table 2 presents the average total margins for rural hospitals with and without the COVID-19 relief funds from 2020-2022. The COVID-19 relief funds increased the total margin for all hospitals.<ul><li>For some rural hospitals with negative (-) total margins, COVID-19 relief funds resulted in margins that were still negative, but less so. These rural hospitals experienced 2.59% point increase after the inclusion of COVID-19 relief funds. Among these hospitals, the total margin increased from -10.44% to -7.85%.</li><li>For other rural hospitals with negative (-) total margins, COVID-19 relief funds fully covered the cost of providing care and resulted in positive (+) margins. Among these hospitals, total margin increased 12.42% points after the inclusion of COVID-19 relief funds. The total margin increased from -5.52% to 6.90%.</li><li>COVID-19 relief funds increased the margins of some hospitals that would have had positive margins without the relief funds. However, margin increases among this group were relatively small. This group of rural hospitals experienced a margin increase of 2.65% points after the inclusion of the COVID-19 relief funds. Their total margin increased from 9.64 to 12.28%.</li></ul><h3>Table 2. Average Total Margins for Rural Hospitals With and Without the COVID-19 Relief Funds (2020-2022)</h3><table><thead><tr><th>&nbsp;</th><th>Average total margins without COVID-19 PHE funds</th><th>Average total margins with COVID-19 PHE funds</th><th>Absolute change in total margin</th></tr></thead><tbody><tr><td rowspan="2">Negative Total Margin (-)</td><td class="cellcenter">-10.44%</td><td class="cellcenter">-7.85%</td><td class="cellcenter">⇧ 2.59%</td></tr><tr><td class="cellcenter">-5.52%</td><td class="cellcenter">6.90%</td><td class="cellcenter">⇧ 12.42%</td></tr><tr><td>Positive Total Margin (+)</td><td class="cellcenter">9.64%</td><td class="cellcenter">12.28%</td><td class="cellcenter">⇧ 2.64%</td></tr></tbody></table><h2>Discussion</h2>At the outset of the pandemic, there was particular concern that hospitals would not have the financial resources needed to address the challenges posed by the COVID-19 pandemic. Our results show that the worst fears about hospital financial conditions were avoided, in part due to the rapid distribution of COVID-19 provider relief funds. The majority of these funds, and other forms of financial aid, were distributed to hospitals during 2020 and 2021 (though some fund distributions still impacted hospitals’ 2022 reporting years). As a result, the percentage of rural hospitals incurring losses was between 11 and 15 percentage points lower than it would have been between 2020 and 2022. Moreover, in 2020 and 2021, the percent of rural hospitals with negative margins dropped below pre-pandemic levels.Unfortunately, these benefits did not accrue to all groups of rural hospitals during the pandemic period. Almost half of rural hospitals experienced negative margins from patient care both before the pandemic, in 2020, and in each year after. Moreover, total margins in 2022, the most recent year of data available, have declined. When provider relief funds are excluded from margins, the average total margin for all groups of hospitals is lower than it was in any year of our sample.Our analysis of hospitals with persistent negative margins from patient care, persistent positive margins from patient care and mixed margins revealed that these groups differ in important ways. The hospitals that struggled financially during the study period had higher volumes of Medicare and Medicaid patients. They were also smaller and less likely to be affiliated with a hospital system. The fact that the most financially vulnerable rural hospitals share similar characteristics suggests that these providers may require unique strategies or policy interventions to remain financially viable.Overall, our results suggest that relief funds provided much needed support to rural hospitals, and in addition to addressing the financial needs stemming from the COVID-19 pandemic, these funds were able to provide a measure of relief to many rural hospitals from long-standing financial pressures. However, these observations raise questions about how rural hospitals will cope financially as COVID-19 funding has ended but persistent financial challenges remain.<h2>Conclusion</h2>Provider relief funds were successful in preventing financial losses for many hospitals during the pandemic and, in some cases, contributed to positive hospital margins in 2021. However, as this funding declined in 2022, and hospitals faced persistent, and in some cases worsening, financial challenges, margins dropped. This decline is especially concerning for the large percentage of hospitals that struggled financially even prior to the pandemic. Rural hospitals that were part of hospital systems were perhaps able to mitigate the financial effects of the pandemic. Hospital systems may be able to provide aid to rural hospitals, navigate the operational and regulatory challenges that came with the COVID-19 pandemic and provide efficiencies in those operations.