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COVID-19 Bulletin

September 21, 2021

Here is today’s COVID-19 update. 

Bi-State continues to keep our website updated with the latest on the Bi-State COVID-19 Resources webpage. This links to various credible COVID-19 resources, archives all Bi-State COVID-19 Bulletins, and holds a section of resources for patients.

Notes from today's "Today with Macrae" phone call are included at the very bottom of this bulletin. 

Bi-State COVID-19 Resources
New Hampshire Resources

NH Fiscal Policy Institute Publications

This issue brief published 9/1 analyzes the uneven impacts of the pandemic on certain groups of workers and industries.

This blog published 9/1 explores how NH's new flexible federal funds have been appropriated. 

NH Medical Society Bulletin 9-18-21

Click here to view a PDF of the NH Medical Society's 9/18 Newsletter with the latest COVID-19 news, including:

  • COVID-19 Boosters: A FDA advisory panel voted unanimously on Friday in favor of a booster dose of the Pfizer-BioNTech COVID-19 vaccine for people 65 and older and for individuals at high risk for severe disease, with the shot given at least six months after their initial full vaccination.
  • The CDC ACIP is scheduled to meet tomorrow, 9/22 to outline the parameters for the booster's administration, which will likely include defining who qualifies as "high risk" which could include people with underlying health conditions like obesity, and groups like health care workers who are exposed to COVID-19 during the course of their jobs.

NH DPHS Webinar Changes

NH DPHS will resume webinars for Healthcare Providers and Public Health Partners on the 2nd and 4th Thursday of each month from 12:00 to 1:00 p.m.  The first in the new series is on Thursday, September 23, 2021.   Please contact Colleen Dowling or Kaylana Blindow for the Zoom link.  

State of NH COVID-19 Resources
Governor Sununu Executive and Emergency Orders
Vermont Resources
State of VT COVID-19 Resources
VT Health Care Provider Resources
Federal Resources

Reminder: Please Use the VAERS System for Vaccine Adverse Events

This is a reminder that all hospitalizations and deaths following the administration of a COVID-19 vaccine under Emergency Use Authorization (EUA) must be reported to the Vaccine Adverse Reporting System (VAERS), regardless of the date since vaccination or the patient’s post-vaccination COVID-19 infection status.

Current EUA authorized COVID-19 vaccines include Moderna, Janssen, and Pfizer for those 12 through 15 years of age.

In addition to hospitalization and death, the following adverse events must be reported for all EUA authorized COVID-19 vaccines irrespective of the timeframe following vaccination:

  • Vaccine administration errors, regardless of whether they are associated with an adverse event (AE)
  • Serious adverse events regardless of causality. Defined as:
    • Death
    • Life-threatening adverse event
    • Inpatient hospitalization or prolongation of existing hospitalization
    • A persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions
    • A congenital anomaly/congenital disability
    • An important medical event based on an appropriate medical judgment that may jeopardize the individual and require medical or surgical intervention to prevent one of the outcomes listed above
  • Cases of Multisystem Inflammatory Syndrome
  • Cases of COVID-19 that result in hospitalization or death

For those vaccinated with the FDA-approved Pfizer COVID-19 vaccine, Comirnaty, there is no specified timeframe after vaccination for reporting serious adverse events, including deaths, for patients 16 years of age and older.  If judgment deems it appropriate to report, please file in VAERS

Ensure that your organization has appropriate monitoring workflows in place so that all relevant VAERS reporting occurs for your patients.  VAERS reporting is the responsibility of all involved with the patient's care.  VAERS accepts reports from anyone. Patients, parents, caregivers, and healthcare providers are encouraged to report to VAERS even if it is not clear that the vaccine caused the adverse event.

