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Analysis: He Got Tested For Coronavirus. Then Came The Flood Of Medical Bills.

Kaiser Health News - Fri, 04/03/2020 - 5:00am

By March 5, Andrew Cencini, a computer science professor at Vermont’s Bennington College, had been having bouts of fever, malaise and a bit of difficulty breathing for a couple of weeks. Just before falling ill, he had traveled to New York City, helped with computers at a local prison and gone out on multiple calls as a volunteer firefighter.

So with COVID-19 cases rising across the country, he called his doctor for direction. He was advised to come to the doctor’s group practice, where staff took swabs for flu and other viruses as he sat in his truck. The results came back negative.

In an isolation room, the doctors put Andrew Cencini on an IV drip, did a chest X-ray and took the swabs.(Courtesy of Andrew Cencini)

By March 9, he reported to his doctor that he was feeling better but still had some cough and a low-grade fever. Within minutes, he got a call from the heads of a hospital emergency room and infectious-disease department where he lives in upstate New York: He should come right away to the ER for newly available coronavirus testing. Though they offered to send an ambulance, he felt fine and drove the hourlong trip.

In an isolation room, the doctors put him on an IV drip, did a chest X-ray and took the swabs.

Now back at work remotely, he faces a mounting array of bills. His patient responsibility, according to his insurer, is close to $2,000, and he fears there may be more bills to come.

“I was under the assumption that all that would be covered,” said Cencini, who makes $54,000 a year. “I could have chosen not to do all this, and put countless others at risk. But I was trying to do the right thing.”

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The new $2 trillion coronavirus aid package allocates well over $100 billion to what Senate Minority Leader Chuck Schumer of New York called “a Marshall Plan” for hospitals and medical needs.

But no one is doing much to similarly rescue patients from the related financial stress. And they desperately need protection from the kind of bills patients like Cencini are likely to incur in a system that freely charges for every bit of care it dispenses.

On March 18, President Donald Trump signed a law intended to ensure that Americans could be tested for the coronavirus free, whether they have insurance or not. (He had also announced that health insurers have agreed to waive patient copayments for treatment of COVID-19, the disease caused by the virus.) But their published policies vary widely and leave countless ways for patients to get stuck.

Although insurers had indeed agreed to cover the full cost of diagnostic coronavirus tests, that may well prove illusory: Cencini’s test was free, but his visit to the ER to get it was not.

As might be expected in a country where the price of a knee X-ray can vary by a factor of well over 10, labs so far are charging between about $51 (the Medicare reimbursement rate) and more than $100 for the test. How much will insurers cover?

Those testing laboratories want to be paid — and now. Last week, the American Clinical Laboratory Association, an industry group, complained that they were being overlooked in the coronavirus package.

“Collectively, these labs have completed over 234,000 tests to date, and nearly quadrupled our daily test capacity over the past week,” Julie Khani, president of the ACLA, said in a statement. “They are still waiting for reimbursement for tests performed. In many cases, labs are receiving specimens with incomplete or no insurance information, and are burdened with absorbing the cost.”

There are few provisions in the relief packages to ensure that patients will be protected from large medical bills related to testing, evaluation or treatment — especially since so much of it is taking place in a financial high-risk setting for patients: the emergency room.

In a study last year, about 1 in 6 visits to an emergency room or stays in a hospital had at least one out-of-network charge, increasing the risk of patients’ receiving surprise medical bills, many demanding payment from patients.

That is in large part because many in-network emergency rooms are staffed by doctors who work for private companies, which are not in the same networks. In a Texas study, more than 30% of ER physician services were out-of-network — and most of those services were delivered at in-network hospitals.

The doctor who saw Cencini works with Emergency Care Services of New York, which provides physicians on contract to hospitals and works with some but not all insurers. It is affiliated with TeamHealth, a medical staffing business owned by the private equity firm Blackstone that has come under fire for generating surprise bills.

