Tag Archives: Mental Health

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Why we need differentiated instruction now more than ever

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Carol Ann Tomlinson defines differentiation as a continual process of assessing and monitoring students’ readiness levels, interests, and learner profiles. We are in an unprecedented time and unchartered teaching territory as we aim to support all students virtually (synchronous or asynchronous).

As such, our learners are logging into our virtual classrooms with various emotional and academic needs. Based on such diversity, differentiating instruction is the one approach that will work. Upon pre-assessment/diagnosis in virtual and online environments, teachers can differentiate with the following:

Learning environment.

Learning environment is the where. The learning environment is a strong community of learners. It involves the organization of time, space, and resources for teaching and learning. In our online environments, we can provide students with check-ins, fun community builders, and offer gratitude journaling to support the emotional well-being of students.

One of my favorite starting activities for online communities is to provide students an opportunity to use a mood meter to share how they are feeling. National Educators for Restorative Practices provides lots of self-awareness meters for students to check in. Lucky Little Learners provides dozens of community builders and fun activities for zoom. Also, Hooked On Innovation provides fun games to reinvigorate students before starting academic instruction.

Content.

Content is the what. Content is defined by the curriculum guides based on standardized assessment. The content is what students will know, understand, and be able to do. In our online environments, we can provide diverse materials with varied readability (NewsELA.com and Scholastic Learn At Home) and elicit student interest and multiple ways to access ideas/information.

Process.

Process is the how. Process is how students will make sense of the content. The process is made up of the strategies and methods that form the sequence of teaching and learning. In our online environments, we can use small-group instruction; provide choices about how to work (alone, pair, small group); assign tasks in multiple modes; and provide a variety of scaffolding.

For example, many teachers are using YouTube or Vimeo to create videos as another form of instruction. LearnZillion.com, CrashCourse.com, and Edpuzzle.com are also great video alternatives for students to navigate content for review or acceleration.

Products.

Products are the evidence of student’s knowledge, understanding, and skills. They are the tools teachers use to assess student progress toward the content goals. In our online environments, teachers can provide product assignments with multiple modes of expression; choices about how to share learning; and opportunities to connect learning with individual interests. If the objective allows for flexibility, students can create a skit or use household objects to create diagrams (no-tech) and record their voice using Educreations.com or Flipgrid.com (with tech).

As always, teachers RISE, showing just how amazing and important we are in facilitating more kind, critical thinkers of the future.

Please find time to rest, self-care, and celebrate the victories over the past few months. I look forward to working with you in August!

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Medical practices are up against it as they struggle to retain patients, cash

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For some more than others, the COVID-19 pandemic rages on. Still, medical practices remain at the center of battling the virus as they treat patients. They also face personal financial pressures like many of their American counterparts.

More than half of clinicians (55%) fear another wave of the virus. They are stressed because of potentially limited access to testing and personal protective equipment, according to a survey of 730 primary care clinicians in 49 states and Washington, D.C.

Caregivers say they are under severe stress (76%). Fifty-one percent worry they will have trouble accessing testing, and 59% say they have no PPE.

The Larry A. Green Center conducted the survey with the Primary Care Collaborative from May 15-18.

Along with these struggles, most clinicians (84%) indicate that their practice’s finances are in trouble, too, as they have reduced patient volumes, with 53% saying they want “payment of any kind at this point,” the survey found. Patients are delaying and postponing chronic and preventive health concerns due to stay-at-home orders, clinicians report.

Because of the current conditions, physicians are facing similar struggles as others. Some say they’ll try to sell their practices; others will close or retire.

Follow-ups for lung disease, hypertension, and diabetes is happening “very little” (58%) or “not at all” (2%). New symptom evaluation or acute injuries and accidents continues unchecked, however.

“We see a growing concern among clinicians about preventive and chronic care that isn’t happening, either because patients are putting off anything but the most urgent health concerns during the pandemic or because some preventive and chronic care needs are not amenable to digital health platforms,” said Rebecca Etz, Ph.D., co-director of The Larry A. Green Center.

According to the survey, 40% of primary care clinicians said they’ve laid off or furloughed staff, and 42% say staff has been out because of illness or quarantine.

