Time Magazine

When COVID-19 hit the Southwest Georgia Regional Medical Center in Cuthbert, a small rural town in Randolph County, in late March, the facility—which includes a 25-bed hospital, an adjacent nursing home and a family-medicine clinic, was quickly overwhelmed. In just a matter of days, 45 of the 62 nursing home residents tested positive. Negative residents were isolated in the hospital while the severely ill patients from both the nursing home and the local community were transferred to other better-equipped facilities.

“We were trying to get the patients out as fast as possible,” says Steve Whatley, Southwest Georgia Regional’s board chairman. “It was a daily nightmare.”

The scramble was exacerbated by a dire lack of medical necessities. Employees had to diligently conserve personal protective equipment. The hospital had no ventilators. And the nursing home’s air systems had to be retrofitted to create negative-pressure rooms to contain the airborne virus particles. Making matters even worse, one of the county’s only two physicians became ill with a severe respiratory disease unrelated to the coronavirus, while the other had an unexpected surgery requiring eight weeks of recovery time. Nurse practitioners stepped up as Southwest Georgia Regional waited for backup from neighboring health care organizations. More than 30 of 200 employees stopped working out of fear or because they got sick; the state of Georgia provided six nurses and two respiratory therapists as emergency relief. Despite the heroic efforts of the center’s staff, more than a dozen nursing home residents died within eight weeks of the virus’ arrival, though it’s unclear how many were directly due to COVID-19.

The ordeal left Southwest Georgia Regional—which was already struggling to survive—in financial shambles, as costs related to the coronavirus greatly exceeded revenues. It will permanently close on Oct. 22, making it the seventh Georgia hospital to do so since 2010. After Southwest Georgia Regional closes, Randolph County will become the 55th in the state to have no hospital at all. Residents will need to drive 30 minutes west and across the state line to Eufaula, Ala. or 50 minutes east to Albany, Ga. for care.

The middle of a pandemic is a bad time for a hospital to close. Yet Southwest Georgia Regional isn’t unique. Hospitals in St. Paul, Minn., Chicago, Houston and Philadelphia have recently closed or are set to do so soon. And in rural areas of the country, where hospitals often have enough beds for just a few dozen patients, 15 facilities have shuttered this year as of Oct. 20, including 11 since March, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. There may be as many as 18 such closures in 2020, topping last year’s record high. The hospitals in the worst financial shape generally have one thing in common: they serve the country’s most vulnerable people, who rely on Medicare and Medicaid or who are poor and uninsured.

Read more.

This afternoon, HHS through HRSA announced the latest Provider Relief Fund (PRF) application period had been expanded to include provider applicants such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received PRF distributions. Further, HHS also updated its September 19, 2020, Frequently Asked Questions (FAQ) document clarifying purposes of relief payments and loss revenues.

Appalachia reached two grim milestones last week when the Region recorded 500,000 confirmed COVID-19 cases and 10,000 covid-related deaths. From March 6, 2020, COVID-19 cases increased at a gradual pace. In the past few months, the number of confirmed cases increased faster, and has continued to increase every day since October 2. This week, Appalachia set a new record high for the seven-day rolling average of new daily cases with 5,062 on October 20th. The seven-day average of new daily cases was 4,425 a week ago and 3,805 two weeks ago.

The seven-day rolling average of new daily deaths stands at 68 per day, up from 60 a week ago and 53 two weeks ago. As of 11:30am today, October 22, 2020, there were 545,567 cumulative cases throughout Appalachia and 10,666 cumulative deaths in 383 of Appalachia’s 420 counties.

For more information on the coronavirus in Appalachia, visit here.

Stateline, Pew

The nation’s pandemic hotspots have shifted to rural communities, overwhelming small hospitals that are running out of beds or lack the intensive care units for more than one or two seriously ill patients.

And in much of the Midwest and Great Plains, hospital workers are catching the virus at home and in their communities, seriously reducing already slim benches of doctors, nurses and other professionals needed to keep rural hospitals running.

Nationwide, positive coronavirus cases started rising in mid-September as children and college students returned to school, more businesses reopened and more people started resuming daily activities outside of their homes. Wisconsin and other less populous states became the new hotspots.

