PART 19. April 14, 2020 CORONOAVIRUS. “…overlooked in the.. mobilization against..coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

1. NY hospitals operating as one system. 2. CV impact on essential services “under the radar.” 3. Private Equity Firms change the face of hospitals.

to read posts 1-19 in chronological order highlight and click on

CORONOVIRUS TRACKING Links to Parts 1-19

New York hospitals are beginning to operate as one system under a new plan by Gov. Andrew Cuomo as the state tries to increase its medical capacity to stop the coronavirus pandemic.

Right now, New York’s hospitals are no longer operating as independent facilities. Under the plan announced this week by New York Gov. Andrew Cuomo, there is effectively one big New York state hospital system fighting off the coronavirus…

Cuomo announced that he had met with New York hospital leaders and come up with a plan to, in effect, merge them into one operating system with many different locations. From Buffalo to NYC, hospitals will be sharing staff, patients, and supplies for the foreseeable future, with Albany overseeing the distribution of resources.

“It’s not unusual for a time of an emergency for regulatory authorities to basically say, ‘Hospitals, you must do this.’ Usually there are provisions in state law that enable that to happen,” Susan Dentzer, a senior policy fellow at Duke University’s Margolis Center for Health Policy, told me. Hurricane Katrina is one recent example she gave.

But the plan is still remarkable. There are about 200 hospitals in New York state, totaling 53,000 beds before Cuomo told them to double their capacity. About 20,000 of those beds are in New York City.

It is a matter of necessity, as New York has already seen more than 100,000 Covid-19 cases and 1,500 deaths — with the peak still projected to be a week away, according to the Institute for Health Metrics and Evaluation’s estimates, requiring as many as 100,000 beds.

“This is on a scale that has not happened in the United States ever, with the possible exception of 1918,” Dentzer said of the New York strategy. “Nothing on this scale has ever happened in at least 100 years.”

I asked Peter Viccellio, associate chief medical officer at the Stony Brook emergency department in Long Island, about the New York hospitals plan. I want to share his response in full:

We’re in an almost apocalyptic crisis, which requires cutting through the bullshit. If hospital A has resources and hospital B doesn’t, it’s in the best interest of the patient that hospital A and B work together. Protective equipment should be available to all health care providers, not just those who work at a place with a better procurement officer. We ALL need the proper equipment to treat the patient, and adequate space. Fighting against each other for resources — this isn’t the time. Resources need to be distributed in a rational way. The current rugby scrum is nonsense.

The top priority in Cuomo’s plan is moving staff from less affected hospitals to those buckling under a surge of Covid-19 cases. Doctors and nurses from upstate hospitals will be transferred to NYC facilities. Likewise, hospitals will try to send patients from overcrowded hospitals to those with available beds. Ventilators, which support critical patients’ breathing, could also be shuffled between hospitals based on need.

The New York state department of health will manage the movement of staff and resources, in conjunction with hospitals. It will set certain thresholds for the number of occupied ICU beds or ICU Covid-19 cases that would trigger some of these transfers. The state will also coordinate the distribution of the protective gear that helps keep doctors and nurses healthy and able to work from the various state and hospital stockpiles…

This kind of coordination is relatively commonplace within a single hospital system that has multiple facilities. What’s unique here is the scale: an entire state merging all of its hospital systems into one.

And that will present plenty of challenges both logistical (what happens when patients move from an in-network hospital to an out-of-network one?) and personal (are patients going to be moved far away from their families?). A few more questions, via the Kaiser Family Foundation’s Larry Levitt: What are the payment rates and who is paying? Do hospitals have to pay each other when one sends another resources?

“I do think it’s going to be incredibly messy and complicated to sort out reimbursement of all this on the back end,” he said.

Another one: Is Congress going to provide more funding to bail out hospitals in New York and elsewhere, which have taken a brutal financial hit as they cancel elective surgeries to free up more beds and staff to battle Covid-19?

We’ll need answers to those questions. But the time for radical action is here. As Joynt Maddox put it, “If not now, when?”

“This is the kind of organization we need in a pandemic, with very clear guardrails around the scenarios under which it’s put into place and under which it no longer applies,” she said. “I can see plenty of potential problems, but plenty of upside too.”