Like many businesses that have been forced to pivot models because of a changing business environment, clinicians turned their attention to virtual care during the pandemic to care for patients remotely.

Telehealth isn’t the be-all-end-all, though. Eighty-four percent of clinicians measured in the study said they continue to encounter patients who struggle with virtual health.

“Front-line clinicians are in a double bind: They can take care of their patients without sufficient payment and personal protection from COVID-19, or they can abandon their patients. They choose to continue to serve, despite the hardships. It’s inspiring,” Etz added.

In a separate report featured by the American Medical Association, physician practices of all sizes state that they face financial problems caused by the countermeasures designed to mitigate COVID-19. Almost all (97%) of practices experienced a negative financial impact. Less than half of primary caregivers have enough patient volume and cash to stay open for the next four weeks. The AMA posted its update regarding the study on May 8.

These data were present in a webinar hosted by Henry Schein Medical, “Physician Practice Financial Sustainability During the COVID-19 Pandemic,” and featured AMA experts. The AMA said the discussion focused on financial strategies and new federal programs available to physician practices to address the challenges brought on by COVID-19.

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Infographic: Trusting remote workers amid the new normal

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Remote work has become the new normal for many workers. Unfortunately, this uncharted territory has led many managers to become overzealous. This infographic outlines the psychology behind why it’s so important to trust remote workers.

Infographic courtesy Online Psychology Degrees

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Infographic: The psychology of isolation fatigue

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Amidst the COVID-19 pandemic, 2 in 3 Americans have felt anxious, depressed, lonely, or hopeless at least once a week. Panic buying was just the first step in dealing with the psychologically overwhelming nature of the pandemic.

This infographic outlines the psychology to help us deal with these trying times as well as healthier ways to cope.

Infographic courtesy EduRef.net

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Study: Healthcare insurers are missing significant communication opportunities with consumers

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Despite the continual conversations and protests from payers and some health systems claiming their consumer patients can’t understand transparency with insurance plans and pricing, health plans have a member communication problem, a new study says.

The study, the J.D. Power 2020 U.S. Commercial Member Health Plan Study, shows that this communication challenge is growing worse in light of COVID-19.

While communication issues may not be mutually exclusive to pricing transparency, it seems there’s a much bigger cultural issue. According to consumers interviewed by J.D. Power, consumer attitudes toward commercial health plans found that as many as 60% of private plan members say their insurers never contacted them regarding the virus.

“Health plans are widely perceived as lacking a customer-centric mindset and not putting the best interests of their members first,” said James Beem, managing director, global healthcare intelligence at J.D. Power. “The COVID-19 pandemic has amplified these shortcomings, but they are not new. If traditional health insurance plans want to resist the threat from disruptors, they need to demonstrate partnership with members—and on behalf of employers—to improve member health, reduce costs and help members navigate the healthcare system.”

Additionally, nearly 50% (48%) said they feel their insurer has not shown concern for their health since the pandemic reached U.S. shores. That’s a pretty significant disconnect between patient perception and insurer desired outcomes.

J.D. Power says this gap between member expectations and how health plans view their role remains a critical concern. “Consumers want a coordinated, integrated experience that their health plan may be unwilling or unable to provide,” FierceHealthcare reported.

Telehealth is one of the most significant opportunities where communication has faltered. According to the survey, less than 10% of plan members say they used telehealth in the past. This fact is relevant because almost half of plan members would consider using telehealth if it was covered and if they knew the service was offered by their health plan.

Perhaps even more expository from the survey is that 75% of consumers know about telehealth’s capabilities. Still, a majority (54%) told J.D. Power that they don’t understand if their insurer offers and allows coverage of such benefits.

The one takeaway from the survey is that health insurance companies are not appropriately engaging or communicating with their customers. Because of this disconnect in communication, many insured consumers cannot assign the proper value for the dollars spent on their health insurance products.

Additional key points from the study include:

Health plans lack customer centricity: Just 36% of commercial health plan members say their health plan acts in their best interest “always” or “most of the time,” and just 25% of members say they view their health plan as a trusted partner in their health and wellness. This lack of a customer-centric positioning results in an overall satisfaction score this year for commercial health plans of 719 (on a 1,000-point scale), among the lowest of all industries evaluated by J.D. Power.

