CMS | Independent Nursing Home COVID-19 Commission Findings Validate Unprecedented Federal Response

From the Centers for Medicare and Medicaid Services

Today, the Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE.  CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. Today’s announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

The Trump Administration’s effort to protect the uniquely vulnerable residents of nursing homes from COVID-19 is nothing short of unprecedented,” said CMS Administrator Seema Verma. “In tasking a contractor to convene this independent Commission comprised of a broad range of experts and stakeholders, President Trump sought to refine our approach still further as we continue to battle the virus in the months to come. Its findings represent both an invaluable action plan for the future and a resounding vindication of our overall approach to date. We are grateful for the Commission’s important contribution.”

As the capstone to the Commission’s extensive report, tomorrow, Administrator Verma will join Vice President Mike Pence and the Centers for Disease Control and Prevention (CDC) Director Dr. Robert R. Redfield, some members of the Commission, and other public health and elder care experts at the White House. The Vice President, Dr. Redfield and Administrator Verma will lead the group in a discussion regarding the Commission’s findings and general issues facing the nation’s elder care system.

Nursing homes and other shared or congregate living facilities have been severely affected by COVID-19, as these facilities often house older individuals who suffer from multiple medical conditions, making them particularly susceptible to complications from the virus. To help CMS inform immediate and future actions as well as identify opportunities for improvement, the   Commission was created to conduct an independent review and comprehensive assessments of confronting COVID-19. The Commission’s report contains best practices that emphasize and reinforce CMS strategies and initiatives to ensure nursing home residents are protected from COVID-19.

As outlined in the overview released today, the Trump Administration has already taken significant steps to implement many of the Commission’s findings. The Administration has worked to support nursing homes financially during this challenging time, distributing over $21 billion to America’s nursing homes – more than $1.5 million each on average. To ensure nursing homes had access to supplies, the Trump Administration shipped a 14-day supply of personal protective equipment (PPE) to more than 15,000 nursing homes across the Nation in May.

The Administration has also required facilities to report data about COVID-19 cases, deaths, and supply levels, with 99.3 percent of facilities currently reporting. CMS took action to keep COVID-19 out of nursing homes by requiring them to test staff, a requirement that was paired with the Administration’s distribution of 13,850 point-of-care testing devices to America’s nursing homes. The Administration has also deployed federal Task Force Strike Teams in six waves, in 18 states so far, to 61 facilities particularly affected by COVID-19 to share best practices and gain a deeper understanding of how the virus spreads. CMS also required states to conduct focused infection control inspections at their nursing homes; between June and July, states completed these inspections at 99.8 percent of Medicare and Medicaid certified nursing homes.

Additionally, since March, CMS has conducted weekly calls with nursing homes, issued over 22 guidance documents and established a National Nursing Home COVID-19 Training program focused on infection control and best practices.  CMS is also using COVID-19 data to target support to the highest risk nursing homes. In May, CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to nursing homes.  The toolkit is a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. CMS updates the toolkit on a biweekly basis.

To view the full independent Coronavirus Commission for Safety and Quality in Nursing Homes report, visit here:  cms.gov/files/document/covid-final-nh-commission-report.pdf

To view the Trump Administration Response to Commission findings, visit here: cms.gov/files/document/covid-independent-nursing-home-covid-19-federal-response.pdf

To view the COVID-19 Guidance and Updates for Nursing Homes during COVID-19, visit here: cms.gov/files/document/covid-guidance-and-updates-nursing-homes-during-covid-19.pdf

The full list of CMS Public Health Actions for Nursing Homes on COVID-19 to date is in the chart below.

CMS Public Health Action for Nursing Homes on COVID-19 as of September 16, 2020

February 6, 2020

CMS took action to prepare the nation’s healthcare facilities for the COVID-19 threat.

March 4, 2020

CMS issued new guidance related to the screening of entrants into nursing homes.

March 10, 2020

CMS issued guidance related to the use of PPE.

March 13, 2020

CMS issued guidance on the restriction of nonessential medical staff and all visitors except in certain limited situations.

March 23, 2020

CMS announced a suspension of routine inspections, and an exclusive focus on immediate jeopardy situations and infection control inspections.

March 30, 2020

CMS announced that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital – including nursing homes.

April 2, 2020

CMS issued a call to action for nursing homes and state and local governments reinforcing infection control responsibilities and urging leaders to work closely with nursing homes on access to testing and PPE.

April 15, 2020

CMS announced the agency will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases.

April 19, 2020

CMS announced it will require nursing homes to report cases of COVID-19 to all residents and their families, as well as directly to the CDC. On May 1, CMS published the proposed policy in an Interim Final Rule. The rule became effective on May 8.

