UPDATED Coronavirus tracker: FAH calls for permanent policy changes to Medicare

Businessman video-chats with doctor on laptop
The Federation of American Hospitals sought to make several COVID-19-related waivers to Medicare permanent to help providers. (Getty/AndreyPopov)

UPDATED: Friday, July 10, at 4:03 p.m.

FAH calls for permanent policy changes to Medicare

The Federation of American Hospitals sought to make several COVID-19-related waivers to Medicare permanent to help providers.

The letter sent to the Centers for Medicare & Medicaid Services Friday comes as the public health emergency is set to expire by the end of the month. The waivers are expected to expire when the public health emergency does.

The hospital groups want to make these waivers permanent policy:

  • Telehealth services such as the elimination of originating site restrictions to allow services to be provided in any area of the country.
  • Allow pathologists to review pathology slides remotely and enable payment for COVID-19 lab testing without an order from a treating physician.
  • Expanding the list of eligible practitioners that could furnish healthcare services via remote technology including professional counselors.

UPDATED: Thursday, July 9, at 3:20 p.m.

Azar pledges to support the permanent expansion of telehealth services

HHS Secretary Alex Azar said the Trump administration will take regulatory steps to support the permanent expansion of telehealth services.

During the COVID-19 pandemic, the Trump administration has opened up access to telehealth with sweeping—but temporary—changes to reimbursement policies.

Some of the regulatory flexibility on reimbursement is going to stick around, according to Azar, speaking during an event Thursday sponsored by The Hill newspaper

"Telehealth is now an embedded part of the healthcare system. It has changed the nature of delivery. We’re going to do everything we can through regulations to keep the gains that we’ve had and to keep the patient and the doctor relationship in the center," he said.

Azar said HHS plans to work with Congress to make the necessary statutory changes to make Medicare reimbursement telehealth policy changes permanent.

Azar credited the Trump administration with waiving many embedded requirements that had been barriers to healthcare innovation and kept U.S. healthcare "in a 1960s-style of delivery," he said.

The HHS Secretary said he has met with doctors, hospital executives, and nurses who have all supported expanded access to telehealth.

"I think we’d have a revolution if anyone tried to go backward on this, he said.

UPDATED: Thursday, July 9, at 12:41 p.m.

Geisinger CEO sees a ‘mixed bag’ in COVID-19’s future

The CEO of major hospital system Geisinger has mixed feelings about the extent of a second surge of COVID-19, largely based on how the public will respond.

“I am optimistic because we have learned a lot,” said Jaewon Ryu, president and CEO of Geisinger, during an event Thursday sponsored by The Hill newspaper. “We are in a very different place now whether it is PPE or testing or understanding more about the virus and its biology.”

But Ryu said that overall the future could be a “mixed bag,” and the severity of a second surge will depend on whether the public plays its part by wearing masks, social distancing and hand hygiene.

“The battle is not just clinical, but it is communication,” he added.

He said that education and communication in the community will be a major issue moving forward.

“If we do those things we will be in a much better position,” Ryu said.

UPDATED: Wednesday, July 8 at 11:56 a.m.

Health systems, payers team up on PSA to encourage people to seek care

Big-name health systems and payers including Humana and Providence have joined forces to launch a new public service announcement to encourage social distancing while also seeking care when needed.

The "Stop Medical Distancing" aims to draw a clear line between social distancing to mitigate the spread of the pandemic and avoiding necessary care out of fear of catching COVID-19, which could lead to significant health problems down the road.

That includes encouraging the use of telehealth when possible and emphasizing the efforts of providers to ensure that their facilities are clean and safe when patients do need to come in person.

"We are seeing a troubling pattern that people are avoiding medical visits in fear of contracting COVID-19," said William Shrank, M.D., chief medical officer of Humana, in a statement. "While we understand the fears that many people have around contracting the virus, our country's medical facilities have adopted CDC guidelines and best practices and even telemedicine options to make your visit as safe as possible to prevent the spread of the virus."

"The intent of the campaign is to let people know that protecting yourself against getting this virus does not need to come at the expense of your overall health," Shrank said.

Other members of the alliance backing the PSA include  Baptist Health South Florida, Baylor Scott & White Health, Children's Hospital of Philadelphia, Health Mart, Kindred Healthcare, LabCorp, McKesson Corporation and Walgreens.

UPDATED: Wednesday, July 8 at 10:34 a.m.

Epidemiologists call for 'Universal Pandemic Precautions' for patients and healthcare workers

The Board of the Society for Healthcare Epidemiology of America — an organization that represents epidemiologists in hospitals and other healthcare settings — is calling for new evidence-based "Universal Pandemic Protections" or UPP for patients and healthcare workers. 

In a commentary published in the journal Infection Control & Hospital Epidemiology, the board proposed widespread COVID-19 testing of patients, visitors, and healthcare workers, even when no symptoms are present. They also called for the required use of masks by patients and masks and eye protection for healthcare workers in nearly all patient interactions.

The board pointed to data that shows the COVID-19 pandemic has led to 2.2 million infections and more than 118,000 deaths in the U.S. as of June 19. Centers for Disease Control and Prevention data reports about 11% of those infections are among healthcare personnel.

They also recognized the implementation of UPP would require careful messaging for our colleagues and patients.

"We realize that paradigm shifts are difficult," board members wrote in the State of the Pandemic Commentary. "We believe that Universal Pandemic Precautions will be accepted by patients and staff and that it will ultimately result in a safer healthcare environment for all."

UPDATED: Tuesday, July 7, at 2:47 p.m.