Customer satisfaction directly linked to customer engagement: Proactive efforts by health plans to engage with members — by providing advice on how to control costs or helping to coordinate care — drive significant improvement in overall customer satisfaction. For example, when a health plan helps members keep out-of-pocket costs low, the average overall satisfaction score is 819, which is 152 points higher than when no such effort is made.

Telehealth growth creates a wildcard opportunity: Expanding telehealth usage is associated with a 39-point increase in overall customer satisfaction. Additionally, with telehealth utilization surging since the COVID-19 pandemic began, J.D. Power projects this trend will continue to proliferate. According to this study, which was mainly fielded before the COVID-19 pandemic hit the United States, just 9% of commercial health plan members have used telehealth. Of those who have not, 48% say they would consider using it if their plan covered it.

The study also measures customer satisfaction with commercial member health plans in 21 geographic regions.

The U.S. Commercial Member Health Plan Study, now in its 14th year, measures satisfaction among members of 149 health plans.

While many health plans say their insured consumers don’t want more information from them regarding pricing, they are missing out on other communication opportunities, so says one of the country’s most respected research firms.

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Webinar for new dentists examines what makes humans happy

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Raise your hand if you want to take a break from the heavy stuff and talk about something happy for just a little while.

Right, me too.

New dentists who wish to increase their own happiness, especially while living in the days of attempting to build their dental practice during a world health pandemic, can soon log into an American Dental Association webinar about building more productive habits and working through strategies for taking control of their own happiness.

The event is called “What Makes Humans Happy?” In it, the ADA is presenting a free hourlong webinar on May 26 from 2 to 3 p.m. EDT. Webinar panelists will discuss widespread misconceptions about happiness and provide timely insights on the science of well-being.

The webinar kicks off the ADA Accelerator Series, a new online program designed to provide all kinds of information tailored to young (in their career) dentists and addressing their unique financial, business, leadership, growth and work-life balance needs.

Early-career dentists have a lot on their plates, according to Dr. Susan Becker Doroshow, 8th District trustee and member of the ADA Board’s Standing Committee on Diversity and Inclusion. “It must seem impossible to deal with the challenges of clinical practice, juggle their responsibilities at the office and on the home front, maintain their fitness and personal wellness goals, manage their student debt — and have enough energy in reserve to simply enjoy life,” she said.

Enjoying life and happiness is the exact focus of the upcoming webinar. Dentists who log on will hear from a professor of psychology at Yale University, Laurie Santos, who will reveal misconceptions about happiness, common thought processes that lead people to think the way they do and the research that can help individuals better understand themselves and what they need to do to find — and maintain — happiness.

And a dentist’s day does not end after seeing the last patient. The work continues. Whether you have family members to care for, a home to manage, a spouse to consider, your health and wellness and the million other things that make up a life, it all requires balance. Dr. Grace Yum, a pediatric dentist and founder of a Facebook group called Mommy Dentists in Business, will also share some stories and tips during the webinar from her life as a busy dental professional.

The ADA launched the Accelerator Series (which started with 14 women dentists) to help dentists tackle current challenges and achieve their long-term goals. The program is a resource to member dentists for financial, leadership and work-life balance tools.

Dentists can register and learn more about the ADA Accelerator Series at ADA.org/Accelerator.

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After a huge drop in practice visits, elective healthcare procedures resume in some areas of the US

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The following should come as no surprise to anyone whatsoever — outpatient and medical practice visits have cratered since March because of the COVID-19 pandemic. A new study showing this data comes from The Commonwealth Fund, conducted by researchers from Harvard University.

Per the study, outpatient visits dropped by 57% between March 1 and March 29. Visits were down 54% as of April 12.

Researchers looked at visit volumes for 50,000 providers. The drop is a result of providers who want to avoid transmission in their practices and patients who wish to avoid exposure.

“The COVID-19 pandemic has dramatically changed how outpatient care is delivered in health care practices,” the researchers wrote.

