- With the number of confirmed cases of COVID-19 reported in the United States climbing and concerns over how hospitals can handle the influx of intensive care patients, hospital groups bristled at calls to end lucrative elective surgeries while some prominent hospitals nevertheless moved ahead with such plans.
- The federal government's response to the novel coronavirus outbreak continues to ramp up as more widely available testing is a key focus. The Senate is expected this week to take up a House-passed relief package that includes a 6.2 percentage point hike to the federal Medicaid matching rate, a move approved of by providers.
- Meanwhile, the virus' threat to healthcare workers became starker over the weekend as two emergency physicians were reported to be in critical condition as a result of COVID-19. They are an emergency physician in his 40s in Washington state and a 70-year-old New Jersey doctor who leads his institution's emergency preparedness, according to the American College of Emergency Physicians.
Response to the outbreak hit a new level this weekend, with several major cities temporarily shutting down bars and other indoor gathering places while also restricting restaurants to take-out service. The Centers for Disease Control and Prevention said Sunday night it was recommending no groupings of more than 50 people anywhere in the country.
As of Monday morning, more than 3,770 cases of the disease were confirmed in the United States, but that figure is expected to increase quickly as testing becomes more widely available. Experts agree the true number of cases is unknown but much higher than what has been reported so far.
President Donald Trump on Friday declared a national emergency, a designation providers had called on to help ease restrictions on critical access hospitals and state licensing. Hospitals applauded the move.
The House passed economic relief package early Saturday. The legislation is expected to be cleared by the Senate and signed by the president this week. It includes the update to Medicaid payments, although that provision was watered down from an earlier proposal to hike the matching rate by eight percentage points.
The change, if approved, will provide $35 billion in immediate relief to states to help address public health needs by making testing available, creating quarantine environments and increasing public communication efforts, according to Jennifer Sullivan, senior policy analyst with the Center on Budget and Policy Priorities.
It will also prevent damaging Medicaid cuts during the crisis and more generally support the economy, she wrote. "A broad increase in federal Medicaid funding is the best way to help states make the targeted Medicaid changes that meet their needs."
Hospital groups on Monday asked Congress to include funding to directly support hospital response. "We respectfully ask that Congress provide additional supplemental emergency funding of at least $1 billion during this critical window of time when we are able to best prepare and respond to this outbreak," they wrote.
Congress already approved an $8.3 billion funding package earlier this month that temporarily rolled back some restrictions of telehealth services to help providers in their response.
As providers continue to report worries there won't be enough ICU beds and ventilators to treat the expected spike of coronavirus patients, U.S. Surgeon General Jerome Adams called on healthcare systems to consider halting elective procedures. In a Saturday tweet, he said such surgeries bring possible cases to a facility and tax stores of personal protective equipment and personnel needed for outbreak response.
The American Hospital Association, Federation of American Hospitals and other hospital groups pushed back on a blanket canceling of elective procedures without a clear agreement of how various levels of care are classified.
In a letter to Adams, the groups said elective surgeries could include replacement of a faulty heart valve or removal of a cancerous tumor - procedures that are needed to prevent life threatening conditions. "Where possible, we cannot completely cease caring for illness in our community that is not directly related to the COVID-19 crisis," they wrote. "Our ability to respond to patients must not be prevented by arbitrary directives."
But some groups, including the American College of Surgeons, took the side of at least curtailing elective procedures. The Massachusetts Department of Public Health on Sunday issued an order "mandating that hospitals must cancel non-essential elective procedures." Partners Healthcare in Boston cited the order and told Healthcare Dive it had "moved to defer appropriate elective and non-urgent care" as of Saturday.
And National Institute of Allergy and Infectious Diseases Director Anthony Fauci on Sunday seemed to back the idea. "Keep people out of the hospitals except those that need to be in the hospitals," he said on "Meet the Press."
In a press briefing Sunday, HHS Secretary Alex Azar said he would not disclose details on the availability of supplies like ventilators, but acknowledged hospitals face "an unprecedented challenge."