August 3, 2021

Bedridden COVID patients urge the community to get vaccinated

There’s been dramatic summer surge in COVID-19 positivity rates in South Florida and throughout the country. The vast majority of new cases are younger patients who are not vaccinated.

“If I would have known to take the shot, I would have taken it a while ago because COVID is real,” said Shawn Moses, who prior to being hospitalized with COVID was a healthy 47-year-old. “You need it. Don’t put it on hold. Go take the shot. Listen to me. If I would have listened to myself, I wouldn’t be in this situation right now.”

Moses is now hospitalized at Broward Health, where he has spent 18 hours a day for the last six days laying on his stomach, because that is the only way he can breathe. 

“This past week, the number of hospitalized COVID positive patients has significantly increased again,” said Broward Health Medical Center Chief of Staff Sunil Kumar, M.D.

Dr. Kumar attributes the spike in positivity rates to the Delta variant of the virus, which is more contagious and has been affecting younger, healthier people. He said nearly everyone infected with the virus has not been vaccinated.

Inside Broward Health’s COVID-19 units, there are patients who are 15-, 20- and 32-years-old. The common denominator is that none these patients is vaccinated, and they are all fighting for their lives.

“Mr. Moses is a young, healthy gentleman,” said Dr. Kumar. “Unfortunately, he didn’t have all the information about the vaccine. Now, he realizes that it was a mistake, and he’s struggling.”

As the pandemic shifts, those who are not vaccinated remain the most at risk.

“There’s only one thing that you can do,” said Dr. Kumar. “There is no running away from this. You must vaccinate. It’s a preventable disease at this point, and you need to help yourself and your family. You don’t want to die from COVID, and you don’t want a family member to die either. That can be prevented by getting the vaccine.”

For more information on the vaccine and its availability, visit BrowardHealth.org/Vaccine.



According to Matt Johnson, general manager of Century Ambulance Service, Inc., the company’s business in Florida for the past 20 years has been “pretty much the same – picking up patients and moving them to a new location.” Then came COVID-19, and Johnson admitted, “That kind of created a pause in what we did, and we had to re-evaluate all of our practices.”

He explained that of course, Century couldn’t just shut down. “We had to respond to the threat immediately, but the information was new and we didn’t know what we were dealing with. If somebody says you have tuberculosis, we know exactly what we’re dealing with, but nobody really knew what COVID-19 was. It’s not the flu, it’s not pneumonia, it’s not TB; it’s COVID-19. What does that mean?”
The crews were concerned as well, asking what does that mean to me, what do I need to do to not only treat the patient but to also protect myself? Johnson acknowledged that everyone had questions, but added, “We tried to answer them as well as we could, but we were dealing with the same information they had at the very onset.” He emphasized Century Ambulance needed to make sure its crews knew what they were getting into and that they had the proper equipment to do their jobs. “Our commitment to them was that we weren’t going to put them on a truck or put them out there unless they had 100 percent of all gear they needed to do their job.”
In addition, the vehicles are always cleaned after a patient is transported, but Johnson said that foggers – a device that emits a mist inside the back of an ambulance to make sure it kills anything in the air – are now also used. “We fog the back of the ambulance to make sure that COVID-19 – or anything else – is not transmitted, because we move a lot of people in a day and we wanted to make sure we’re doing our part to contain it, as well to protect our crews and the next patient.” He said their system slowed down considerably with the amount of personal protective equipment the crews had to wear, the new decontamination processes, and also getting over fear of the unknown of what they were actually dealing with.
As for the calls themselves, Johnson said, “We did see a slowdown in areas where we actually do respond – where we’re the 911 provider – but the calls we did see were so much worse. People were delaying care because they didn’t want to go to the hospital; the doctors’ offices were doing everything remotely, which was a new product for a lot of people; as a result, some unfortunately delayed care they probably needed. So while we did see a slowdown in total call volume, the acuteness of those calls went up.”
Comparing those volumes with the current ones, Johnson said that now that everyone is emerging from the pandemic, the calls are at record numbers. “Now that everyone is out and about again, doing their thing – there are car accidents, heat exhaustion because they stay out on the golf course too long. Those types of incidents have definitely come back as well.”
Johnson said that while Century Ambulance does have a general pandemic plan on paper, “it’s like hurricane forecasting. It changes every day.” On the other hand, he pointed out that a hurricane is episodic – it comes in for two weeks, it’s chaotic, and then things return to normal. In the case of COVID-19, he believes it’s not known when and if things might actually return to normal.
“There are a lot of long-term effects that I think have yet to be discovered, especially with our crews. But just the fact that they were out there working, not for a short time but for a very long term, I think some things are probably going to continue to evolve, and hopefully we’ll be able to continue to meet those challenges for the staff.”
Johnson had high praise for Century Ambulance’s employees, saying they did a phenomenal job. “I can’t say enough about them. We had to tell them, ‘We’ve given you all the information we know, we’ve given you all the equipment the CDC has said you need to have; now we need you to do your job.’ And our employees did a phenomenal job.”


The Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement Advanced (BPCIA) model incentivizes healthcare providers who invest in practice innovation and care redesign to better coordinate care. These measures help to reduce variations in care delivery, while improving the quality of care and lower the cost of care for Medicare beneficiaries – achieving the triple aim – Better Care, Better Outcomes and Lower Costs. It’s a patient centric and concierge model around care redesign and value-based care.

The key to navigating the challenges of bundled payments and access to quality healthcare is managing the interprofessional care coordination, care redesign and improving communication and accountability across the continuum of care.
Interprofessional Care Coordination: Transition from the hospital to the clinically appropriate next site of care (Home Selfcare, Home Outpatient Care or HomeHealth, Subacute – Skilled Nursing Facility, Inpatient Rehabilitation Center or Long Term Acute Care Hospital) is a decision that must be made collaboratively by the patient/family and the clinical team. Patients recover best in their familiar environment and in most cases that is their home – residential or congregate setting. The team including our dedicated physicians, nursing, therapy and other support staff assess and identify needs and risk factors so they can order and send out the requisite referrals to providers and other support personnel. Here at Holy Cross Health, our model allows easier access to our clinical and support teams for our Advanced Payment Model Population (BPCI-A, ACO & CJR) which is led by our Population Health Nurses (PHNs) who assist our patients/families navigate our complex healthcare system. Our PHNs and other members of our care management team focus on transition management with an emphasis on proactive patient management this includes early identification of patient needs while in the post-acute setting and addressing barrier(s) to care, some of which are socially influenced.
Care Redesign: The heart of care redesign has cultural underpinnings and very early in our process of redesigning care we identified the need to change our approach and terminology when our patients were leaving the hospital. We started to socialize the term transition among our colleagues with a focus on moving from discharge to a transition process. Standardizing care delivery using evidenced based best practices across healthcare settings – hospital, subacute and home – helps to improve quality of care and success for the patient and the healthcare system. Engaging providers (physician/surgeon/nurse/therapist) in a model that supports standard work and being able to demonstrate the value add and resultant benefits to patients, providers and healthcare system presents its own challenges. Healthcare systems participating in these risk model programs also need to be agile so they can respond to the programmatic changes from Medicare.
From a programmatic perspective, I have found the three-day waiver in BPCI-Advanced to be misaligned with the objectives of the initiative. The waiver could potentially help avoid readmission during days 3 through 90, unfortunately it can only be used within the first 30 days after discharge. There is already a provision that allows Skilled Nursing Facility admission during this period once the patient meets the qualifying 3 midnight stay while an inpatient so this waiver does not provide any benefit to program participants.
Communication and Accountability Across the Continuum of Care: At Holy Cross Health, we call this “transitioning the patient.” It’s more than just a discharge, it’s a warm hand off to additional healthcare providers that are part of the continuum of care. Transition conveys more compassion, which aligns with the Holy Cross Health mission and core values that include reverence, stewardship and integrity. In BPCI your reimbursement is not just for the acute admission, it covers the post-acute care costs as well. Our financial responsibility for the patient continues beyond the hospital walls and for a period of 90 days after their hospitalization or their outpatient procedure. Collaborating with our Community Partners including other Hospital Systems, Skilled Nursing Facilities, Home Health Agencies helps to facilitate the ease of information sharing that allows for continuity of care. It promotes communication between providers and with providers and patients and their families.
An important element in healthcare that does not get the necessary attention is that of advanced directives and their importance in guiding healthcare decisions that support honoring a patient’s wishes when they can no longer speak for themselves. A person-centered approach to healthcare promotes educating patients on the importance of documenting their wishes and sharing this document with their healthcare providers. Its importance was reinforced when CMS introduced Advanced Care Planning as one of the quality measures of the BPCI-A program. Patients can identify a healthcare surrogate or proxy if they are unable to document a plan at that time. I have observed that many healthcare surrogates feel conflicted when the advanced directives do not clearly state a patient’s wishes. We recommend that these discussions pertaining to advanced directives take place in advance so there are no questions and there is no confusion should a health episode arise. Palliative care and hospice care services are also not appropriately utilized. It makes sense to have access early for chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF) or End Stage Renal Disease (ESRD) so teams that are experienced in helping to manage chronic conditions can assist in helping to improve a patient’s quality of life.