New York is the first state to take such a dramatic step as the coronavirus takes its toll there. But it may not be the last. (A)

The state’s largest private employer (the Mayo Clinic) is instituting across the board pay cuts and furloughs to shoulder a projected $3 billion loss this year.

Mayo Clinic’s cost-cutting measures follow its decision in mid-March to halt elective surgeries and procedures — a move that was quickly applied statewide as part of Gov. Tim Walz’s executive order to suspend non-critical medical procedures not deemed essential to save a life.

“The decision to eliminate elective surgeries and outpatient visits was the right decision in terms of protecting the safety of our patients and staff, and also preserving limited PPE (personal protective equipment),” said Chief Administrative Officer Jeff Bolton. “But it has led to significant reductions in revenues.”

Bolton said the hospital in Rochester is at about 35 percent of capacity, while capacity in Mayo’s surgery services is at about 25 percent.

“If you go back to the Great Depression, the institution went through a very similar financial crisis, and salaries were reduced during that period of time,” said Bolton. “There were a lot of actions that were very similar to the ones we are taking today.”

The pay and work reductions, which will apply to all employees at Mayo’s campuses in Minnesota, Florida and Arizona, will start in May, and last until the end of the year. Together, Mayo employs more than 63,000 people…

Mayo Clinic executives, including CEO Gianrico Farrugia, will take a 20 percent cut starting this month. Physicians and senior administrators will take a 10 percent salary cut, other salaried employees will take a seven percent reduction, while other workers will be asked to take extended furloughs.

That’s in addition to a hiring freeze, laying off contract employees and halting some construction projects, Bolton said.

Even after these changes, Mayo will face a $900 million shortfall at the end of the year, which will be covered by Mayo’s reserves established over the last decade, Bolton said.

Bolton said cost-cutting measures will not affect the pay rate of hourly workers.

The financial blow of halting elective services comes on the heels of what Mayo officials had described as a “year of remarkable growth.” In 2019, Mayo reported revenue of $13.8 billion, which was up nearly 10 percent from the previous year.

For the first time in Mayo’s history, net operating income topped out at $1 billion…

Bolton added that Mayo’s ability to rebound after the end of the year will also depend on how long the pandemic lasts, and if a global recession impacts how many patients travel to Mayo for treatment.” (B)

“HHS’ Office of Inspector General released a report April 6 that details the challenges hospitals are confronting due to COVID-19, how they are responding, and what they are asking of the government to better meet their needs during the coronavirus crisis.

The OIG conducted brief telephone interviews March 23-27 with administrators from 323 hospitals across 46 states, the District of Columbia and Puerto Rico, which were part of a random sample. Hospital administrators shared the following challenges their organizations face in response to COVID-19, as well as how they would like the government to respond:

1. Challenge: Severe shortages of testing supplies and extended waits for results. Hospitals reported frequently waiting seven days or longer for test results, which results in a number of “rule-out” cases that strain existing challenges with staffing, bed availability and shortages of personal protective equipment. According to one hospital, 24 hours is typically considered a long turnaround time for virus testing.

Hospitals’ ask: Hospitals expressed a need for greater coordination from the federal government around testing kits and supplies to provide “equitable distribution of supplies throughout the country,” according to the report. Hospitals also asked for the government to provide testing kits, take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests, and expedite results by allowing more entities to produce and conduct tests.

2. Challenge: Widespread shortages of PPE. stockpile, or that the supplies they had received were insufficient in quantity or quality.

3. Challenge: Difficulty maintaining adequate staffing and supporting staff. Hospitals cited need for specialized staff, concerns that staff exposure to the virus will exacerbate shortages and overwork, and concerns about the emotional toll that staff face.

4. Challenge: Decreased revenue, increased costs and gaps in reimbursement. Hospitals have essentially stopped elective procedures and many other services, which accounts for a substantial portion of hospitals’ revenue.

5. Challenge: Changing and/or inconsistent guidance from authorities. (C)

“CMS announced April 9 that it has delivered more than $51 billion in payments to hospitals and other healthcare providers in the past week through the Accelerated and Advance Payment Program.

