In this episode of Unlicensed, we talk with Josh Archambault of FGA about how many states are responding to the coronavirus pandemic by expanding telemedicine options. Meanwhile, Mississippi is making it more difficult for patients to access the doctor of their choice via telemedicine.
The Department of Revenue announced today that they are allowing patrons in a Leisure and Recreation District (LRD) to leave with a mixed drink from their to go order.
This means if you live in one of the 19 LRDs in the state, you can order a mixed drink with your curbside order and take it home.
"Due to the emergency situation all Mississippians are facing, ABC is now allowing drinks in the "to go" orders made by patrons for curbside pick-up if the restaurant is located in an LRD," the order reads.
The following cities are designated LRDs: Bay St. Louis, Tupelo, Ridgeland, Jackson, Gulfport, Biloxi, Ocean Springs, Brandon, Clinton, Diamondhead, D’Iberville, Hattiesburg, Laurel, Long Beach, Moss Point, Natchez, Pascagoula, Pass Christian, and Vicksburg.
Restaurants will still be prohibited from selling you a mixed drink if they are located outside one of the allowable cities because it it prohibited by state law.
Over the past few weeks, DOR has made updated multiple regulations to make it easier to purchase alcohol. Along with the most recent change, liquor stores can now take orders online or over the phone, while providing curbside delivery rather than having to enter the retail establishment. You are also allowed to purchase a sealed bottle of wine with their to-go order.
These actions were previously illegal.
On Friday evening, businesses deemed non-essential closed their doors in Mississippi as they have been doing over the past couple weeks to combat the coronavirus pandemic that has spread across the country.
Was this the right call? Was it too much or too little and too late? Regardless of what the blue checkmarks say, I will defer to the experts who are making those decisions and guiding the governor through these unthinkable times.
My family is doing the best we can to stay safe, and that’s really all we can control. Just like your family is all you can control.
But as we went for a ride on Saturday around lunchtime, we got a weird feeling going through the empty parking lots of the normally bustling Dogwood Festival Market off of Lakeland Drive in Flowood. Of course, as you drive near the Target, Kroger, or Lowe's you probably see more traffic than normal.
But across the street near Belk, Old Navy, HomeGoods, Bath and Body Works, etc., you see a sprawling empty parking lot. For those who are fans of dead malls, it was as if that is what you entered. Except the signage was intact and the landscaping was freshly manicured.
Yet tucked in between large national chains are numerous small businesses, such as Time 4 Toys, a rare independent toy store that competes every day with the likes of Walmart and Amazon. That was already enough of a challenge. Not being able to open their doors is just the latest obstacle.
But they, like many others, are getting creative. They’re offering free delivery within a 10 miles radius of the Flowood store. They are also offering curbside pickup from 11-2 during the week for those who place orders online. If you’re struggling to find something, send them a Facebook or Instagram message or call the store. They will be there to help you.
And that’s just one of the many, many retailers who are trying to survive financially. Because as has been said, this is not just a health crisis. It’s also a financial crisis. The 30,000 Mississippians who filed for unemployment last week can attest to that.
We don’t know when the health issues will pass or when we will all be safe to go about our daily lives. The stay at home order is in effect until April 20, but it could certainly be extended. Beyond not knowing when we’ll return to normal, we don’t even know what normal will look like.
Will we be ready to go into restaurants or will we stick with the convenience of food delivery apps? Will we maintain our virtual approach to business with more people working from home or attending conferences in another state without having to leave town? Will you feel safe being within five feet of another person?
Maybe. Like most everything going on right now, we don’t know is the only answer we can be sure of.
But for those who have kids who enjoy going into a toy store – and those whose livelihood depends on it – we can just hope that our small businesses make it.
While Mississippi’s Board of Medical Licensure largely walked back a previous decision to allow patients to use services provided by out-of-state physicians via telemedicine, other states such as Michigan and West Virginia are removing regulatory restrictions in the wake of the coronavirus pandemic.