Practices that saw the most significant drop in patient volume occurred at in-person patient facilities with specialties, such as ophthalmology, which saw declines in visits by nearly 80% as of the week of April 5. Dermatology was down 73%, and general surgery was down 66%.

Telemedicine visits increased along with the drop in in-person visits, but not enough to offset the decreases. Telemedicine use shot up recently going from almost no visits as late as March 8 to 30% of them as of April 12.

Thirty percent of ambulatory practice visits are delivered through telehealth as of mid-April.

Children between 7 and 17 and adults 75 and older were more likely to avoid such visits, researchers said.

The regions impacted varied, too, as New England saw a drop of 64% and the Mid-Atlantic as of April 12. The West Coast saw a 58% drop.

The financial pressures that accompany the drop-off in patient volumes have been enormous: As many as 20% of primary care practices could close within weeks. If the U.S. economy remains largely shuttered, the healthcare landscape is going to change dramatically across the country.

Of the physicians surveyed, nearly half of physicians said they do not know if they have enough cash to keep their practices open. Many have already laid off staff to stay afloat as the vast majority have seen the drop in visits reflected in the Harvard research.

However, states are beginning to allow the resumption of elective surgery.

The Florida Hospital Association (FHA) released a plan on April 21 for resuming elective surgeries and procedures. “Florida’s hospitals remain vigilant,” said FHA Interim President Crystal Stickle in a statement. “We are committed to ensuring the safety and wellbeing of our patients, employees, and communities. This has been, and will continue to be, our top priority.”

Iowa Gov. Kim Reynolds announced that she’s currently rolling out plans to reopen the state. Hospitals are beginning to phase in elective surgeries and procedures next week. “Each hospital, outpatient surgery center, or clinic that determines they can safely do so may begin,” Reynolds said. “They may begin rescheduling patients and resume surgeries and procedures according to their own schedules.”

Ohio Department of Health Director Dr. Amy Acton issued an order recently directing providers in hospitals and outpatient medical centers to reassess procedures and surgeries that were postponed following the postponement of such activities on March 17.

Gov. Mike DeWine said: “We must now begin the gradual, multi-phased process of reopening, and my first concern is the patients who have had procedures and surgeries delayed.”

The new order directs healthcare professionals to review any postponed procedures or surgeries with their patients, as well as new or other chronic conditions that may have a significant impact on a patient’s quality.

Despite states’ efforts to reopen their economies, COVID-19 cases continue to rise. As of this writing, the U.S. reported more than 1 million.

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Healthcare’s furloughs continue even as parts of the US begin to reopen

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The cratering of the healthcare job market has continued as COVID-19 spreads across the United States. The overall U.S. economy continues to be ravaged, as more than 22 million people have filed for unemployment benefits as of April 17, with the virus, for now, wiping out a decade of job gains.

The United States has not seen this level of job loss since the Great Depression, and the government is struggling to respond fast enough to the deadly coronavirus health crisis.

Healthcare, long seen as an untouchable career field — safe from the ups and downs of the economy — is among the sectors hardest hit by the pandemic. The other, more obvious, sectors affected include hospitality, retail, restaurants, travel, and tourism.

How does healthcare fit into this puzzle?

The new normal under the guise of the COVID-19 crisis seems to level no corner swept out. In healthcare, the reason for the continued firings and furloughs is simple economics. Elective procedures remain shuttered, though, as of this writing, there are some states in phase 1 of the Trump Administration’s economic reopening plan that may soon remove the shutters of business and open doors while maintaining social distancing and having people wear masks in public.

For this part of the plan, elective surgeries can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to the Centers for Medicare and Medicaid Services (CMS) guidelines. States that may be among the first to reopen their economies include Minnesota, Hawaii, Montana, Oregon, West Virginia, and Alaska.

Except for Minnesota and perhaps Hawaii, these locales are relatively rural (sans Portland, Oregon), with smaller populations and economies. Healthcare workers in these areas should be able to get back to work soon, but that’s a small portion of the overall healthcare economy resuming their roles.

Elsewhere, low patient volumes mean many working in healthcare have a longer row to hoe in front of them. To this point, nationwide, nearly half of independent medical practices report they have had to furlough or lay off staff, according to a survey from the Medical Group Management Association.