Some senators had wanted to put a provision in legislation passed in response to the coronavirus to protect patients from surprise out-of-network billing — either a broad clause or one specifically related to coronavirus care. Lobbyists for hospitals, physician staffing firms and air ambulances apparently helped ensure it stayed out of the final version. They played what a person familiar with the negotiations, who spoke on the condition of anonymity, called “the COVID card”: “How could you possibly ask us to deal with surprise billing when we’re trying to battle this pandemic?”

Even without an ER visit, there are perilous billing risks. Not all hospitals and labs are capable of performing the test. And what if my in-network doctor sends my coronavirus test to an out-of-network lab? Before the pandemic, the Kaiser Health News-NPR “Bill of the Month” project produced a feature about Alexa Kasdan, a New Yorker with a head cold, whose throat swab was sent to an out-of-network lab that billed more than $28,000 for testing.

Even patients who do not contract the coronavirus are at a higher risk of incurring a surprise medical bill during the current crisis, when an unrelated health emergency could land you in an unfamiliar, out-of-network hospital because your hospital is too full of COVID-19 patients.

The coronavirus bills passed so far — and those on the table — offer inadequate protection from a system primed to bill patients for all kinds of costs. The Families First Coronavirus Response Act, passed last month, says the test and its related charges will be covered with no patient charge only to the extent that they are related to administering the test or evaluating whether a patient needs it.

That leaves hospital billers and coders wide berth. Cencini went to the ER to get a test, as he was instructed to do. When he called to protest his $1,622.52 bill for hospital charges (his insurer’s discounted rate from over $2,500 in the hospital’s billed charges), a patient representative confirmed that the ER visit and other services performed would be “eligible for cost-sharing” (in his case, all of it, since he had not met his deductible).

This weekend he was notified that the physician charge from Emergency Care Services of New York was $1,166. Though “covered” by his insurance, he owes another $321 for that, bringing his out-of-pocket costs to nearly $2,000.

By the way, his test came back negative.

When he got off the phone with his insurer, his blood was “at the boiling point,” he told us. “My retirement account is tanking and I’m expected to pay for this?”

The coronavirus aid package provides a stimulus payment of $1,200 per person for most adults. Thanks to the billing proclivities of the American health care system, that will not fully offset Cencini’s medical bills.

Categories: Health Care

Unemployed Workers Can Get SNAP During Health Emergency

There’s confusion about whether unemployed workers not raising minor children in their home can get SNAP, given Trump Administration efforts to tighten a rule limiting them to three months of benefits and a new law temporarily suspending that rule due to the coronavirus emergency. Fortunately, the temporary suspension means they can get SNAP throughout the current health emergency.

Categories: Benefits, Poverty

Over 100 Mass. Residents Have Died Of The Coronavirus

CommonHealth (WBUR) - 37 min 21 sec ago

For the latest on the pandemic, WBUR business reporter Zeninjor Enwemeka joined Morning Edition's Bob Oakes.

Categories: Health Care

Boston Students Help Repair Medical Masks After Tufts Receives Damaged Donation

CommonHealth (WBUR) - 57 min 50 sec ago

When the Tufts Medical Center accepted a private donation of some 6,000 face masks in March, their gratitude was mixed with frustration: Although the masks were still wrapped in their original packaging and in serviceable condition, the elastic chords used to secure them to the wearer's face had become so brittle that they snapped easily.

Categories: Health Care

First Edition: April 2, 2020

Kaiser Health News - 2 hours 44 min ago
Today's early morning highlights from the major news organizations.
Categories: Health Care

California Hospitals Face Surge With Proven Fixes And Some Hail Marys

Kaiser Health News - Wed, 04/01/2020 - 8:10pm

California’s hospitals thought they were ready for the next big disaster.

They’ve retrofitted their buildings to withstand a major earthquake and  whisked patients out of danger during deadly wildfires. They’ve kept patients alive with backup generators amid sweeping power shutoffs and trained their staff to thwart would-be shooters.