</div><div class="col-md-4"><a href="/system/files/media/file/2024/04/Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.pdf" target="_blank" title="Click here to download the Assessing the Impact of COVID-19 on Rural Hospitals report PDF."><img src="/sites/default/files/inline-images/Page-1-Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.png" data-entity-uuid="1d21e4b0-b522-462a-984a-192786ce9679" data-entity-type="file" alt="Assessing the Impact of COVID-19 on Rural Hospitals report page 1." width="695" height="900"></a></div></div></div> Thu, 04 Apr 2024 10:22:45 -0500 COVID-19: Caring for Patients and Communities Leading Health Care Partners Announce The Common Health Coalition: Together for Public Health /press-releases/2023-11-09-leading-health-care-partners-announce-common-health-coalition-together-public-health WASHINGTON (November 9, 2023) – Today, the �� Association, AHIP, the Alliance of Community Health Plans, the American Medical Association, and Kaiser Permanente announced the Common Health Coalition: Together for Public Health. The Common Health Coalition is focused on translating the hard-won lessons and successes of the COVID-19 pandemic response into actionable strategies that will strengthen the partnership between our health care and public health systems. The Coalition is the product of a joint commitment to public health made in March 2023 by the five founding member organizations.&nbsp; In early 2024, the Coalition will publish recommendations informed by technical advisory groups of subject matter experts and an advisory council of public health leaders. The recommendations will focus on four initial priority areas: spearheading greater coordination between the public health and health care systems; building shared, well-maintained emergency preparedness plans; establishing national standards for health care data that help identify health disparities; and modernizing infectious disease detection. The development of these recommendations is being facilitated by ChangeLab Solutions, a national nonprofit that uses the tools of law and policy to advance health equity. Former New York City Commissioner of Health Dave A. Chokshi, MD, MSc, chairs the Common Health Coalition. Dr. Chokshi is a practicing physician at Bellevue Hospital and a public health leader who is the inaugural Sternberg Family Professor of Leadership at the City University of New York (CUNY). Dr. Chokshi most recently served as the 43rd Health Commissioner of New York City. From 2020-2022, he led the City’s response to the COVID-19 pandemic, including its historic campaign to vaccinate over 6 million New Yorkers.&nbsp; Chelsea Cipriano, MPH, serves as the Coalition’s Managing Director. Cipriano most recently held leadership roles at the NYC Department of Health and Mental Hygiene and the NYC Mayor’s Office, and she previously served within the federal government at the US Centers for Disease Control and Prevention and the US Department of Health and Human Services. The Coalition’s work is informed by an advisory council of public health leaders chaired by Georges C. Benjamin, MD, Executive Director of the American Public Health Association, and J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health. “Now is the time to reimagine a&nbsp;health&nbsp;system in which health care and public health no longer work in parallel, but hand in hand — with health as the common goal and health equity as a common good,” said&nbsp;Dr. Chokshi. “Throughout the COVID-19 pandemic, our health care and public health institutions collaborated in ways we’d never seen before. We must cement the best of their approaches — and other innovations — into our nation’s core infrastructure. Leaders at Kaiser Permanente, AMA, AHA, ACHP, and AHIP are stepping up to make this vision a reality, and I'm honored to serve with them as chair of the Common Health Coalition.” “As the pandemic showed, far too often the hospital field has been forced to step in and plug gaps in our public health infrastructure. While hospitals are always there, ready to care, in good times and bad, we cannot shoulder this burden alone. This is why the AHA and our members have long been engaged in building collaborations, improving partnerships, and advocating for a stronger, more resilient, and responsive public health sector,” said Michelle Hood, steering committee member and AHA’s executive vice president and chief operating officer. “The AHA is proud to be a founding partner of the Common Health Coalition with these other national organizations to further improve partnerships and increase support for the critical components of our country’s health care system.” “The lessons we learned from the COVID-19 pandemic remain as urgent as ever&nbsp;and health care and public health institutions are ready to act on them,” said&nbsp;Bechara Choucair, MD, Coalition steering committee member and senior vice president and chief health officer at Kaiser Permanente. “Supporting a strong public health system is a foundational part of Kaiser Permanente’s commitment to promoting health equity and improving the health of our members, and the Common Health Coalition is a powerful vehicle for advancing that mission.”