U.S. hospitals, stretched to the brink from the highest surge of coronavirus cases the country has yet seen, are halting elective procedures, turning to novel staffing arrangements and asking for more flexibility from the federal government.
The number of hospitalized COVID-19 patients exceeded 100,000 for the first time Wednesday, nearly doubling spring's peak, according to the COVID Tracking Project.
This time healthcare staff are in increasingly short supply, with outbreaks spread nationwide and many physicians exhausted, burned out or sick with the novel coronavirus themselves. Coronavirus patients also typically require more staff than those admitted with other illnesses, hospital leaders have said.
Mayo Clinic and Cleveland Clinic have reported more than 1,000 workers sidelined by the virus this week. Cleveland Clinic is among several systems that have said they are again curtailing or stopping elective procedures to free up resources for COVID-19 patients.
In a Wednesday letter to HHS, the American Hospital Association urged more flexibility around healthcare staffing and how providers allocate limited resources, asking CMS to waive the threat of enforcement action on hospitals that do not send in the daily COVID-19 data reporting requirements.
AHA also seeks to quell staffing shortages by expanding the physician supervision requirement "to include all nurse practitioners providing care within the scope of their license and privileges" and allocating funds to help front-line staff with child care, housing and travel expenses.
"These steps would allow providers to focus resources entirely on the pandemic response," AHA said in its letter.
Some state governments are lending support to health systems, such as Arizona, where Gov. Doug Ducey allocated $80 million to bolster hospital staffing levels and award bonuses to healthcare workers through the Coronavirus Aid, Relief, and Economic security Act.
Arizona's Health Department is working to secure an additional 500 nurses through the month with additional staffing to last throughout January, according to a release.
The state's largest system, Banner Health, predicts it will reach 100% capacity on licensed beds within a week and will remain above that level for the entire month and into January, Chief Clinical Officer Marjorie Bessel said during a Wednesday press conference.
While flu season is typically busier, "operating above 125% of licensed bed capacity is absolutely not typical, nor is it desirable, especially for a prolonged period as we are forecasting," Bessel said.
Banner recently contracted with 1,500 out-of-state workers and is working to recruit for 900 more.
It's unclear how easily systems will be able to recruit the staff they're trying to, with travel nurse demand outpacing supply and hospitals having to pay much higher rates than in the past.
Banner plans to redeploy some of its corporate staff to hospital settings wherever it can, Bessel said.
"There are many additional activities that our front-line staff could use, so assistance with things like answering telephones, running errands, potentially visiting with a patient and using the iPads so that patients can have a meeting or a Zoom call or FaceTime with their family members," Bessel said.
"We will be putting anybody who's willing to go back into the healthcare setting in the hospital to work to provide helping hands if they do not have a certification for healthcare," Bessel said.
AHA's letter asks HHS to direct federal agencies to encourage cross-training healthcare workers to ease the burden.
"For example, cross-training can prepare clinicians to work in different settings and can be used to prepare administrative support staff to meet the increased demands associated with COVID-19 patients," AHA said.
It also wants CMS to suspend its routine survey process and quality data reporting requirements that it previously waived this spring but since reinstated.
HHS should also coordinate with the Department of Defense, which has "skilled nurses and doctors capable of offering necessary assistance, as well as the resources and equipment, such as navy medical ships and field hospitals that can provide critical relief where appropriate," AHA said.
Meanwhile, the possibility of another federal aid package isn't entirely out of reach. A bipartisan group of lawmakers this week put forward a $908 billion dollar plan that includes $35 billion toward the Provider Relief Fund. Top Democrats on Wednesday said that bill should be used as the framework for negotiations. Republican support, however, is unclear.