Alabama, Florida hospitals scales back surgeries as COVID-19 spike

Huntsville Hospital in Alabama has stopped certain elective procedures as COVID-19 cases in its locality have increased.

The 971-bed hospital located in northern Alabama said on Monday that it will pause inpatient surgical procedures at its main facility but outpatient procedures will continue, according to AL.com. The announcement comes as hospital systems in emerging COVID-19 hotspots try to balance performing surgical procedures and keep enough capacity to treat virus cases.

Huntsville Hospital told AL.com that the cancellation only affects surgical procedures that require a hospital stay and that it will move some procedures to other facilities.

It added that the hospital has 71 COVID-19 cases, mirroring an increase in the state overall.

Huntsville said that it has converted three surgical floors into COVID-19 wards and that it has enough staff and supplies to combat the pandemic.

The issue is similar to what other hospital systems have been experiencing as COVID-19 cases reach record highs in sunbelt states.

In Florida, two of Tampa Bay's largest health system — HCA Healthcare and BayCare Health Systems — said they will halt elective procedures to make capacity for a surge of COVID cases, the Tampa Bay Times reported.

Banner Health, a health system that has a major footprint in Arizona, said that it is continuing to perform elective procedures as cases in the state spike. But the system is making some changes to ensure it has enough capacity, including delaying procedures that require a stay in the intensive care unit.

UPDATED: Tuesday, July 7 at 2:15 p.m.

New polling highlights growing partisan schism over COVID-19

New data released by Axios and Ipsos puts a spotlight on the partisan divides that are growing around wearing masks and avoiding crowds to prevent the spread of COVID-19.

In April, when the survey was first conducted, 16% of Republicans, 20% of independents and 26% of Democrats said they were wearing a mask at all times. While that figure has grown across categories through the end of June, it lags among Republicans and independents.

By June 29, 34% of surveyed Republicans, 50% of independents and 68% of Democrats said they wear a mask at all times.

Similar fault lines emerged on the level of concern about COVID-19. In April, 72% of Democrats said they were either extremely or very concerned about the virus, which rose to 77% by the end of June.

Sixty percent of independents said they were extremely or very concerned about COVID-19 in April, compared to 55% by June 29. Among Republicans, 49% said they were extremely or very concerned in April, a number that dropped to 36% by the end of June.

"We know that America has failed to contain the coronavirus pandemic, and we can't get past partisanship," pollster Chris Jackson, senior vice president for Ipsos Public Affairs, told Axios. "Looking forward the real question is going to be, does having first-hand experience get people past the partisanship?"

UPDATED: Monday, July 6 at 9:54 p.m.

Provider groups urge public to wear a mask

A trio of leading provider groups issued an open letter to the public urging Americans to wear masks to stop COVID-19 transmission amid resistance to the public health measure.

The letter released Monday by the American Hospital Association, American Medical Association and American Nurses Association comes as mask wearing has become a political issue and COVID-19 has hit record highs in several sunbelt states.

“We are not powerless in this public health crisis, and we can defeat it in the same way we defeated previous threats to public health—by allowing science and evidence to shape our decisions and inform our actions,” the letter said.

The groups called for the public to wear a face mask, maintain social distancing and wash their hands.

UPDATED: Wednesday, July 1 at 9:58 p.m.

Society of Actuaries launches tool to help payers model COVID-19 costs

The Society of Actuaries (SOA) has created a tool that will allow health plans to model the costs they could face next year due to COVID-19.

The tool was backed by a grant from the Robert Wood Johnson Foundation, and models several potential scenarios for costs in 2021. Insurers can use the tool to model costs for testing, the cost associated with deferred care and costs for the eventual vaccine.

For example, researchers at SOA estimate that for each month that there is a high level of social distancing, annual insured healthcare costs decrease by 4%. 

“This modeling tool helps insurance carriers and regulators as they look to 2021 health insurance costs, the impact of COVID-19 treatment costs and how these trends may progress over the next year,” said R. Dale Hall, managing director of research at the SOA, in a statement. “We developed this model to help understand the first wave and plan for a variety of potential future scenarios of COVID-19, as well as to see how the different factors play out over time, such as when there is a vaccine and how insurers cover future costs.”

UPDATED: Tuesday, June 30 at 2:11 p.m..

Fauci would not be surprised if COVID-19 cases rise to 100K a day

Top infectious disease expert Anthony Fauci, M.D., told lawmakers that he wouldn’t be surprised if COVID-19 cases rise to 100,000 a day after massive spikes in the sunbelt states.

Fauci spoke before the Senate Health, Education, Labor and Pensions Committee on Tuesday on the pandemic.

Sen. Elizabeth Warren, D-Massachusetts, asked Fauci how many deaths and infections Americans should expect before the end of the pandemic.

“I can’t make an accurate prediction, but it is going to be very disturbing,” Fauci, the head of the National Institutes for Allergic and Infectious Diseases, responded.

He said that an outbreak in one part of the country could put other parts that are doing well at risk. Currently the U.S. is experiencing around 40,000 cases a day, but “I would not be surprised if we go up to 100,000 a day if this does not turn around,” Fauci said. “I am very concerned.”

UPDATED: Tuesday, June 30 at 12:59 p.m.

Mayo Clinic guiding Delta Air Lines COVID-19 safety measures

Delta Air Lines is partnering with Mayo Clinic for guidance on safety and infection control measures amid COVID-19 pandemic concerns. 

Officials said the Mayo will be offering expert advisors to review, enhance and advise on improvements to Delta's safety protocols to mitigate the risk of virus transmission during travel. 