Michigan’s Gov. Gretchen Whitmer, a Democrat, has issued two executive orders. The first suspended the state’s certificate of need program and removed some restrictions on medical licenses and nursing assistants. The second order issued on March 29 was more thorough, with several components:
- It allows nurse practitioners, nurse anesthetists and licensed practical nurse to treat COVID-19 patients without physician supervision.
- The order also allows medical students, physician assistants and emergency medical technicians to become licensed or certified to act as respiratory therapists.
- It also allows licensed medical personnel who don’t have a Michigan license to treat COVID-19 patients in Michigan.
- Pharmaceutical drug distributers, who are licensed in other states, can distribute Corona virus-related medications in the state.
On a similar note, West Virginia’s Republican Gov. Jim Justice issued an executive order on March 19 that suspended the state’s regulations in several areas:
- Allowed medical providers with expired licenses (except for those with pending complaints, investigations or other pending disciplinary procedures) to practice during the state of emergency.
- Removed the requirement for telemedicine providers to be licensed in West Virginia, as long as they are licensed in another state.
- Halted the requirement that telemedicine be performed by video only.
- Temporarily halted the requirement that medical licenses are valid for two years and educational permits for one year.
- Halted the requirements for continuing education requirement for physicians.
Mississippi has been a mixed bag. The state’s Board of Nursing issued a proclamation that allowed out-of-state nurse practitioners to use telemedicine to treat Mississippi patients without having a state license. The practitioner only needs a license in another state. The proclamation also allows practitioners licensed outside the state to complete a waiver form to practice in Mississippi.
The Mississippi Board of Medical Licensure issued an amended proclamation last week that limited telemedicine for out-of-state physicians not licensed to practice in Mississippi to only those who have an existing doctor-patient relationship rather than any licensed physician.
On March 15, the board issued a proclamation that said it would not enforce regulations governing out-of-state physicians using telemedicine to treat patients in the state in response to an emergency declaration by Gov. Tate Reeves that urged a reduction of regulations due to the spread of the coronavirus.
The proclamation would also have the board not enforcing its rules requiring physicians to examine patients prior to prescribing medication, including controlled substances, to encourage the use of telemedicine. That part of the proclamation is still in effect.
Under existing regulations, a physician using telemedicine to treat patients must be licensed to practice in Mississippi.
All three states are part of the Interstate Medical Licensure Compact, which has 26 states that have joined together to streamline their normal licensing process for licensed physicians. This provides physicians moving from one compact-participating state to another the ability to get a license in their new state within days rather than weeks or even months.
There are two policies that could increase the supply of hospital beds and the supply of healthcare providers in Mississippi. The first policy is certificate of need (CON). The second is telemedicine.
In part 1 of this series, we focused on what the goals of healthcare policy should be during the coronavirus outbreak and reviewed recent federal and state actions aimed at increasing supply and access. In this second part, we recommend five reforms Mississippi policymakers should make to CON laws to immediately increase bed capacity and five reforms they should make to telemed laws to increase access to qualified healthcare professionals.
Certificate of Need
A certificate of need (CON) compels would-be medical providers to demonstrate a community need for a new facility or service. In Mississippi, the Department of Health is the arbiter of this process. The problem with CON laws is that they circumvent the natural interaction between supply and demand, by which providers and consumers determine where new medical services should be offered. In place of the free market, we end up with Soviet-style, bureaucratic planning. This planning tends to be biased toward current providers and is sometimes used to block out-of-state providers from offering their services in Mississippi. The results are well documented: reduced access, lower-quality, and higher mortality rates.
In the context of the coronavirus, certificate of need laws make it more difficult for hospitals to quickly respond to patient needs. States are thus creating pathways for providers to submit emergency CON applications. Mississippi already has an emergency CON application process in place, but the current application could be customized and streamlined so that providers aren’t hindered by red tape during the current pandemic.
As things stand, Mississippi is projected to run out of ICU hospital beds as of May 3. In this respect, we are better off than most states, and for both better and worse, are at the high end of existing hospital beds per capita: 4.0 beds per 1,000 vs. a nationwide average of 2.4. This surplus could serve us well during the current outbreak. But in a nonemergency situation it suggests we are not using healthcare resources efficiently. It is also safe to assume that not every area of the state has equal access to hospital beds. Some hospitals, in an emergency, may need to ramp up supply.
