Hospitalizations reach new high 3rd straight day
Virus-patient surge prompts moves to free up more beds
Arkansas’ count of coronavirus cases rose by 1,950 on Tuesday as the number of covid-19 patients in the state’s hospitals reached a new high for the third day in a row.
The state’s death toll from the virus, as tracked by the Department of Health, rose by 10, to 2,512.
The number of covid-19 patients in hospitals increased by 11, to 1,074.
After reaching a record level on Monday, the number of virus patients who were on ventilators fell by 16, to 195.
In response to the growing number of hospitalizations, Gov. Asa Hutchinson announced Tuesday that the state will create a system, similar to the state’s trauma system, to match such patients with hospitals with available resources.
He said he has also asked U.S. Health and Human Services Secretary Alex Azar to
help free up hospital beds by directing Medicare managed care plans to waive requirements that have delayed the transfer of patients from hospitals to nursing homes.
“It has become apparent that there are barriers within the Medicare Advantage program that are creating unnecessary delays in transitioning Medicare beneficiaries through the health care system,” Hutchinson said in a Nov. 24 letter to Azar that he released to reporters.
At his weekly news conference on the pandemic, the Republican governor said he’s watching the state’s hospitalization numbers as he weighs whether to take additional steps, such as placing more restrictions on businesses, to slow the virus’s spread.
“Hospitalizations and our capacity to manage the health care of our citizens, both in terms of routine illnesses and covid, is a critical factor, and that’s one of the things that we’ll continue to look at,” he said.
The increase in cases on Tuesday was up from the 1,112 that were added a day earlier but less than the 2,122 that were added the previous Tuesday.
Hutchinson noted that the Health Department had received the results of 5,161 polymerase chain reaction, or PCR, tests that were performed on Monday, which he said is “less than we’d like to see.”
On the other hand, the state had also received the results of 4,365 antigen tests, which are typically quicker but less accurate.
That was up from the 531 antigen test results the state reported receiving from Sunday.
After peaking at 1,824 on Nov. 26, the average number of cases added to the state’s tallies each day over a rolling seven-day period has mostly fallen, reaching 1,571 as of Tuesday.
But Hutchinson said he isn’t “going to put a whole lot of emphasis” on the slowdown in new cases because it could reflect a slowdown in testing last week because of Thanksgiving.
He said he wanted to thank those who “cooperated and had a different kind of Thanksgiving with a smaller gathering” this year to avoid spreading the virus.
“We’ll find out what our report card says a couple weeks from now, but I know that so many worked hard to make sure that everyone was safe during the Thanksgiving holiday,” he said.
ACTIVE CASES FALL
The cases added to the state’s tallies on Tuesday comprised 1,142 that were confirmed through PCR tests and 808 “probable” cases, which include those identified through antigen tests.
The state’s cumulative count of cases rose to 159,309.
The number of cases that were considered active fell by 46, to 16,094, as 1,986 Arkansans were newly classified as having recovered.
Pulaski County had the largest number of new confirmed or probable cases, 178, followed by Benton County with 171, Washington County with 140, Saline County with 101 and Greene County with 92.
Among prison and jail inmates, the Health Department’s count of cases rose by 15.
Department of Corrections spokeswoman Cindy Murphy said the number of cases among inmates increased by 14, to 443, at the Wrightsville Unit; by two to 185, at the Tucker Unit in Jefferson County and by two, to five, at the East Central Arkansas Community Correction Center in West Memphis.
Of those prisons, the Tucker Unit has the largest number of cases that were active, 35, followed by the Wrightsville Unit, which had 25.
The West Memphis lockup had two active cases, Murphy said.
The state’s death toll rose by nine, to 2,304, among confirmed cases and by one, to 208, among probable cases.
Among nursing home residents, the state’s count of deaths rose by two, to 1,061.
The number of people who have ever been hospitalized in the state with covid-19 rose by 84, to 9,021.
The number who have ever been on a ventilator rose by five, to 994.