Cybersecurity in Top 10 in VHEPC for Second Year Running

Annually the Vermont Healthcare Emergency Preparedness Coalition surveys the Vermont health care community (long term care, hospitals, primary care, etc.) about top concerns for health care landscape disruption and compiles the results.  The top hazards included in the 2021-2022 Hazard Vulnerability Analysis workshop, based on their potential to impact multiple healthcare facilities across the State, are:

  1.  Epidemic/Pandemic
  2. Cyber Attack
  3. Severe Winter Weather (includes blizzards and ice storms
  4. Communications/Information Technology (IT) Failure
  5. Supply Shortage
  6. Electrical Failure
  7. Mass Casualty Incidents
  8. Water Supply Shortage
  9. Workplace Violence
  10. Severe Hail/Thunderstorm

For reference, the 2020-2021 Top Hazard List

Top Coalition Hazards The top hazards that were included in the 2020-2021 HVA workshop:

  1. Cyber Attack
  2. Severe Winter Storm
  3. Mass Casualty Incident
  4. Infectious Diseases
  5. Power Failure
  6. Information System (IS) Failure

HITEQ

More information on cybersecurity (repeatedly in the top 10) is available at the HITEQ website.  

Here is a cybersecurity checklist for health center staff working remotely. 

HRSA COVID-19 FAQ
NACHC COVID-19 Resources
WHO Situation Report
Other Resources

Maps for Hospital Utilization

On the HHS Protect Data Hub there are some national Hospital Utilization tools.   Hospital utilization is reported to HHS Protect by all hospitals registered with CMS as of June 1, 2020.  The Hospital Utilization page displays visualizations on the utilization and capacity status in the United States.  

Vaccine Hesitancy in Health Care Personnel

On September 20, 2021 Cambridge University Press published COVID-19 Vaccine Hesitancy among Physicians, Physician Assistants, Nurse Practitioners, and Nurses in Two Academic Hospitals in Philadelphia.  Health Care Personnel  were surveyed between November-December 2020 about their intention to receive the COVID-19 vaccine.

The Cost of the Unvaccinated

Kaiser Family Foundation published an article on Unvaccinated COVID patients cost the U.S. health systems billions of dollars.   Published on September 14, 2021

A surge in COVID-19 hospitalizations among people who have not been vaccinated in August is adding billions of dollars in preventable costs to the nation’s health-care system, this updated KFF analysis finds.

Sprint to Accelerate Vaccination Equitibility

Harvard Medical School’s Center for Primary Care is hosting a virtual 10-week improvement program to support community health, rural health and primary care leaders and teams to accelerate the safe and equitable administration of the COVID vaccine for their target populations. The program includes: • Weekly hour-long webinars featuring content, and coaching from national primary care experts; • Interactive discussions and resource-sharing with peer practices from across the country and; • Short, relevant weekly assignments to support your practice's specific program goals.

Please let Georgia know if you are interested in participating. We have attached a flyer for your review.

Johns Hopkins Interactive Map and Summary
Community and Patient Resources
Non Coronavirus Content

Our 2021 Clinical Quality Symposium
VIRTUAL PARTICIPATION


Earlybird rates end 9/22/21;
Registration closes 10/1/21

Registration is open for the Clinical Quality Symposium
Register here: https://events.eventzilla.net/e/clinical-quality-symposium-2138802726?resp=on&dateid=2138322027
The keynote will focus on Health Equity. Other sessions include: Long-term Effects of COVID-19 on Cognition and Brain Function; Exploration of Multidimensional Therapies for Managing Chronic Pain (panel); Bringing Care to Patients (on home visits); Addressing Depression in Patients with Chronic Conditions; the Neuroscience of Pain, Addiction, and Trauma.
CMEs/CNEs/CDEs/CEUs anticipated.

Today with Macrae Notes
September 21, 2021

Bi-State participated in the “Today with Macrae” webinar on 9/21/2021. The next call will be on 10/21/2021 at 3 PM. Slides for the 9/21/2021 can be found here.
 
Jim Macrae welcomed everyone.  He expressed his deep appreciation for everything that the health centers, PCAs, HCCNs, NTTAPs, Board Members, staff, and BPHC staff have done over the past year.  It has been an incredible year with incredible challenges and amazing responses to those challenges.
 
BPHC knows you are tired.  BPHC is tired too.  But we need to keep on with the work to get into a better place sooner rather than later. Thank you.
 
