Hospitals, physicians, nurses and community health centers are warning that funding proposed by Senate Republicans for a third coronavirus response package will not be enough to prepare for an onslaught of COVID-19 patients and critical shortage of medical supplies.
Senate Republicans included a Medicare payment bump and a hospital add-on payment in their first draft of an economic stimulus package. But comments by Senate leaders indicate direct funding for hospitals, money to purchase more medical supplies and increase testing capacity could be left for later.
It's unclear when Congress would get to major legislation after it passes this third response package. Providers are saying they can't wait.
"This is very urgent and I don't know that we can wait for a fourth package," American Hospital Association President and CEO Rick Pollack told reporters Saturday. "We need to make sure that it is in this package."
The AHA, American Medical Association and American Nurses Association asked Congress for a $100 billion to provide an emergency fund for hospitals' COVID-19 costs, childcare for frontline healthcare workers and money to bolster surge capacity.
AHA also suggested ensuring that hospitals were eligible for low-cost loans, as many small and mid-sized hospitals have faced cashflow concerns. Most hospitals would not be eligible for the small business loan assistance outlined in the Senate GOP proposal, the AHA said.
Washington Gov. Jay Inslee (D) on Thursday called for a halt to elective surgeries and dental services. That followed a March 18 guidance from the CMS recommending that hospitals postpone all non-essential medical and surgical procedures until the pandemic subsides. J. Scott Graham, the CEO of Three Rivers and North Valley rural hospitals in Brewster, Wash.,, said he fears having to close if he can't make payroll or pay suppliers for protective equipment.
"In terms of planning, we know we need to ramp up, but we are concerned that we will not be able to be around by the time the surge hits," Graham said Saturday.
AHA Executive Vice President Tom Nickels said he expects the Senate GOP's opening offer will be "massaged and improved," and believes more funding for providers will be added during negotiations.
The Federation of American Hospitals on Friday hiked its funding request for hospital aid to $225 billion, including $90 billion for bi-weekly supplemental payments to help with hospitals' cashflow, and $100 billion loan backstop program.
"The truth is the care will not be there without Congress ensuring hospitals are properly funded. It's never been more important that policymakers take bold action now to assure care and save lives," said FAH President and CEO Chip Kahn.
Community health centers were set to receive $1.3 billion in new payments under Senate Republicans' initial offer, but the National Association of Community Health Centers ripped the funding as inadequate. Ongoing federal funding for the centers will expire May 22, and the group has agitated for $3 billion in emergency funds and a longer longer-term funding guarantee.
"The COVID-19 crisis demands health centers stay on the front lines, but their mandatory funding runs out on May 22 and not a single dollar of emergency funds has reached them yet," NACHC President and CEO Tom Van Coverden.
Physician groups, including the AMA, American College of Physicians, American Academy of Family Physicians, American College of Surgeons, and Medical Group Management Association, called for tax relief, no-interest loans, and additional steps to accelerate telehealth services.
The draft text would allow the HHS secretary to develop and implement a new payment rule for federally qualified health centers and rural health clinics that provide telehealth services to eligible patients. Payment rates would be based on payment that currently applies to comparable telehealth services under the physician fee schedule, according to the text.
It's a continuation of recent efforts from lawmakers and the Trump administration to reduce telehealth restrictions in the wake of the COVID-19 outbreak.
AMA also asked Congress for additional medical supplies and workforce support to expand paid family, medical and sick leave. Healthcare workers could be exempted from paid leave provided in Congress' second aid package.
AMA President Dr. Patrice Harris, who participated in a virtual meeting with President Donald Trump and Vice President Mike Pence on March 18, said she told them that alleviating personal protective equipment shortages and testing shortages are the group's top priorities. A March 19 MGMA survey found that 89% of physician practices surveyed reported experiencing shortages of critical PPE.
"The funding that Congress has already approved must be increased, and all possible actions must be taken to increase the capacity to manufacture, acquire, and distribute PPE," AMA Executive Vice President and CEO Dr. James Madara wrote in a letter to congressional leaders.
The Trump administration on March 17 asked for $3.4 billion in additional funding to the Centers for Disease Control and Prevention to expand lab capacity and response efforts and $5.2 billion for HHS to develop vaccines, treatments, and diagnostics, bolster stockpile supplies and conduct pandemic forecasting.
Senate Majority Leader Mitch McConnell (R-Ky.) has indicated that the Senate would take up the administration's request in a fourth COVID-19 response bill.