"As we continue adjusting our business to mitigate the risk of COVID-19 transmission, there’s no organization in the world better equipped than the Mayo Clinic to act as Delta’s medical advisor," says Ed Bastian, CEO of Delta Air Lines in a statement. "The role Mayo will play in testing our employees and advising on safety practices at airports and work spaces will help deliver the additional layers of protection needed to safeguard our customers and employees."

Specific areas Delta will consult with Mayo on include its COVID-19 Testing for the full Delta workforce, the creation of an integrated advisory council and customer health consulting.

UPDATED: Tuesday, June 30 at 10:04 a.m.

HHS spokesman expects public health emergency will be renewed

A spokesman for Health and Human Services said he expected the public health emergency for COVID-19 will be renewed, giving a major win for providers.

Spokesman Michael Caputo tweeted on Monday that the public health emergency has already been renewed once, which HHS Secretary Alex Azar decided to do back in late April. The current emergency will expire on July 25.

The duration of the emergency is critical to providers as several pieces of regulatory relief are tied to the emergency.

The American Hospital Association wrote to HHS two weeks ago laying out criteria to end the public health emergency. Criterion includes that the supply chain is able to meet the continued increased demand for personal protective equipment and the number of patients in intensive care unit beds in the U.S. is fewer than 5,000 per day for 14 days.

UPDATED: Monday, June 29 at 9:59 a.m.

HHS secures 500K courses of remdesivir for distribution to hospitals

The Department of Health and Human Services has secured more than 500,000 courses of remdesivir, an antiviral treatment for COVID-19, that it will distribute to hospitals for purchase.

The amount secured represents 100% of drugmaker Gilead's projected production for July (94,200 courses), 90% of production projected for August (174,900 courses) and 90% of production projected for September (232,800 course).

AmerisourceBergen will ship the product hospitals, who will pay no more than the wholesale acquisition price per course, which is about $3,200, HHS said.

“To the extent possible, we want to ensure that any American patient who needs remdesivir can get it," HHS Secretary Alex Azar said in a statement. "The Trump Administration is doing everything in our power to learn more about life-saving therapeutics for COVID-19 and secure access to these options for the American people.”

HHS expects that shipments will go out every two weeks, in a similar fashion as the 120,000 courses donated by Gilead were allocated. The last shipment of those donated drugs is going out to hospitals today.

UPDATED: Friday, June 26, at 2:55 p.m.

HHS extends funding for Texas testing sites after outcry

The Department of Health and Human Services decided to extend funding for five Texas-based COVID-19 testing sites after a request from the state.

The agency had planned to stop funding for 13 testing sites on June 30 , including seven sites in Texas.

The sites were set up at the beginning of the pandemic and the federal government had planned to turn over control to the state government.

However, the announcement of closing the seven Texas sites drew a rebuke from public health officials as cases have rose dramatically in the state.

The administration defended the funding decision earlier this week by noting that it had long-planned to transition the sites to state control and it had delayed the transition for the 13 sites to give states more time to prepare.

Now the state’s public health leaders asked HHS to extend funding for five sites for an additional 14 days.

“We will continue to closely monitor COVID-19 diagnoses and assess the need for further federal support of these sites as we approach the extension date,” said Assistant Secretary for Health Admiral Brett Giroir, who coordinates testing for the federal government.

UPDATED: Friday, June 26, at 12:45 p.m.

CMS proposes permanent telehealth changes for home health agencies

The Centers for Medicare and Medicaid Services wants to make telehealth expansion a permanent part of home health under a proposed rule released by the agency Thursday.

The rule will allow home health agencies to continue to use telecommunications technologies including remote patient monitoring, virtual care, and two-way audio-visual technologies to provide care to Medicare beneficiaries beyond the COVID-19 public health emergency.

The technology usage must be related to the skilled services being furnished, is outlined on the plan of care, and is tied to a specific goal indicating how such use would facilitate treatment outcomes, CMS said.

If finalized, the proposed changes would go into effect Jan. 1, 2021.

CMS Administrator Seema Verma highlighted the changes in a tweet: "Today, CMS  is sharing one of the many system upgrades we’re making to ensure our Medicare program runs smoothly for our beneficiaries & providers – ready to handle any curves in the road ahead."

A CMS official said this week that an upcoming Medicare payment rule for providers will include proposals for permanent changes to telehealth flexibilities.

The proposed changes for home health agencies accompanied CMS' Home Health Prospective Payment System for 2021 rule which will boost Medicare pay for providers by 2.6%, or about $540 million.

UPDATED: Wednesday, June 24, at 3:59 p.m.

HHS ends funding for 13 states amid rising case numbers

Department of Health and Human Services officials defended a decision to transition 13 testing sites spread across five states, including Texas where COVID-19 cases skyrocket in the state.

HHS Assistant Secretary Brett Giroir told reporters on Wednesday that the federal government had developed 41 community-based testing sites across the country at the onset of the pandemic back in March. However, the sites were meant to be limited through one or two months, he said.

But the federal government agreed at the end of May to continue the 13 sites until the end of this month.

“Those sites are not ending,” Giroir, who coordinates testing for the federal government, said. “They are transitioning to state control and state funding. The other ones might be completely redundant, that is up to the governors.”

However, local officials in Texas told Talking Points Memo that they had tried to get HHS to extend funding for the seven sites still operating in the state.

Giroir said that the federal government is still supplying free tubes and swabs for the tests and that insurers, Medicare and Medicaid can cover the cost of a test.