But nothing has prepared them for a crisis of the magnitude facing hospitals today.

“We’re in a battle with an unseen enemy, and we have to be fully mobilized in a way that’s never been seen in our careers,” said Dr. Stephen Parodi, an infectious disease expert for Kaiser Permanente in California. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

As California enters the most critical period in the state’s battle against COVID-19, the state’s 416 hospitals — big and small, public and private — are scrambling to build the capacity needed for an onslaught of critically ill patients.

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Hospitals from Los Angeles to San Jose are already seeing a steady increase in patients infected by the virus, and so far, hospital officials say they have enough space to treat them. But they also issued a dire warning: What happens over the next four to six weeks will determine whether the experience of California overall looks more like that of New York, which has seen an explosion of hospitalizations and deaths, or like that of the San Francisco Bay Area, which has so far managed to prevent a major spike in new infections, hospitalizations and death.

Some of their preparations share common themes: Postpone elective surgeries. Make greater use of telemedicine to limit face-to-face contact. Erect tents outside to care for less critical patients. Add beds — hospital by hospital, a few dozen at a time — to spaces like cafeterias, operating rooms and decommissioned wings.

But by necessity — because of shortages of testing, ventilators, personal protective equipment and even doctors and nurses — they’re also trying creative and sometimes untried strategies to bolster their readiness and increase their capacity.

In San Diego, hospitals may use college dormitories as alternative care sites. A large public hospital in Los Angeles is turning to 3D printing to manufacture ventilator parts. And in hard-hit Santa Clara County, with a population of nearly 2 million, public and private hospitals have joined forces to alleviate pressure on local hospitals by caring for patients at the Santa Clara Convention Center.

Yet some hospitals acknowledge that, despite their efforts, they may end up having to park patients in hallways.

“The need in this pandemic is so different and so extraordinary and so big that a hospital’s typical surge plan will be insufficient for what we’re dealing with in this state and across the nation,” said Carmela Coyle, president and CEO of the California Hospital Association.

Across the U.S., more than 213,000 cases of COVID-19 have been confirmed, and at least 4,750 people have died. California accounts for more than 9,400 cases and at least 199 deaths.

Health officials and hospital administrators are singling out April as the most consequential month in California’s effort to combat a steep increase in new infections. State Health and Human Services Secretary Mark Ghaly said Wednesday that the number of hospitalizations is expected to peak in mid-May.

Gov. Gavin Newsom said there were 1,855 COVID-19 cases in hospitals Wednesday, a number that had tripled in six days, and 774 patients in critical care. By mid-May, the number of critical care patients is expected to climb to 27,000, he said.

Newsom said the state needs nearly 70,000 more hospital beds, bringing its overall capacity to more than 140,000 — both inside hospitals and also at alternative care sites like convention centers. The state also needs 10,000 more ventilators than it normally has to aid the crush of patients needing help to breathe, he said, and so far has acquired fewer than half.

Newsom and state health officials worked with the Trump administration to bring a naval hospital ship to the Port of Los Angeles, where it is already treating patients not infected with the novel coronavirus. The state is working with the Army Corps of Engineers to deploy eight mobile field hospitals, including one in Santa Clara County. And it is bringing hospitals back online that were shuttered or slated to close, including one each in Daly City, Los Angeles, Long Beach and Costa Mesa.

The governor is also drafting a plan to make greater use of hotels and motels and nursing homes to house patients, if needed.

But the size of the surge that hits hospitals depends on how well the public follows social distancing and stay-at-home orders, said Newsom and hospital administrators. “This is not just about health care providers caring for the sick,” said Dr. Steve Lockhart, the chief medical officer of Sutter Health, which has 22 hospitals across Northern California.

While hospitals welcomed the state assistance, they’re also undertaking dramatic measures to prepare on their own.