This week, per capita rates of COVID-19 were highest in North Dakota, followed by South Dakota, Montana, Wisconsin, Nebraska, Idaho, Utah, Wyoming, Iowa, Arkansas and Illinois. Hospitalization rates also were rising in those states and others.

Health care experts expect that a seasonal spike in flu and pneumonia, combined with a steady rise in COVID-19 cases, will swamp many health care systems, particularly in rural areas.

Wisconsin recently opened a 530-bed field hospital on state fairgrounds in Milwaukee that was set up in the early days of the pandemic but sat unused until now. Last week, 50 beds were readied for patients, and the staff was working on transfers with hospitals that were hitting their capacity limits. The number of hospitalized COVID-19 patients in the state tripled in the last 30 days.

In Oklahoma City and the surrounding area, no ICU beds were available last week, according to the University of Oklahoma. The lack of beds required medical professionals in those already understaffed hospitals to spend hours on the phone arranging patient transfers to other Oklahoma hospitals.

Fewer than 20 ICU beds were available in the entire state of North Dakota, according to state data. That meant patients had to be transferred hundreds of miles, in some cases to South Dakota and Montana.

Read more.

As a fall resurgence of COVID-19 becomes more evident in Pennsylvania and across the country, Pennsylvania Governor Tom Wolf and Sec. of Health Dr. Rachel Levine today presented an update on the COVID-19 Early Warning Monitoring System Dashboard and case data, and asked Pennsylvanians to unite against COVID.

“The fall resurgence is here,” Gov. Wolf said. “And while we must always take this deadly virus seriously, now is the time for all of us to double down on our efforts to keep ourselves and those around us safe. We’ve seen what happens when masks aren’t worn and social distancing isn’t practiced – people get sick, so we need to stay vigilant and work together to stop the spread of COVID-19.”

Last week, Dr. Levine introduced the team of public health experts leading the work to make sure all Pennsylvanians are as protected as possible from both COVID-19 and influenza. The team is prepared for the resurgence, is managing a robust testing plan, preparing for vaccine distribution when a vaccine is available, and working to track influenza (flu) cases across the state.

“Our data, including case counts, hospitalizations and percent positivity reflect the fall resurgence occurring,” Secretary Levine said. “The department and the Wolf Administration are working continuously to ensure we are prepared for this resurgence and to protect Pennsylvanians. We all must unite to protect ourselves and loved ones from COVID-19 by washing our hands, wearing a mask, social distancing, avoiding large gatherings and downloading the COVID Alert PA app.”

Dr. Levine also presented the latest data from the state’s COVID-19 Early Warning Monitoring System Dashboard, which tracks the level of community transmission as a basis for the recommendations for Pre-K to 12 schools to determine instructional models; data on cases among 5-18-year-olds; cases that reported visiting a business among potential locations where exposures may have occurred; and updated travel recommendations.

The dashboard is designed to provide early warning signs of factors that affect the state’s mitigation efforts. The data available on the early warning monitoring dashboard includes week-over-week case differences, incidence rates, test percent-positivity, and rates of hospitalizations, ventilations and emergency room visits tied to COVID-19.

This week’s update compares the period of October 9 – October 15 to the previous seven days, October 2 – October 8.

As of Thursday, October 15, the state has seen a seven-day case increase of 8,723; the previous seven-day increase was 7,398, indicating a 1,325-case increase across the state over the past week.  The statewide percent-positivity went up to 4.3% from 3.9% last week.

“COVID is tough, but together, Pennsylvanians are tougher,” Gov. Wolf said. “The last seven and a half months have shown us that when we unite, we can defeat this virus. Pennsylvanians came together to stop COVID in its tracks and we can do it again and stop this fall resurgence in its tracks if we stand united against COVID.

“You matter, and so do your actions. When we make good choices and follow health and safety measures, we see results. Let’s work together to stop the spread.

2020 Health Workforce Field Strength Numbers Increase Access to Primary and Substance Use Disorder Care

Read the full press release

There are now more than 16,000 National Health Service Corps (NHSC) members providing care to more than 17 million Americans. An additional 1.8 million patients are cared for by over 1,700 Nurse Corps clinicians. Nurse Corps also added 135 faculty to its rolls.

NHSC and Nurse Corps programs support the recruitment and retention of dedicated primary care, dental, and behavioral health providers who care for underserved patients daily in high-need areas of the U.S. and its territories.

