Transforming the market for a COVID-19 surge

Transforming the health care marketplace has gone from an academic discussion to modern-day reality.

As the state prepares for a surge of infected patients in Florida hospitals and potential community spread of the virus in long-term care facilities, federal and state regulators are adding flexibility to longstanding rules to allow patients to receive care from a broader number of providers at different locations and with different equipment.

The state Agency for Health Care Administration on Friday sent guidance to hospitals asking them to “strongly” consider converting anesthesia machines to ventilators. The U.S. Food and Drug Administration authorized the conversion and the steps that must be followed last week.

AHCA said in its guidance that anesthesia “professionals” will be necessary to “put these machines into service and manage during use.”

In a prepared statement, Florida Hospital Association interim President Crystal Stickle said hospitals are considering all options.

“Florida’s hospitals are carefully identifying, preparing and prioritizing the availability of life-sustaining resources that are a critical part of their COVID-19 emergency response efforts,” Stickle said in a prepared statement. “The Food and Drug Administration’s recent approval of converting anesthesia machines into ventilators is one of many federally-authorized options for hospitals to consider as they continue contingency planning to meet the increased needs of COVID-positive hospitalized patients. During this unprecedented time, hospitals remain focused on saving lives and restoring their patients’ health.”

Meanwhile, the federal Centers for Medicare & Medicaid Services this week issued temporary rules that would allow certified registered nurse anesthetists to receive Medicaid and Medicare reimbursements without having to be directly supervised by physicians. The goal is to expand the health care workforce and free up physicians from current supervisory requirements.

But the provision won’t help in Florida because it only applies to states that allow CRNAs to practice without physician supervision. The Legislature this year authorized independent practice for some advanced nurses but not CRNAs. Despite his influence, House Speaker Jose Oliva could not get lawmakers to approve autonomy for CRNAs in a scope-of-practice bill that Gov. Ron DeSantis signed into law March 11.

Some Governors in recent weeks, though, have issued executive orders waiving supervisory requirements of CRNAs during the pandemic, including Maine, New York, West Virginia, Michigan, Louisiana, Massachusetts, New Jersey and Kentucky.

Jose Castillo III, president of the Florida Association of Nurse Anesthetists, sent two letters to DeSantis that asked him to follow suit. But DeSantis has not acted.

The CRNA provision was included in the Trump administration’s efforts to add capacity to the nation’s health care system during the COVID-19 pandemic. The administration also announced this week that ambulatory surgical centers can enter arrangements with hospitals to care for patients during the pandemic or enroll in the Medicare program as a hospital.

Amid an edict to focus only on essential surgeries, many ambulatory surgical centers have essentially closed, said David Shapiro of the Florida Society of Ambulatory Surgical Centers.

Shapiro, a Tallahassee anesthesiologist, said his association had reached out to the state to see how ambulatory surgical centers could best serve patients as Florida struggles with the pandemic and braces for a surge of patients requiring hospital care.

Shapiro said ambulatory surgical centers can provide a number of services and would play whatever role was needed, from providing emergency room-type services to delivery rooms, and the centers are looking for AHCA to issue some guidance.

AHCA had not replied Friday afternoon to a request for comment from The News Service of Florida about an expanded role for the centers.

Meanwhile, Florida’s hospital capacity can be tracked at a new state website. The data includes hospital beds on a state, county and hospital-specific basis.

As of Friday afternoon, 38 percent of intensive-care unit beds for adults were available on a statewide basis. Available adult ICU beds in Southeast Florida, where the virus has hit the hardest, ranged from 35 percent in Broward County to 32 percent in Miami-Dade.

Florida had 9,585 cases of COVID-19 as of Friday morning, and 163 residents had died. But those numbers will continue climbing as the number of Floridians tested increases. According to state data, 91,722 people had been tested. The virus had infected 143 long-term care residents or staff members in 21 counties as of Friday morning. Broward County had 32 cases in long-term care facilities, the largest amount in the state.

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Republished with permission of the News Service of Florida.