Jennifer Maggiore NAPT Executive Director

NAPT Community Forum

April 24th, 2020

• Welcome and Overview - Jennifer Maggiore

• Health Disparities in COVID-19 Cases and Deaths

• Testing in Centers • Beaumont Health antibody testing study - Craig

Stevens, MD, Beaumont Health

• Update from Member Centers• Penn Medicine-Fern Nibauer-Cohen and Josh Lahav,

Director of Operations

• Identifying COVID-19 through CT scans in Radiation Oncology Treatment Planning-Experience at Inova and Open Discussion- Bajaj Gopal, MD

• HHS Relief Funding under CARES -Jason Caron, MWE

• Impact on Cancer Patients- Result from ACS CAN survey

• Discussion/ Questions

Health Disparities in COVID-19 incidences and deaths

In Chicago, more than 50% of COVID-19 cases and nearly

70% of COVID-19 deaths involve black individuals,

although blacks make up only 30% of the population.

In Louisiana, 70.5% of deaths have occurred among black

persons, who represent 32.2% of the state’s population.

Yancy CW. COVID-19 and African Americans. JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6548

Health Disparities in COVID-19: Impact on African American Communities

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Kansas Michigan Illinois Wisconsin

Confirmed Cases and Deaths for African Americans as of April 15th, 2020

Deaths Cases Total Population

Kaiser Family Foundation Growing Data Underscore that Communities of Color are Being Hit Harder by Covid-19, April 21, 2020

Health Disparities in COVID-19: Impact on Native American Communities

0%

5%

10%

15%

20%

25%

30%

35%

40%

Arizona New Mexico

Confirmed COVID-19 Cases and Deaths for Native Americans as of April 15th, 2020

Deaths Cases Total Population

Reasons for Health Disparities in COVID-19

• Disproportionate levels of comorbidities such as diabetes, heart disease, and hypertension

• Inability to follow CDC guidelines such as telecommuting, social distancing, and proper hygiene

• Lack insurance coverage

• More likely to be employed in jobs that are essential preventing option of working at home

• Residing in high risk communities with high density housing

• Limited resources for preventative measures, healthy food and medicine

• Yancy CW. COVID-19 and African Americans. JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6548

• HHS Office of Minority Heath

Key Points to Consider in Health Disparity

Awareness

Educate Staff

Connect to Resources

Commit to Cultural Competency

Resources

• Covid_19 Exacerbating Inequalities in the US

• Coronavirus Impact on Native Americans

• Office of Minority Health

• COVID-19 Targets Communities of Color

• COVID-19 and African Americans- JAMA

• CDC Minority Health

Guidelines:Opening UpAmerica Again

Phase One

Phase Two

Phase Three

TESTING & CONTACT TRACING

Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results

Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results

Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans)

Guidelines for Opening Up American Again: White House

Study at Beaumont Health SystemCraig Stevens, MD

How susceptible are health care workers to acquiring COVID-19?

What is the relationship between antibody levels to symptoms or the severity of disease?

Does are antibody response increase or decrease over time and how long will it last?

Will COVID-19 antibodies protect you from a new COVID-19 infections?

Penn Medicine Health Care

Heros

NY Proton TeamStaying Strong

Texas Proton Center

MD Anderson Choir

Bruno Mars

“Count on Me”

Including our own Joy Godby

mwe.com

The Public Health Emergency Fund

19

mcdermottplus.com

THE PUBLIC HEALTH EMERGENCY FUND

The current total of the Public Health and Social Services Emergency Fund: $175B

• CARES Act (03/27) allocated $100B

• Paycheck Protection Program and Health Care Enhancement Act (04/24) allocated: $75B

These funds are designed to reimburse eligible health care providers for expenses or lost revenue

PHSSEF Allocation: $175 Billion

Allocated Funds

$50 billion

Medicare facilities and providers

•$30B in first wave

•$20B in second wave

$10 billion Hospitals in hotspots

$10 billion Rural health clinics and hospitals

$400 million Indian Health Service

Remaining Funds

$104.6 billion yet to be allocated from $175 billion

Remaining Priorities Identified by HHS

•Uninsured, sole Medicaid providers, Skilled Nursing

Facilities (SNFs) and dentists

mwe.com

• “Provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19” • While this component of the T&Cs hasn’t change, the HHS Website guidance provides that “HHS

broadly views every patient as a possible case of COVID-19”

• Recipient will use the funds to “prevent, prepare for and respond to coronavirus”

• “Only for health care related expenses or lost revenues that are attributable to coronavirus”

• Not use the funds to “reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse”

• Two levels of reporting, including quarterly reporting for those who receive more than $150,000

• Balance billing prohibition, which is limited to “presumptive or actual case[s] of Covid-19”

• Standard appropriations restrictions including financial management & salary limitations (e.g., $197,300)

Terms and Conditions Raise Compliance Considerations

21

mwe.com

• HHS to distribute the announced second wave of funding for Medicare facilities and providers, and distribute initial funds for rural facilities and clinics and hospitals in high impact areas

• Additional guidance on Terms & Conditions? Updated several times since the program was launched.

• The remaining $104.6B in the PHSSEF

• Will it target those not yet covered in the funding distribution: uninsured, SNFs, sole Medicaid providers

• Tensions remain between application process and formulaic distributions

What Happens Next

22

COVID-19 Pandemic Impact on Cancer Patients and Survivors Survey Findings Summary-ACS CAN

To better understand the impact of COVID-19 on the vulnerable population of US cancer patients and survivors, the American Cancer Society Cancer Action Network (ACS CAN) initiated a survey on March 25, 2020.

The survey was deployed across a two-week period to the 3,055 cancer patients and survivors participating in the Survivor Views initiative and was also shared through ACS CAN social media and email channels to recruit additional respondents.

The web-based survey was taken by more than 1,200 cancer patients and survivors. This sample provides a margin of error +/- 3% and 96% confidence level.

Cancer Patient Concerns over Delays and Affordability of Treatment

• A third of cancer patients and survivors are worried about the impact of COVID-19 on their ability to get treatment for their cancer. This was particularly acute for those in active treatment with over 40% expressing concern

• Over 50% reported that their treatment was delayed or cancelled, and many reported they were unsure when it would be rescheduled

• Over 30% reported financial challenges that would affect how they were able to afford they care they required

Delays in Treatment

Concerns Regarding Affordability of Treatment

COVID-19 Impact on Cancer Patients

Delays in Treatment

Access and Affordability

Cancer Patients are Experiencing Increased Anxiety

Isolated and Anxious

Concerned about expsosure as a high-risk group

Financial concerns

Increased vulnerability

Improve the Patient Experience

Assess needsRefer to

counseling resources

Payment plans for co-

payments

Referral to online support

programs

Assistance with insurance

Connect to financial

resources

National Proton Conference July 24th 2020