This spring, we watched in collective shock and horror as New York City and a handful of other major cities in the U.S. — and dozens of COVID-19 hotspots internationally — struggled to contain outbreaks. Those were desperate days, and the tools were too few. Today, as the disease transmission rates climb and hospital capacity plummets, the image of localized hotspots increasingly has been supplanted by the equivalent of a forest fire running amuck.
This week, hospitals’ physician leaders joined in a public statement urging all Missourians — including Gov. Mike Parson — in the strongest possible terms to become more resolute in their adherence to public health guidance. That message was followed by a strong endorsement from the MHA Board of Trustees for a statewide mask mandate. It is critical that all leaders provide a full-throated endorsement of personal responsibility and public engagement in COVID-19 mitigation, and we got that message this week from hospital chief medical officers and the MHA board.
Hospital adult ICU capacity has dropped to approximately 25% statewide, but locally, we know that some hospitals have little to no room for COVID-19 care. Worse yet, this is occurring at the beginning of flu season — where normally we would expect a utilization spike — and at the beginning of the holiday season, where COVID-19 and culture could clash.
If this was a forest fire, fire jumpers would be around the blaze building fire breaks, clearing undergrowth and using their tools on the ground to box in the spread. The tankers would fly over and drop fire retardant to reduce the blaze, and help shape and contain the conflagration.
The public health efforts to control COVID-19 have been similar, with mixed results. As with the wind in a forest fire, human behavior can influence the ability to control a pandemic. As long as a fire has fuel, it will burn. And, an ember blowing in the wind can expand the range of the damage.
Populationwide distribution of a COVID-19 vaccine is months away. In the long run, it will act like the strong rains that often check an uncontrolled forest fire. However, what we do now will influence the damage done to our communities and our health care system. We won’t be rescued from afar. Without significant change, we can expect hospitals to be overwhelmed in the weeks and months ahead.
Missourians must reduce their chances of exposure. They must modify their behaviors — whether mandated or not — to reduce the person-to-person spread of the virus. The mitigation tools are the same as they were in the spring, but the stakes of failure now are much higher.
“The cavalry is coming,” Dr. Anthony Fauci said this week when he was describing the effort to gear up for the largest vaccination effort in U.S. history. But until those vaccines arrive, we must double down on public health precautions. Missourians and health care workers sacrificed greatly to get us to today. Now is not the time to tread lightly with the severe strain on the health care system leading us to contemplate crisis levels of care. Failure to redouble our efforts means lives will be lost as our ability to provide care becomes overwhelmed. That’s what the state’s leading physicians and the MHA board are telling us.
To protect hospital capacity, we need fewer embers in the wind.
The MO HealthNet Oversight Committee met on Thursday and heard reports from Director Todd Richardson on the progress of the administration’s Medicaid expansion implementation. The most significant news was that the state has decided that expansion participants will receive the standard Medicaid package instead of a more limited alternative that would be allowed under the Affordable Care Act. Richardson told the committee that the financing plan for the expanded program will be included in the budget recommendations Gov. Parson submits to the General Assembly in January.
The Missouri Medicaid caseload grew by more than 13,000 in October to just more than 1 million. Enrollment in all eligibility categories increased: elders, disabled, parents, kids and pregnant women. This marks the ninth straight month of caseload growth after more than two years of steady declines. Since Jan. 31, Missouri’s Medicaid caseload has grown by 158,000, or 19%. The number of children covered has increased by nearly 98,000 during this span.
The growth in the caseload is expected and will continue for at least the next three months. To qualify for a 6.2% increase in federal matching funds available to the state under the Families First Coronavirus Relief Act, those currently eligible for Medicaid coverage will remain covered unless they move to another state, die or request that their coverage end. Also, because Medicaid is an income-tested program, the COVID-19-weakened economy is increasing the number of citizens qualifying for coverage.
The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.
Critical care: Comparative Billing Report in November
Skilled nursing facility 3-day rule billing
COVID-19: nonphysician practitioner billing for CPT codes 98966-98968
Home Health Prospective Payment System rate update for calendar year 2021