CMS expanded the payment program to a broader group of healthcare providers in late March to help offset the financial impact of COVID-19. On April 7, the agency said it had distributed $34 billion in funds to healthcare providers and suppliers through the program in the past week. Two days later, CMS said the amount had grown to $51 billion.

CMS has received roughly 32,000 requests from healthcare providers and suppliers for advance payments in the past week, and 21,000 of those requests have been approved. That’s compared to the 100 total requests CMS approved in the past five years.” (D)

“The $2 trillion federal coronavirus aid package signed into law that includes $100 billion for nonprofit hospitals won’t completely cover the revenue hospitals will lose as a result of the pandemic, Moody’s Investors Service wrote in an April 3 note.

While the aid package includes several provisions like compensation for lost revenue, increased Medicare reimbursement and advances on future Medicare reimbursement, cash flow at nonprofit hospitals will still likely be materially lower for the next several months. Postponed services alone are likely to reduce hospital revenue by 25 percent to 40 percent a month on average, Moody’s said, a reduction that is affecting even hospitals that aren’t treating large COVID-19 case loads.” (E)

“As the coronavirus crisis intensified, and many Americans started losing their employer-based health coverage, the Trump administration considered creating a special open-enrollment period for the Affordable Care Act. It seemed like a common-sense move, which had the backing of private insurers.

But the White House balked, to the surprise of nearly everyone involved in the process. As Politico reported the other day, the decision appeared to be largely political: Team Trump didn’t want to turn to “Obamacare” to help people in a crisis.

“You have a perfectly good answer in front of you, and instead you’re going to make another one up,” one Republican close to the administration said. “It’s purely ideological.”

It also left the White House in search of a policy alternative. Roll Call reported on the apparent solution: the administration plans to reimburse providers for uninsured COVID-19 patients.

Health and Human Services Secretary Alex Azar said at a White House press briefing that hospitals and health care providers would be reimbursed at Medicare rates for the treatment of uninsured patients. Providers would be banned from balance billing patients or sending them a surprise medical bill to make up the difference in costs not covered by the government.

Note, there was already a policy in place to cover the cost of virus testing, regardless of coverage status. This new policy goes considerably further: uninsured Americans who get the virus will be able to go to the hospital and receive care, and the federal government will reimburse the medical facilities for the cost…

There are, however, some lingering concerns. For one thing, many hospital administrators have said their facilities are facing a severe financial crunch now, and the new policy is based on after-the-fact reimbursements. That money will arrive, but not anytime soon…

A New York Times report added that there are other concerns about whether the funding will go to facilities in the states hardest hit by the crisis: “The administration’s plan … would tend to shift more money toward states with more uninsured patients. New York, California and Washington, which have experienced early surges in infections, entered the crisis with very low levels of uninsured residents. Republican-led states, like Florida and Texas, that have declined to expand Medicaid are likely to benefit more from funding targeted directly at uncompensated care.” (F)

“Hospital CEOs are blasting HHS’ decision to distribute the first $30 billion in emergency funding based on Medicare fee-for-service revenue, according to Kaiser Health News.

HHS said April 10 it would allocate money to hospitals and providers based on their historical share of revenue from the Medicare program, rather than the burden caused by the coronavirus or number of uninsured patients treated….

Kenneth Raske, CEO of the Greater New York Hospital Association, wrote in a memo to association members that the method is “woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in ‘hot spot’ areas such as the New York City region.”..

An HHS spokesperson told Kaiser Health News the agency decided to use Medicare revenue as the basis of distribution because it “allowed us to make initial payments to providers as quickly as possible.” (T)

“The CEO and executive leadership team at Mount Sinai Health System will take pay cuts to help offset the significant COVID-19 costs the New York City-based health system is facing.

