Williamsport, Pa. -- In a roundtable discussion today at UPMC Williamsport, Congressman Fred Keller sat down with leaders at UPMC to discuss the current COVID-19 outlook, the status of the vaccine rollout, how telehealth has impacted Pennsylvanians, and legislation surrounding rural hospitals.
Rutul Dalal, MD, Medical Director of Infectious Disease at UPMC reported 22 patients being treated with a positive COVID-19 diagnosis in northcentral Pennsylvania as of April 6. Two are in ICU, and one is on a ventilator, according to the doctor. “There has been a lull in new cases, but over the last two weeks we’ve seen a small spike,” he said.
Dalal pointed out that UPMC Williamsport has only treated one patient for flu this past season, and local pediatricians who are normally very busy seeing sniffly kids over the winter have reported a decrease in patients with those symptoms.
Keller questioned the experts on whether or not the COVID-19 vaccines had anything to do with fewer flu cases, but both Dalal and David Lopatofsky, MD, Chief Medical Officer, indicated that while the vaccine does address other COVID-19 variants, it does not address the variety of flu strains that typically circulate each year
“A change in behavior has led to a major reduction in flu, common cold, and RSV cases,” said Lopatofsky. Dalal agreed. “Masking, social distancing, and reduction of large group gatherings have directly impacted the effects of the flu.”
Across the system statewide, UPMC has administered 341,445 COVID-19 vaccine doses as of April 6, 2021, including 11,246 to residents and staff of both UPMC and non-UPMC long-term care facilities. More than 210,000 doses have been administered to people who are not affiliated with UPMC, including:
149,285 to vulnerable community members, 65 or older, and predominantly from neighborhoods hardest hit by the pandemic.
55,791 to non-UPMC employed health care workers — prioritizing those who serve medically under-resourced communities.
5,015 doses administered at special events, including large scale clinics, high rise outreach, and other local organization partnerships.
COVID-19 testing has not gone up dramatically, and UPMC continues to monitor the percent positivity rate. Steve Johnson, President, UPMC in the Susquehanna Region, said that this time last year, the positivity rate was around 5%. “It peaked as high as 50% at one point,” he said, “and now is steady around 18%.”
“If we can reach 70% of the community, by the end of June or mid July we could be back to near normal,” Dalal said. But as the high risk community is vaccinated and focus turns toward the younger, more healthy population, vaccination rates will likely decrease. “Vaccination might slow down due to acceptance levels. Local leaders like yourself,” said Dalal to Keller “can have influence.”
How legislation can help -- and hurt -- healthcare delivery
Much of the roundtable discussion served as an opportunity for Congressman Keller to hear feedback from healthcare leaders regarding legislation that impacts healthcare delivery and payment rates.
Rural hospitals face difficulties when it comes to hiring doctors, nurses, and specialized providers. “It costs rural communities more to hire these professionals,” said Johnson.
Healthcare providers who earn specialized degrees typically look to practice in more urban areas, where there is a larger patient pool and state-of-the-art technology. "We have to pay a 'rural tax'," Lopatofsky called it. The extra incentive to bring talent to rural areas.
Administrators at UPMC look favorably on the reintroduction of the RURAL HELP Act, which aims to bring parity to inpatient Medicare reimbursement payments between rural and urban hospitals.
“Quality care in rural America should be affordable for those who need it, and be cost effective for the rural hospitals administering it,” Keller said. “Unfortunately rural hospitals are constantly faced with the risk of closure from things like lopsided Medicare reimbursement rates.”
Keller said his team reintroduced the RURAL HELP Act to "systematically reevaluate declining Medicare payments and ensure rural hospitals can continue their important service to communities."
Additionally, the restrictive regulation surrounding licensing has been “unduly burdensome,” according to Dawn Wright, VP of Human Resources. During the staff shortages that COVID-19 brought upon the hospital, it would have been helpful if nurses from other states could have been licensed more quickly. Of the 36 states that participate as a “contact state,” meaning licenses can transfer quickly across state lines, Pennsylvania is not one.
“We could send agency nurses to other states in one day; here, we were waiting four to six weeks to get licenses up and running,” said Susan Duchman, VP of Patient Care Services & Chief Nursing Officer.
On the flipside, some restrictions that were loosened during the pandemic helped healthcare providers flourish services, like telehealth. “The no-show rate went to zero with telehealth, as opposed to in-person appointments,” said Lopatofsky. Further investment in infrastructure to bring high speed internet to rural areas will only help this method of healthcare delivery grow.
Loosening of other regulations allowed for faster transfer of patients to the next level of care, moving those who no longer needed hospital care be discharged more quickly to rehab or nursing facilities, saving patients from costly bills and freeing space in the hospitals for patients in need of hospital care.
“Let’s not go back to some of the more restrictive policies if we don’t need to,” said Johnson. Covid triggered a way to look differently to the structure of pricing and delivery,” he said. “Let’s not let the progress sunset.”