“These 13 sites kept up long after expiration date at the request of the state and abundance of caution to do everything we could to make sure states were comfortable in assuming those sites,” Giroir said.

He also pushed back that the Trump administration is not slowing down testing despite President Trump’s remarks made during a rally Saturday that he wants to slow down testing because it increases reported cases.

“Neither the president, vice president or no one on the task force or White House has told us to decrease testing,” he added.

UPDATED: Wednesday, June 24 at 10:14 a.m.

A look at how COVID-19 is impacting job-based health coverage

A new survey found that two in five people experienced disruptions at the jobs that provide their health coverage.

The Commonwealth Fund polled 2,271 people between May 13 and June 2 and found that of those who experienced disruptions in their jobs, one in five lost coverage entirely, or reported that their spouse did, due to the pandemic.

The results highlight the gaps that people can fall into in the design of the current health insurance ecosystem, the report's authors said.

“This survey shows how our piecemeal approach to health insurance coverage in the United States leaves too many people without coverage or just a layoff away from losing it," Sara Collins, lead author of the study and Commonwealth Fund Vice President for Health Care Coverage and Access, said in a statement. "Here in the fourth month of COVID-19 related job losses, a growing number of people won’t be able to afford health care in the midst of the worst public health crisis in modern times."

The survey found that Hispanic workers and workers with low- and middle-incomes were the most likely to experience disruption amid the pandemic. For example, 31% of Hispanic respondents reported job disruption compared to 18% of whites.

Twenty-seven percent of those with incomes below $50,000 said they experienced job disruption, compared to 16% of those with incomes above $50,000.

UPDATED: Tuesday, June 23 at 2:00 p.m.

Apple Watch adds handwashing detection feature in latest update

Apple wants to make sure that you wash your hands properly to help curb the spread of COVID-19. 

Among the announcements at Apple’s 2020 Worldwide Developer Conference Monday, the tech giant previewed watchOS 7 updates for the Apple Watch, including automatic handwashing detection.

The U.S. Centers for Disease Control and Prevention recommends people spend at least 20 seconds washing their hands to help prevent the spread of COVID-19 and other infectious diseases.

The Apple Watch now uses its motion sensors, microphone, and on-device machine learning to automatically detect handwashing motions and sounds, Apple announced.

It then initiates a 20-second countdown timer, and if the user finishes early, they will be prompted to keep washing. Apple Watch can also conveniently remind the user to wash their hands when they return home. Watches will sense when a user is coming back from a trip outside by using location data and send them an alert. 

"The Health app on iPhone will show frequency and duration of the user’s handwashing, as well as information on the importance of handwashing, as it relates to overall health," the company said.

UPDATED: Monday, June 22, at 3:21 p.m

CMS: 325K Medicare beneficiaries diagnosed with COVID by May 16

The Trump administration released new data Monday examining how COVID-19 has impacted Medicare beneficiaries, saying that 325,000 were diagnosed with the virus between Jan. 1 and May 16.

The equals about 518 cases per 100,000 beneficiaries, the Centers for Medicare & Medicaid Services said. CMS said that 110,000 Medicare beneficiaries were hospitalized for COVID-19 treatment in that same window, making for 175 COVID-19 hospitalizations per 100,000 beneficiaries.

In addition, CMS' data revealed significant racial disparities in hospitalization rates. Black Medicare beneficiaries had the highest rate of hospitalization, at 465 per 100,000. Hispanic beneficiaries were hospitalized with COVID-19 at a rate of 258 per 100,000.

Asians were hospitalized at a rate of 187 per 100,000 and whites at a rate of 123 per 100,000, according to CMS.

CMS also found that Medicare beneficiaries with other chronic illnesses were at far greater risk for COVID-19 hospitalization. Beneficiaries with end-stage renal disease, for example, were hospitalized at a rate of 1,341 per 100,000 beneficiaries.

Dually eligible beneficiaries, who are also enrolled in Medicaid and frequently have complex health needs, were hospitalized at a rate of 473 per 100,000.

CMS Administrator Seema Verma said that the findings reflect the critical need for the healthcare industry to continue pushing for more value-based care.

“The disparities in the data reflect longstanding challenges facing minority communities and low income older adults, many of whom face structural challenges to their health that go far beyond what is traditionally considered ‘medical’,” Verma said in a statement. “Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office. The transition to a value-based system has never been so urgent."

UPDATED: Monday, June 22, at 3:21 p.m.

Majority of healthcare execs prepared for second surge: survey

A majority of leading healthcare executives said in a recent survey they are prepared to handle a potential second wave of the novel coronavirus that could occur this fall.

The survey released Friday by the consulting firm Advis found that 65% of the 135 executives, the majority of which were from health systems and individual hospitals, say they are ready. That is a 15-percentage point increase from a March poll that asked the same question.

The reason providers feel they are more prepared is due to a relaxation of regulations and guidelines, Advis said.

However, while providers feel they are better prepared to meet a second surge they are still worried about the financial hit they took from the pandemic.

“Almost 70% of respondents are worked about replacing lost patient volume and revenue,” Advis said.

Another 55% are worried about staffing issues and burnout among providers, and nearly 54% are concerned that a second wave is likely to occur.

But even if a second surge is to occur, 62% said they didn’t want another lockdown or cancellation of elective procedures.

UPDATED: Friday, June 19, at 2:37 p.m.

COVID-19 could cause additional 10K breast, colon cancer deaths

The COVID-19 pandemic could cause an additional 10,000 deaths from breast and colon cancer over the next decade due to delays in screening and treatments, a top National Institutes of Health official said.