The survey received 724 responses from medical practices between April 7 and 8. The practices surveyed said they experienced at least a 60% drop in patient volume and a 55% decrease in revenue since the country shut down because of the coronavirus.

Forty-eight percent of practices said they have temporarily furloughed staff, and 22% permanently laid off staff. Many layoffs and furloughs may still be yet to come, especially if conditions persist during the next month.

Nearly 75% of the respondents said they are part of independent medical practices but employ less than 50 full-time physicians.

“Our new data reflect a shocking decline in the number of patients seeking non-COVID-19 medical care during this crisis,” said Anders Gilberg, MGMA’s senior vice president of government affairs, in a statement. “Patients are foregoing necessary preventive and even acute care out of fear of exposure. Medical practices are struggling to keep their doors open as volume collapses.”

One medical center in Detroit announced it furloughed 480 workers that are not on the front lines of the COVID-19 outbreak or other critical patient needs.

It’s worth noting that practices not treating COVID-19 are still in operation, many of them using telehealth technology to see and interact with patients. CMS agreed to pay for virtual visits at the same rate as in-person visits. At the same time, the coronavirus emergency remains in effect and will pay physicians for telephone-based patient visits.

Even when elective procedures return, practices and health systems face the encumbering problem of finding PPE to perform the procedures. The American Hospital Association and American College of Surgeons laid out a potential roadmap for resuming the processes vital to a hospital’s bottom line.

Elective procedures can only begin once a facility has had at least 14 days of sustained reduction of COVID-19 cases in the geographic area. Still, the facility also must have an appropriate number of intensive care units and non-ICU beds, PPE, ventilators, and staff to treat any non-elective patients.

Even health insurers are taking a hit. UnitedHealthcare said commercial plan membership declined by 475,000 compared to the first quarter of 2019 because of job losses related to COVID-19. UnitedHealthcare is seeing an uptick in customers seeking premium relief as a result of the pandemic. Typically, these payment plans represent about 0.4% of premium revenue, while on March 1, that increased to 1%. For April 1, it was 3%.

Don’t feel bad for the health insurance giant, though. In its first-quarter earnings report, the company reported $3.4 billion in profit.

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Could the pandemic mark the end of surprise medical billing?

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The White House has said “no” to surprise billing of patients receiving treatment for COVID-19, and hospitals agreeing to accept money as part of the $2 trillion stimulus bill must agree not to engage in the practice.

Surprise billing happens when a patient with health insurance is treated at an out-of-network hospital or when an out-of-network doctor assists with the procedure at the hospital. Bills for such services can range from hundreds to tens of thousands of dollars.

“The Trump administration is committed to ensuring all Americans are not surprised by the cost related to testing and treatment they need for COVID-19,” said White House spokesman Judd Deere in a statement.

Keeping hospitals from practicing surprise billing will protect patients covered by government programs, employer plans, or self-purchased insurance.

The hospitals that accept money from the stimulus plan also must not collect more money than the patient otherwise owed if the medical attention had been provided in-network.

The White House said it also received commitments from health insurers, which agreed to not bill patients for co-pays or deductibles for virus testing. Several insurers are waiving co-pays for coronavirus treatment provided within their networks.

The stimulus includes $100 billion for healthcare systems to brunt the damage done in the wake of the collapse of elective procedures.

Just like the coronavirus itself, surprise medical billing is threatening to become a pandemic. But unlike the apparent inevitability of COVID-19, the surprise medical billing crisis can be stopped with the right solution, some say.

Considered unjust, the practice is opposed by both parties in Congress.

Democratic and Republican members of the House Energy and Commerce Committee tried developing legislation to stop surprise billing. In the Senate, members of the Health, Education, Labor, and Pensions (HELP) Committee were drafting a similar bipartisan solution.

The subsequent agreement would have fixed how much doctors could charge for surprise bills, subject to appeal. It also required insurers to cover these costs. The proposed legislation had bipartisan support.

“I do not think it is possible to write a bill that has broader agreement than this,” said Lamar Alexander, the Republican chairman of the Senate HELP Committee. Frank Pallone, his Democratic counterpart in the House, agreed. “I’m hopeful that this bipartisan, bicameral agreement can be voted on quickly.”

