Combating the Novel Coronavirus (COVID-19): Week of April 12

MHA Covid-19 update

A somber milestone was reached April 17 when, according to Johns Hopkins University data, the global number of deaths caused by COVID-19 surpassed 3 million. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

MHA Board of Trustees Focuses on COVID-19 Data, Vaccines

The MHA Board of Trustees held a virtual meeting April 14, where much of the agenda focused on COVID-19 as the spring surge continues to challenge Michigan communities and health system resources (see related article). Board members heard presentations on hospitalization and other surge-related COVID-19 data, which may be starting to show signs of improvement as growth rates and emergency department visit rates begin to slow and plateau. Despite these encouraging signs, healthcare providers must continue to urge their communities to stay vigilant in preventive actions.

Board members also discussed vaccine-related issues, including the Johnson & Johnson pause and how it may impact conversations around equity, hesitancy, safety/effectiveness and more. They also discussed efforts health systems can pursue to encourage as many employees as possible to be voluntarily vaccinated. For more information on the board meeting, contact Amy Barkholz at the MHA.

Board members also met April 12 via Zoom with U.S. Sen. Gary Peters (D-West Bloomfield), who expressed interest in the experience of hospitals and health systems during the current surge of infection. Members shared the damage the pandemic has done to staffing capacity by causing exhaustion and early retirements; the need for post-COVID-19 care for brain health including seizures, anxiety and depression; and the younger average age of hospitalized patients. Peters announced his Committee on Homeland Security and Governmental Affairs is doing a complete after-action study of the COVID-19 pandemic to improve preparedness and communications for future long-term crises. For more information about federal advocacy and policy, members may contact Laura Appel at the MHA.

J&J Vaccine Paused While Investigation Continues on Six Blood Clot Events

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), out of an abundance of caution, issued a statement April 13 that providers should halt administration of Johnson & Johnson (J&J) COVID-19 vaccines while they investigate six instances of blood clots in previously vaccinated individuals. More than 6.8 million J&J vaccines have been administered to date nationally, meaning these instances are extremely rare. All those affected were women between the ages of 18 and 48, and their symptoms developed six to 13 days after vaccination.

The CDC Advisory Committee on Immunization Practices (ACIP) met April 14 to discuss and review these incidents and, after several hours of debate, concluded that it would take additional time to review the cases and make a final recommendation for continued use of the vaccine. A decision is expected by the end of April.

Because the ACIP is an advisory committee, it is permissible, but highly unlikely, that the CDC and FDA would advise providers to resume use of the vaccine without a new recommendation from the ACIP. In the meantime, providers should continue to only use Pfizer and Moderna vaccines, and store/label J&J vaccines as instructed by recent alerts from the Michigan Department of Health and Human Services (MDHHS). The department stated, in part, “Clinics that are scheduled to administer J and J vaccine should be rescheduled to use a different vaccine. If you have inventory of this vaccine, please separate in your storage unit, mark do not use and store appropriately until further notice.”

The MHA will keep members apprised of recommendations as they become available. Members with questions on vaccines may contact Ruthanne Sudderth at the MHA.

Pfizer Requests Emergency Use Authorization for Younger Children

Pfizer recently asked the FDA to grant expanded emergency use authorization (EUA) of its COVID-19 vaccine for use in adolescents between the ages of 12 and 15. The request is based on data from Pfizer’s late-stage trial of the vaccine in children in this age group with or without prior evidence of COVID-19 infection, which demonstrated 100% efficacy and robust antibody response after vaccination.

The participants tolerated the vaccine with the incidence of side effects similar to adults, and Pfizer continues to monitor these adolescents. The company is also confident the vaccine will deliver long-term protection for as long as two years after the completion of dosage, although currently available data supports at least six months of protection. Since the vaccine is currently allowed to be used for anyone ages 16 and older, young Michiganders are urged to get vaccinated with the Pfizer vaccine as quickly as possible to prevent further spread among this age group, as well as illness, hospitalization and death.

Given the speed at which the expanded EUA could take effect, making 12- to 15-year-olds eligible for vaccination, health systems are encouraged to educate their family practice/pediatric care settings on administration of the Pfizer vaccine. The MHA will work with the Michigan Association of Family Physicians and the Michigan Chapter of the American Association of Pediatrics to coordinate messaging and resources. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

FDA Recommends Moving Away from Decontaminated N95 Respirators

The FDA recently issued guidance recommending that healthcare personnel and facilities transition away from crisis capacity conservation strategies for N95 respirators. Due to an increased supply of respirators approved by the National Institute for Occupational Safety and Health, the FDA believes there is a sufficient domestic supply to allow organizations to transition away from decontamination or bioburden reduction and reuse of respirators intended as single-use items. The guidance does not specify a “days on hand” calculation for when the recommendations should be implemented; it simply references moving away from the crisis capacity strategy.