&nbsp; “AHIP is honored to be part of this important coalition focused on learning from our collective experience responding to the COVID pandemic and bringing together public health and the health care system to strengthen the partnerships and advance health equity,” said Kate Berry, steering committee member and senior vice president, clinical innovation and strategic partnerships at AHIP. “We are committed to making health care accessible and affordable for everyone, and look forward to working with the Coalition to continue guiding greater health.” “Partnership and collaboration are intrinsic parts of our DNA at the Alliance of Community Health Plans. From the way our teams work cross-functionally with each other, with our nonprofit payer-provider aligned health plan member companies and with our network of like-minded partner organizations here in D.C. and across the country, we understand we are all stronger when we collaborate and work together,” said Dan Jones, steering committee member and senior vice president of federal affairs at the Alliance of Community Health Plans. “We are proud to be part of the Common Health Coalition and to seek opportunities to build stronger partnerships between public health and health care systems, all with an eye to advancing health equity and proactive preparedness.” “The AMA is excited to work with our coalition partners to support a shared vision of a stronger, more robust and better prepared health system,” said&nbsp;AMA President Jesse M. Ehrenfeld, M.D., M.P.H. “For far too long, our public health system has been woefully underfunded, understaffed, and lacking the necessary data infrastructure and interoperability necessary to respond quickly to public health emergencies. That’s why we are bringing together health care leaders and decisionmakers to connect around a common agenda of actionable interventions to strengthen the connectivity between public health and the health care sector. Through the coalition’s work, we believe we can create a stronger public health system and healthier future for all.”&nbsp; For more information, visit <a href="https://commonhealthcoalition.org/">CommonHealthCoalition.org</a>. ### Thu, 09 Nov 2023 13:50:47 -0600 COVID-19: Caring for Patients and Communities COVID-19 Vaccination During Pregnancy: Barriers and Best Practices /center/living-learning-network/covid-19-vaccination-during-pregnancy-barriers-and-best-practices Mon, 02 Oct 2023 11:08:57 -0500 COVID-19: Caring for Patients and Communities Recent Study on Pandemic Funding Narrow and Incomplete /news/blog/2023-07-20-recent-study-pandemic-funding-narrow-and-incomplete America’s hospitals and health systems, regardless of size, location and ownership type, provided essential care to their patients and communities during the pandemic. Congress recognized the critical role hospitals play as the backbone of our health care system and swiftly took steps in the early days of the pandemic to provide support to ensure&nbsp;hospitals would remain resilient. These funds were for hospitals to use to prevent, prepare for, and respond to COVID-19, including by setting up alternative care sites, procuring testing, administering vaccines and supporting their workforce, to name a few examples. Importantly, each hospital and health system came into the pandemic with their own unique financial situation, which this <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2807183">recent study published in JAMA</a> fails to acknowledge. In addition, the study suffers from several methodological setbacks that undermine its credibility. These include: &nbsp; <ul> <li>An extremely narrow definition of financial distress. The authors determined a hospital to be new financial distress during the pandemic “if it had both (1) a weighted average net operating income across 2020/2021 that was negative and (2) the weighted average 2020/2021 net operating income was less than the hospital’s pre-2020 weighted average net operating income.” Therefore, a hospital that saw a large drop in operating margins during the pandemic but that was still at or slightly above breakeven would not be considered “in distress.” This is an overly restrictive way to define “financial distress,” and ignores other serious pressures facing hospitals during that period. </li> <li>Not including 2022, which was the worst financial year of the pandemic, due to a rapid increase in expenses for supplies, labor, drugs, equipment and other goods and services. 2022 also included the Omicron surge with some of the highest patient volumes of the pandemic. No new relief funds were applied for this period, and more than half of hospitals experienced negative margins. Even now in 2023, nearly half of hospitals are still seeing negative operating margins. Drawing conclusions about the finances of hospital and health systems during the pandemic based on data that do not include that timeframe are immediately flawed.