Last month, Aducanumab (Aduhelm™) was approved as a treatment for Alzheimer’s Disease by the U.S. Food and Drug Administration (FDA). This is the first FDA-approved therapy to potentially delay decline from the disease, compared to current medications that only address symptoms.

Alzheimer’s Disease affects 7.8 million American adults age 65 and older, according to the Alzheimer’s Association. That number is expected to rise to more than 12 million by 2050, according to the latest projections from Alzheimer’s Association and dementias affecting people age 65 or older.
While other drugs relieved some symptoms of the condition, Aducanumab has been found in one clinical trial to actually reduce the size of the plaques associated with Alzheimer’s in patients with early stages of the disease.
Dr. Barry Baumel, a neurology specialist with University of Miami Neurology Department, calls the FDA approval very significant.
“It’s the first drug considered to be a disease modifier to ever be approved for Alzheimer’s Disease,” he says. “This means it impacts the way the disease progresses. In this case, it slows the progression of the disease, so people hopefully stay better, longer.”
Aducanumab removes amyloid from the brain which may delay decline in people who are living with Alzheimer’s.
“The drug is an antibody for amyloid,” says Dr. Baumel. “It attaches to the amyloid in the brain, removes and disposes it through the body.”
According to the FDA, Biogen researchers evaluated the drug’s efficacy in two different studies that looked at almost 3,500 patients. Both were “double-blind, randomized, placebo-controlled, dose-ranging studies” in patients living with Alzheimer’s disease.
In the clinical trials, Aducanumab reduced the amount of plaque in the brain, according to Dr. Baumel.
This could mean more time for people with Alzheimer’s to actively participate in daily life, have sustained independence and hold on to their memories longer.
“They should expect to preserve more of their function for a longer period of time,” says Dr. Baumel.
Aducanumab is administered intravenously (IV) via a 60-minute infusion every four weeks. The infusion, which takes about an hour, can be done at an infusion therapy center by specialized nurses. An MRI will be required within a year of beginning therapy and every six months after that.
In clinical trials, the most common side effects were ARIA-E (abnormal brain changes associated with anti-amyloid treatments — most often swelling in the brain — that are spotted with neuroimaging techniques like MRI), headache, ARIA-H (micro hemorrhage/superficial siderosis) and fall, according to the Alzheimer’s Association.
“The most concerning side effects are swelling of the brain and small hemorrhages,” notes Dr. Baumel. “If you stop the medication, those problems typically resolved, and the patients were able to continue the medication.”
While some researchers and medical experts were concerned that there was not enough data from the trials to warrant an approval by the FDA, Dr. Baumel says that many people were concerned that we went too long with no treatment.
“At least now we can affect the natural history of the disease,” he says. “The historical basis for approving a medication like this comes from the world of cancer therapy where a change in the biology of the tumor is an effect that is interpreted as being good for the patient. Likewise reducing the amount of amyloid in the brain is thought to be good for the patient.”
Approval of Aducanumab is a milestone in the treatment of Alzheimer’s.
“This drug and the recent news about it increase the amount of the awareness of the disease and gets people talking about it,” adds Dr. Baumel. “Overall people with Alzheimer’s are suffering but now should be happy that there may be another therapy that could perhaps help them.”