To date, the Michigan Occupational Safety and Health Administration (MIOSHA) has not issued guidance or statements on how it will interpret this FDA letter in Michigan. The MHA will continue to advocate with state leaders for organizational flexibility in determining their supply needs and crisis capacity strategies.

Organizations that have concerns about their supply of personal protective equipment (PPE) should contact the appropriate Regional Health Care Coalition. Members with questions or concerns on PPE may also contact Adam Carlson at the MHA.

MIOSHA Issues Permanent COVID-19 Workplace Rules

The MIOSHA released draft rules that would make permanent workplace regulations governing the use of PPE, physical distancing, contact tracing and other pandemic-related modifications. The MHA participated in a work group on the development of the permanent rules, but its suggestions to allow the rules to be flexible for updated CDC guidelines and to set an end date to the rules were not adopted in the draft rule set. The association followed up by submitting its recommendations to the MIOSHA in writing.

Emergency rules already in place on this topic were slated to expire April 14 and are expected to be extended to Oct. 14, 2021. The MHA hosted a webinar in December on that rule set for members, and the association will review the renewed emergency rules when they are available. The MHA will compile additional recommended changes to the permanent rule set prior to a public hearing being scheduled. Members with questions on the emergency or permanent MIOSHA rules may contact Adam Carlson at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of April 5

MHA Covid-19 update

MHA COVID-19 UpdateMichigan hospitals are quickly reaching inpatient capacity as coronavirus variants spread throughout the state and contribute to a severe surge in COVID-19. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Chief Medical Officers Urge Michiganders to Help Prevent COVID-19 Spread

The MHA released a media statement April 9 on behalf of Michigan’s hospital/health system chief medical officers urging people to protect those who cannot be vaccinated by taking the responsible, proven preventive measures. The statement provides context on the increased transmission and risks of the virus and associated complications for children.

In addition, Gov. Gretchen Whitmer held a news conference April 9, which also featured Tina Freese Decker, Spectrum Health president and CEO and MHA board chair-elect, outlining Michigan’s COVID-19 caseload and the need to stop the spread of the virus. The governor is urging federal agencies to redirect resources, including a large influx of vaccine, to Michigan as soon as possible. Her administration has indicated it is focused on getting more vaccine supply to providers/mass vaccination clinics where it can be administered most quickly to stop viral spread.

The Protect Michigan Commission is also planning regional press events, some of which will include hospital/health system participants, to promote the need for everyone eligible to get vaccinated as soon as possible. The MHA will keep members apprised and share any messaging or materials that hospitals can use on their own platforms to amplify the message.

Questions on COVID-19 vaccines should be directed to Ruthanne Sudderth at the MHA.

Testing and Vaccination Key to Curtailing Viral Spread

The Michigan Department of Health and Human Services (MDHHS) is offering free, on-site rapid COVID-19 testing in partnership with Michigan's intermediate school districts, local school districts and local health departments for residents returning from spring break travel. These fully staffed events are open to students, educators, district staff and community members, and will be scheduled prior to classes restarting. The current list of locations is available on the MDHHS website. Members with questions on testing sites should contact Laura Appel at the MHA.

As part of a virtual session with MHA staff April 5, U.S. Rep. Elissa Slotkin (D-Holly) outlined two strategies hospitals can follow to help address vaccine hesitancy in their communities. She encourages hospitals and health systems to use every patient interaction as an opportunity to discuss the COVID-19 vaccine, regardless of the reason for the visit. In addition, she suggested facilities provide vaccine educational opportunities in the form of webinars, town halls and other events that feature physicians and can reach vaccine-hesitant groups.

As the vaccine becomes more widely available, hospitals are encouraged to revisit offers to vaccinate employees who declined vaccines when first made available to them. Some may have wanted to wait for a single dose vaccine or a more convenient time, were reluctant to get the vaccine while pregnant, or faced other circumstances that may have since changed. In addition, as the state receives media requests, it is expected to begin sharing data on healthcare personnel vaccination rates. To ensure healthcare organizations are accurately represented in any data sharing that occurs, members are urged to confirm their employee vaccine data is up to date in the state’s EMResource portal.

MDHHS Reinstates 14-Day Quarantine, Reminds Providers to Use Michigan EUA Fact Sheets

Due to increasing case rates and variant spread in Michigan, the MDHHS is reinstating a 14-day quarantine for anyone who experiences close contact with a COVID-19-positive person, removing the option for a 10-day quarantine. The department’s COVID-19 public health frequently asked questions document has been updated to reflect the change.