</li> <li>Undercounting the number of Medicaid DSH hospitals dramatically. The authors report a much smaller number of Medicaid DSH hospitals than are reported by MACPAC, or even are included in CMS' annual DSH report data. These differences are not adequately explained in the article, which raises questions about the data sources and methodology used in the analysis. &nbsp;</li> </ul> In sum, the authors have essentially taken a snapshot of a limited time and drawn far more sweeping conclusions than is appropriate. The authors half acknowledge this weakness by stating in the limitations:&nbsp; “Though this represents the first two years of the COVID-19 PHE, results may not generalize after 2021. For example, the HRSA COVID-19 Uninsured Program, which reimbursed health care entities caring for uninsured individuals with COVID-19, was insolvent by fall 2022; this analysis may therefore underestimate the 2022 and 2023 risk of PHE financial distress for hospitals that disproportionately care for larger numbers of uninsured patients.” (Emphasis added.) Implicit in the study seems to be an assumption that the policy goal of pandemic relief should have been widespread negative operating margins across all hospitals. The fact that hospitals were buoyed by relief funds in 2020 and 2021, especially before the depths of extreme financial pressures in 2022, should be seen as a policy success. Incomplete analyses like this are not reflective of the many immense struggles and challenges the hospital field has faced and continues to face, including a workforce shortage crisis, along with skyrocketing input costs for supplies, equipment, drugs and labor, and persistent inflation. It is in everyone’s interest to keep hospitals strong and our patients healthy. Aaron Wesolowski is the �� Association's vice president of policy, research, analytics and strategy. Thu, 20 Jul 2023 15:04:50 -0500 COVID-19: Caring for Patients and Communities New York City hospitals ensure access to COVID-19 services past end of public health emergency /vaccine-stories/role-of-hospitals-nyc-health-hospitals <div class="container"> <div class="row"> <div class="col-md-9"> <div class="row"> <div class="col-md-7"> <img alt="Stock Photo of health worker in full PPE taking patient's temperature in triage bay" data-entity-type="file" data-entity-uuid src="/sites/default/files/2023-04/stock-coronavirus-test-triage%20bay-ppe-700x532.jpg" class="align-left"> </div> Pandemic testing and treatment options that New Yorkers have relied upon for three years will continue to be available after the official expiration of the federal emergency on May 11. NYC Health + Hospitals, which operates the public hospitals and clinics in New York City, <a href="https://www.nychealthandhospitals.org/pressrelease/health-hospitals-ensures-new-yorkers-continue-to-have-access-to-covid-19-services-as-end-of-federal-emergency-nears/" target="_blank">announced plans</a>&nbsp;to ensure New Yorkers continue to have the access to COVID-19 testing, vaccination, and treatment, as well as services to address Long COVID in all five boroughs. Hospital-based walk-in testing tents and mobile Test to Treat units will transition to permanent services inside the public health care system’s hospitals and community-based outpatient care centers. The city's 212-COVID19 hotline will remain in operation, and at-home test kits are still available at over a thousand locations across the city, including all libraries. Mitchell Katz, M.D., president and CEO of NYC Health + Hospitals, said, “We can now transition the Test &amp; Treat Corps emergency operations knowing that we have built a stronger, more responsive public health care system that can provide the appropriate level of services to our communities and seamlessly preserve access to the COVID-19 testing, vaccination, and treatment New Yorkers may need for as long as we need it.” </div> </div> <div class="col-md-3"> <div> <h4>COVID-19 Vaccine Resources</h4> <ul> <li><a href="/vaccine-stories">Vaccine Stories</a></li> <li><a href="/vaccineconfidence">Vaccine Communications Resources</a></li> <li><a href="/2021-04-23-share-your-vaccination-story">Share Your Story</a></li> </ul> </div> <div> <h4>Resources on the Role of Hospitals</h4> <ul> <li><a href="/advocacy/access-and-health-coverage">Access to Care</a></li> <li><a href="/roleofhospitals">All Case Studies</a></li> </ul> </div> </div> </div> </div> Mon, 03 Apr 2023 14:33:26 -0500 COVID-19: Caring for Patients and Communities CDC: Updated booster reduces COVID-19 risk for nursing home residents /news/headline/2023-01-26-cdc-updated-booster-reduces-covid-19-risk-nursing-home-residents Between Oct. 10, 2022, and Jan. 8, 2023, nursing home residents who were not up to date with the recommended COVID-19 vaccinations had a 30%-50% higher risk for SARS-CoV-2 infection than residents who were up to date, according to a <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7204a3.htm">study</a>&nbsp;released today by the Centers for Disease Control and Prevention. New COVID-19 cases among residents who received a bivalent booster in the past two months (or a primary series and monovalent booster if they were not yet eligible) ranged from 7.2 to 15.6 per 1,000, compared with 9.5 to 18.8 per 1,000 for residents whose vaccinations were not up to date. By Jan. 8, about 49% of residents were up to date with the recommended COVID-19 