Healthcare is always in a state of flux, and last year’s pandemic added more volatility to what is already a shifting landscape. Trying to keep up with all of the COVID regulatory changes, on top of the regular tax implications of running a business, is an overwhelming task without the help of professional accounting firms.

“When the pandemic first began, we reached out to our clients to determine how we could help them—a number had partially or fully closed down and they were concerned about how to make ends meet,” said Jeff Kramer, CPA, CGMA, managing director, BDO USA, LLP. “We had to digest all of the new IRS and federal government regulations, educate our clients, and help them apply for relief.”
“A lot of businesses also reached out to their accounting firms to help see them through,” added Angelo Pirozzi, partner, Healthcare Center for Excellence & Innovation, BDO USA, LLP. “There was so much uncertainty and so many gray areas within the new regulations; clients had—and still have—a lot of questions. And regulations are still being clarified today, which is why businesses need tax and advisory guidance.”
Kramer works with individual physicians, small and large medical practices, accountable care organizations (ACOs), Medicare Advantage plans and home healthcare companies to help them find their way through the recent regulatory changes and resulting tax implications.
“With the pandemic, a lot of companies took part in the Paycheck Protection Program (PPP), which allowed businesses, including medical practices, to receive loans or advances from the government to meet operating expenses,” he explained. “We spent a lot of last year helping them apply for these loans and then helping them get forgiven by the government.”
Some of these same businesses received Employee Retention Credits (ERCs), which are provided by the government if a business had a 20 percent or more reduction in revenue compared to 2019. The tax credits could be used to offset increased operating expenses caused by the pandemic.
While hospitals were not able to take advantage of the PPP because most exceed the 500-employee limit, most, if not all, participated in the Provider Relief Fund (PRF).
“The Department of Health & Human Services (HHS) came to the rescue of hospitals early on in the pandemic; in March and April, billions of dollars were given to hospitals across the country, based on their size and number of claims, to spend on COVID-caused revenue loss as well as COVID-caused expenses,” explained Pirozzi.
“Hospitals originally had until June 30 of this year, which has now been moved to December 31 and for some, into 2022, to provide an accounting to HHS of how they spent the money,” he added. “But the challenge is in the details—documenting revenue loss and expenses incurred because of COVID.”
For example, when hospitals were ordered to shut down elective surgeries in mid-March for anything other than emergencies, they experienced huge revenue losses. “This is in addition to having to order protective equipment and respiratory equipment, and having to bring on more nurses, often through agencies, which is much more expensive,” explained Pirozzi.
Although many hospitals are tax-exempt, for-profit hospitals may need assistance in determining the 2020, 2021 and even 2022 tax aspects of utilizing these funds.
Hospitals also received Employee Retention Credits, which have been extended through December 31 of this year. “Most hospitals didn’t furlough or lay people off, and continued to pay their employees full wages even though they were working less time,” said Pirozzi. “A number of hospitals continued to pay surgeons their full wages even though they couldn’t operate because elective surgeries were shut down due to government order.”
In 2020, the credit was 50 percent per employee and was limited to the first $10,000 of wages paid for a maximum 2020 ERC credit of $5,000 per employee. The ERC was substantially increased to $7,000 per employee, per quarter, in 2021 for a total potential credit of $28,000 per employee.
“To the government’s credit, their reaction was quick and the capital distribution was swift and helped a tremendous amount of companies reposition themselves,” said Pirozzi. “A lot of companies have come out on the other side of the tunnel potentially stronger than ever.”
Many medical practices, laboratories and hospitals have introduced new service lines, or embraced growing trends such as telehealth. “It’s a credit to entrepreneurship and the brilliance of these business owners and providers that they have been able to reinvent themselves to deal with the ‘new normal,’” said Pirozzi.
“We’ve also seen a lot of movement with smaller medical practices merging into larger practices, with some becoming owned by private equity firms,” said Kramer of other emerging trends. “The level of sophistication has grown, and organizations have expanded into providing different kinds of care and service at a better level than before as a result of increased expertise, IT infrastructure and better management.”
As healthcare businesses adjust to the ‘new normal,’ there’s no doubt that there will be more changes to come; having a knowledgeable accounting firm can help guide clients through the process.