HEALTH CARE BRIEFING: Tests—A Costly Necessity for Nursing Homes

Regular Covid-19 testing for nursing home staff and residents is the only way to contain the spread of the respiratory disease that wreaks havoc on the elderly. But a lack of funds and access to testing supplies are hampering that objective, nursing home executives say.

A 100-bed facility with 100 workers should test all staff and residents every two weeks “at a minimum,” said George V. Hager Jr., CEO of Genesis HealthCare, one of the nation’s largest nursing home operators, on a recent earnings call.

If each test costs $75, as Hager suggested on the call, the facilities would end up paying about $30,000 per month to conduct 400 Covid-19 tests. That’s on top of the extra cost of additional cleaning; pricier personal protective equipment; and increased staffing costs for overtime, bonus pay, and replacement workers.

The Trump administration has called for all nursing home residents and staff to be tested for the coronavirus, but that largely left individual facilities and states to tackle the logistics. That’s created a patchwork of inconsistent testing policies at 15,000-plus nursing homes across the U.S. Depending on their resources, the facilities are using a mixture of state and federal grants and loans, even support from the National Guard, to get adequate testing.

Testing all nursing home employees and patients just one time would cost $440 million, according to the American Health Care Association, the leading nursing home trade group. But the results would “give us a false sense of security as this virus continues to spread,” the group told Bloomberg Law. “Repeated, ongoing testing will be needed, and long term care providers cannot do this alone.”

Access remains a problem, said Richard Feifer, chief medical officer at Genesis. Some 1,500 residents at the company’s 361 facilities in 25 states have died due to Covid-19, the company said. Another 6,700 patients and residents and more than 2,500 Genesis employees and clinical staff have tested positive for it. Tony Pugh has more.

Happening on the Hill

Democrats Decry U.S. ‘Gifting’ of Ventilators to Russia: House Oversight and Reform Chairwoman Carolyn Maloney (D-N.Y.), House Foreign Affairs Chairman Eliot Engel (N.Y.), and other top Democrats sent a letter to Secretary of State Mike Pompeo seeking information on a decision by the president to use “U.S. taxpayer funds to purchase ventilators from Russian President Vladimir Putin” that are “not only unsafe for use in the United States, but were manufactured by a subsidiary of a Russian company currently under U.S. sanctions.” Read the letter here.

Thompson Seeks HHS Details on Virus Response: House Homeland Security Chairman Bennie Thompson (D-Miss.) sent letters to acting Secretary of Homeland Security Chad Wolf and HHS Secretary Alex Azar demanding that they hand over documents and information the panel has requested regarding the federal response to the outbreak. “In some cases, the requested documents have been outstanding for as long as two months,” Thompson’s office said in a statement. “HHS has failed to provide a single page of documents in response to Committee requests.” Read the letter to Wolf here and Azar here.

House Democrats Seek Immigration Probe: House Judiciary Chairman Jerrold Nadler (D-N.Y.), Appropriations Labor-HHS-Education Subcommittee Chair Rosa DeLauro (D-Conn.), Appropriations Homeland Security Subcommittee Chair Lucille Roybal-Allard (D-Calif.) and others requested HHS’ Office of Inspector General investigate allegations that U.S. Immigration and Customs Enforcement is preventing the the reunification of migrant children with families and deporting unaccompanied minors without due process. Read the letter here.

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Research, Testing & Treatment

VA Says It’s Lowering Hydroxychloroquine Use: The Department of Veterans Affairs has significantly decreased its use of hydroxychloroquine for coronavirus and will continue to do so, Secretary Robert Wilkie said yesterday in a virtual briefing to the House Appropriations Committee Military Construction-VA panel. The use of hydroxychloroquine peaked sometime in April and VA doctors started decreasing its usage “as we went more to remdesivir and convalescent plasma,” which seem to be more effective, Wilkie said. Jack Fitzpatrick has more.

Hospitals Walk Tightrope as Workers Speak Out: Clashes between hospitals and their employees who speak out about their fears and frustrations over the virus—either in-house, publicly on social media, or in the press—has sparked a new litigation trend. Sarah Cusick, a hospital worker in D.C., sued her employer for wrongful termination, claiming the hospital fired her for social media posts voicing concerns that it wasn’t following federal and D.C. patient screening and social distancing policies. Similar lawsuits are likely in the pipeline, according to one attorney. Read more from Mary Anne Pazanowski.

Cuomo Expands Mask Order: New York Gov. Andrew Cuomo (D) will sign an executive order that lets owners of private businesses deny entry to any person who doesn’t wear a mask or face covering. Cuomo defended the new order in his daily briefing, saying that individuals “don’t have a right to expose the store owner to the virus.” Read more from Keshia Clukey.

Washington Reopens in a Win for Trump Amid Nagging Safety Doubts: As President Donald Trump urged the states to begin reopening economies shuttered by the pandemic, the nation’s capital stubbornly resisted. Not any more. Starting Friday, Washington finally lifts its stay-at-home order. The move represents a symbolic victory for Trump who is eager to demonstrate that the country is getting back to normal. But it also poses risks as a resurgence of the virus in Washington, currently one of the worst hot spots in the nation, would be an equally potent symbol of the downside of Trump’s go-fast approach.

Washington, a city of 700,000 residents, has reported nearly 8,500 cases and more than 450 deaths from Covid-19, the diseased caused by the virus, and ranks third behind New Jersey and New York in terms of positive tests rates, according to Bednarczyk. Even Deborah Birx, the epidemiologist who coordinates the White House’s coronavirus task force, said last week that the Washington metropolitan area has become an epicenter of the U.S. outbreak. But Mayor Muriel Bowser, a Democrat, said she was relaxing the stay-at-home order because the city had met its goal of a 14-day decline in community spread of the illness. Read more from Ari Natter.

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What Else to Know Today

For-Profit Hospitals Seek Lower Rates: The Federation of American Hospitals, which represents more than 1,000 investor-owned hospitals, urged the Senate yesterday to redefine the terms of Medicare loans thousands of providers have taken out during the pandemic. They want Congress to restart the program and decrease the interest rate for the Medicare Accelerated and Advance Payments Program, among other changes.

The group also wants HHS to change how it sends out CARES stimulus funds to target “lost revenue” and Covid-19-related costs. That is contrary to how other hospital groups that represent nonprofits have sought to shape the payments, Alex Ruoff reports. Read the letter here.

FDA Urged to Enact Tobacco Application Deadline: Senate Health, Education, Labor, and Pensions ranking member Patty Murray (D-Wash.) wrote to Food and Drug Administration head Stephen Hahn seeking details for when its “long-delayed” application deadline for e-cigarettes and other tobacco products currently on the market will be enacted. Murray and nine other Senate Democrats cited the Trump administration as having a “long record” of delaying oversight of tobacco. Read their letter here.

ProPublica Wants HHS Info on Stockpile: ProPublica sued HHS yesterday to require it to respond to its Freedom of Information Act requests regarding the government’s cache of medical supplies and drugs, called the Strategic National Stockpile. The independent news group asked the HHS in mid-March and early April to provide information about items collected by the government to respond to sudden crises, but hasn’t received a substantive response, according to a complaint filed in the U.S. District Court for the Southern District of New York. Read more from Mary Anne Pazanowski.

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To contact the reporters on this story: Brandon Lee in Washington at blee@bgov.com; Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Giuseppe Macri at gmacri@bgov.com; Zachary Sherwood at zsherwood@bgov.com; Michaela Ross at mross@bgov.com

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