FACILITATING TRANSFERS
The new system for facilitating the transfer of patients was a recommendation of Hutchinson’s winter covid-19 task force, which he set up to study how to better manage the state’s coronavirus caseload in hospitals and reduce the virus’s spread.
Hutchinson displayed a chart showing that 37% of the state’s patients in intensive care units as of Tuesday were being treated for covid-19.
Across the state’s seven Arkansas Hospital Association regions, however, the percentage ranged from 57% in the southwestern region to 30% in the Arkansas Valley region in the state’s west.
“You can see just in this one illustration how necessary it is to coordinate the placement of someone in a hospital,” he said.
Baptist Health Chief Executive Officer Troy Wells, a member of the task force, said the current system for transferring patients “usually involves a lot of phone calls.”
“It’s really a guessing game as to who may have the ability to care for a particular patient,” he said.
He said the system will categorize hospitals based on their capabilities and resources and use a tool allowing hospitals to classify patients according to their needs.
“A patient today may be able to be cared for in a facility that’s not in one of the metropolitan areas, for example,” Wells said.
“Instead of just going immediately to Little Rock or Northwest Arkansas or Jonesboro for care, there may be another community that could accommodate that patient.”
He said the system will allow the state to better match patients with hospitals to “prevent certain hospitals from being overwhelmed with patients from around the state that might be able to be cared for elsewhere.”
Hutchinson said the system could be set up in as little as two weeks and is expected to cost about $70,000 a month.
He said the Health Department will be able to fund it for the first few months using money from its budget.
“As we prove it successful, we might have to add additional funding to it,” Hutchinson said.
WAIVER SOUGHT
In his letter to Azar, Hutchinson said the privately run Medicare Advantage plans “appear to have declined to adopt key waivers that are being applied to the rest of Medicare and that we have adopted in our Medicaid program in Arkansas.”
In particular, Hutchinson said the plans, which provide benefits to Medicare beneficiaries in exchange for monthly payments from the federal government, haven’t waived a requirement for enrollees to spend three days in the hospital before they can be transferred to a nursing home.
“These barriers must be lifted on all Medicare beneficiaries in acute care and post-acute care settings and [I] request that you direct all plans to do so immediately,” Hutchinson said in the letter.
He also asked for federal officials to waive any prior authorization requirements for Medicare beneficiaries, including those in Medicare Advantage plans, being transferred from a hospital to a nursing homes or other facilities.
“While the priority for Arkansas, right now, is to ensure that staffed hospital beds are available for sick patients, it is also important to evaluate whether patients are remaining in hospital beds when waiting for prior authorizations for discharges to home-based care requiring respiratory assistance devices or ventilators, oxygen deliveries, or transfers to a new provider,” Hutchinson wrote.
“With the prevalence of disease increasing, removing prior authorizations for diagnostic radiology and imaging of the chest for COVID-19 patients might also be advised.”
The managed care plans cover more than 40% of the 451,000 Arkansans on Medicare.
The U.S. Centers for Medicare and Medicaid Services has waived a requirement for Medicare beneficiaries to spend three days in a hospital before being transferred to a nursing home “for those people who experience dislocations, or are otherwise affected by COVID-19.”
Arkansas Hospital Association Chief Executive Officer Bo Ryall said the group would like to see the waiver “applied to any patient, so we can move patients through the system.”
Likewise, he said hospitals would like to see an Arkansas Insurance Department directive prohibiting insurers from requiring prior authorization for covid-19 treatment extended to all patients.
“We do find obstacles with other plans, commercial insurance, Medicare Advantage, Medicaid,” he said. “We’re working through those with those different components, but there’s some issues with all of those.”
Hutchinson spokesman Katie Beck said in an email that the governor’s office has “drawn attention” to the letter to Azar “at the staff level and have not received a response yet.”
“We know it’s an issue with Medicare Advantage plans and we are still gathering information on whether it could be broadened to other plans,” Beck said.