Ned Sharpless, head of the National Cancer Institute, wrote an article in the journal Science on Friday on the impact that the COVID-19 pandemic has had on cancer. Sharpless said that fear of contracting the virus has dissuaded people from getting screening, diagnosis and treatment for non-COVID-19 diseases.

“There has already been a steep drop in cancer diagnoses in the United States since the start of the pandemic, but there is no reason to believe the actual incidence of cancer has dropped,” Sharpless wrote. “Cancers being missed now will still come to light eventually but at a later stage (“upstaging”) and with worse prognoses.”

Another concern is that elective cancer treatments and surgeries have been de-prioritized at hospitals to conserve clinical capacity for COVID-19.

Sharpless added that the institute’s analysis of excess cancer deaths is conservative and doesn’t factor in other cancer types. He added the effects could be less severe in parts of the country with a shorter or less severe lockdown.

UPDATED: Thursday, June 18 at 10:23 a.m.

Blue Cross NC keeps expanded telehealth polices in place through end of year

Blue Cross and Blue Shield of North Carolina is keeping its expanded telehealth reimbursement options in place through the end of the year.

The insurer said that it will continue covering video and telephonic visits at the same rate as in-person visits for the rest of 2020. The policy was enacted in response to COVID-19.

“Blue Cross NC is committed to helping members get the quality, affordable care they need, when they need it,” said Rahul Rajkumar, M.D., chief medical officer at Blue Cross NC, in a statement. “We strongly encourage members to seek virtual care whenever possible and are committed to continuing to respond to this crisis to best serve our members, support doctors, nurses and hospitals.”

UPDATED: Thursday, June 18 at 10:10 a.m.

BCBSA survey highlights COVID's impact on pregnant women

New data from the Blue Cross Blue Shield Association finds that the COVID-19 pandemic is having a significant impact on pregnant women.

The survey of more than 1,000 commercial plan members found that 53% of women surveyed said they gave birth without a loved one in the room due to procedures put in place to avoid the spread of the virus.

In addition, 15% of women said they opted to give birth at home due to the pandemic.

The survey also found that the pandemic is pushing pregnant women to increasingly seek out virtual options, within 48% switching their prenatal care to virtual visits. 

“Protecting the health and wellbeing of expecting and current mothers remains of paramount importance to the generational health of America moving forward, especially during these uncertain times,” said Vincent Nelson, M.D., vice president of medical affairs for BCBSA, in a statement. 

UPDATED: Wednesday, June 17 at 12:00 p.m.

CHIME survey: Health executives report massive spike in telehealth visits

Most healthcare executives were doing less than 25 virtual visits a day prior to the COVID-19 pandemic. The majority are now doing 50 telehealth visits a day and a full one-third of executives are doing more than 250 visits a day, according to a survey from the College of Healthcare Information Management Executives (CHIME).

Perhaps not surprising the survey of nearly 200 digital healthcare executives revealed huge increases for virtual visits and appointments.

Even organizations that already had been seeing high volumes of patients virtually prior to COVID-19 experienced a 366% increase in the number of virtual visits. Organizations also reported a pre vs. post-COVID-19 hike in the use of remote patient monitoring, according to the survey.

CHIME conducted the online survey of CHIME’s membership between May 16 and June 1.

Many respondents listed the swift deployment and implementation of telehealth and virtual visits – some within mere days or a week – as their greatest success, CHIME reported.

Many executives noted quick adoption by clinicians and physicians as a win, along with physician and patient satisfaction with the ability to safely provide and get remote care.

Executives also faced challenges with ramping up telehealth during the pandemic, including limited supplies of high-demand technology, integration issues, patients’ lack of resources like broadband and unfamiliarity with the technology, the survey found. 

Based on their experience handling COVID-19, almost 80% suggested that telehealth would require more future funding and more than 60% supported more funding for remote monitoring.

The federal government has allowed regulatory flexibilities during the public health emergency, a move that some respondents praised and wanted to see continue. 

When asked in the survey how concerned members are with meeting upcoming federal deadlines on information blocking, more than 45% were extremely or very concerned and 25% were concerned. About 7% said they hadn’t had time to learn about the deadlines because they were devoting their attention to the COVID-19 pandemic.

Earlier this year, the U.S. Department of Health and Human Services extended the compliance deadline for the Office of the National Coordinator for Health IT’s information blocking provisions to Nov. 2. 

UPDATED: Monday, June 15 at 3:18 p.m.

FDA: Apple Watch ECG app can replace in-clinic diagnostic testing during pandemic

Apple has expanded the use of heart monitoring features of its Apple Watch under new guidance issued by the Food and Drug Administration.

The FDA has issued changes to encourage the use of remote monitoring technologies and telemedicine devices during the COVID-19 pandemic.

During the COVID-19 national emergency in the U.S., the ECG app on Apple Watch can serve as a substitute for in-clinic diagnostic testing during a telemedicine visit or virtual care, according to Apple, citing the FDA's recent guidance (PDF) that expands the use of certain noninvasive patient-monitoring technologies, including the ECG app, during the coronavirus disease 2019 (COVID-19) public health emergency.

The Apple Watch received FDA clearance in 2018 for its electrocardiogram feature, officially classifying it as a medical device capable of alerting its user to abnormal heart rhythms.

With this FDA guidance, healthcare providers can now access, for the duration of the pandemic, the expanded capability of the ECG app on Apple Watch for telemedicine services, Apple said in a notice (PDF). Healthcare providers can use the Apple Watch ECG app for clinical use cases where a single-Lead or Lead I ECG test can help effectively diagnose certain arrhythmias or manage related conditions.