The department also reminds vaccinators that they need to provide the Michigan versions of the emergency use authorization (EUA) fact sheets available on the MDHHS website. Each fact sheet has been updated and includes information on the Michigan Care Improvement Registry.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of March 29

MHA Covid-19 update

MHA COVID-19 UpdateThe MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

COVID-19 Cases Continue to Surge in Michigan

New cases of the coronavirus and related hospitalizations have recently ranked Michigan as having the most severe surge of viral spread in the nation. Gov. Gretchen Whitmer urged vaccination providers March 29 to inoculate anyone they can accommodate, regardless of age or health status, to mitigate the spread and ensure no doses are wasted. State officials continue to encourage vaccinators to prioritize doses among all recipients to ensure that medically frail or otherwise more vulnerable individuals are protected.

As the MHA reported in a March 24 news release, hospitalization rates are increasing rapidly for younger age groups that are less likely to have been vaccinated, while the vaccine appears to be preventing hospitalizations at or near 100%. MHA Chief Medical Officer Gary Roth, DO, discussed the need for Michigan residents to improve preventive measures and get vaccinated during an interview on CNN’s New Day program March 30. Additional media coverage of the increasing hospitalizations is outlined in a related article.

The governor announced March 31 that Michigan’s state allocation of vaccines will exceed 620,000 during the week of April 5. That figure does not include vaccines that will be sent to Michigan retail pharmacies and federally qualified health centers directly from the federal government.

Vaccinating Michiganders became even more important when a Bay County resident tested positive March 31 for the COVID-19 variant that originated in Brazil (P.1). The Bay County Health Department is taking all appropriate measures to identify the source of the infection, which is known to be more transmissible than the original virus. Hospitals are encouraged to continue communicating with their patients and communities about variants present in Michigan to urge continued mask wearing, distancing, hand washing and vaccination.

For more information about the COVID-19 vaccines, contact Ruthanne Sudderth at the MHA.

Medicare Claims Held as Congress Considers Extending Sequestration Moratorium

The Centers for Medicare & Medicaid Services recently instructed Medicare Administrative Contractors (MACs) to hold all Medicare fee-for-service claims for dates of service on or after April 1, 2021, for a short period in anticipation of possible congressional action to extend the moratorium on the 2% sequestration cut to all Medicare payments. Absent congressional action, the moratorium was to expire April 1, reinstating the cuts.

The U.S. Senate recently passed a bill that, among other provisions, would eliminate the 2% cut to all Medicare payments until the end of 2021. The U.S. House is expected to take up the Senate-passed bill when it returns to session the week of April 13.

If necessary, the MACs will automatically reprocess any claims paid with the reduction applied. Elimination of the sequester cuts was included in the CARES Act and was effective from May 1 through Dec. 31, 2020; it was subsequently extended through March 31, 2021.

The MHA, along with the American Hospital Association and others, continues to advocate for payment policies that support COVID-19 relief and recovery. Those wishing to urge their representative to support an additional extension of the moratorium on the 2% sequestration cuts can obtain their lawmaker’s contact information at the MHA Legislative Action Center by entering their ZIP code into the “Find Officials” field. Members with questions should contact Vickie Kunz at the MHA.

New Resources on Therapeutic Options Available on MDHHS Website

The Michigan Department of Health and Human Service (MDHHS) has posted new resources on the variety of therapeutics available to treat COVID-19. The information includes the types of therapies available, how to prescribe and administer them, how to order them and more. The website also allows individuals who want to receive antibody treatment to locate treatment near them. The MDHHS encourages all providers to actively seek out COVID-19-positive individuals to whom they can provide therapeutic treatments.

Clinic Preparation for Vaccination Webinar Materials Posted

The MDHHS has made available the recording and materials from its March 26 webinar for those who wish to vaccinate patients in physician office/clinic settings. Materials include a checklist that outlines all steps the clinic must have in place to receive, administer, bill for, store, prepare and document COVID-19 vaccines. The MDHHS provides materials from this and other relevant webinars on its COVID-19 Vaccine Webinars page in the provider education section of the website. Health systems that plan to redistribute vaccine to new sites or enroll new sites in the COVID-19 vaccination program are encouraged to share these materials with those offices to assist in preparation.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).
 

Combating the Novel Coronavirus (COVID-19): Week of March 22

MHA Covid-19 update

MHA COVID-19 UpdateThe MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

MHA News Release Urges Vigilance as COVID-19 Cases, Hospitalizations Rise

The MHA issued a news release March 24 regarding the increase in hospitalization rates across Michigan and the positive impact vaccines are having on preventing hospitalization in older adults. The MHA urged residents to help prevent a spring surge of COVID-19 by ensuring they follow recommended preventive measures.

The news release generated significant statewide and national media coverage (see related article), including social media. Members may receive additional inquiries about the surgeRuthanne Sudderth at the MHA.

