Note to Readers: Sarah Jane Tribble spent more than a year and half reporting on a small town in Kansas that lost its only hospital. This month, KHN and St. Louis Public Radio will launch “Where It Hurts,” a podcast exploring the often painful cracks growing in America’s health system that leave people vulnerable — and without the care they need. Season One is “No Mercy,” focusing on the hospital closure in Fort Scott, Kansas — and what happens to the people left behind, surviving the best way they know how. You can listen to Episode One on Tuesday, Sept. 29.

David Usher is sitting on $1.7 million he’s scared to spend.

The money lent from the federal government is meant to help hospitals and other health care providers weather the COVID-19 pandemic. Yet some hospital administrators have called it a payday loan program that is now, brutally, due for repayment at a time when they still need help.

Coronavirus cases have “picked up recently and it’s quite worrying,” said Usher, chief financial officer at the 12-bed Edwards County Medical Center in rural western Kansas. Usher said he would like to use the money to build a negative-pressure room, a common strategy to keep contagious patients apart from those in the rest of the hospital.

But he’s not sure it’s safe to spend that cash. Officially, the total repayment of the loan is due this month. Otherwise, according to the loan’s terms, federal regulators will stop reimbursing the hospitals for Medicare patients’ treatments until the loan is repaid in full.

The federal Centers for Medicare & Medicaid Services has not yet begun trying to recoup its money, with the coronavirus still affecting communities nationwide, but hospital leaders fear it may come calling for repayment any day now.

Hospital leaders across the country said there has been no communication from CMS on whether or when they will adjust the repayment deadline. A CMS spokesperson had not responded to questions by press time.

“It’s great having the money,” Usher said. “But if I don’t know how much I get to keep, I don’t get to spend the money wisely and effectively on the facility.”

Usher took out the loan from Medicare’s Accelerated and Advance Payments program. The program, which existed long before the pandemic, was generally used sparingly by hospitals faced with emergencies such as hurricanes or tornadoes. It was expanded for use during the coronavirus pandemic — part of billions approved in federal relief funds for health care providers this spring.

A full repayment of a hospital’s loan is technically due 120 days after it was received. If it is not paid, Medicare will stop reimbursing claims until it recoups the money it is owed — a point spelled out in the program’s rules. Medicare reimburses nearly $60 billion in payments to health care providers nationwide under Medicare’s Part A program, which makes payments to hospitals.

More than 65% of the nation’s small, rural hospitals — many of which were operating at a deficit before the pandemic — jumped at the Medicare loans when the pandemic hit because they were the first funds available, said Maggie Elehwany, former vice president of government affairs for the National Rural Health Association.

Read the full article here.

Centers for Disease Control and Prevention (CDC) director Robert Redfield warned Congress this week that it could take six to nine months after approval to get enough people vaccinated to control the pandemic. President Trump has promised a vaccine fast, but Redfield said the U.S. will struggle to distribute an eventual vaccine. Redfield also offered a bridge between now and vaccine availability:

• “[F]ace masks are the most important, powerful public health tool we have.”
• “[W]e have clear scientific evidence they work, and they are our best defense.”
• “I might even go so far as to say that this face mask is more guaranteed to protect me against COVID-19 than when I take a COVID-19 vaccine, because the immunogenicity might be 70%, and if I don’t get an immune response, the vaccine’s not going to protect me. This face mask will.”
• “I do want to keep asking the American public to take the responsibility — particularly the 18- to 25-year-olds. … because we haven’t got the acceptance of personal responsibility that we need for all Americans to embrace this face mask.”

The Pennsylvania Department of State offers a consolidated list of licensure regulations that have been impacted by the COVID-19 pandemic. The list includes all pandemic actions taken by the state’s licensure boards and includes:

• Buprenorphine Treatment. Suspension of the initial medical history and physical examination requirement for Buprenorphine treatment extended for the duration of the disaster declaration
• CE Credits for Poll Work. Nursing Home Administrators, Physical Therapists, Social Workers, Marriage & Family Therapists, Professional Counselors, Speech-Language Pathologists and Audiologists can earn up to 2 hours of CE for serving as poll workers for the election

For a complete list of the licensure board actions during the pandemic, click here.

The Pennsylvania Department of Health released Health Alert 525-09-14: Guidance for Patients Under Quarantine After Exposure to SARS-CoV-2. If PA DOH or the local health department identifies that someone is a close contact to a person with COVID-19, the close contact must quarantine for 14 days from last contact, even if the person remains asymptomatic. A negative test result obtained while a close contact is under quarantine does not release the person from quarantine. Because infection can develop up to 14 days after exposure, persons with negative test results must still quarantine for the full 14 days. Patients being tested for SARS-CoV-2 infection must be instructed to isolate at home until results are received. Click here to access all of the 2020 health alerts, advisories and updates.