April 30, 2020

CMS announced the formation of an independent commission by a contractor that will conduct a comprehensive assessment of the nursing home response to COVID-19.

May 6, 2020

CMS released a memorandum to State Survey Agency directors providing more details on the new reporting requirements of the May 8, 2020, Interim Final Rule.

May 13, 2020

CMS published a new informational toolkit comprising recommendations and best practices from a variety of front line health care providers, governors’ COVID-19 task forces, associations and other organizations and experts that is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. Toolkit is found here: Toolkit

May 18, 2020

CMS issued guidance for state and local officials on the reopening of nursing homes.

June 1, 2020

CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. CMS also issued a letter to Governors.

June 4, 2020

CMS posted the first set of underlying COVID-19 nursing home data and results from targeted inspections conducted by the agency since March 4, 2020, linked on Nursing Home Compare.

June 19, 2020

CMS announced membership of Independent Coronavirus Commission on Safety and Quality in nursing homes

June 23, 2020

CMS released FAQs on nursing home visitation.

June 25, 2020

CMS released a memo announcing the end of the emergency blanket waiver for the nursing home staffing data submission requirement.

July 10, 2020

CMS announced it will deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in hotspot areas.

July 14, 2020

HHS and CMS announced an initiative for rapid point-of-care diagnostic devices and tests in nursing homes.

July 22, 2020

CMS announced several new initiatives designed to protect nursing home residents from COVID-19, including new funding, enhanced testing and additional technical assistance and support.

August 7, 2020

HHS announced the distribution of $5 billion in Provider Relief Funds, consistent with the Administration’s announcement in late July, which will be used to protect residents of nursing homes and long-term care facilities from the impact of COVID-19.

August 14, 2020

CMS released nursing home enforcement actions during pandemic.

August 24, 2020

CMS issues informational bulletin on Medicaid Reimbursement Strategies to Prevent Spread of COVID-19 in Nursing Facilities

August 25, 2020

CMS announced an unprecedented national nursing home training program for frontline nursing home staff and nursing home management.

August 25, 2020

CMS strengthens COVID-19 Surveillance with New Reporting and Testing Requirements for Nursing Homes, Other Providers. On Aug. 26, CMS posted guidance for the new requirements.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS and @CMSgov

Trump Administration Releases COVID-19 Vaccine Distribution Strategy

FOR IMMEDIATE RELEASE
September 16, 2020

Contact: HHS Press Office
202-690-6343
media@hhs.gov

Trump Administration Releases COVID-19 Vaccine Distribution Strategy

The U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD) today released two documents outlining the Trump Administration’s detailed strategy to deliver safe and effective COVID-19 vaccine doses to the American people as quickly and reliably as possible.

The documents, developed by HHS in coordination with DoD and the Centers for Disease Control and Prevention (CDC), provide a strategic distribution overview along with an interim playbook for state, tribal, territorial, and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their respective jurisdictions.

“As part of Operation Warp Speed, we have been laying the groundwork for months to distribute and administer a safe and effective COVID-19 vaccine as soon as it meets FDA’s gold standard,” said HHS Secretary Alex Azar. “This in-depth, round-the-clock planning work with our state and local partners and trusted community organizations, especially through CDC, will ensure that Americans can receive a safe and effective vaccine in record time.”

The strategic overview lays out four tasks necessary for the COVID-19 vaccine program:

  • Engage with state, tribal, territorial, and local partners, other stakeholders, and the public to communicate public health information around the vaccine and promote vaccine confidence and uptake.
  • Distribute vaccines immediately upon granting of Emergency Use Authorization/ Biologics License Application, using a transparently developed, phased allocation methodology and CDC has made vaccine recommendations.
  • Ensure safe administration of the vaccine and availability of administration supplies.
  • Monitor necessary data from the vaccination program through an information technology (IT) system capable of supporting and tracking distribution, administration, and other necessary data.

On August 14, CDC executed an existing contract option with McKesson Corporation to support vaccine distribution. The company also distributed the H1N1 vaccine during the H1N1 pandemic in 2009-2010. The current contract with McKesson, awarded as part of a competitive bidding process in 2016, includes an option for the distribution of vaccines in the event of a pandemic.

“CDC is drawing on its years of planning and cooperation with state and local public health partners to ensure a safe, effective, and life-saving COVID-19 vaccine is ready to be distributed following FDA approval,” said CDC Director Robert Redfield. “Through the Advisory Committee on Immunization Practices, CDC will play a vital role in deciding, based on input from experts and stakeholders, how initial, limited vaccine doses will be allocated and distributed while reliably producing more than 100 million doses by January 2021.”

Detailed planning is ongoing to ensure rapid distribution as soon as the FDA authorizes or approves a COVID-19 vaccine and CDC makes recommendations for who should receive initial doses. Once these decisions are made, McKesson will work under CDC’s guidance, with logistical support from DoD, to ship COVID-19 vaccines to administration sites.

