April 1 COVID-19 Update – Pennsylvania American College of Physicians

​PA-ACP MAKES RECOMMENDATIONS TO GOVERNOR, SECRETARY LEVINE
 
On April 1, PA-ACP asked the Governor and Secretary Levine to consider several actions to ensure that small and independent primary care physician practices can continue to play their critical role not only during the emergency, but on an ongoing basis.

Among the actions recommended:

• Making sufficient PPE available to every physician, nurse and health worker on the front lines.
• Waiving prior authorization for ongoing care and treatment of existing patients, and for prescription of generic drugs.
• Changes in telehealth policies, including requirements that all payers cover and pay for audio-only telehealth visits; ensure coverage of telehealth are by the patient centered medical home and subspecialists, not defaults to existing vendor contracts; waive cost sharing for families; paying for telehealth care visits at parity with in-person visits; allow telehealth care for new and established patients and allow all types of clinically appropriate services to be provided via telehealth during the COVID-19 crisis.
• Setting aside a portion of state and federal funds for the COVID-19 response for express use of physician practices experiencing revenue and staff losses.
• Making independent private and small physician practices eligible for all state/federally funded grants and forgivable loans for small businesses.

PA COVID-19 DATA UPDATE
The Pennsylvania Department of Health on Tuesday said the number of coronavirus cases in Pennsylvania had increased by 756 to 4,843 in 60 counties. Five percent of those have been health care workers.

Of those positives, 514 required hospitalization since March 6 and 159 of those required treatment in an ICU.  94 of those required use of a ventilator.  The number of deaths statewide increased by 15, to 63.  One of those newly reported deaths was in Lehigh County.

Most of the patients hospitalized are aged 65 or older, and most of the deaths have occurred in patients 65 or older. There have been no pediatric deaths to date. More data is available here.

Of the patients who have tested positive to date the age breakdown is as follows:

Less than 1% are aged 0-4; Less than 1% are aged 5-12; 1% are aged 13-18; Nearly 10% are aged 19-24; Nearly 41% are aged 25-49; Nearly 29% are aged 50-64; and Nearly 19% are aged 65 or older.

In addition to the state’s 4,843 positive-test cases, there have been 37,645 patients who have tested negative for the virus. 

Stay at Home Orders
Seven new counties – Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon and Somerset counties have been added to the stay home order, at least through April 30.  A total of 33 counties are now under the governor’s order.  Under the Governor’s orders, all non-life-sustaining businesses are ordered to be closed and schools are closed statewide indefinitely.

Questions to Dr. Levine this afternoon
If a company has an employee that tests positive, is it required to shut down?  That employee needs to go into isolation, then specific criteria from CDC.  Those close contacts to the employee would need to be quarantined for 14 days.  A deep cleaning according to CDC guidelines for business then can reopen and others can return to work. (See note below.)

What are the state’s conditions for testing an individual?  We are prioritizing testing in the Exton laboratory to individuals from hospitals, nursing homes, etc.  The state is still looking to test only symptomatic patients.  However, with a doctor’s order it would be unusual for someone to be turned away.  She added that pinkeye is not a symptom specific to COVID-19.

How are counties determined for stay at home orders?  Dr. Levine said factors include the number of cases, number per capita, rate of change, and requests and recommendations from county officials and state legislators) within the counties.  All factor into governor’s decisions.

Is the state doing contact tracing?  We are doing it for specific vulnerable populations (ex. Nursing homes) but don’t have the resources for a more broad effort with more than 4,000 positives.

What if an employee is confirmed positive for COVID-19? Dr. Levine said the employee should be in isolation, following CDC guidelines. Other staff members who had contact with this individual should self-quarantine for up to 14 days. Then a deep cleaning of the business should be followed per CDC guidelines before the business can reopen. These guidelines have been sent to Members in past editions of “On the Fly …” and can be accessed by clicking here.
 
CDC Providing Additional Guidance for Healthcare Professionals
CDC added to their FAQ document for healthcare professionals additional information on drugs and investigational therapies to address common questions and misperceptions on available and approved drugs to treat COVID-19. CDC also released guidelines and a decision algorithm for how to guide care advice and messages with evaluating and triaging potential patients.

State Board of Medicine and chloroquine and hydroxychloroquine: Information for prescribers
The State Board of Medicine and the State Board of Osteopathic Medicine, in response to COVID-19 and potential shortages of medications that may be effective against the virus such as hydroxychloroquine:  prescribers should include the patient’s diagnosis on the prescription. If written for a COVID-19 diagnosis, the diagnosis has been confirmed by a positive test result and documented on the prescription. Smaller quantities of hydroxychloroquine should be prescribed for COVID-19 patients when appropriate to prevent potential shortages.
 
PACE Program Updates
Department of Aging Secretary Robert Torres today announced that the Pharmaceutical Assistance Contract for the Elderly (PACE) Program can help older adult enrollees with refill extensions.  “PACE is working to ensure older adults remain in their residences and receive their prescriptions when they desire them. All enrollees should be able to receive free home delivery of their medications from their pharmacies, he said.”

Under regular circumstances, enrollees with prescriptions must use 75% of their supply before refills will be reimbursed. PACE will now reimburse refills even though the required 75% of the days’ supply has not passed – except for opioids and other controlled substances – which will be handled on a case by case basis.

Enrollees must have their pharmacy provider contact PACE at 1-800-835-8040, 24/7.to make the request. The program has traditionally not offered this exception unless an enrollee’s medications were lost or stolen. Enrollees who have difficulty obtaining their refills can call cardholder services at 1-800-225-7223.
 
Small Business Updates 3-31
As of 6 p.m. Tuesday, the Pennsylvania Department of Community and Economic Development no longer is accepting applications for the COVID-19 Working Capital Access Program. The applications received as of that time have surpassed the funding available to the program.

Paycheck Protection Program Opens April 3
Small businesses and sole proprietorships affected by the coronavirus pandemic can apply for loans under the federal Paycheck Protection Program (PPP) beginning Friday April 3.  Starting April 10, independent contractors and self-employed individuals can apply.

The application can be found here on the Treasury site. Treasury urged those in need of funding to apply quickly, noting that the program has a cap and demand is likely to be high.

Under the program, small businesses with 500 or fewer employees including not-for-profits, veterans’ organizations, tribal concerns, self-employed individuals, sole proprietorships, and independent contractors are eligible for loans to pay up to eight weeks of payroll costs including benefits as well as other costs.

Loan forgiveness is based on the employer’s maintaining or quickly rehiring employees and maintaining salary levels, Treasury said in its overview documents. Forgiveness will be reduced if full-time headcount declines or if salaries and wages decrease. PPP funds can also be used to pay interest on mortgages, rent, and utilities. Treasury noted that due to likely high demand for the program, at least 75% of the forgiven loan amount must have been used for payroll.

Loan payments will be deferred for six months. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees.

An employer who receives a loan under the PPP is not eligible to also claim an employee retention credit under the CARES Act. The employee retention credit gives eligible employers whose business operations are fully or partially suspended due to the COVID-19 pandemic a credit against employment taxes equal to 50% of qualified wages (up to $10
,000 in wages) for each employee.

UC update
The Department of Labor & Industry said it is hiring 100 additional staff and will continue to expand as needed to handle the unprecedented call volume requesting unemployment compensation.  More than 830,000 Pennsylvanians have filed in the last two weeks.

The CARES Act provides an extension in the maximum time for receiving UC benefits from 26 to 39 weeks and provides $600 in addition to the standard payment.