Mount Sinai President and CEO Kenneth Davis, MD, and his executive team offered and agreed to take a 50 percent pay cut, according to information the health system shared with Becker’s Hospital Review April 9. The pay cuts will continue “as long as necessary so that these dollars can be directed to our front lines in this fight,” the health system said.” (G)

“California Gov. Gavin Newsom said April 8 that the state is working to gather more  demographic information on COVID-19 patients. One major finding revealed that healthcare workers made up roughly 10 percent of the confirmed cases as of April 7, according to The New York Times.” (H)

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“All day, most days, for $10 an hour, Marley Brownlee comes and goes from the homes of the old and the weak.

She has almost none of the equipment that could protect her vulnerable clients — or herself — from the deadly virus that has transformed life across the United States. No masks, goggles or gown. She takes what precautions she can using gloves, hand sanitizer and disinfectant wipes. Her hands are raw from washing, and last week, she considered spraying herself down with Lysol between appointments.

Brownlee is one of the millions of health-care workers whose challenges have been largely overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes. At least 12 million people in the United States depend on such services every year, according to the National Association for Home Care and Hospice, many of them older or coping with severe disabilities.

It is a sprawling sector of the U.S. health-care delivery system — and one whose fortunes could be critical in efforts to contain covid-19, the deadly lung disease caused by the coronavirus. With nursing homes across the country locked down and hospitals preparing for an onslaught of covid-19 patients, many who require medical services or help with the basic tasks of daily living are likely to be confined to their homes in the weeks and months ahead. Yet the providers of those services say they are unprepared to step into the breach, hamstrung by regulations ill-suited to the current pandemic and unable to access protective gear that could shield workers and clients alike from infection.

“There’s no doubt that we’re being sort of forgotten in all this, and I fear that mentality is going to eventually come back and punish us,” said Joe Russell, executive director of the Ohio Council for Home Care and Hospice. “If we’re carrying this disease from household to household, these people are just as vulnerable as anybody in a hospital or a nursing home.”..

Such concerns are being pressed in states across the country and in Washington, where home-care industry leaders are pleading with Trump administration officials and members of Congress not to exclude their providers from the nation’s belated efforts to launch a coherent policy response to the pandemic.” …

They have two primary requests: An adequate supply of protective equipment — including the scarce N95 masks that are most effective in preventing transmission of the coronavirus — and increased flexibility in Medicare regulations that govern person-to-person contact at patients’ homes…

The home-care industry lacks the prominence and cachet of American hospitals, especially its most celebrated medical centers. No agency that sends workers into houses to help a stroke victim learn to mount the stairs again or assist a patient with a wheelchair in the bathroom vies for recognition with Johns Hopkins Hospital or the Cleveland Clinic. Yet home care has grown into a pillar of the medical and senior-care systems, serving both older clients who wish to avoid nursing homes — now more than ever — and people with disabilities, who in previous decades were often clustered in large institutions.” (S)

“Washington (CNN)A sailor who tested positive for Covid-19 on the USS Theodore Roosevelt has died of coronavirus, the US Navy said Monday.

The Navy did not disclose the name of the sailor, who was admitted to the intensive care unit of a US Navy hospital on Thursday. CNN previously reported a sailor from the USS Theodore Roosevelt who tested positive for the virus March 30 was found unresponsive and placed in the intensive care unit during a daily medical check.

The Navy said that the sailors who found him unresponsive attempted to administer CPR prior to his being transferred to the intensive care unit.

In addition, a US defense official told CNN that four sailors from the ship have been transferred to hospital.

Nearly 600 sailors on the Roosevelt have tested positive for Covid-19, the US Navy said in a statement, adding that 92% of the Roosevelt’s crew members have been tested for the virus.

The impact of the coronavirus pandemic on the Roosevelt was at the center of a controversy that led to the resignation last week of acting Navy Secretary Thomas Modly, who had dismissed the aircraft carrier’s captain Brett Crozier after the leak of a memo in which he implored Navy officials to urgently evacuate the ship to protect the health of its sailors. Crozier also flagged his concerns about challenges of trying to contain the virus aboard the ship and requested that sailors be allowed to quarantine on land.

“We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset: our Sailors,” he wrote in the memo that three US defense officials confirmed to CNN.

More than 4,000 sailors have since been evacuated and moved ashore in Guam. Sailors who have tested negative for the coronavirus are being housed in isolation in local area hotels.

