It’s hard to know where we are in the arc of this crisis—or how much financial assistance many health and human service organizations will need to make it to the other side. Are we in the first wave or second wave? Are personal protective equipment (PPE), testing, treatment, and vaccines close or far from available?
What we do know is that health and human service organizations have been hard hit financially (see Fewer Appointments = Less Revenue & Less Cash, The Sound Of Closing Doors, The Big Questions For Leading Through This Crisis Period, and 68% Of I/DD Provider Organizations Closed One Or More Service Lines Due To The COVID-19 Pandemic). During coronavirus surge periods, hospitals are closed to all non-emergency services and even after, consumers are hesitant to return. In March and April, 55% fewer people sought care at hospitals, while visits from the uninsured rose 114%. Through June of this year, 29 hospitals have declared bankruptcy. In 2019, there were 30 such bankruptcies. Over 260 hospitals furloughed employees to make ends meet between March and June (see More Hospitals Face Bankruptcy Due To Coronavirus Losses).
The new National Council For Behavioral Health survey examining the economic impact of COVID-19 on behavioral health provider organizations found that without additional financial relief, almost half (44%) will only be able to remain open for six months at most (see The Financial Viability Of The Nation’s Mental Health And Addiction Treatment Organizations Is In Jeopardy). And, as of June, 31% of organizations assessed did not receive any funding from the Coronavirus Aid, Relief, and Economic Security Act—and among those who did, 39% received under $50,000.
At the federal level, there have been four bills to provide financial relief between March and April:
- $484 billion signed on April 24 through the Paycheck Protection Program & Health Care Enhancement Act (see House Resolution 266: Paycheck Protection Program & Health Care Enhancement Act).
- $2 trillion in funding emergency assistance and health care response signed on March 27 (see House Resolution 748: CARES Act).
- $3.4 billion for COVID-19-related sick leave, paid family leave, and testing signed on March 18 (see House Resolution 6201: Families First Coronavirus Response Act).
- $8.3 billion enacted on March 4 through the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 for federal, state, and local agencies to combat the virus (see R.6074 – Coronavirus Preparedness & Response Supplemental Appropriations Act, 2020).
And on July 10, the U.S. Department of Health and Human Services announced another financial relief package—a $4 billion round of funding (see HHS Announces Over $4 Billion In Additional Relief Payments To Healthcare Providers Impacted By The Coronavirus Pandemic). Approximately $3 billion will be allocated to safety net acute care hospitals, with $1 billion earmarked for specialty rural provider organizations, including a number of safety net organizations that did not previously qualify for the June 9 round of funding totaling $15 billion (see $15 Billion HHS Relief Fund For Medicaid & CHIP Provider Organizations Is Open For Applications).
But emergency funding can’t keep up with the widening financial losses. Many trade associations representing provider organizations are asking for government financial relief (see $38.5 Billion Request To Congress For Emergency Funding To Avert Collapse Of Behavioral Health Organizations Nationwide and Mental Health, Addiction Services Clamoring For Coronavirus Funds).
There is a wide array of state initiatives to support financially stressed provider organizations, but they are quite variable in the amount and the approach (see Options To Support Medicaid Providers In Response To COVID-19). For example, states can temporarily increase rates to compensate for the increase in costs (due to PPE or staffing), or decrease in utilization; or create disaster relief funds using the Section 1115 waiver. States can also make interim advance payments to provider organizations according to recent guidance from the Centers for Medicare and Medicaid Services (see COVID-19 Frequently Asked Questions (FAQs) For State Medicaid And Children’s Health Insurance Program (CHIP) Agencies). Although the most common initiative adopted by states as of June was to increase payment rates, the majority of funding has been allocated towards nursing home facilities and long-term care provider organizations.
And the situation on the ground varies greatly by state—Connecticut Hospitals Seek $450M From The State To Cover Coronavirus-Related Financial Losses, California Governor, Lawmakers Reject Hospitals’ Call For $1 Billion In Relief, and More Than $3M Distributed To Northeast Florida Nonprofits For COVID-19 Relief.
We’ll keep you posted on the financial relief available as the pandemic crisis continues. And this is our executive wrap-up of the recent crisis-related developments.
The Florida Agency for Health Care Administration issued an emergency rule requiring that all facility staff be tested for the virus every two weeks. Although the emergency order does not require that residents be tested, many of the facilities are testing residents independently.
Kroger Health, the health care division of The Kroger Co., announced the U.S. Food and Drug Administration has granted Emergency Use Authorization for the COVID-19 Test Home Collection Kit. The testing solution combines the safety and convenience of at-home sample collection with the expert guidance of a telehealth consultation to help improve the quality of the collection process.
In the midst of the COVID-19 pandemic, telehealth has rapidly expanded to support consumers and complex populations. This article from EHR Best Practices outlines the key performance indicators and electronic health record functionalities necessary for success with telehealth amid the pandemic.
On March 17, 2020, the Department of Health and Human Services and the Trump Administration announced steps to expand access to telehealth services during the COVID-19 outbreak. This market intelligence report examines the provisions of health plans with respect to the emergency telehealth provisions.
With the dramatic increase in use of telehealth, best practices are critical for success. In this article, Jaye Williams, MBA, chief administrative officer at Open Hearts Family Wellness provides her perspective on the best practices in leadership and technology for a virtual service delivery model.
On June 5, 2020, the National Committee for Quality Assurance announced adjustments to 40 Healthcare Effectiveness Data and Information Set measures to support the use of video telehealth, telephonic telehealth, and e-visits that take place virtually over a portal during the COVID-19 pandemic and after.