“The Department of Defense is using its world-class logistical expertise to plan for distributing a safe and effective vaccine at warp speed,” said General Gustave Perna. “Americans can trust that our country’s best public health and logistics experts are working together to get them vaccines safely as soon as possible.”

Download the Strategy for Distributing a COVID-19 Vaccine – PDF*

Download the COVID-19 Vaccination Program Interim Playbook – PDF

About Operation Warp Speed:

OWS is a partnership among components of the Department of Health and Human Services and the Department of Defense, engaging with private firms and other federal agencies, and coordinating among existing HHS-wide efforts to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.

About HHS & CDC:

HHS works to enhance and protect the health and well-being of all Americans, providing for effective health and human services and fostering advances in medicine, public health, and social services. To learn more about federal support for the nationwide COVID-19 response, visit coronavirus.gov.

CDC works 24/7 protecting America’s health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About DoD:

The Department of Defense’s enduring mission is to provide combat-credible military forces needed to deter war and protect the security of our nation. The Department provides a lethal and effective Joint Force that, combined with our network of allies and partners, sustains American influence and advances shared security and prosperity.

* People using assistive technology may not be able to fully access information in this file. For assistance, please contact digital@hhs.gov.

CO | Anesthesiologists want paramedics to stop injecting people with ketamine during arrests

From the Colorado Sun

A group of Colorado anesthesiologists wants paramedics to stop injecting people with a powerful sedative when police believe suspects are out of control until officials finish a review launched nearly a year after the death of Elijah McClain, a Black man put in a stranglehold by officers and injected with ketamine.

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Study | Vitamin D reduces risk of ICU admission

From The Journal of Steroid Biochemistry and Molecular Biology

“Of 50 patients treated with calcifediol [bloodstream-form Vitamin D], one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%)… Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.”

Read the full study> Castillo, Marta Entrenas, et al. “Effect of Calcifediol Treatment and best Available Therapy versus best Available Therapy on Intensive Care Unit Admission and Mortality Among Patients Hospitalized for COVID-19: A Pilot Randomized Clinical study.” The Journal of Steroid Biochemistry and Molecular Biology (2020): 105751.

CMS Updates Medicare COVID-19 Snapshot

From CMS on September 3, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 773,000 COVID-19 cases among the Medicare population and nearly 215,000 COVID-19 hospitalizations.

Other key findings:

  • The rate of COVID-19 cases among Medicare beneficiaries grew 40% since the July release to 1,208 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 33% since the July release to 338 hospitalizations per 100,000 beneficiaries.
  • Weekly counts of COVID-19 cases and hospitalizations reached the lowest point to date in late June and began to increase in July.
  • The rate of COVID-19 cases and hospitalizations grew the most among disabled beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $3.5 billion or just over $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the July release. 29% of beneficiaries went home at the end of their hospital stay and 24% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.

The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to July 18, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by August 14, 2020.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

NHTSA COVID PPE & Resource Reporting Tool

NHTSA asks EMS agencies across the U.S. to take a few minutes each week to report PPE, personnel status within their agency.

EMS and its public safety colleagues continue to serve at the frontlines in the fight against the COVID-19 pandemic. Resource procurement and distribution of personal protective equipment and staffing shortages continue to challenge EMS leaders. It is vital that local, State and Federal officials have the information they need to help address these issues.

The NHTSA Office of EMS, with support from the team at the NEMSIS Technical Assistance Center, has designed a reporting tool to allow for a consistent, real-time method of reporting PPE supply status and personnel shortages. Your participation in the EMS COVID Resource Reporting Tool provides objective evidence to ensure your local agency’s resource status is understood by State and National EMS leadership, and that your resource needs are being prioritized.

While this information will be available to State and Federal Officials, this reporting tool does not supersede coordination with local and state emergency management, public health, or healthcare coalitions. Organizations should still follow local and state procedures for reporting information and requesting supplies or other additional resource needs.

NHTSA is asking agencies to take a few minutes each week, preferably on Monday mornings, to complete the online form. You can find the form, as well as a video and other information explaining how the information is used and how to complete the form, here.

For questions regarding this process, please contact nemsis@hsc.utah.edu.

EMS COVID Resource Reporting Tool

NYT | FDA Allows Expanded Use of Plasma to Treat Coronavirus Patients

From the New York Times

F.D.A. Allows Expanded Use of Plasma to Treat Coronavirus Patients

The Food and Drug Administration on Sunday gave emergency approval for expanded use of antibody-rich blood plasma to help hospitalized coronavirus patients, allowing President Trump, who has been pressuring the agency to move faster to address the pandemic, to claim progress on the eve of the Republican convention.