The Navy says it is required to keep about 1,000 sailors aboard the vessel to perform key functions such as the operation of the ship’s nuclear reactors…

Vice Chairman of the Joint Chiefs of Staff Gen. John Hyten told reporters Thursday the US military needed to plan for similar outbreaks in the future as the Defense Department works to cope with the virus’ impacts.

“I think it’s not a good idea to think the Teddy Roosevelt is a one-of-a-kind issue. We have too many ships at sea, we have too many deployed capabilities. There’s 5,000 sailors on a nuclear-powered aircraft carrier. To think it will never happen again is not a good way to plan. What we have to do is figure out how to plan in these kind of Covid environments,” Hyten said.

Nearly 3,000 US service members have tested positive for coronavirus, two service members have died.” (I)

“There is much that the military can do to protect the American populace from the coronavirus’s ravages, and service members undoubtedly wish they could do more. They should have been well positioned to do just that: Internal 2017 documents obtained Wednesday by The Nation show that the military had planned for a coronavirus-type pandemic and predicted many of the same equipment shortages that the U.S. is now experiencing. But the data and murmurs emerging from the U.S. national security complex paint a picture of a hamstrung bureaucracy that’s as ill-prepared to protect its own people as most states are.

Numbers tell part of that story. As of last Friday, the Pentagon had reported 613 cases of Covid-19 in its combined military and civilian workforce, putting its total ahead of 28 states’. (The Department of Defense’s “population” of about 2.9 million people, by contrast, only makes it bigger than the population of 15 states.) But by Monday, military-linked infections had already topped 1,000, and Esper had ordered all U.S. commanders across the globe to stop reporting new infections on their installations to the public, calling such reports “information that is classified as a risk to operational security.” Subordinates of Esper at several U.S. military bases told Stars & Stripes that the order “could harm their ability to inform their own force and strain their ability to work with officials in their surrounding civilian communities amid the pandemic.”

Local military commands are already in disarray in many respects. The Navy is fast learning that ships and bases are breeding grounds for the coronavirus; in addition to the Roosevelt outbreak, cases have been reported on the USS Ronald Reagan and USS Boxer, as well as at the service’s boot camp and the Naval Academy. New York–based recruiters for the Marine Corps begged the service last week to shut down its boot-camp training base at Parris Island, South Carolina—always a close-quarters hotbed for germs. “Decision-makers are absolutely in denial if they believe high rates of infection and hospitalization will not happen on the depot under close proximity and enclosed spaces,” one Marine told Military.com. By Monday, Marine Corps officials were forced to relent, after at least 20 Parris Island recruits and trainers tested positive for the virus; the service’s West Coast boot camp in San Diego, however, remains open.” (J)

“At Crown Heights Center for Nursing and Rehabilitation in Brooklyn, workers said they had to convert a room into a makeshift morgue after more than 15 residents died of the coronavirus, and funeral homes could not handle all the bodies.

At Elizabeth Nursing and Rehabilitation Center in New Jersey, 19 deaths have been linked to the virus; of the 54 residents who remain, 44 are sick.

After 13 people died in an outbreak at the New Jersey Veterans Home in Paramus, the governor called in 40 combat medics from the National Guard…

The virus has perhaps been cruelest at nursing homes and other facilities for older people, where a combination of factors — an aging or frail population, chronic understaffing, shortages of protective gear and constant physical contact between workers and residents — has hastened its spread.

In all, nearly 2,000 residents of nursing homes have died in the outbreak in the region, and thousands of other residents are sick.

As of Friday, more than half of New York’s 613 licensed nursing homes had reported coronavirus infections, with 4,630 total positive cases and 1,439 deaths, officials said…

In New York, nursing home administrators said they had been overwhelmed by an outbreak that quickly spun beyond their control. They were unable, they said, to have residents tested to isolate the virus or to get protective equipment to keep workers from getting sick or transmitting the virus to residents.

“The story is not about whether there’s Covid-19 in the nursing homes,” said Scott LaRue, the chief executive of ArchCare, which operates five nursing homes in New York. “The story is, why aren’t they being treated with the same respect and the same resources that everyone else out there is? It’s ridiculous.”” (K)

“POLICE FORCES ACROSS the country are being increasingly hobbled by the coronavirus outbreak, with officers falling ill and operations being adjusted as the numbers of cases and deaths increase exponentially.

