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By Rose Hoban
Even as Congress acts to provide financial relief for families and industries that have been shell-shocked by the effects of the worldwide coronavirus pandemic, legislators at the N.C. General Assembly are starting to address the many legal and financial issues the ongoing outbreak is presenting to the state.
This week, lawmakers met for the first time in any committee since March 12, when the full brunt of the emerging coronavirus crisis and the need for social distancing drove legislators from the cramped meeting rooms of the General Assembly building in Raleigh.
This week, equipped with glitchy video conferencing software that many legislators were still only learning to operate, the newly minted House Select Committee on COVID-19 started meetings. On Wednesday, a working group looking at economic issues created by the crisis met for the first time, and on Thursday, the health care group got themselves up and running.
Instead of presiding at the front of a cramped committee room, House Speaker Tim Moore (R-Kings Mountain) kicked off the meeting in a sparsely attended room with only about a dozen attendees. He told lawmakers that he felt the state was well-positioned financially to deal with the crisis and was interested in finding any legislative solutions necessary.
“A lot of the great ideas we’re seeing in the field, we’re seeing how the hospitals are responding,” he said.
Moore formulated the working groups with bipartisan leadership and told chairmen that he wanted to have the two parties working together to address issues, according to Rep. Josh Dobson (R-Nebo), who is one of the chairs of the health care working group.
“He has been very clear that he wanted this to be beyond the politics because we don’t have the luxury of partisanship right now, with the crisis that our state’s facing,” Dobson said. “He’s made it a point not to criticize the governor on some of the decisions that have been made.
“I think that he set a tone of we’ve got to be above partisanship when it comes to this crisis that we’re facing. And I think that’s to his credit.”
The working group’s first priorities are around providing support to the health care workers and institutions where North Carolina’s coronavirus patients will soon start arriving in droves, if other states are any example.
PPE shortage top of mind
By video call, Donald Gintzig, head of Raleigh’s WakeMed Health and Hospitals, told legislators the point of social distancing and stay at home orders is to slow the spread of the virus to give health care providers time and the chance to acquire more personal protective equipment, such as masks, gloves and face shields, to protect them.
Right now, some of that PPE is coming to health systems via donations.
Leah Burns, from the N.C. Healthcare Association, described how the North Carolina Dental Society put out a call to their members to donate PPE to hospitals.
“We have just been overwhelmed by all the dentists across the state,” Burns said. “If you do know anyone who has PPE that they’d be willing to donate, please reach out to me.”
She said that the state, which is getting supplies from the federal government, is currently able to fulfill only about 30 percent of the requests for PPE from hospitals.
“Our concern is that if we’re relying on the feds for our PPE, we’re going to be behind states such as Washington and New York that have had a surge prior to North Carolina,” Burns said. She said that hospitals and health systems are looking across the country and world to find equipment such as ventilators.
Gintzig said that hospitals, often fierce competitors, are working together “at an unprecedented level to share best practices and share resources to plan for what we know will come.”
He expressed that his biggest fear was the rate at which the number of coronavirus cases was doubling.
“It doesn’t take long to look down the road to see that if it doubles every 2.5 days, where we’ll be in 10, 20, 30 days,” he said. “If we can get it double every 4.5 days, if we can get it to double every 6.5 days, that gives us the bandwidth to be able to deal with the challenges that we face.”
Cash flow woes
Burns and Gintzig also explained that in the effort to free up beds and conserve PPE, hospitals had stopped performing non-time sensitive surgeries, such as joint replacements. But those procedures provide robust cash flow for hospitals.
“Hundreds of thousands of surgeries have been canceled across the state,” Burns said. “We are very concerned about the cash flow problems our hospitals are going to have at this critical time due to the fact that they did cancel so many non-time-sensitive surgeries.”
Burns did note that telehealth has been critical in filling the gap. Federal and state payors have made changes to pay for telehealth visits at close to parity with many office visits.
“We’re so thankful for that at this time,” she said. “Medicaid announced last week to do virtual visits and that is going to save so many people.”
Even with reimbursement changes, smaller providers are finding it hard to bridge their financial gaps.
“This COVID-19 pandemic has created a drastic change in the delivery of health care in our state in the span of less than a week and a half,” Eileen Raynor, a board member of the North Carolina Medical Society, told the lawmakers via video link.
“Over the past week, we have noticed a big difference in the number of clinical visits where patients have been asked to not access the health care system for routine appointments in order to minimize risking exposure of them to other patients who may be carrying the virus and who might expose health care personnel.”
Raynor detailed the massive shift to telehealth that’s occurred in just days, causing confusion and forcing medical practices to scramble to get up to speed with technology and planning for survival. She made these points even as she struggled with her own presentation, which she was making remotely.
“This has put a lot of burden on small and independent physicians as well as medium-sized practices because there’s such drop in patient throughput,” she said. “There’s also a drastic reduction in the revenue flow and that adversely affects those independent practices that are struggling to keep doors open.”
Chip Baggett, the lobbyist and vice president of the Medical Society, punctuated Raynor’s concerns about the financial implications of coronavirus on physician practices.
“I have had more calls in the last two weeks from members than I’ve ever had,” he said. “And those calls, they’re desperate.”
He described providers furloughing and laying off critical staff, because of the lack of elective procedures and other income-generating visits falling to the wayside because of concerns around coronavirus.
He described providers worried about the lack of PPE.
“I have to decide whether to expose myself, potentially, to keep seeing my patients, or close my doors,” he said. “Physicians, PAs and other health care workers are having to worry about, ‘Even if I do have PPE, should I go home? Should I stay in the same room as my family? Should I sleep in the garage? What if my health system or employer tells me I’ve got one mask for five days, and I know that mask is inadequate, is this jeopardizing my whole family?’”
He said that many providers were willing to take the risks for themselves, but not for their entire families.
“You can just imagine the pressure building up,” Baggett said.
He described how one of his board members had been at the hospital for days and happened to be on call the night of their first coronavirus case.
“When he finally got out of work after three or four days of constant work he thought he was doing just fine, he realized his hand was shaking,” he said.
Baggett said the Medical Society was ramping up wellness services for their members.
“This is a critical time when it looks like we’re asking you for a lot without really talking a lot about our patients, but every single bit of this, whether it’s cash flow, whether it’s equipment, whether it’s wellness care, every bit of that is so we can stay available and well to help serve patients,” he said.
Lawmakers also heard presentations about emergency changes made at the federal and state level to health care and payment regulations, and said they were waiting to see what the latest Congressional coronavirus relief bill, passed in the wee hours of the morning, would bring to the state.
They mostly took it all in and asked questions about what would be helpful.
A text message that popped up on the screen came from Rep. Larry Potts (R-Lexington) who noted that the working group could “recommend that the House will have to go into session to take action.”
Correction: Initially in this story, Donald Gintzig’s name was misspelled. That has been corrected.