COVID-19 is a highly infectious illness that has rapidly spread across the globe. Coronavirus refers to a large group of viruses that typically affect the respiratory tract and are spread much the same way as a common cold; through coughing, sneezing, shaking hands with someone who has the virus, or having direct contact with a surface an infected person has touched. COVID-19 spreads through the air, by touch of an infected person or surface, and occasionally through fecal contact.
On January 20, 2020, President Donald Trump issued a nationwide emergency proclamation for COVID-19, which provided support for emergency planning and response to the disease. On March 6, Wolf signed a statewide disaster emergency proclamation for COVID-19—this declaration was a necessary precursor for Wolf’s major disaster request.
On March 29, in a letter to the Trump Administration, Pennsylvania Governor Tom Wolf asked the federal government to declare the commonwealth’s COVID-19 outbreak a major disaster. President Trump approved this request on March 30.
President Trump and Governor Wolf have issued orders and guidance related to slowing the spread of COVID-19, which will help reduce the likelihood that a large number of people will need intensive hospital care at the same time. We all have a role to play in ensuring that hospitals and health care facilities can manage the flow of patients and the supply of resources.
In keeping with recommendations from the Centers for Disease Control and Prevention, Governor Wolf, and the Pennsylvania Department of Health Secretary of Health Rachel Levine, MD, have instructed Pennsylvanians to practice social distancing (staying six feet apart); good hygiene, including frequent hand washing and covering coughs; and regularly cleaning surfaces such as doorknobs and phones. If you are sick, stay home and contact your health care provider. Your primary care provider is the best person to determine whether you need to seek hospital-level care—or if you can get treatment from another facility or in your home.
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Protecting the health and safety of our health care workers and patients is of the utmost importance. Our hospitals in some cases have experienced COVID-19 positive employees, and they follow CDC and DOH guidelines in dealing with this situation. Further, employees with exposures, even if not positive are properly screened and monitored pursuant to same guidelines. Keeping employees COVID-19 free is critical to fulfilling our mission.
During these uncertain, often frightening times, the Pennsylvania’s health care community has provided a source of inspiration and hope. Health care workers—clinical, administrative, environmental services, culinary services—from across the state and country are going above and beyond the call of duty to help their patients and colleagues. Each member of our hospital family is making untold sacrifices to help facilities across the commonwealth respond to this crisis. Their work is saving lives.
We honor these extraordinary individuals and we are forever grateful for all they do.
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The COVID-19 pandemic has touched every part of the state, from critical access hospitals to integrated delivery networks. Andy outlined on a previous press call that a HAP-commissioned study by Health Management Associates projected that Pennsylvania hospitals will collectively suffer $10 billion in losses of revenue in 2020. This is due to the cancellation of scheduled and non-emergent services and the costs of preparing for a surge of patients with COVID-19 (including increasing capacity and purchasing supplies and PPE, the cost of which rose sharply as demand increased). The report estimated that the state’s hospital community lost an estimated $914 during March, and are projected to lose $4.6 billion between April and June.
This report came on the heels of a state analysis of hospital financial performance, which found that, during fiscal year (FY) 2019, 34 percent of Pennsylvania’s hospitals operated in the red; another 29 percent reported operating margins of zero to 4 percent. The report also found that foregone value of care for which hospitals do not receive payment (uncompensated care) rose 9.3 percent, from $750 million during FY 2018 to $820 million during FY 2019. We anticipate that this will continue to rise as more Pennsylvanians lose their employer-sponsored health insurance.
The financial impact has caused hospitals make incredibly difficult decisions in order to ensure their long-term viability. This has impacted thousands of jobs across the state.
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HAP continues to work with state and federal lawmakers to make sure that the health care community has the resources it needs to respond to the ever-changing situation in the state, and to ensure that hospitals remain financially stable as many of them have retooled to prepare for a surge in COVID-19 patients.
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In response to the COVID-19 pandemic, the federal government has passed a series of measures to help the health care and business communities manage the crisis.
HAP continues to advocate for short- and long-term resources and regulatory relief to be sure that Pennsylvania hospitals and health systems receive urgently needed funding to test and treat patients for COVID-19.
Legislative packages have supported the hospital community through a variety of avenues, including:
- A $100 billion emergency fund to reimburse eligible health care providers for health care-related expenses or lost revenues attributable to COVID-19
- Creating a new Medicare add-on payment to be applied when a hospital treats a patient with COVID-19
- Expanding the Accelerated and Advance Payment Program which offers upfront payments to increase immediate cash flow
- Relief from detrimental payment cuts including the across-the-board 2 percent Medicare sequestration cut and a delay in the Medicaid Disproportionate Share Hospital (DSH) cuts to December 2020
- Providing emergency loans to help small businesses keep the workforce employed and offering lending through the U.S. Department of Treasury and Federal Reserve
- Broadening the availability of telehealth through Medicare
HAP calls on the Administration to continue to expedite actions and financial relief consistent with Congress’s intent to provide direct funding for hospitals accounting for expenses incurred due to potential COVID-19 patient surges, as well as the lost revenue as hospital efforts have turned to COVID-19 response. HAP will be working with the Administration and Congress moving forward to ensure the needs of Pennsylvania hospitals are met during this challenging time, and additional resources are dedicated in subsequent coronavirus relief packages.
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Our funding request at the state level is driven by the immediate need to spend resources to support our surge planning and build out, and to handle the mounting costs which accompany this crushing pandemic. This is need is only further intensified by the fact that resources the hospital community have built their operations in reliance of—and many of our hospitals already operated on narrow or negative margins (losses)—do not now exist.
Specifically, HAP has urged the Wolf Administration and members of the state General Assembly to provide:
- Resources for additional staff and supplies to help hospitals bolster existing facilities and expand to temporary options to treat patients
- Emergency response funding to support the front-line health care providers who are preparing for and responding to a potential surge of patients
- Coordination of public health entitles (state, county, and city) to ensure that all organizations are speaking with the same, unified voice. This will minimize unnecessary administrative burden on hospital staff and provide a consistent public message
- Expanded access to testing and treatment for COVID-19
- Insurance coverage and payment for telemedicine as a way to help patients get screening and care for non-emergency health needs
- Waivers to provide flexibility for staffing and maximizing efficient health care delivery (known as 1135 waivers)
- Support for health care workers who need child care
- Access to places for COVID-19 patients to go after they no longer need hospital care, but still need to complete their 14-day quarantine
- Temporary suspension of surveying health care facilities during the COVID-19 crisis, to allow hospitals to solely focus on patient care
- Temporary suspension of burdensome requirements by insurers to approve procedures
- Expedited licensure for nurses and other health care providers who care for COVID-19 patients
- Support for federal funding from the Coronavirus Preparedness and Response Supplemental Appropriations Act and future federal funding mechanisms
Additionally, HAP supports additional state relief, including:
- An infusion of liquidity for hospitals through cancelling third and fourth quarter hospital Quality Care Assessment payments
- Creation of a Healthcare Coronavirus Emergency Response Fund, similar in nature to the fund set up by the Federal Government
- Periodic Interim Payments from both commercial insurers and within the Medicaid Program, similar to what has already been done in Medicare
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