Approximately 17% of uniformed New York City Police Department employees – more than 6,000 total – are currently out sick, a department spokeswoman says. But 1,400 NYPD officers have now tested positive for the coronavirus, Commissioner Dermot Shea told CNN – a large increase over the number reported by the department as recently as Tuesday…

But police departments are being crunched in many other cities. Detroit Mayor Mike Duggan announced Monday that nearly 500 of the city’s police officers and more than 100 civilian employees were quarantined due to exposure to the coronavirus, according to WJBK-TV in Detroit. Sixty-nine Detroit Police Department officers and employees had tested positive as of Monday. Major metropolitan police departments in cities like Boston, Chicago, Los Angeles and New Orleans have positive cases as well, according to The Associated Press…

Police agencies across the country are responding to the crisis in a variety of ways, according to the Police Executive Research Forum, an independent research organization.

Some departments have begun suspending in-person briefings, while many others have postponed training and limited public access to police facilities, according to the organization. Garcia says the San Jose Police Department started conducting its daily briefings outside so that people could spread out more.

Policing itself is also being adjusted – many agencies are directing officers to avoid handling calls in person when possible and discouraging arrests for low-level offenses, the forum finds.

Garcia says that while his department started making preparations six weeks ago – long before California Gov. Gavin Newsom issued a stay-at-home order for the state’s 40 million residents – the outbreak has since affected operations, including shift changes and the daily briefings tweaks. But he is proud of how his staff has “risen to this challenge.”..

But Garcia notes that, in San Jose at least, “things pop up every day,” including calls regarding gatherings that might be violating the shelter-in-place order.

“There’s no playbook for this,” Garcia says. “Every day there’s something different that we’re trying to come up with.” (L)

“Much attention in this terrible pandemic is being focused on the country’s hospitals, and rightly so. But the battle is also being fought by the nation’s front-line emergency medical workers, paramedics and E.M.T.s. These skilled professionals are responding to a deluge of calls, risking their lives to aid millions of sick Americans.

In New York City, where the Fire Department’s roughly 4,400 emergency medical workers are already underpaid and overworked, the pandemic is taking an enormous toll.

They are responding to 6,000 to 7,000 calls a day; in normal times, the average is about 4,000. Nearly a quarter of these workers are on sick leave, according to Fire Department officials. At least three are in critical condition with coronavirus symptoms.

One question amid the shortage is how many face masks in the city’s stockpile are actually making it to the E.M.T.s, paramedics and other city workers who are most at risk. City officials declined to respond to repeated inquiries about how the masks and other critical medical supplies were being distributed across city agencies.

Mayor Bill de Blasio said at a news conference Tuesday that the F.D.N.Y. commissioner, Daniel Nigro, had assured him the department had the supplies it needed. The mayor said the department was meeting a “crisis standard” of personal protective equipment held as acceptable by the Centers for Disease Control and Prevention. “Anything more they need, they will get,” Mr. de Blasio said.

In interviews, they said some stations started running out of N95 masks weeks ago. They said they have been forced to reuse masks, gowns and other protective gear. To request additional N95 masks, they said they must explain in writing how they used their previous supply. And they said there is little or no coronavirus testing available to them or their colleagues…

How did this happen in New York, a city with a world-class department justly celebrated for its heroic service during the Sept. 11 attacks?

Emergency medical services have been an afterthought in New York for years. In much of the country, firefighters also serve as paramedics or E.M.T.s. But in New York, E.M.S. is a separate division within the Fire Department. Firefighters receive a base pay of about $85,000 after five years on the job, compared to about $65,000 for paramedics and $50,000 for E.M.T.s. The firefighting force is three-quarters white and about 99 percent male; more than half of E.M.S. workers are minorities, and more than a quarter are women, according to city data.” (M)

“As the coronavirus preys on the most vulnerable, it is taking root in New York’s sprawling network of group homes for people with special needs.