The committees announced the deal on Dec. 8. The insurance industry endorsed it. So did consumer advocates. The White House supported and pushed for its inclusion in a must-pass Dec. 20 spending package. But within two days, hospitals and doctors’ groups opposed the proposal. The American Medical Association fought it. The American Hospital Association said it would jeopardize patient access to care.

The Dec. 20 deadline came and went. Nothing changed.

Eliminating surprise billing would save people with employer-provided health insurance as much as $40 billion annually. But surprise billing lets doctors extract more money from patients and demand higher payments from insurers.

“You piss enrollees off so much, piss patients off so much, that they then complain to their insurer or employer, who are then willing to pay even more,” said Loren Adler, a health policy expert at Brookings. Insurers then pass along higher costs to patients in the form of higher deductibles and premiums. Employers pass the cost on to workers by keeping their salaries down.

House Energy and Commerce ranking member Greg Walden (R-Ore.) is pushing to get surprised billing legislation into a future package to address the impacts of the pandemic. Walden said that he has been working with Chairman Frank Pallone (D-N.J.) on the problem.

“We need to get it done, and we need to get it done now,” Walden said. Pallone told reporters separately that he’s working with Walden on what could be in a fourth coronavirus legislative effort but stopped short of saying surprise medical bill legislation should be included.

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Health systems scrambling for federal cash amidst coronavirus pandemic

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Hospitals, many of which are hamstrung under near-fatal cash shortages brought on by the onslaught of the COVID-19 virus, are slated for another round of federal stimulus funding. The funding from the first round of stimulus money designated to hospitals was aimed at fighting the coronavirus front in some of the nation’s most troubling hot spots.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma told reporters on April 15 that cash-strapped hospitals should expect details about a second wave of emergency funding in a matter of days.

Her agency, she said, is contemplating how best to address providers that have not been able to work because of the countless cancellations of elective procedures at health systems across the U.S. Health systems shuttered such procedures even while their essential first-response teams led the charge in the battle against the virus, which has infected more than 2 million people worldwide, as of this writing.

“Large segments of the healthcare community aren’t able to provide services they would normally do,” Verma said.

Verma didn’t say how much funding hospitals may be able to expect in the funding round; $30 billion was dispersed earlier in April as part of a $100 billion fund passed by Congress in a much larger economic stimulus package. Per reports, the original $30 billion went only to providers receiving Medicare fee-for-service reimbursements, not to providers that rely heavily on other sources of income, like Medicaid.

The Department of Health and Human Services (HHS) said April 10 that the money was allocated to hospitals and providers based on their historical share of revenue from the Medicare program, rather than the burden caused by the coronavirus or number of uninsured patients treated. Those payments were made to those recipients most likely because those are the health systems in which the government has payment data readily available, using direct deposit to ensure the quickest payment to providers.

Politicians continue to want more money funneled into healthcare. Congress, for example, is weighing a second new round of funding for hospitals. Democrats are calling for another push of $250 billion.

Under the original stimulus, passed in March, hospitals are slated for $100 billion to cover related expenses for treating the COVID-19 outbreak and for recouping lost revenue. The currently distributed $30 billion is part of emergency stimulus funding earmarked for hospitals from the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed on March 27.

“We had lots of meetings with providers, and consistent feedback was we wanted to get this money out fast,” Verma said during her call with the media.

A portion of the $100 billion will also be used to cover the cost of care for uninsured patients, but Verma didn’t specify how much. While people who are newly uninsured after losing a job will have the opportunity to enroll in marketplace plans through Healthcare.gov, the administration has not opened a special enrollment period for those who were already uninsured.

Among the hardest hit in all of healthcare are those professionals who have lost their jobs because of the shuttering of elective procedures. Scuttling these elective procedures means health systems have lost or anticipate losing large swaths of revenue in the months ahead. Thus, cost reductions are top of mind and a key tactic available to protecting these organization’s long-term health. These individuals are still without much hope, other than the $1,200 receiving a personal stimulus from the federal government.

More than 115 hospitals have furloughed staff, as of this reporting. Those numbers are likely to continue rising.

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