“We have also asked hospitals to identify specific areas and carriers that are presenting challenges.”
Spokesmen for Arkansas Blue Cross and Blue Shield and Louisville, Ky.,-based Humana both said they have waived the three-day hospital stay requirement for Medicare Advantage enrollees being transferred to nursing homes.
Humana has about 51,000 Medicare Advantage enrollees and Arkansas Blue Cross has about 12,350.
Humana spokesman Mark Mathis said in an email the insurer “has suspended authorization requirements for skilled nursing facilities and long-term acute care for Medicare Advantage and commercial members for the entire state of Arkansas through Dec. 31, 2020.”
BED TOTAL FALLS
The state’s total hospital beds — whether in use or not — dropped by 166, according to Health Department data.
From the beginning of the pandemic in March, the Health Department has reported that there are a total of 9,144 beds in the state’s hospitals. On Tuesday, that number dropped to 8,978.
Health Department spokeswoman Danyelle McNeill did not give specifics when asked where the loss of beds originated.
“Hospitals continue to adjust their bed types depending on several factors such as available staff or if they increase the numbers by opening up a new wing with more beds,” McNeill said. “This process is the same for the other bed types, not just ICU.”
Out of the state’s total 8,978 hospital beds, 2,344 remained available as of Tuesday. Included in that number are a few hundred beds in psychiatric or rehabilitation facilities that are not used for covid-19 care.
Hospitals around the state have been carving out space for new intensive care unit beds since the beginning of the pandemic by expanding into new physical areas or changing the use of current areas.
Tuesday’s hospitalization report showed that eight more ICU beds have been added, raising the total inventory to 1,147.
Out of that number, 72 are available — meaning that nearly 94% of the state’s ICU beds are occupied.
Eddie Phillips, chief medical officer for Baptist Health, said available hospital beds as well ICU beds are “extremely limited across our system and this varies hourly.”
“This is a very busy time, but it is important to remember that it is not uncommon to run at or near capacity for ICU beds. A big challenge is critical care staffing,” Phillips said. “We feel we are meeting our patients’ needs with quality, safe care, though staffing is always a challenge and something we deal with on a daily basis.”
Phillips said the decision to hospitalize a covid-19 patient is determined mainly on the patient’s oxygen requirement.
“If they are symptomatic and they need additional oxygen, they need to be admitted. This gets more complicated with comorbidities,” Phillips said. He added that covid-19 patients are typically hospitalized from three to five days, unless they are placed on a ventilator.
“In order to be discharged, the patient shows that they can be adequately managed without supplemental oxygen,” Phillips said. “Patients are placed on a ventilator when they are unable to maintain adequate oxygenation levels by conservative means such as nasal prong O2 or BiPAP machine administered oxygen.”
The University of Arkansas for Medical Sciences opened its second covid-19 unit, spokeswoman Katrina Dupins said Tuesday.
“There were 58 covid-19 patients Monday morning,” Dupins said.
Martine Pollard, spokeswoman for the Northwest Arkansas Covid-19 health care community, said in a release Tuesday that there are 107 covid-19 patients in Northwest Arkansas hospitals. Twelve more patients were admitted to ICU units since Monday, bringing the total to 106 ICU beds filled by covid-19 patients.
There were 35 covid-19 patients on ventilators in the region’s hospitals on Tuesday — five fewer than the previous day.
Pollard said the region’s hospitals had nearly 100 noncovid hospital admissions since Monday, increasing the pressure on health care workers.
“While repetitive, our message remains consistent: Caring for inpatient COVID patients, ICU high acuity patients, along with other diverse medical needs, gives us grave concern,” Pollard said.
The Northwest Arkansas Covid-19 health care community includes Mercy Hospital Northwest in Rogers, Washington Regional Medical System, Northwest Health System, Arkansas Children’s Northwest, the Veterans Health Care System of the Ozarks and the University of Arkansas for Medical Sciences Northwest.