As of Monday, 1,100 of the 140,000 developmentally disabled people monitored by the state had tested positive for the virus, state officials said. One hundred five had died — a rate, far higher than in the general population, that echoes the toll in some nursing homes.

Separately, a study by a large consortium of private service providers found that residents of group homes and similar facilities in New York City and surrounding areas were 5.34 times more likely than the general population to develop Covid-19 and 4.86 times more likely to die from it. What’s more, nearly 10 percent of the homes’ residents were displaying Covid-like symptoms but had not yet been tested, according to the consortium, New York Disability Advocates.

Trouble throughout the New York City region — and, to a lesser extent, the state — was revealed in interviews with caregivers, parents, advocates and senior officials.

In Brooklyn, two parents of adult children in a group home said they were unnerved after another resident died in a suspected coronavirus case. “If it is the virus, what the hell are we going to do?” one of them said, while adding that the staff “deserve a lot of credit” for showing up.

On Staten Island, three state employees who are direct caregivers said 50 of their roughly 600 colleagues in the borough had tested positive. They described the challenges they faced on the job.

“One of the individuals here is positive, and his behavior is to get up, to pace, and he wants to give me a hug, shake my hand,” said one of the caregivers, asking that his name not be used because he was not authorized to speak.” (N)

“Seventy people at San Francisco’s largest homeless shelter have tested positive for the coronavirus, Mayor London Breed said on Friday.

The outbreak, which included two staff members, is the largest reported at a single shelter in the United States. It reinforces a major fear that homeless people, many whom have pre-existing respiratory illnesses, are especially vulnerable to the pandemic.

Advocates in San Francisco, where there are more than 8,000 homeless people, had expressed concern in recent weeks that the city had not moved quickly enough to use empty hotel rooms to thin out the shelter system.

California has procured more than 8,000 hotel rooms for homeless people and those who need to quarantine themselves, far short of the more than 100,000 people in the state who sleep on the streets.

The shelter where the outbreak occurred, Multi-Service Center South, normally houses around 400 people. In recent weeks, the city had reduced that number of occupants to 144, all of whom were tested on Friday.

The outbreak underlined the breathtaking speed at which the virus can spread in a congregate setting…

Experts say cities face a dilemma in addressing the homelessness crisis during the pandemic. Bringing people indoors offers access to showers and bathrooms but might also make the virus more transmissible.

“The shelters present a greater risk of transmission because you have people interacting and sleeping in close quarters,” said Linsey Marr, an expert in airborne disease transmission at Virginia Tech. “You have much greater density of people.”

Mr. Kositsky said that in addition to homeless people, hundreds of city employees charged with looking after them were also vulnerable to the virus.

“I’m out with the outreach workers and none of us have protective gear,” he said.” (O)

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“The Coronavirus crisis has exposed the ways in which big investors of hospitals are squeezing the sick and injured for as much money as possible after they leave the hospital.

The New Yorker reported Thursday about the way private equity firms have been throwing “surprise medical billing” on patients that accepted their health insurance. In some cases the hospital may be in-network for a patient, but the emergency surgeon isn’t or the radiologist, or anesthesiologist isn’t in-network…

Eileen Appelbaum at the Center for Economic and Policy Research has kept a watchful eye on the effort. She discovered that private equity firms “investment funds that purchase companies and try to increase their profitability,” are the ones responsible for changing the face of a hospital.

“In many cases, companies were sending work to other countries where labor costs were lower. In others, they were practicing ‘domestic outsourcing’: subcontracting out parts of their businesses to other U.S.-based companies, to run their accounting departments, corporate cafeterias, or janitorial services, among others, rather than employing those workers directly,” the report explained.

“They moved away from the idea of, How do we make our current workforce more productive? to, How do we move workers off our payroll and onto a contract company? And then they can do whatever they want with the workers,” Appelbaum said. “And, if you’re a contract company, how do you get the contract? By being the lowest bidder. You’re at rock bottom, offering just barely enough to attract any workers at all.”