A review of Mississippi’s numerous CON laws raises multiple red flags. These laws need to be suspended, not only to deal with the current coronavirus outbreak, but to create capacity for other emergency services, such as open heart surgery, ambulatory surgical services and diagnostic imaging.
In particular, Mississippi should suspend the following five CON requirements:
- Multiple restrictions related to capital expenditures made for the purposes of expanding bed capacity.
- Restrictions related to relocating and renovating facilities, major medical equipment and, even, medical office buildings (which could be used to provide space for certain patients on a temporary basis).
- Restrictions on the transfer and relocation of beds.
- Restrictions on swing bed services, which allow patients to transfer from an acute care setting to a skilled nursing setting.
- Restrictions related to intermediate care and comprehensive rehabilitation facilities.
This latter requirement is particularly onerous, insofar as the state is currently enforcing a moratorium on the approval of new CONs for the construction or expansion of skilled nursing facilities and intermediate care facilities.
There are likely other policies that hinder hospitals from increasing bed capacity in an emergency. Instead of forcing hospital administrators to operate in a gray area during this and future pandemics, state policymakers should act now to clarify the process by which providers can increase bed supply, especially in critical care situations.
Telemedicine
Telemedicine has emerged as an important tool for sustaining and supporting healthcare services in the current “shelter-at-home” environment. Telemed allows patients to consult with a doctor over the phone and/or via video.
In response to the coronavirus, Mississippi’s key licensing boards have taken divergent stands. The Board of Medical Licensure initially (see proclamation dated March 15) encouraged “all physicians to utilize telemedicine so as to avoid unnecessary patient travel, both in-state and out of state.” In order to facilitate this stated goal, the Board waived the requirement for an initial in-person examination and, also, clarified that physicians licensed in another state could treat patients in Mississippi. A few days later, however, the Board walked back from this proclamation, claiming that only out-of-state doctors with a previous patient relationship could practice telemed in Mississippi.
By contrast, the Board of Nursing is allowing nurses who hold an out-of-state license to practice in Mississippi. The Nursing Board is also allowing recent graduates and retired nurses to practice in appropriate settings.
Mississippi took an early lead in using telemedicine to treat various conditions like diabetes, and the University of Mississippi Medical Center is using telemed in a number of innovative ways. The state is also part of various interstate compacts that make it easier for out-of-state healthcare professionals to see Mississippi patients in a telemed setting. These include the Interstate Medical Licensure Compact, the Nurse Licensure Compact, and the Physical Therapy Compact.
That said, the overall legal and regulatory environment for telemed in Mississippi is mixed. As other states are opening the door wide to telemedicine and many patients are using it for the first time, we are going to see an expansion of telemedicine services across the country both during and after the current health emergency.
Here are five things Mississippi should do to avoid falling behind:
- Allow doctors licensed in another state, but not Mississippi, to offer telemed to Mississippi patients (§ 73-25-34). This would increase access, especially because so many counties suffer from a primary care physician shortage.
- Eliminate the statutory requirement for a prior doctor-patient relationship.
- Clarify the current definition of telemed provider so that it includes a wider array of healthcare professionals. This is especially urgent because so many counties have severe shortages of dental and mental health providers.
- Remove restrictions on store-and-forward services and remote patient monitoring. Mississippi has one of the worst laws in the country in this area, such as requiring that remote patient monitoring be offered only by a Mississippi entity and allowing only FDA Class II hospital-grade medical devices.
- Eliminate the insurance reimbursement requirement (§ 83-9-351) that excludes audio-only telemed. This would benefit low-income patients, as well as those in situations where video is not accessible.