BPHC REACH
Jim Macrae and other leaders within BPHC then detailed the many transitions that are occurring within BPHC. A new operating structure was announced recently in the Federal Register. BPHC will take this new structure and vision and actualize it over the coming months.
BPHC’s overarching vision – (1) expand health centers to every high need community, (2) ensure that they offer comprehensive range of services, (3) ensure that they lead on equity, (4) have state-of-the-art facilities.
The organizational changes will support Health Center Program compliance and funding. Capital will be more fully integrated with other BPHC staff. Design the new Quality Improvement Fund.
Jim Macrae shared a slide detailing the new BPHC Operating Model.  This model has separate lanes of work for (1) Health Center Program Requirements (the Health Center Model of Care), (2) Health Center Investments, and (3) Innovation.  All of this is supported by various enterprise functions and enabling functions.
 
Ernia Hughes then spoke about the new Office of Health Center Investment Oversight. The purpose of this office is to create a measurable and lasting impact to health outcomes, health equity, and Health Center Program performance through effective oversight of Health Center Program funding.  A focus of this office is to “do what we promised.”  The functional areas she discussed include: strategic services, infrastructure improvement, clinical performance improvement, emergent health response, and service expansion.  This office is about the base funding, the supplemental awards; it is about improving the range of health services with focus on achieving intended outcomes.  Are you achieving outcomes?  If so, can we share your lessons learned? If not, can we work with you to get on track?
 
Angela Powell spoked about the new Office of Health Center Program Monitoring. The purpose of this office  is to promote and support the health center model of care, engage health centers and other stakeholders to optimize organizational performance, improve primary care outcomes, and advance health equity. Functional areas include:
compliance evaluation (changes in scope, changes in Project Directors); health center engagement; TA/assessments (OSVs and TA Site visits); program data and risk analysis (how can we better use data we get?); and strategic operations (“the folks who will keep the trains running”). 
 
Jim Macrae, Ernia Hughes, and Angela Powell shared various themes they have heard from health centers as they think about the changes.  The statement next to each of these themes is that BPHC is listening.  BPHC is looking for ways that it can be more flexible, more responsive.
 
Angela Powell discussed the future vision to streamline compliance.   She used words like “proactive TA,” “restorative compliance” (identifying trouble areas and work proactively to keep folks in compliance). She stated that an aim was for grantees to be compliant in the least burdensome way,
 
BPHC is in the process of piloting a health center portfolio transition. This means transitioning some things from the Investment Office to the Monitoring Office and vice versa.  BPHC is working to ensure that during and after this transition health centers don’t have to tell their stories to multiple people within BPHC.  They have heard that health centers find value in having a primary Point of Contact, that they want the people answering the questions to have familiarity with them and with the program.
 
Suma Nair then spoke about the 2023 UDS and its requirement for Patient Level Submission (UDS+). Beginning with the 2023 UDS, BPHC will require patient-level report data. Data elements at the individual level will include UDS Tables PBZC, 3A, 3B, 4, 6A, 6B, and 7. This will be de-identified. This more robust data will support BPHC efforts in health equity, in telling the health center story. BPHC will also be able to use insights to direct its programming, TA, and investments.  Examine subgroup differences. Target innovation investments.  The patient level data submission will be done through a manual file upload system or through FHIR. UDS+ is not a full copy of data directly from patients’ EHR.
 
Funding Updates
Jim Macrae provided updates on the status of various funding opportunities:
Recently Announced:
  • School Based Service Sites (congrats, Amoskeag!)  Funded 27 applications (from a pool of 300+). There are many approved but unfunded applications.  “We’ll see what the Congress does...” 
  • Ending the HIV Epidemic – Primary Care HIV Prevention
Upcoming Awards:
  • ARPA Health Center Construction and Capital Improvements (C8E) (to be announced in late September)
  • Optimizing Virtual Care (to be announced in January)
 
Jim Macrae cautioned health centers not to forget to submit your SAC applications as they come due.
 