Using the Apple Watch, patients can send ECG waveform recordings as a PDF to a health provider. 

"In the context of the COVID-19 public health emergency, the leveraging of current non-invasive patient monitoring technology will help eliminate unnecessary patient contact and ease the burden on hospitals, other health care facilities, and health care professionals that are experiencing increased demand due to the COVID-19 pandemic as it relates to diagnosis and treatment of patients with COVID-19 and ensuring other patients who require monitoring for conditions unrelated to COVID-19 can be monitored outside of health care facilities," the FDA said in its guidance.

Other digital health companies have taken advantage of the FDA's guidance, including Livongo, which received an emergency use authorization to allow its blood glucose monitors to be used in hospitals.

FDA also has temporarily waived requirements around low-risk software tools to address mental health.

UPDATED: Monday, June 15 at 1:30 p.m.

FDA ends emergency use authorization for chloroquine and hydroxychloroquine

The Food and Drug Administration said Monday it is ending its emergency use authorization for malaria drugs chloroquine and hydroxychloroquine.

The FDA said it has determined that the drugs are "unlikely to be effective in treating COVID-19 for the authorized uses in the EUA."

"Additionally, in light of ongoing serious cardiac adverse events and other serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use," the FDA wrote in its notice Monday.

The FDA issued the emergency use authorization for the drugs in March. 

The drugs were heavily promoted by President Trump after a handful of small, poorly controlled studies suggested that they could work in treating the disease. Trump said he took hydroxychloroquine after he had been exposed to two people who tested positive for the coronavirus.

According to a letter on Monday revoking the authorization, Denise Hinton, the FDA’s chief scientist, said the request to revoke the authorization came from the Biomedical Advanced Research and Development Authority, the unit of the Department of Health and Human Services that had initially asked for the authorization.

Several trials of hydroxychloroquine are still underway, including additional studies of whether it can be used to prevent coronavirus infection, according to The New York Times. The World Health Organization has also resumed a study of the drug.

UPDATED: Thursday, June 11, at 3:40 p.m.

FCC doles out $100 million for COVID-19 telehealth programs

The Federal Communications Commission has allocated almost $105 million in funding for 305 health providers to build up their telehealth infrastructure in the wake of the COVID-19 pandemic.

The $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, earmarked $200 million for telehealth funding. FCC has allocated half the total amount to date.

In the later round, the FCC approved an additional 67 applications for the COVID-19 Telehealth Program for $20.2 million in funding to provide telehealth services.

The FCC has faced criticism about delays in disbursing the funds. FCC Chairman Ajit Pai told the Energy and Commerce Health Subcommittee in May that only one provider had so far presented a certified invoice required by the FCC for the award money.

The latest round of funding includes close to $1 million to NYC Health + Hospitals in New York City and Northwestern Kentucky Mental Health in Covington, Kentucky. 

St. Thomas Community Health Center in New Orleans was awarded $900,000 to for its telehealth program. Renown Regional Medical Center in Reno also was awarded $977,000 to fund a virtual screening system, remote patient monitoring equipment, and laptop computers. 

Other funding recipients include Community Hospital North in Indianapolis ($872,000); Providence St. Jospeh Health Consortium in Renton, Washington ($866,000), and Greene County Health Care in North Carolina ($948,000). 

UPDATED: Thursday, June 11, at 11:42 a.m.

Hoyer: House open to liability protections for businesses

House Majority Leader Steny Hoyer said the House is open to liability protections for businesses, a key demand of the hospital industry fighting the COVID-19 pandemic.

“There may well be room to talk,” Hoyer said Thursday on a webinar hosted by the law firm BakerHostetler.

The House passed a $3 trillion economic stimulus bill that gives another $100 billion to providers and half a trillion to states and localities. But the bill has not been taken up by the Senate, where Republicans have blasted it as a partisan wish list.

Republicans have also been reluctant to pass more stimulus funding before seeing how the trillions of dollars already approved are distributed and helping the economy.

However, Republicans have wanted to include liability protection for businesses from lawsuits, a major ask for the hospital industry as well.

Hoyer seemed open to those protections if it brings Senate Republicans to the table for a deal on another round of stimulus funding.

“What we don’t want to see is blanket liability protections so there is no redress if someone does not act in a way that does not follow best practices and follow rules and regulations and the law,” he said.

But he mentioned that House Democrats agreed to give 3M liability protection for an order of masks during an earlier stimulus package back in March.

“We did it before, and if the Senate comes to the table and wants to compromise and that is part of their proposal I certainly think that would get fair and fulsome consideration,” he said.

UPDATED: Thursday, June 11 at 10:04 a.m.

HHS awards $8M for training, technical assistance

The U.S. Department of Health and Human Services awarded $8 million to support training for health centers in responding to the COVID-19 pandemic. 

More than 70 organizations were awarded the funding to provide the training and technical assistance to health centers funded by HHS' Health Resources and Services Administration.

Primary care associations received nearly $6 million to conduct COVID-19 training activities based on the needs of states and regions, officials said. As well, National Training and Technical Assistance Partners (NTTAP) received $2.5 million for helping to strengthen health center operations and capacity to ensure access to comprehensive primary care services.

“During the COVID-19 pandemic, it is critical to continue providing Americans with access to comprehensive primary care services, and these funds will provide the training and technical assistance for health centers to accomplish that goal,” said HHS Secretary Alex Azar in a statement. 

UPDATED: Tuesday, June 9 at 12:28 p.m.