vaccinations. &nbsp; “Nursing home residents can maximize protection against COVID-19 by receiving bivalent COVID-19 booster doses to stay up to date with recommended COVID-19 vaccinations,” the authors conclude. In a second and <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7204a4.htm">ongoing study</a>&nbsp;of nursing and veterans homes in Ohio and Rhode Island, SARS-CoV-2 antibody levels waned within two months after receiving a monovalent booster, but a bivalent booster restored immunity and broadened antibody response. &nbsp; Thu, 26 Jan 2023 16:05:00 -0600 COVID-19: Caring for Patients and Communities CDC releases COVID-19 testing locator /news/headline/2023-01-25-cdc-releases-covid-19-testing-locator The Centers for Disease Control and Prevention yesterday launched a <a href="https://www.cdc.gov/media/releases/2023/s0124-testing.html">website</a>&nbsp;to help consumers locate no-cost COVID-19 testing through its Increasing Community Access to Testing program, which includes pharmacies, commercial laboratories and other sites that bill the tests to government and private insurers and focus on vulnerable communities. The tests may include laboratory-based nucleic acid amplification tests and rapid antigen point-of-care tests, with results typically provided in 24-48 hours.&nbsp; Wed, 25 Jan 2023 15:17:30 -0600 COVID-19: Caring for Patients and Communities Survey finds information can raise COVID-19 booster coverage /news/headline/2023-01-19-survey-finds-information-can-raise-covid-19-booster-coverage In an online survey last November of 1,200 U.S. adults previously vaccinated against COVID-19, 62% had not yet received a bivalent booster dose, most often because they did not know they were eligible or the booster was available, or believed they were immune against infection, the Centers for Disease Control and Prevention <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7203a5.htm?s_cid=mm7203a5_w">reported</a> today. After viewing information about eligibility and availability, over two-thirds of them planned to get a bivalent booster and 29% reported receiving the booster in a follow-up survey in December. To help increase bivalent booster coverage, the report recommends using evidence-based strategies to inform patients about booster recommendations and waning immunity. Thu, 19 Jan 2023 14:04:16 -0600 COVID-19: Caring for Patients and Communities FEMA streamlines Public Assistance Program funding procedures, allows COVID-19 retroactive agreements /news/headline/2023-01-12-fema-streamlines-public-assistance-program-funding-procedures-allows-covid-19-retroactive-agreements The Federal Emergency Management Agency this week <a href="https://content.govdelivery.com/attachments/USDHSFEMA/2023/01/11/file_attachments/2376933/FEMA%20Advisory%20FEMA%20Releases%20Public%20Assistance%20Simplified%20Procedures%20Policy%20%28January%2011,%202023%29.pdf">simplified procedures</a>&nbsp;for its Public Assistance Program, which provides disaster response grants to non-profit health care organizations and others. In another policy change, during the COVID-19 public health emergency, the program also will allow nonprofit health care facilities to sign <a href="https://www.fema.gov/sites/default/files/documents/fema_covid-19-legal-responsibility-eligible-work.pdf">retroactive agreements</a> &nbsp;with their state or local governments to fund certain eligible emergency work, including reimbursement for child care services and shared transportation services provided to health care workers early in the pandemic. Thu, 12 Jan 2023 14:58:19 -0600 COVID-19: Caring for Patients and Communities AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation /lettercomment/2022-12-01-aha-letter-dea-regarding-request-release-special-registration-telemedicine-regulation <div class="container"> <div class="row"> <div class="col-md-8"> December 1, 2022 The Honorable Anne Milgram Administrator Drug Enforcement Administration 800 K Street N.W., Suite 500 Washington, D.C. 20001 Re: Request for Release of Special Registration for Telemedicine Regulation Dear Administrator Milgram, On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations; our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers; and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the Drug Enforcement Agency’s (DEA’s) continued efforts to support the safe prescribing of medically necessary controlled substances via telehealth during the COVID-19 public health emergency (PHE). Prior to the pandemic, the Ryan Haight Act of 2008 amended the Controlled Substances Act to prohibit prescribing of controlled substances via online forms and outlined requirements for in-person evaluations prior to the prescribing of controlled substances. There are certain exceptions to the in-person visit requirement, including when there are PHEs. During the COVID-19 state of emergency, the DEA enacted flexibilities to certain requirements to ensure patients could continue to receive life-saving medications via telehealth while minimizing exposure and preserving provider capacity. Flexibilities, including waiving the required initial in-person visit prior to prescribing