She explained that given the coronavirus, the issue of “surprise billing” is even more important. COVID-19 has a tendency to go from bad to dangerous in some who come down with the virus. That can be the moment that people are forced to go to the hospital or call an ambulance. It’s exactly the conditions where surprise billing can surface and bankrupt people, even if they are fully insured.” (P)

“Doctor Ming Lin is the first emergency room doctor to be fired for going public with his concerns about poor hospital emergency room safety practices and shortages of medical supplies and protective gear for health workers. He won’t be the last.

Like many hospitals in the US, PeaceHealth St. Joseph Medical Center in Bellingham Washington, where Ming Lin worked for the past 17 years as an emergency room doctor, has outsourced the management and staffing of its emergency room. So, Lin works on-site at the hospital’s ER, but he is employed by a physician staffing firm that runs the ER. These staffing firms are often behind the surprise medical bills for ER services that patients receive after their insurance company has paid the hospital and doctors, but not the excessive out-of-network charges billed by these outside staffing firms.

About a third of hospital emergency rooms are staffed by doctors on the payrolls of two physician staffing companies — TeamHealth and Envision Health — owned by Wall Street investment firms. Envision Healthcare employs 69,000 healthcare workers nationwide while TeamHealth employs 20,000. Private equity firm Blackstone Group owns TeamHealth, Kravis Kohlberg Roberts (KKR) owns Envision.

Care of the sick is not the mission of these companies; their mission is to make outsized profits for the private equity firms and its investors. Overcharging patients and insurance companies for providing urgent and desperately needed emergency medical care is bad enough. But it is unconscionable to muzzle doctors who speak out to advocate for the health of their patients and co-workers during the global pandemic that is rapidly spreading across the US…

The American Academy of Emergency Medicine protested Dr. Lin’s ouster and questioned how TeamHealth is allowed to provide hospital services when the law requires that physician practices must be owned by a licensed medical practitioner. TeamHealth skirts the law by owning all the assets of the physician practices it acquires — the real estate, offices, equipment, supplies, inventory, and even accounts receivable.

On paper, the physician practices are owned by a doctor-led organization that TeamHealth has set up to comply with the law. But what does it mean to own a physician practice if the practice has no assets and no possibility to exist on its own?

The furor over patients hit by surprise medical bills revealed that TeamHealth controls the billing for the doctors it supplies to hospital emergency rooms. The firing of Doctor Ming Lin pulls back the curtain and reveals that TeamHealth controls the doctors as well.” (Q)

“Hospitals taking money from the $2.2 trillion stimulus bill will have to agree not to send “surprise” medical bills to patients treated for COVID-19, the White House said Thursday…

“The Trump administration is committed to ensuring all Americans are not surprised by the cost related to testing and treatment they need for COVID-19,” White House spokesman Judd Deere said in a statement.

The stimulus bill includes $100 billion for the health care system, to ease the cash crunch created by the mass cancellation of elective procedures in preparation to receive coronavirus patients. Release of the first $30 billion, aimed at hospitals, is expected soon.

The prohibition on surprise billing will protect patients covered by government programs, employer plans or self-purchased insurance.

Hospitals that accept the grants will have to certify that they won’t try to collect more money than the patient would have otherwise owed if the medical attention had been provided in network.

“In a time when nothing is certain, patients can take solace in knowing that they will not receive outrageous, unavoidable bills weeks and months after they have survived the virus,” Annette Guarisco Fildes, head of the ERISA Industry Committee, said in a statement. ERISA is the name for a federal law that sets terms and conditions for multistate employer plans.

A spokeswoman for the organization said it’s their understanding that the ban on surprise billing will apply to doctors as well as hospitals.” (R)

WORTH SCANNING

Hope, and New Life, in a Brooklyn Maternity Ward Fighting Covid-19,

In a hospital at the center of the crisis, nearly 200 babies have arrived since March. Some pregnant women have fallen extremely ill, but doctors are winning battles for their lives and their children’s.

‘A Tragedy Is Unfolding’: Inside New York’s Virus Epicenter In a city ravaged by an epidemic, few places have been as hard hit as central Queens., by Annie Correal and Andrew Jacobs, https://www.nytimes.com/2020/04/09/nyregion/coronavirus-queens-corona-jackson-heights-elmhurst.html?referringSource=articleShare

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