BCBSRI offers 25% dental premium credit

Blue Cross and Blue Shield of Rhode Island is making a 25% premium credit on dental plans available, while also growing its teledentistry offerings.

The premium credit will be applicable to fully insured plan members, the insurer announced. It will cover March, April and May and appear as a one-time credit on July invoices for those who purchase dental care directly through BCBSRI.

Customers who buy dental coverage from HealthSource RI will receive a check in the mail for the credit.

BCBSRI also said it will extend coverage for teledentistry provided by in-network dentists through July 31.

“The COVID-19 pandemic and the resulting stay-at-home order have made it incredibly challenging for our dental members to access routine dental care, and offering premium relief is just one of the ways we can help,” said Kim Keck, BCBSRI president and CEO, in a statement. “We also recognize that visiting a dentist in person may not be a viable option for those who are older or who have underlying health conditions that put them in the higher risk category."

UPDATED: Monday, June 8, at 4:34 p.m.

Molina extends COVID-19 cost waivers till end of 2020

Molina Healthcare said it will continue to waive all out-of-pocket costs associated with COVID-19 treatment through the end of 2020.

The extension applies to its Medicare, Medicaid and Affordable Care Act exchange customers.

“We want to entirely remove the burden of any expenses associated with testing and treatment for COVID-19,” said Jason Dees, the insurer’s executive vice president and chief medical officer.

Molina had announced the cost waivers a few months ago but did not say when they would expire.

The announcement comes a few days after Anthem decided to extend the cost-share waivers through the end of 2020. Anthem also extended the coverage and waived cost-sharing for virtual care through Sept. 30.

UPDATED: Monday, June 8 at 1:20 p.m.

Study: Shutdown measures prevented 60M coronavirus infections in the U.S.

Wide-spread closings and stay-at-home orders prevented about 60 million novel coronavirus infections in the United States and 285 million in China, according to a new research study published Monday.

Researchers examined how six countries — China, the United States, France, Italy, Iran, and South Korea — responded to the pandemic and how social distancing restrictions, business closings, travel bans, and stay-at-home policies limited the spread of the contagion.

The researchers concluded that the six countries collectively managed to avert 62 million confirmed COVID-19 cases. As most people who are infected never get tested, the actual number of infections that were averted is much higher, corresponding to preventing roughly 530 million total infections, according to the research published in the journal Nature.

The estimates suggest that there would be roughly 37 million more cumulative confirmed cases in China (or 285 million more total infections, including the confirmed cases); 11.5 million more confirmed cases in South Korea (38 million total infections); 2.1 million more confirmed cases in Italy (49 million total infections); 5 million more confirmed cases in Iran (54 million total infections); and 1.4 million more confirmed cases in France (45 million total infections) had these countries never enacted any anti-contagion policies since the start of the pandemic.

In the U.S., without these lockdown measures, there would be 4.8 million more confirmed cases, or 60 million total infections, the researchers said.

Large-scale anti-contagion policies are slowing the COVID-19 pandemic, the researchers said.

"We hope these results can support critical decision-making, both in the countries we study and in the other 180 + countries where COVID-19 infections have been reported," the study authors said.

"Societies around the world are weighing whether the health benefits of anti-contagion policies are worth their social and economic costs. Many of these costs are plainly seen; for example, business restrictions increase unemployment and school closures impact educational outcomes," Solomon Hsiang, director of the Global Policy Laboratory at the University of California at Berkeley, and the leader of the research team wrote.

"It is therefore not surprising that some populations have hesitated before implementing such dramatic policies, especially when their costs are visible while their health benefits – infections and deaths that would have occurred but instead were avoided or delayed – are unseen," Hsiang said.

“Without these policies employed, we would have lived through a very different April and May," Hsiang told The Washington Post.

UPDATED: Friday, June 5 at 1:56 p.m.

Intermountain offering acute-level care in patients' homes

Intermountain Healthcare is offering hospital-level care in patients' homes in partnership with Castell.

The health system accelerated the process of launching the program as part of its work to manage a surge of patients with COVID-19. The service will be offered to patients with congestive heart failure, some kidney conditions, certain intestinal or vein conditions, infections such as cellulitis and certain cancer diagnoses.

Intermountain said that the home care program is meant to avoid unnecessary trips to the emergency department, and shorten the length of hospital stays, while maintaining patients' acute care needs.

“The hospitals of the future will expand virtually into homes to provide appropriate acute-level care. This new service supports patients who are at risk for hospitalization or complications, along with their families,” said Rajesh Shrestha, Castell CEO and Intermountain vice president and chief operating officer for community-based care, in a statement.

“Many patients find they feel more calm and comfortable at home than in a hospital, and that in itself can be conducive to healing. It also allows people to be more independent,” Shrestha said.

UPDATED: Friday, June 5, at 12:45 p.m.

BARDA, Evidation Health developing earning warning system for COVID-19

Technology company Evidation Health is working on an early warning algorithm for coronavirus symptoms, with backing from the Biomedical Advanced Research and Development Authority.

The system, which is also funded by the Bill & Melinda Gates Foundation, will analyze behavior, including sleep and activity patterns, alongside self-reported symptoms for 300 people at high risk of developing COVID-19.

The analysis, performed in collaboration with non-profit 4YouandMe, will use de-identified data generated by self-reporting and wearable devices to track symptoms of COVID-19 in those at particularly high risk, including health care workers and other first responders, in order to better understand susceptibility to SARS-CoV-2 infection.

One potential outcome of this work is an early warning algorithm to help individuals better understand and monitor their respiratory disease symptoms and take precautions against their spread, the organizations said.