“I’m genuinely very worried, and it scares me that so many people are still out there doing business as usual,” said Chris Van Gorder, CEO of Scripps Health, a system with five major hospitals in San Diego County. “It wouldn’t take a lot to overwhelm us.”

Internal projections show the hospital system could need 8,000 beds by June, he said. It has 1,200.

In addition to taking precautions to protect its health care workers — such as using baby monitors to observe patients without risking infection — it is working with area colleges to use dorm rooms as hospital rooms for patients with mild cases of COVID-19, among other efforts, he said.

“Honestly, I think we should have been better prepared than we are,” Van Gorder said. “But hospitals cannot take on this burden themselves.”

Van Gorder and other hospital administrators say a continued shortage of COVID-19 tests has hampered their response — because they still don’t know exactly which patients have the virus — as has the chronic underfunding of public health infrastructure.

Kaiser Permanente wants to double the capacity of its 36 California hospitals, Parodi said. It is also working with the garment industry to manufacture face masks, and eyeing hotel rooms for less critical patients.

Harbor-UCLA Medical Center, a 425-bed safety-net hospital in Los Angeles, is working to increase its capacity by 200%, said Dr. Anish Mahajan, the hospital’s chief medical officer.

Harbor-UCLA is using 3D printers to produce ventilator piping equipped to serve two patients per machine. And in March it transformed a new emergency wing into an intensive care unit for COVID-19 patients.

“This was a shocking thing to do,” Mahajan said of the unprecedented move to create extra space.

He said some measures are untested, but hospitals across the state are facing extreme pressure to do whatever they can to meet their greatest needs.

In March, Stanford Hospital in the San Francisco Bay Area launched a massive telemedicine overhaul of its emergency department to reduce the number of employees who interact with patients in person. This is the first time the hospital has used telemedicine like this, said Dr. Ryan Ribeira, an emergency physician who spearheaded the project.

Stanford also did some soul-searching, thinking about which of its staff might be at highest risk if they catch COVID-19, and has assigned them to parts of the hospital with no coronavirus patients or areas dedicated to telemedicine. “These are people that we might have otherwise had to drop off the schedule,” Ribeira said.

Nearby, several San Francisco hospitals that were previously competitors have joined forces to create a dedicated COVID-19 floor at Saint Francis Memorial Hospital with four dozen critical care beds.

The city currently has 1,300 beds, including 200 ICU beds. If the number of patients surges as it has in New York, officials anticipate needing 5,000 additional beds.

But the San Francisco Bay Area hasn’t yet seen the expected surge. UCSF Health had 15 inpatients with COVID-19 Tuesday. Zuckerberg San Francisco General Hospital and Trauma Center had 18 inpatients with the disease Wednesday.

While hospital officials are cautiously optimistic that local and state stay-at-home orders have worked to slow the spread of the virus, they are still preparing for what could be a major increase in admissions.

“The next two weeks is when we’re really going to see the surge,” said San Francisco General CEO Susan Ehrlich. “We’re preparing for the worst but hoping for the best.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Coronavirus Cases Now In Three Prisons And Four Jails Across Mass.

CommonHealth (WBUR) - Wed, 04/01/2020 - 7:04pm

The coronavirus is now in three prisons and four jails across the state, bringing the total known infected staff and prisoners to 35 people.

Categories: Health Care

Listen: COVID-19 Stresses Rural Hospitals Even Before They Have A Single Case

Kaiser Health News - Wed, 04/01/2020 - 5:12pm

KHN Midwest correspondent Lauren Weber appeared on WOSU’s “All Sides with Ann Fisher” out of Columbus, Ohio, to talk about the coronavirus pandemic’s impact on rural hospitals. Weber recently reported on the financial implications for such hospitals even before they handle any COVID-19 cases.

Almost half of the nation’s rural hospitals already operated in the red on a good day. Rural hospital CEOs now warn that some soon may be unable to pay their workers because they’ve had to cancel elective procedures, therapy, tests and other visits that bring in most of their revenue. Despite the recent federal bailout, their doors may close when the community most needs them.