controlled substances via telehealth and allowing the use of telephone evaluations to initiate buprenorphine prescribing, have proved critical in best supporting our patients. These waivers have improved access to care for patients with substance use disorder where there were already shortages in prescribers even prior to the pandemic. While waiving the in-person requirement has supported continuity of care in the interim, providers, hospitals and health systems need clarity on the permanent, post-pandemic process for virtual prescribing. We envision that this will involve a special registration process for telemedicine to waive this in-person visit. Indeed, the requirement that the agencies issue a regulation outlining the special registration process for telemedicine was first established nearly 14 years ago in the Ryan Haight Act and was re-enforced over three years ago in the SUPPORT Act. During this time, providers have waited patiently for guidance. However, there is growing concern that the pending expiration of the COVID-19 PHE and its associated waivers, combined with the lack of a special registration regulation, will leave providers in a position where they will need to cut services and leave patients without access to necessary treatment. With the expiration of the COVID-19 PHE currently scheduled for next year, this situation could come to pass as early as mid-January. Therefore, we urge the DEA to release proposed rules for the Special Registration for Telemedicine as soon as possible. Doing so is necessary to ensure an appropriate feedback period and time for hospitals and health systems to comply with requirements. Considering unprecedented staffing shortages, provider burnout and financial constraints, it is critical that hospitals have adequate time to reallocate resources to operationalize regulation components. In addition, we also urge the DEA to provide an interim plan to support continuity of care for the period between the expiration of the COVID-19 PHE and implementation of the Special Registration for Telemedicine final rules if there is a gap period. Specifically, we would suggest components of the interim plan include policies such as: <ul> <li>Waiving the in-person requirement and continuing flexibilities for telephone evaluations to initiate buprenorphine prescribing. Given concerns regarding the expiration of the COVID-19 PHE, we would recommend transitioning this waiver for Substance Use Disorder under the Opioid Epidemic PHE which does not have an anticipated end date;</li> <li>Providing a solution for patients engaged in an episode of care where the episode was initiated via telemedicine prior to the end of the COVID-19 PHE. Current waivers do not address how the in-person requirement will be addressed at the end of the COVID-19 PHE for open episodes, so we recommend extending the waiver for an in-person exam for the duration of the episode; and</li> <li>Providing a solution for patients who initiate an episode of care between the expiration of the COVID-19 PHE and publication of the final rule for Special Registration for Telemedicine. Again, current waivers do not address how the in-person requirements will be addressed for episodes initiated in the gap period where the COVID-19 PHE expires and the final rule is published, so we recommend extending the waiver for an in-person exam for the duration of the episode.</li> </ul> Given the continued workforce challenges of today, we also urge the DEA to grant permanent exception for practitioners in states that have medical licensing reciprocity requirements to file separate DEA registration in any state a provider practices under the reciprocity arrangement to ensure appropriate prescribing for patients through telehealth services. We thank you for considering our request. If you have any questions concerning our comments, please feel free to contact me, or have a member of your team contact Jennifer Holloman, AHA’s senior associate director of policy, at <a href="mailto:jholloman@aha.org">jholloman@aha.org</a>. Sincerely, /s/ Stacey Hughes Executive Vice President Government Relations and Public Policy </div> <div class="col-md-4"> <a href="/system/files/media/file/2022/12/Letter-to-DEA-Regarding-Request-for-Release-of-Special-Registration-for-Telemedicine-Regulation.pdf" target="_blank" title="Click here to download the AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation PDF."><img alt="AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation page 1." data-entity-type="file" data-entity-uuid="53e5a181-4ce1-4950-a81c-70f849947d98" src="/sites/default/files/inline-images/Page-1-AHA-Letter-to-DEA-Regarding-Request-for-Release-of-Special%20Registration-for-Telemedicine-Regulation_0.png" width="699" height="900"></a> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/12/Letter-to-DEA-Regarding-Request-for-Release-of-Special-Registration-for-Telemedicine-Regulation.pdf" target="_blank" title="Click here to download the AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation PDF.">Download the PDF</a></div> </div> </div> </div> Thu, 01 Dec 2022 10:10:36 -0600 COVID-19: Caring for Patients and Communities