"This pilot study is not only an early step in demonstrating the utility of models developed using person-generated health data but also may provide data to better understand the varied symptoms of COVID-19," said BARDA Acting Director Gary Disbrow, Ph.D., in a statement.

UPDATED: Thursday, June 4, at 1:30 p.m.

Nursing home deaths increase to 32,000 as more report data

The number of COVID-19 deaths increased to 32,000, up from 25,000 reported earlier this week, the Trump administration said on Thursday.

The Centers for Medicare & Medicaid Services said there have been more than 95,000 confirmed cases in nursing homes, an increase from the roughly 60,000 cases that the agency reported on Monday.

CMS Administrator Seema Verma told reporters on a call Thursday that the increase is likely due to more nursing homes reporting data to the federal government.

She said that on Monday there were 80% of nursing homes giving out data, compared with 88% on Thursday. That represents almost 14,000 nursing homes out of the roughly 15,000 that exist in the U.S.

“These numbers are going to move in the next couple of weeks. We see more nursing homes reporting in,” she added.

Verma added that the Nursing Home Compare website will be updated so people can view the COVID-19 infections and death data for a specific nursing home.

She expects to have a weekly update on the nursing home infections and deaths due to COVID-19.

UPDATED: Thursday, June 4 at 1:08 p.m.

Majority of counties lack infectious diseases physicians

Nearly two-thirds of Americans live in areas with little or no access to infectious disease specialists, according to a study published in the Annals of Internal Medicine.

The study comes amid the spread of the COVID-19 virus. Researchers led by Rochelle Walensky, MD, of Massachusetts General Hospital, also found 80 percent of counties with the highest numbers of people diagnosed with the virus have below-average access to infectious disease physicians.

“The deficits in the [infectious diseases] workforce today have left us poorly prepared for the unprecedented demand ahead," Walensky said in a statement.

The expansion of telehealth, or virtual doctor visits, can expand the reach of infectious disease physicians, but will need to be supported by health coverage providers, the authors wrote.

UPDATED Wednesday, June 3 at 4:53 p.m.

Fitbit received emergency use authorization

Wearables company Fitbit received emergency use authorization from the FDA for a new emergency ventilator device.

The FDA nod pertains to use during the COVID-19 public health emergency.

Fitbit’s R&D, engineering and design teams worked quickly to apply their collective expertise in advanced sensor technology, signal processing, robotics, hardware development, and manufacturing to develop the device, called Fitbit Flow.

The company also consulted with clinicians at Oregon Health & Science University and MassGeneralBrigham Center for COVID Innovation, who are treating COVID patients, on the design to meet the needs of practitioners.

Fitbit Flow is an automatic resuscitator inspired by the MIT E-Vent Design Toolbox and based on specifications for Rapidly Manufactured Ventilation Systems, the company said.

 Fitbit Flow builds on standard resuscitator bags, like those used by paramedics, but the device is designed to be intuitive and simple to use, potentially helping to reduce the strain on specialized staff who are typically needed to operate a commercial ventilator, according to the company.

Other similar emergency ventilators vary in the combination of features they offer, but Fitbit believes that none delivers all of the attributes of its device at the same lower price range.

The company is in talks with state and federal agencies to understand current domestic needs for emergency ventilators and plans to work with U.S. and global aid organizations. Fitbit’s intent is to make the devices available to help address both current needs and potential future resurgences of the virus. 

Fitbit also plans to make the design available via open-source software to promote further collaboration. 

UPDATED Wednesday, June 3 at 11:50 a.m.

Banner Health launches telehealth in all hospital COVID-19 units 

Banner Health is deploying telehealth in all of its inpatient COVID-19 units, the Phoenix-based health system announced Wednesday. 

Banner partnered with VeeMed, a global telehealth company focused on virtual technology and physician services to rollout the new tool. They also partnered with Intel, which through their Pandemic Response Technology Initiative, provided NUC compute devices with Intel vPro Technology, which transformed the patient room televisions to allow two-way video conferencing.  

Using the technology, physicians and specialists can now access patients via two-way audiovisual technology from a safe and private location in the hospital instead of having to physically enter each patient room. They can speak with patients, view their vital sign monitors and, using the advanced camera option, can zoom in close enough to even check a patient’s pupils, officials said. 

The telehealth offering will help preserve personal protective equipment (PPE) and improve patient and staff safety in the busy patient care units, they said. 

“The process is streamlined to maintain efficiency in our existing workflows, while preserving vital PPE supplies,” said Syed Ismail A. Jafri, MD, physician executive for hospital medicine with Banner Medical Group in a statement. “More importantly, the physician-patient relationship has gotten stronger along the way.” 

Banner plans to expand the telehealth to its Banner Health Emergency Rooms next. 

UPDATED Tuesday, June 2 at 10:20 a.m.

Blue Cross NC extends Medicare Advantage copay waivers through end of 2020

Blue Cross and Blue Shield of North Carolina will waive Medicare Advantage copayments for primary care and outpatient behavioral healthcare through the end of 2020, the insurer announced Tuesday.

Blue Cross NC said that the covered visits must be to in-network providers but do not have to be specifically for COVID-19-related visits. Both in-person and telehealth visits will be applicable.

The Blues plan has 69,000 Medicare Advantage members.

“Blue Cross NC is committed to doing all we can to best serve our members during this public health crisis,” said Rahul Rajkumar, chief medical officer at Blue Cross NC. “By eliminating these copays, we hope that it will make it easier, and encourage our senior members to get the care they need.”

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