In this exclusive executive roundtable, OPEN MINDS Senior Associate Deborah Adler was joined by executives from Aetna, Alliance Health, Beacon Health Options, and Optum, for a discussion on the future of telehealth reimbursement based on lessons learned with the pivot to virtual care during the COVID-19 public health emergency.
Guidance On Reopening
On June 25, 2020, the Pennsylvania Department of Heath issued a three-step plan to allow long-term care facilities to resume activities, visitation, and other events for residents during the COVID-19 pandemic. The plan applies to nursing homes and personal care homes, assisted living residences, and private intermediate care facilities.
The document was released on June 25, 2020, by the Pennsylvania Department of Heath. The state described its three-step plan to allow long-term care facilities to resume activities, visitation, and other events for residents during the COVID-19 pandemic.
Rhode Island Governor Gina Raimondo announced a plan to expand home-based care options in Rhode Island as the state continues to grapple with the spread of COVID-19 in congregate living facilities. Before COVID-19, 61% of the state’s long-term care recipients lived in nursing facilities, which have struggled to contain the spread and impact of COVID-19 on residents and staff.
Maintaining Support For Vulnerable Populations
Heal, a Los Angeles-based health care startup, has launched a new offering for individuals who are uninsured or underinsured. The company announced the rollout of “Heal Pass,” a monthly subscription program designed to keep clients at home and out of emergency rooms, which are increasingly becoming overcrowded due to the COVID-19 virus.
Vista, California is planning to launch a pilot program to prevent homelessness and a new program to provide rental assistance to low-income families and individuals affected by COVID-19. These are new public services not previously provided by the City of Vista.
Nextdoor is launching the Kindness Is Nextdoor (KIND) Challenge, a global effort that aims to unite neighbors to cultivate a kinder world by fighting loneliness and social isolation. With new research showing that COVID-19 has had a negative impact on mental health, the KIND Challenge will encourage neighbors to reach out online to build deeper connections in their neighborhoods.
As a result of the coronavirus disease 2019 pandemic, Sigma Mental Health Urgent Care is expanding access to mental health care across the state of Texas through their proprietary, HIPAA complaint platform. Sigma’s platform allows a psychiatrist to conduct an appointment virtually with the same quality and efficiency as a face-to-face appointment.
Unemployment is projected to increase homelessness by up to 45%, from 568,000 as of January 2020 to more than 800,000 people by the end of 2020, due to the COVID-19 public health emergency. The projection is based on the historic data trend indicating that for every percentage point increase in the unemployment rate, the rate of homelessness per 10,000 people increases by 0.65%.
On June 26, 2020, federal judge Dolly Gee ruled that due to the severity of the COVID-19 pandemic, Immigration and Customs Enforcement must release migrant children by July 17, 2020, if they have been held for more than 20 days in a family detention center.
The order was issued on June 26, 2020. It directs Immigration and Customs Enforcement to release migrant children held in ICE-run family detention centers to mitigate the risk posed by COVID-19. The order applies only to children held for more than 20 days.
During the COVID-19 outbreak, Canadians age 15 and older who lived with another person in the household reported better perceived mental health than those who lived alone or in larger households. Those who were employed and working also reported better mental health than Canadians who were employed but on furlough.
Updates On School Reopening
Approximately 33% of surveyed parents in Illinois, Michigan, and Ohio may not send their children to school during the 2020 to 2021 school year due to the COVID-19 risk at school. Approximately 12% of parents reported they likely will not send at least one of their children to school during the upcoming school year.
On June 22, 2020, the U.S. Department of Education clarified that mediation to resolve special education disputes during the COVID-19 pandemic can take place through video conferences or conference calls. Both state education agencies and local education agencies can resolve disputes using video conferencing.
The U.S. Department Of Education issued the document on June 22, 2020. It includes the department’s responses to questions about implementing dispute resolution procedures for the Individuals With Disabilities Act Part B during the COVID-19 public health emergency.
Executive Leadership Resources For Crisis Management & Recovery
This web briefing, led by OPEN MINDS Vice President Richard Louis, III, covered the key elements for conducting a crisis assessment of a rapidly changing market; engagement strategies for new payer contracting, partnerships, and strategic alliances for market positioning and growth; and tips for leveraging payer relationships for contract expansion and service line development.
There is a lot of telehealth going on. Medicare has temporarily increased access through the Medicare 1135 waiver, which covers all office visits provided via telehealth in any setting throughout the country, for any physical or mental health service; has suspended enforcement of the “established-relationship” requirement; and added 85 more physician procedure codes.
When a crisis hits, executive teams must balance a short-term survival plan with a long-term strategy. In this web briefing, OPEN MINDS Senior Associate Joe Naughton-Travers discussed the essential components for successful strategic planning in periods of market disruption, and the OPEN MINDS 10-step approach to strategic planning.
For more on best practices in crisis management and recovery, join us for our upcoming web briefings, offered as part of The OPEN MINDS Executive Blueprint For Crisis Recovery:
- Social Media That Puts You In The Community – Virtually – July 30 at 1:00 pm EDT led by OPEN MINDS Executive Vice President Rob Hickernell.
- Getting Paid More For What You Do – Tactics To Increase Fees & Rates From Payers & Moving To New Reimbursement Models – August 6 at 1:00 pm EDT led by OPEN MINDS Senior Associate Paul M. Duck