As part of our commitment to recruiting clinicians interested in serving in underserved areas, we take an active role in connecting clinicians with employment opportunities at approved sites. After a pause this spring and summer, we recently resumed hosting Virtual Job Fairs -a live interactive platform that provides students and clinicians the opportunity to meet with hundreds of recruiters hiring in underserved communities across the country.

Share how we’re making strides to impact health equity and increase access to care for those who need it most. Forward this email and use the graphics below to share with your audiences. Follow and tag us on our NHSC and Nurse Corps Facebook, NHSC and Nurse Corps LinkedIn, and NHSC Twitter accounts.

Thank you all for the hard work you do. Your dedication and support throughout 2020 has helped communities all over the nation get through a very difficult year.

Learn about HRSA’s Coronavirus response at hrsa.gov/coronavirus

The Centers for Medicare & Medicaid Services (“CMS”) appreciates its long-standing partnership with immunizers, including pharmacies, to facilitate the efficient administration of vaccinations, particularly for vulnerable populations in long-term care facilities and other congregate care settings across America. Leveraging immunizers’ capabilities and expertise will play an important role in the Department’s ability to broadly distribute and administer COVID-19 vaccinations, including Medicare beneficiaries.

America is facing an unprecedented challenge. Quickly, safely, and effectively vaccinating our most vulnerable citizens in settings that have accounted for about 30 percent of U.S. COVID-19 deaths is a top-priority mission for the Trump Administration. Unfortunately, many long-term care facilities may not have sufficient capacity to receive, store, and administer vaccines. And some long-term care facility residents cannot safely leave the facility to receive vaccinations.

Outside immunizers can help fill that urgent need and provide onsite vaccinations at skilled nursing facilities (“SNFs”). But to do so during this global emergency, Medicare-enrolled vaccinators must be able to bill directly and receive direct reimbursement from the Medicare program. However, the Social Security Act requires SNFs to bill for certain services, including vaccine administration, even when SNFs rely on an outside vendor to perform the service. See Social Security Act §§ 1862(a)(18), 1842(b)(6)(E).

Therefore, in order to facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance (collectively, “SNF Consolidated Billing Provisions”). Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.

CMS will exercise such discretion (1) during the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or (2) so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings—whichever is later. While CMS exercises this enforcement discretion, compliance with SNF Consolidated Billing Provisions is not material to CMS’ decision to reimburse for COVID-19 vaccine administration. If CMS decides in the future to cease exercising this enforcement discretion, CMS will provide public notice in advance and allow at least 60 days for affected outside immunizers to modify their business practices.

On October 14, CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well. This revolutionary method of improving access to care is transforming health care delivery in America. President Trump will not let the genie go back into the bottle.”

Expanding Medicare Telehealth Services:

For the first time using a new expedited process, CMS added 11 new services to the Medicare telehealth services list since the publication of the May 1 COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available on the List of Telehealth Services webpage.

In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries’ access to telehealth services during the COVID-19 PHE.

Since the beginning of the PHE, CMS added over 135 services to the Medicare telehealth services list – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services. With this action, Medicare will pay for 144 services performed via telehealth. Between mid-March and mid-August, over 12.1 million Medicare beneficiaries – over 36% – of people with Medicare Fee-for-Service received a telemedicine service.

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement:

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS released, for the first time, a preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE. This snapshot shows, among other things, that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June of this year, representing an increase of more than 2,600% when compared to the same period from the prior year. The data also shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both age groups and states.

To further drive telehealth, CMS released a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that implemented telehealth changes. The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.

The toolkit includes approaches and tools states can use to communicate with providers on utilizing telehealth for patient care. It updates and consolidates in one place the FAQs and resources for states to consider as they begin planning beyond the temporary flexibilities provided in response to the pandemic.

View the Medicaid and CHIP data snapshot on telehealth utilization during the PHE.

Some of the country’s least populous states are facing major COVID-19 surges in what North Dakota Gov. Doug Burgum called “a regional COVID storm,” according to The New York Times. North Dakota, South Dakota and Montana are among the states with the highest number of cases per capita, while other rural states like Wyoming, Idaho and Nebraska have recently seen their highest seven-day case average of the pandemic.