HHS Renews the Declaration of a Public Health Emergency

On July 23, HHS Secretary Alex M. Azar III renewed the COVID-19 Public Health Emergency declaration.

As a result of the continued consequences of Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective July 25, 2020, my January 31, 2020, determination that I previously renewed on April 21, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.

Ambulance Crews and In-Home Care Providers Seek Collaboration

From Home Health Care News

Ambulance Crews and In-Home Care Providers Seek Collaboration—Not Competition

As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home.

Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space — have always provided some degree of care in the home setting. To do so, they’ve often worked alongside traditional home health and home care agencies, too.

“There’s been a certain amount of care [or treatment] in the home for many years,” Hanan Cohen, paramedic and director of corporate development at Empress EMS, told Home Health Care News. “On the 911 system, it’s not at all uncommon for an EMS crew to respond to a multitude of emergencies. After assessing and, sometimes, treating the person, … they may decide not to go to the hospital.”

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OCR Issues Guidance on Civil Rights Protections Prohibiting Race, Color, and National Origin Discrimination During COVID-19

News Release from the U.S. Department of Health and Human Services |  Monday, July 20, 2020

OCR Issues Guidance on Civil Rights Protections Prohibiting Race, Color, and  National Origin Discrimination During COVID-19

Yesterday, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) is issuing guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19. This Bulletin focuses on recipients’ compliance with Title VI of the Civil Rights Act of 1964 (Title VI).

To help ensure Title VI compliance during the COVID-19 public health emergency, recipients of federal financial assistance, including state and local agencies, hospitals, and other health care providers, should:

  • Adopt policies to prevent and address harassment or other unlawful discrimination on the basis of race, color, or national origin.
  • Ensure – when site selection is determined by a recipient of federal financial assistance from HHS – that Community-Based Testing Sites and Alternate Care Sites are accessible to racial and ethnic minority populations.
  • Confirm that existing policies and procedures with respect to COVID-19 related services (including testing) do not exclude or otherwise deny persons on the basis of race, color, or national origin.
  • Ensure that individuals from racial and ethnic minority groups are not subjected to excessive wait times, rejected for hospital admissions, or denied access to intensive care units compared to similarly situated non-minority individuals.
  • Provide – if part of the program or services offered by the recipient – ambulance service, non-emergency medical transportation, and home health services to all neighborhoods within the recipient’s service area, without regard to race, color, or national origin.
  • Appoint or select individuals to participate as members of a planning or advisory body which is an integral part of the recipient’s program, without exclusions on the basis of race, color, or national origin.
  • Assign staff, including physicians, nurses, and volunteer caregivers, without regard to race, color, or national origin. Recipients should not honor a patient’s request for a same-race physician, nurse, or volunteer caregiver.
  • Assign beds and rooms, without regard to race, color, or national origin.
  • Make available to patients, beneficiaries, and customers information on how the recipient does not discriminate on the basis of race, color, or national origin in accordance with applicable laws and regulations.

OCR is responsible for enforcing Title VI’s prohibitions against race, color, and national origin discrimination. As part of the federal response to this public health emergency, OCR will continue to work in close coordination with our HHS partners and recipients to remove discriminatory barriers which impede equal access to quality health care, recognizing the high priority of COVID-19 testing and treatment.

Roger Severino, OCR Director, stated, “HHS is committed to helping populations hardest hit by COVID-19, including African-American, Native American, and Hispanic communities.” Severino concluded, “This guidance reminds providers that unlawful racial discrimination in healthcare will not be tolerated, especially during a pandemic.

“Minorities have long experienced disparities related to the medical and social determinants of health – all of the things that contribute to your health and wellbeing. The COVID-19 pandemic has magnified those disparities, but it has also given us the opportunity to acknowledge their existence and impact, and deepen our resolve to address them,” said Vice Admiral Jerome M. Adams, Surgeon General, MD, MPH. “This timely guidance reinforces that goal and I look forward to working across HHS and with our states and communities to ensure it is implemented.”

To read the new OCR Bulletin, please visit: Title VI Bulletin – PDF

To learn more about non-discrimination on the basis of race, color, national origin, sex, age, and disability; conscience and religious freedom; and health information privacy laws, and to file a complaint with OCR, please visit: www.hhs.gov/ocr.

For more OCR announcements related to civil rights and COVID-19, please visit: https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/index.html.