Click here to listen on WOSU’s website.

Categories: Health Care

Under Pressure, Florida Governor Finally Orders Residents To Stay Home

Kaiser Health News - Wed, 04/01/2020 - 4:49pm

With pressure mounting from public health officials and political leaders nationwide, Florida Gov. Ron DeSantis on Wednesday reversed course and ordered residents across the state to stay at home to help reduce the toll of the coronavirus pandemic.

The order takes effect at 12:01 a.m. Friday, April 3.

Florida joins more than 30 other states and the District of Columbia in moves that have similarly restricted residents and businesses. DeSantis’ decision came as Texas and Pennsylvania took similar action.

For more than a week, DeSantis said a statewide order was unnecessary because many parts of the state ― particularly large swaths of central and northern Florida — had few if any cases. When asked about the issue Tuesday, the governor said he wasn’t issuing an order because he had not been told by the White House coronavirus task force that an order was necessary.

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DeSantis spoke to President Donald Trump about the outbreak before his announcement.

DeSantis said what changed his mind was Trump’s call on Sunday for the national social-distancing guidelines to be extended through April because of mathematical models showing how death tolls would soar if the population did not observe the recommended public health guidelines for staying at home. Trump has not issued a national stay-at-home order.

“That was a signal,” DeSantis said. “It’s a very serious situation.”

Scott Gottlieb, a former Food and Drug Administration commissioner under Trump who has been outspoken on the need for officials to act to quell the outbreak, said in a tweet:

“New actions just announced by Florida’s Governor to implement tougher mitigation will hopefully reduce spread of #COVID19 in state. Florida is also testing much less than other states and needs more screening capacity to keep up with its expanding epidemic.”

Before DeSantis reversed course, Gottlieb said in an interview with CNBC earlier Wednesday that Florida and Texas are “wild card” states that could leave the United States with more deaths from the coronavirus if they don’t take tougher actions.

Many public health experts had strongly criticized Florida officials for allowing large spring-break beach gatherings in mid-March, raising concerns that the parties could be spreading COVID-19, the disease caused by the coronavirus. Even more recently, large beach and sandbar parties in late March have brought condemnation.

DeSantis resisted closing all beaches via a state decree, but most counties in Florida have now done so on their own.

The Florida order is less restrictive than that of some other states. In addition to common exceptions for errands deemed essential, such as grocery shopping and picking up prescriptions, it allows people to still attend religious services at churches and synagogues and take care of relatives and their pets.

The Florida governor had already ordered nightclubs and restaurant dining rooms across the state to close and restricted gatherings of 10 or more people on beaches. The state had already closed all schools.

Several of Florida’s largest cities and counties — including all of South Florida, which on Wednesday afternoon had about 3,900 COVID-19 cases — had earlier ordered residents to stay at home.

Public health and political leaders praised DeSantis’ order Wednesday, although some said he should have acted earlier.

“Thank you, Governor, for making the right call,” said Florida Agriculture Commissioner Nikki Fried, a statewide elected member of the Florida Cabinet. She noted she asked DeSantis to issue the order on March 20 to save lives.

As of Tuesday morning, Florida had about 7,000 confirmed cases of COVID-19, nearly 900 hospitalizations and at least 87 deaths. More than 60% of the cases were in South Florida.

Categories: Health Care

There Are Now More Than 100 Deaths Due To COVID-19 In Mass.

CommonHealth (WBUR) - Wed, 04/01/2020 - 4:03pm

The 122 deaths reported is a 37% jump from the day before.

Categories: Health Care

Listen: Why It Takes So Long To Get COVID-19 Test Results

Kaiser Health News - Wed, 04/01/2020 - 3:38pm

In this episode of “The Daily Dive,” a news podcast, KHN senior correspondent Julie Appleby and iHeart Radio’s Oscar Ramirez discuss the steps involved in processing coronavirus tests and how these circumstances can lead to lags and variations in the turnaround time the patients face as they wait for results.