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Income Disparities In Access To Critical Care Services

From Health Affairs

Income Disparities In Access To Critical Care Services

Genevieve P. Kanter, Andrea G. Segal, and Peter W. Groeneveld

ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of intensive care unit (ICU) beds in preventing death from the severe respiratory illness associated with COVID-19. However, the availability of ICU beds is highly variable across the US, and health care resources are generally more plentiful in wealthier communities. We examined disparities in community ICU beds by US communities’ median household income. We found a large gap in access by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds. Income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas. Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the COVID-19 pandemic on mortality rates in low-income communities.

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NEMSAC Meeting August 18–19

From EMS.gov on July 29

Register Now for the National EMS Advisory Council Meeting Webcast Aug. 18-19
The National EMS Advisory Council will be holding a virtual meeting on Tuesday and Wednesday, August 18-19. Members of the public can register for the webcast and view the full agenda here.

The agenda for each day includes meetings of NEMSAC committees during the morning sessions, with the webcast beginning when the full council convenes at 1 pm EDT on Tuesday, August 18, 2020, and 12 pm EDT on Wednesday, August 19, 2020. Items on the council’s agenda include:

  • COVID-19 response and PPE tracking
  • The Emergency Triage, Treat and Transport Model (ET3)
  • Telemedicine
  • Civil unrest
  • Workforce mental health
  • EMS for Children
  • The National EMS Assessment
  • EMS and social determinants of health
  • The FICEMS strategic plan

Individuals registered for the meeting interested in addressing the council during the public comment periods must submit their comments in writing to Eric Chaney at eric.chaney@dot.gov by August 13, 2020.

Register Now

For more information about the National EMS Advisory Council, including previous meeting materials, advisories and a list of council members, visit ems.gov/nemsac.html.

CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries

Released by CMS on July 28

The Centers for Medicare & Medicaid Services today released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries. The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.

The updated data confirm that the COVID-19 public health emergency is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities. This is due, in part, to the higher rates of chronic health conditions in these populations and issues related to the social determinants of health.

In response to the first Medicare data snapshot and related call to action from CMS Administrator Seema Verma on June 22, the CMS Office of Minority Health hosted three listening sessions with stakeholders who serve and represent racial and ethnic minority Medicare beneficiaries. These sessions provided helpful insight into ways in which CMS can address social risks and other barriers to health care that will help in our efforts to reduce health disparities.

The updated data on COVID-19 cases and hospitalizations of Medicare beneficiaries covers the period from January 1 to June 20, 2020. It is based on Medicare claims and encounter data CMS received by July 17, 2020.

Other key data points:

  • Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries.
  • Beneficiaries eligible for both Medicare and Medicaid – who often suffer from multiple chronic conditions and have low incomes – were hospitalized at a rate more than 4.5 times higher than beneficiaries with Medicare only (719 versus 153 per 100,000).
  • Beneficiaries with end-stage renal disease (ESRD) continue to be hospitalized at higher rates than other segments of the Medicare population, with 1,911 hospitalizations per 100,000 beneficiaries, compared with 241 per 100,000 for aged and 226 per 100,000 for disabled.
  • CMS paid $2.8 billion in Medicare fee-for-service claims for COVID-related hospitalizations, or an average of $25,255 per beneficiary.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

MI | Opioid Treatment Ecosystems Save Lives

From Second Wave Michigan, “Leading the nation, Michigan’s Opioid Treatment Ecosystems save lives through holistic model,” feating AAA member Emergent  Health Partners

Often the first on the scene, emergency medical technicians (EMTs) working within the Opioid Treatment Ecosystem do more than administer naloxone, CPR, and ambulance transport. In Monroe County, Opioid Treatment Ecosystem initiative partner Emergent Health takes a team approach to overdose patients that includes law enforcement, medical providers, and mental health services.

“Unfortunately, opiate abuse is an addiction disease that’s a tough habit for people to overcome. We do see some people on a lot more frequent basis than we’d like,” says Karl Rock, vice president of south central operations for Emergent Health, which oversees Monroe Community Ambulance and Jackson Community Ambulance. “It is really [impacting] everybody, one of those diseases that spans all demographics, ages, race, economic status, everything.”

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AJC | New COVID-19 cases push hospitals to capacity

From the Atlanta Journal-Constitution,  featuring AAA Board leader Chuck Kearns.

On a recent day, several ambulances packed the hospital bays outside one hospital’s emergency room, as an unusual number of paramedics waited in the hallway with their patients in cots, ready to drop them off. But there were no beds to receive them, and crews can’t leave until patients are admitted. That can take hours, said  Chuck Kearns, chief of Chatham County EMS, the region’s 911 provider.

“One patient was held for seven hours; it’s unheard of,‘’ Kearns said.

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