ESO Announces Peer-Reviewed COVID-19 EMS Research

From Yahoo Finance via Cision

ESO Announces Peer-Reviewed Research Describing Characteristics of COVID-19 EMS Encounters with Linked Hospital Diagnoses

Key Findings from the Report Include:

  • COVID-19 Diagnoses and Ailments: Those with COVID-19 hospital diagnoses were more likely to present with elevated heart and respiratory rate, hypoxia and fever during the EMS encounter.
  • COVID-19 Suspicion: A COVID-19 EMS suspicion was documented for 78 percent of hospital-diagnosed COVID-19 patients.
  • Patient Origin: EMS responses for patients with COVID-19 were more likely to originate from a skilled nursing or assisted living facility.
  • PPE Usage: PPE usage by EMS was more frequently documented on records of patients who had hospital diagnosed COVID-19.
  • Dispatch Complaints: While dispatch complaints for hospital-confirmed COVID-19 patients most commonly included general illness and breathing difficulties, there were also cases dispatched as falls, chest pain, and strokes.
  • Demographic Insights: Consistent with reported in-hospital findings, African American and Hispanic patients made up a disproportionately larger number of COVID-19 diagnoses.

NYT | The Fullest Look Yet at the Racial Inequity of Coronavirus

From the New York Times on July 5, 2020 by By Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright and Mitch Smith

Early numbers had shown that Black and Latino people were being harmed by the virus at higher rates. But the new federal data — made available after The New York Times sued the Centers for Disease Control and Prevention — reveals a clearer and more complete picture: Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups.

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WSJ | TX, AZ and FL have been some of the worst-hit states in recent days

From the Wall Street Journal on July 5

Some Hospitals in Southern, Western U.S. States Near Capacity Amid Coronavirus Outbreaks

Top officials in southern and western U.S. cities and states with growing coronavirus cases sounded the alarm Sunday, saying hospitals were near capacity and that stricter social-distancing enforcement was needed to stem the growing outbreaks.

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Study | Nationwide EMS Calls Have Dropped 26%, Attended Deaths Doubled

From the University at Buffalo News Center

Since early March and the start of the COVID-19 pandemic in the U.S., 911 calls for emergency medical services have dropped by 26.1 % compared to the past two years, a new study led by a University at Buffalo researcher has found.

But the study also found that EMS-attended deaths have doubled, indicating that when EMS calls were made, they often involved a far more serious emergency.

Study Details

Effect of the Coronavirus Disease 2019 (COVID‐19) Pandemic on the United States Emergency Medical Services System: A Preliminary Report
E. Brooke Lerner PhD
Craig D. Newgard MD, MPH
N. Clay Mann PhD, MS, MBA

CDC Chief Says COVID-19 Cases May be 10x Higher Than Reported

From the Washington Post on June 25

CDC chief says coronavirus cases may be 10 times higher than reported

The number of Americans who have been infected with the novel coronavirus is likely 10 times higher than the 2.3 million confirmed cases, according to the head of the Centers for Disease Control and Prevention.

In a call with reporters Thursday, CDC Director Robert Redfield said, “Our best estimate right now is that for every case that’s reported, there actually are 10 other infections.”

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6/25 | CMS Open Door Forum | Documentation Requirement Lookup Service

From the Centers for Medicare and Medicaid Services

Special Open Door Forum:  Medicare Documentation Requirement Lookup Service
Thursday, June 25, 2020 | 2:00-3:00 pm Eastern Time
Conference Call Only

The Centers for Medicare & Medicaid Services, Center for Program Integrity will host a series of Special Open Door Forum (SODF) calls to educate the public about a new initiative underway to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service prototype. Also, to allow physicians, suppliers, IT and Electronic Health Record (EHR) Developers and Vendors, and/or all other interested parties to provide feedback to CMS and inform how interested parties can get involved or track the progress of this initiative.

CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare FFS Documentation Requirement Lookup Service and is participating in two workgroups to promote development of standards that will support the Lookup Service. One workgroup is a private sector initiative hosted by Health Level Seven (HL7), the Da Vinci project. The second workgroup is The Office of the National Coordinator for Health Information Technology (ONC) Fast Healthcare Interoperability Resource (FHIR) at Scale Taskforce (FAST).

By working with HL7, ONC, other payers, providers, and EHR vendors, CMS is helping define the requirements and architect the standards-based solutions. In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare FFS programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR based solutions.

The goals of the Documentation Requirement Lookup Service prototype are to reduce provider burden, reduce improper payments and appeals, and improve “provider to payer” information exchange. The prototype will be made accessible to pilot participants and will allow providers to be able to discover the following at the time of service and within their EHR or practice management system:

  • 1. If Medicare FFS requires prior authorization for a given item or service; and
  • 2. Documentation requirements for:
  • 3. Home Oxygen Therapy
  • 4. Continuous Positive Airway Pressure (CPAP) Devices
  • 5. Home Blood Glucose Monitors and Supplies
  • 6. Non-Emergency Ambulance Transportation (NEAT)
  • 7. Respiratory Assist Devices (RAD)

For more information and to access the slide presentation for the SODF, please visit our website: go.cms.gov/MedicareRequirementsLookup.

We look forward to your participation.

Special Open Door Participation Instructions

Participant Dial-In Number: 1-(888)-455-1397
Participant Passcode: 2900212

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.