Quarterly Reports
Ernia Hughes highlighted the importance of the progress reporting.  BPHC is on a journey with health centers around the investments that BPHC is making in them. The data from the progress reports keeps BPHC appraised of this journey, it “keeps us smart.” It is very important for health centers to provide good data.  EHB will open on 10/1 for quarterly reports H8F, L2C, and any extensions on H8C/D/E and L1C – these reports will be due on 10/14.
 
Testing Supply Distribution Program
Ernia Hughes then spoke about the new Testing Supply Distribution Program. There will be both Point-of-Care and At-Home test supplies.
  • Point-of-Care will include free analyzers and test kits.  The supplier will be BD VeritorTM.  There will be an “opt-in” for health centers and LALs.
  • At-Home will provide free, at-home rapid test kits for patients, staff, and the community.  There will be an “opt-out” for health centers and LALs.
 
HRSA Vaccine Program
Suma Nair provided updates on the accomplishments under the HRSA Vaccine Program.
  • Almost 15M vaccine doses have been administered by health centers to date.
  • Health centers provided 17K+ doses to immunocompromised populations in just the last two weeks.
  • Looking ahead, FQHCs need to focus on the unvaccinated and plan for pediatric vaccinations. FQHCs may want to think about administering COVID vaccinations with other regular vaccinations.
 
Monoclonal Antibody Therapy (mAb)
Suma Nair also provided an update on Monoclonal Antibody Therapy at health centers.
  • She thanked health centers for beginning to provide this information in the Health Center Surveys.
  • She noted that it is BPHC’s goal is for all eligible health center patients to have access to this treatment. It may make sense for the health center to provide it directly, or it may make sense for the health center to refer to another provider.
  • She recommended the following webinar: The Critical Role of Monoclonal Antibodies as the COVID-19 Pandemic Continues - YouTube
 
Jim Macrae ended the presentation by highlighting a “HIV Care Tools App”
 
Q&A
Q: Given the “Health Center Points of Contact Pilot,” who do we contact when?
A: The pilot has been a way for us to experiment. Stay tuned for us to continue with the pilot and share what we’ve learned.  This is moving from a 1:1 relationship to a team-based relationship.  We are going to test a few different ways to figure out what works best for which issues.
Q: Is patient-level data reporting required or optional for UDS+ and how does this reduce reporting burden?
A: The 2021 UDS will not change.  The 2022 UDS will not allow chart sampling (most FQHCs use an ONC-certified EHR now) – this is the first step to patient-level data reporting. The 2023 will require patient-level data. Using the FHIR resource is a current expectation of all EHRs. CMS will require this in 2025; BPHC is pushing health centers to start this early. There will be more standardization. Don’t worry, there will be a lot of TA and resources.  BPHC feels confident that this is a transformation we can take together.
Q: Does the operating model include an area of focus for LALs?
A: Yes, we talk in terms of “health centers” which includes LALs.
Q: Is there any chance that future funding will be made available to LALs?
A: There have been questions about capital. That opportunity is currently only for funded health centers.  But the reconciliation language in the House is inclusive of LAL, so it is possible that future funding may be made available, depending on the final language. 
Q: Would BPHC consider flexibility in postponing OSVs and TA Site Visits in states that are experiencing high levels of COIVD? Health centers are working really hard.
A: Thank you for always stepping up in the front lines. BPHC is working individually with health centers on those requests.  The challenge is that sometimes the site visit is necessary given when the SAC is due, etc. If you have concerns, let us know.
 
Jim Macrae ended the meeting as he began it with a huge thank you.  You have translated the investments into real results for our patients and communities.
 

Questions for Bi-State

Vermont: Please contact: Kaylana Blindow, 802-229-0002 ext. 226 kblindow@bistatepca.org

New Hampshire: Please contact: Colleen Dowling, 603-228-2830 ext. 127 cdowling@bistatepca.org

Introducing Porkchop.   Porkchop lives with Kim Anderson from Community Health Centers of Burlington.   Porkchop is three months old and is getting regular preventative care.

Would you like to see your furbaby featured in a future bulletin? Email pictures to Heather Skeels
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