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For more on this topic, check out Julie’s story.


Categories: Health Care

Tribal Nations — Highly Vulnerable to COVID-19 — Need More Federal Relief

Center on Budget and Policy Priorities - Wed, 04/01/2020 - 1:24pm

By providing $8 billion for 574 federally recognized tribes in its $150 billion Coronavirus Relief Fund for tribal, state, local, and territorial governments, the Coronavirus Aid, Relief, and Economic Security Act marked a historic federal recognition of tribes — contrasting sharply with the 2009 Recovery Act, which excluded tribes from its major state fiscal relief.

Categories: Benefits, Poverty

R.I. Mayors Want Shuttered Hospital Reopened As COVID-19 Care Site

CommonHealth (WBUR) - Wed, 04/01/2020 - 10:47am

Pawtucket Mayor Donald Grebien and Central Falls Mayor James Diossa sent a letter to Care New England this week saying Memorial Hospital in Pawtucket could be used as a testing site, respiratory center or isolation center.

Categories: Health Care

After COVID-19 Deaths At Holyoke Veterans' Home, Sister Facility In Chelsea Reports Cases, 1 Death

CommonHealth (WBUR) - Wed, 04/01/2020 - 10:20am

At least two residents and two employees of the Soldiers' Home in Chelsea -- a state-run facility for older veterans -- have tested positive for COVID-19. Of those residents, one has died. It's unclear when the death occurred.

Categories: Health Care

I'm A Doctor Who Got COVID-19. Here's What I Learned

CommonHealth (WBUR) - Wed, 04/01/2020 - 10:19am

I exposed my patients, my parents and my friends. I exposed my husband and my kids. All without knowing.

Categories: Health Care

Legal Research Reports: Points-Based and Family Immigration

Law Library of Congress: Research Reports - Wed, 04/01/2020 - 10:00am

The Law Library of Congress is proud to present the report, Points-Based and Family Immigration.

This report explains the points-based immigration systems adopted by Australia, Austria, Canada, Japan, New Zealand, South Korea, and the United Kingdom. Each of these countries determines a noncitizen’s eligibility to obtain a particular visa or residence status partly by whether that noncitizen is able to score above a threshold number of points in accordance with the country’s points scoring system. All of the countries have points-based immigration system for skilled workers. Other categories for which a points-based immigration system is used include investor, entrepreneur/business start-up, persons with exceptional capabilities, temporary worker, and job seeker.  

This report is one of many prepared by the Law Library of Congress. Visit the Comprehensive Index of Legal Reports page for a complete listing of reports and the Current Legal Topics page for our highlighted and newer reports. 

Categories: Research & Litigation

Different Takes: Lessons On Death Drawing Near Again; Pleas From Cruise Ships Looking For Safe Harbors

Kaiser Health News - Wed, 04/01/2020 - 9:09am
Editorial pages focus on these health topics and others.
Categories: Health Care

Telemedicine Companies Struggle To Keep Up With Ever-Increasing Demand

Kaiser Health News - Wed, 04/01/2020 - 9:09am
It's an industry that hasn't always found success, but now amid the crisis, telemedicine is booming. That doesn't mean companies are equipped to handle the surge of patients, though.
Categories: Health Care

Test Results Come Back Negative?: Don’t Assume You Don’t Have It If You’re Symptomatic, Doctor Says

Kaiser Health News - Wed, 04/01/2020 - 9:09am
A physician explains what happened to a patient, saddled by fevers, saying the problem might be with the tests which might have a particularly high rate of missing infections. Public health news is on isolating at home to protect loved ones, warnings about overusing alcohol, dealing with anxiety when alone, turning back immigrant children at the border, overcoming language barriers, disrupting fertility treatments, going without toilet paper and other supplies, and advice to keep walking (even in your livingroom), as well.
Categories: Health Care


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