CDC | Testing Guidelines for Nursing Homes

On June 13, the Centers for Disease Control and Prevention issued updated guidance for COVID-19 testing in nursing homes. Thank you to the many  member organizations  providing this vitally important care to our nation’s vulnerable populations. Changes are summarized below:

  • Reorganized recommendations to address:
    • Viral testing of healthcare personnel (HCP)
    • Viral testing of residents
    • Viral testing in response to an outbreak
  • Changed “baseline” testing to “initial” testing, although these terms are interchangeable
  • Added the following recommendations:
    • Testing the same individual more than once in a 24-hour period is not recommended.
    • Clinicians are encouraged to consider testing symptomatic residents for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2.

CDC Nursing Home Testing

Race Gaps in COVID-19 Deaths Are Even Bigger Than They Appear

From the Brookings Institute  on June 16

The COVID-19 pandemic has been like the flash of an X-ray, exposing the deep fractures in U.S. society – not least by race. New data from CDC shows that the death rates among Black and Hispanic/Latino people are much higher than for white people, in all age categories…

Stark inequalities in COVID outcomes exist for the American Indian and Alaska Native population as well, however information on death rates for these groups is incomplete. Here, we focus on the three largest racial/ethnic groups, white, Black, and Hispanic/Latino, for which data are more reliable and which account for 93% of all COVID deaths reported by the CDC (through June 6).

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NYT | Low-Cost Drug Reduces Coronavirus Deaths, Scientists Say

From the New York Time on June 16, 2020

LONDON — Scientists at the University of Oxford said on Tuesday that they had identified what they called the first drug proven to reduce coronavirus-related deaths, after a 6,000-patient trial in Britain showed that a low-cost steroid prevented the deaths of some hospitalized patients.

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Politico | Nursing Homes Go Unchecked As Fatalities Mount

From Politico on June 15, 2020 by Rachel Roubein and Maggie Severns

Thousands of nursing homes across the country have not been checked to see if staff are following proper procedures to prevent coronavirus transmission, a form of community spread that is responsible for more than a quarter of the nation’s Covid-19 fatalities.

Only a little more than half of the nation’s nursing homes had received inspections, according to data released earlier this month, which prompted a fresh mandate from Medicare and Medicaid chief Seema Verma that states complete the checks by July 31 or risk losing federal recovery funds.

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KHN | EMTs Facing A Pandemic And Protests At Once

For EMTs, There’s No ‘Rule Book’ For Facing A Pandemic And Protests At Once

By Carmen Heredia Rodriguez | From Kaiser Health News

Emergency medical services across the country, already burdened by the high demands of COVID-19, have faced added pressure in the past week as they responded to protests ignited by the death of George Floyd in the custody of Minneapolis police.

The need to protect themselves against the coronavirus adds another complication to emergency crews’ efforts in these dangerous conditions. Their personal protective equipment (PPE) can be difficult to wear in a crowd, said emergency medical services officials. Plus, switching from that gear to equipment needed to shield medics from bullets, rocks or tear gas can be challenging.

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MIT | What Does and Does Not Correlate With COVID-19 Death Rates

From the Massachusetts Institute of Technology Center for Energy and Environmental Policy Research

What Does and Does Not Correlate With COVID-19 Death Rates
Christopher R. Knittel and Bora Ozaltun
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Abstract
We correlate county-level COVID-19 death rates with key variables using both linear regression and negative binomial mixed models, although we focus on linear regression models. We include
four sets of variables: socio-economic variables, county-level health variables, modes of commuting, and climate and pollution patterns. Our analysis studies daily death rates from April 4, 2020 to May 27, 2020. We estimate correlation patterns both across states, as well as within states. For both models, we find higher shares of African American residents in the county are correlated with higher death rates. However, when we restrict ourselves to correlation patterns within a given state, the statistical significance of the correlation of death rates with the share of African Americans, while remaining positive, wanes. We find similar results for the share of elderly in the county. We find that higher amounts of commuting via public transportation, relative to telecommuting, is correlated with higher death rates. The correlation between driving into work, relative to telecommuting, and death rates is also positive across both models, but statistically significant only when we look across states and counties. We also find that a higher share of people not working, and thus not commuting either because they are elderly, children or unemployed, is correlated with higher death rates. Counties with higher home values, higher summer temperatures, and lower winter temperatures have higher death rates. Contrary to  past work, we do not find a correlation between pollution and death rates. Also importantly, we do not find that death rates are correlated with obesity rates, ICU beds per capita, or poverty rates. Finally, our model that looks within states yields estimates of how a given state’s death rate compares to other states after controlling for the variables included in our model; this may be interpreted as a measure of how states are doing relative to others. We find that death rates in the Northeast are substantially higher compared to other states, even when we control for the four sets of variables above. Death rates are also statistically significantly higher in Michigan, Louisiana, Iowa, Indiana, and Colorado. California’s death rate is the lowest across all states.

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