Vaccine Allocation to Increase

The state indicated March 26 that approximately 600,000 vaccines will come into Michigan during the week of March 29, marking an increase over the previous two weeks. That number includes the state’s supply and those vaccines being sent directly by the federal government to retail pharmacies, federally qualified health centers and the Ford Field mass vaccination site that opened March 24. As of March 25, Michigan providers had administered more than 3.8 million vaccine doses and fully vaccinated more than 1.4 million Michigan residents — or nearly 18% of the eligible adult population. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

Medicaid Payment for Vaccine Administration to Increase to Medicare Rates

As previously reported, the Biden administration March 15 updated Medicare rates for vaccine administration, increasing them to $40 per dose of each of the currently available vaccines.

A final policy issued by the Medical Services Administration in December stipulates that Medicaid fee-for-service (FFS) and managed care payment rates for COVID-19 vaccine administration services will equal the Medicare rates for equivalent services. All Medicaid reimbursement rates will be reviewed and updated as applicable and are available on the MDHHS webpage for Medicaid providers by clicking on Billing & Reimbursement and Provider Specific Information.

The MSA also issued concurrent proposed and final policies indicating that the vaccine cost for MI Health Link beneficiaries will be covered by the Medicare FFS program during calendar years 2020 and 2021. Members with questions should contact Vickie Kunz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of March 15

MHA Covid-19 update

MHA COVID-19 UpdateAs of March 18, the state’s COVID-19 Vaccine Dashboard indicated just over 27% of Michigan’s nearly 8.1 million residents ages 16 and above had received at least one dose of a vaccine. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Medicare Payments Rates for COVID-19 Vaccinations Increased

Medicare payments to healthcare providers administering COVID-19 vaccines nearly doubled March 15 when the Biden administration updated the rates with immediate effect. The change is designed to increase the number of providers administering the shots nationwide.

Rates have increased to $40 per dose administered for all three of the currently available vaccines, up from approximately $23 per shot for two-dose vaccines and $28 for the single-dose vaccine.

The White House also announced that the administration will fully cover all Medicaid and Children’s Health Insurance Program beneficiaries’ COVID-19 shots, as mandated by the $1.9 trillion relief package President Joe Biden signed into law March 11.

There are currently more than 2,500 providers enrolled to administer vaccines in Michigan, but most have not been receiving vaccines due to limited supply. The state of Michigan may activate more of those providers to expand the vaccinations to additional populations as more vaccine becomes available.

Member Communication Tools Updated as Data Suggests Spring Surge of COVID-19

The MHA is concerned that data shows the start of a spring COVID-19 surge, with rising levels of case numbers over the first two weeks of March after weeks of plateau, in concert with hospitalizations that have again risen above 1,000. With these data trends in mind, the MHA is emphasizing the need for all Michigan residents to remain cautious, continue to practice proven preventive measures and be vaccinated as soon as a vaccine is available to them. Wearing masks, physically distancing and hand washing continue to be important following vaccination, since the vaccine’s protection doesn’t take full effect for up to a month after the final dose, and it will be several months before the majority of people can be vaccinated.

Members are encouraged to use the association’s updated COVID-19 communication toolkit and their trusted clinicians and healthcare professionals to amplify these messages to their communities. Additional information and talking points may be requested from Ruthanne Sudderth at the MHA.

Vaccine Allocations to Increase, Eligible Groups and Vaccination Sites Expand

The Michigan Department of Health and Human Services (MDHHS) has continued to urge the federal government to provide additional doses of the Johnson & Johnson one-dose vaccine. A small allocation of the vaccine is expected to arrive during the week of March 22, and hospitals that receive it are asked to use it for individuals in the inpatient or emergency department settings prior to discharge.

The state has expanded vaccine eligibility to include anyone 16 or older with an underlying medical condition effective March 22. Two weeks later, April 5, anyone 16 and older will become eligible. The complete MDHHS Prioritization Guidance is available on the state's coronavirus webpage.

In addition, several new retail pharmacy settings have joined the federal retail pharmacy vaccination program, including CVS, Walgreen’s, Walmart, Meijer, Rite-Aid, Snyder Drugs, Kroger and many more in Michigan. The federal mass vaccination clinic at Ford Field in Detroit will start vaccinating people March 24. The vaccine doses sent to the federal retail partners and Ford Field are in addition to Michigan’s state allocation of vaccines and are shipped directly to the federal retail partners and Ford Field. These shipments do not affect the supply of doses being sent to hospitals and health departments.

The Ford Field site will vaccinate approximately 6,000 individuals per day at the building and through a mobile clinic. Any Michigander may register for an appointment at the clinic by visiting the online portal, texting “EndCOVID” to 75049 or calling the state’s COVID-19 hotline at (888) 535-06136 and pressing 1. The hotline should be used only by those without internet access and could be the slowest option.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).