The coronavirus has demonstrated the U.S. healthcare system is far more fragile than any of us imagined. In spite of spending more per capita than any other country, our healthcare system is suffering from personnel and supply shortages. To meet the current need, some states are cutting red tape to increase supply. Monopolistic practices – embodied by archaic policies like certificate of need requirements and telemedicine restrictions – are not only increasing prices and limiting access during normal times, they are literally crippling our ability to respond to both individual and systemic healthcare emergencies. Mississippi would do well to follow other states in lifting these restrictions during the current outbreak and in repealing them after the crisis passes.
Gov. Tate Reeves issued a statewide 'shelter-in-place' order today to help slow the spread of coronavirus in Mississippi. The order begins on Friday at 5 p.m.
The statewide order came a day after a local order in Lauderdale county.
Individuals will only be allowed to leave their house for health-related reasons, to obtain food and common household supplies, to engage in individual outdoor activity, and to work in an essential business. Those essential businesses include, but are not limited to, hospitals, healthcare facilities, grocery stores, pharmacies, child-care centers, as well as a variety of functions from sectors such as utilities, transportation, agriculture, manufacturing, and finance and banking.
The guidelines for the order include:
- Individuals are to stay at home except for the limited allowances in the executive order.
- When outside of their homes, people must follow social distancing guidelines by maintaining a 6-foot distance from others and avoid groups of 10 or more.
- Evictions are suspended, though people are still required to pay any rent or make any mortgage payments.
- All nonessential businesses are to stop all activities other than those necessary for minimum operations (e.g. payroll, health insurance, security) and enabling employees to work from home.
- Social and other non-essential gatherings in groups of more than 10 people must be cancelled or rescheduled.
- Restaurants and bars may only remain open for drive-thru, curbside, and/or delivery service.
- People may leave their homes only to perform essential activities, such as caring for someone in the vulnerable population, getting food or necessary supplies, and working for an essential business.
- Individual outdoor recreation is encouraged, but not group recreation or activities such as soccer or basketball games.
Mississippi’s first positive case of coronavirus was confirmed on March 11. As of April 1, that number had escalated to 1,073 as the number of people being tested continues to climb. These numbers now count tests from the state, as well as private providers. Twenty-two deaths have been reported. Using the available data, the current mortality rate is 2 percent.
All local, county, and state law enforcement officers will be able to enforce the order. The order is in effect until April 20.
As the coronavirus pandemic began to sweep across the nation, it became clear that we were critically short on certain medical necessities including hand sanitizer, masks, and ventilators. Many feared for what would be a soon to come shortfall on these items that are medically critical to prevent further spread of the virus and effectively treat those who have it.
Thankfully, private enterprise has stepped up to the plate in a historic way. Businesses are transitioning to fill the existing gaps and provide the supplies that the country needs. In Mississippi, we have seen local business leaders bravely take risks in order to fill critical medical needs.
A few days ago I had the chance to speak with Josh West, owner and founder of Blue Delta Jeans, a high-end clothing company based out of Oxford that creates custom order jeans, tailored to each individual.
In 2012, Josh launched Blue Delta Jeans after working in economic development. Through his previous role, he had the opportunity to work with a range of factories, and it was clear to him that while some manufacturing was moving abroad, there was a strong supply of skilled workers in North Mississippi and a demand for American-made products.
And that business has only grown in the past eight years.
Today, Blue Delta Jeans is doing things a little differently. They have fully transitioned its factory to make much-needed masks. After only two weeks of production their team is now able to construct 10,000 masks a week and are aiming even higher. While not medical-grade, these high-quality masks are designed to be used in non-acute situations, especially those in waiting rooms, grocery stores, and elsewhere, thus allowing for the medical-grade masks to be entirely used by those who need them. Once the masks are constructed, they are then shipped to government entities for statewide distribution.
If he had been told in February that Blue Delta would be making masks, Josh said to me that he never would have believed it. Yet, as the virus got worse, he heard more about the need for supplies, especially masks. So, he started looking further into it and then began contacting his local suppliers. His focus was on making the product safe, so he worked with Mississippi State University to conduct initial tests before construction of the product. Then, in just a 48-hour period, they changed the entire factory over from jeans to masks.
Blue Delta is now not only providing masks, but also continued employment, a critically important need for people as we undergo a continued economic slump due to the virus. Josh told me that each employee was given the opportunity to leave, and that when times returned to normal, he assured each that they would have a job waiting for them, and yet every single employee chose to stay and transition to working on masks. They are ensuring a safe work environment by placing temporary walls up and allowing each individual to practice social distancing while sewing the masks.
Blue Delta has been able to keep people employed and has even sought to hire more workers in order to expand their capacity for mask construction. The power of a steady paycheck is critically important for those seeking to provide for their families during this time of need. And so, in this way, Blue Delta Jeans has fulfilled a dual need both through their support of their workers and supports of thousands of people through the construction of their masks.
This local clothing company, that started in 2012 with just one seamstress, is now making 10,000 masks a week to support the community. Josh West and his company highlight what’s great about Mississippi and this country.
As we closed the conversation, Josh noted that, “[h]opefully we’ll be making jeans again one day.” Neither Josh nor I are certain when this crisis will end, but even once the Blue Delta Jeans factory is back to its normal line of work, I don’t think anyone will soon forget what they did for the state.
These businesses that are stepping up deserve to be highlighted, and so the Mississippi Center for Public Policy is launching a series dedicated to doing just that. Over the coming weeks, we aim to showcase the stories of these local businesses who have willingly given up their normal operating procedures to help as many people as they possibly can.
If you know of a local Mississippi business that is helping those in need during this critical time, we’d love to highlight the work that they’re doing. Please email Hunter Estes via [email protected] to discuss further.
Mississippi’s two largest cities – Jackson and Gulfport – are issuing orders for residents to stay at home in light of the coronavirus pandemic.
In Jackson, Mayor Chokwe Antar Lumumba will make the announcement at a press conference later today. Hinds county has the most cases in the state at 90, which is about 10 percent of the total cases in Mississippi.
Mayor Billy Hewes is issuing a similar order for Gulfport. Hewes said this is necessary because too many people aren’t following limitations on gathering sizes.
“This selfishness is unfair to those who have been acting in good faith, and has now put our community at risk,” Hewes told the Sun Herald. “It is because of these activities that we are now forced to implement additional measures to protect the public. This is anything, but ‘business as usual.’”
Violators of the order in Gulfport can receive a $300 fine and/ or jail time.
Tupelo and Holly Springs have issued similar orders and on Tuesday Gov. Tate Reeves issued a lockdown order for residents in Lauderdale county because of a rapid rise in positive COVID-19 cases in the county, including an outbreak at a local nursing home.
What are stay at home orders?
Generally speaking, these orders close nonessential businesses and only allow residents to leave their home for specific, approved needs.
Under an order, you can still shop for groceries, pick up medications, pick up food from a restaurant, help family members in need, and exercise outdoors.
Essential businesses include hospitals, healthcare facilities, grocery stores, pharmacies, child-care centers, as well as a variety of sectors such as utilities, transportation, and finance and banking.
Alcohol delivery apps have seen a boom in sales in the states where they are legal since the outbreak of coronavirus. This doesn’t include Mississippi.
Drizly is an alcohol delivery app that lets you place an order for your favorite beer, wine, or liquor based on your location, and get it delivered to your front door. Drizly operates in 26 states plus the District of Columbia.
In the middle of March, their sales were up approximately 300 percent from the prior year. And that is mostly driven by new customers, who accounted for more than 40 percent of sales in March compared to the normal 15 percent.
Same story with Mininbar Delivery, another app that allows you to place an order to have alcohol delivered. They operate in 18 states. From March 11-16, there sales were up 131 percent from the prior week.
Helping to drive the increase in sales were larger orders that came with a price tag 20 percent higher than usual.
In light of the coronavirus pandemic, the Mississippi Department of Revenue has eased off a couple regulations to make it easier to purchase alcohol. Curbside pickup is available at liquor stores and you can order a bottle of wine with your to-go order from a restaurant.
Just not delivery.
For now, Mississippians cannot partake in the convenience of technology that allows their neighbors to order their drinks online or on their phone.