March 27, 2020
Issue SpotlightWhat's in the stimulus package: Provisions of interest to physician practices
Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. House passage is expected on Friday and the President is expected to sign the bill into law.
Provisions of particular interest to physicians and their practices include the following:
- Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
- $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
- Suspension of the 2% Medicare sequester in May through December 2020.
- Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
- A temporary waiver of the face-to-face visit requirement with home dialysis patients.
- Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
- Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.
Also of interest, the "health extenders" package that was set to expire on May 22 has now been extended to Nov. 30. For a complete summary once the bill is signed into law, visit the AMA COVID-19 website.
The COVID-19 pandemic represents an enormous threat to public health and an extreme challenge to health care workers on the front lines. The AMA is advocating at all levels of government to ensure physicians have the tools they need to provide the patient care that is so critical.
Echoing the urgent pleas from physicians and members of the Federation, the AMA is urging the administration to provide more personal protective equipment (PPE) and testing components which are critical to treating the surge of COVID-19 cases. AMA is pressing for the urgent activation of every power in the arsenal of the federal government to alleviate dangerous shortages of essential medical supplies.
PPE and testing
On March 21 in a joint letter to President Donald Trump, the AMA, the American Hospital Association (AHA) and the American Nurses Association (ANA) asked that the Defense Production Act be used to increase the domestic production of medical supplies and equipment desperately needed for all front-line providers. AMA also wrote to congressional leadership on March 18 urging the federal government to expeditiously move to spur massive, increased production of supplies, along with distribution and access to gowns, masks, gloves, testing kits, testing swabs and respiratory machines.
Direct financial support for practices
On March 25 the AMA, along with over 95 medical specialty societies and every state medical society (including Washington, D.C.), sent a sign-on letter to congressional leadership asking that financial support for physician practices be included in any economic stimulus package.
In addition, combining forces again with the AHA and ANA, the AMA asked Congress for $100 billion to support front-line health care personnel and providers with a stabilization fund for emergency expenses related to COVID-19. The organizations also asked for funding to provide childcare to health care workers and funding to expand surge capacity so that moderately ill patients can be moved to outpatient facilities.
Telehealth has quickly become an essential tool for physicians in this crisis. The AMA has long been a champion of expanding Medicare telehealth coverage and played a key role in ensuring that provisions in the first COVID-19 supplemental legislation significantly expanded Medicare telehealth coverage for the duration of the emergency. This expansion has already had a transformative impact on patient access to care by keeping less severely ill patients out of the emergency room.
Medicare will now pay for two-way audio-visual communications between physicians and patients through widely available consumer products, such as smart phones. In addition, physicians can now use tools like Facetime and Skype for telehealth without worrying about Health Insurance Portability and Accountability Act penalties. The AMA will continue to press the Centers for Medicare & Medicaid Services (CMS) for additional telehealth guidance and will also continue to work with private insurers to mirror new Medicare flexibility for telemedicine.
Additionally, the AMA fast-tracked new Current Procedural Terminology (CPT®) codes for COVID-19 and is providing new guidance on special coding advice related to COVID-19. One resource outlines coding scenarios designed to help health care professionals apply best coding practices. The scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for an E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19, and is directed to come to a physician's office or physician's group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to an E/M visit), and is directed to come to the physician's office for testing; and more. There is a quick-reference flowchart that outlines CPT® reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19.
To expand the physician workforce to meet the challenge our health care system now faces, the AMA is urging the State Department to open visa processing at embassies worldwide for physicians seeking to join U.S. residency programs starting in July and publicly confirm that J-1 physicians are permitted to be redeployed to new rotations within the host training institution to the COVID-19 pandemic. The AMA is also urging that extensions and changes of status for foreign national doctors currently in the U.S. be expedited.
The AMA will continue advocating on the federal and state levels to support patients and physicians during this public health emergency by removing obstacles to guidance and treatment.
Visit the AMA COVID-19 Advocacy Progress Report for a comprehensive view of the AMA's work to team up with the essential partners in health care to reach the highest levels of government, and visit the AMA's COVID-19 web page for additional resources.
The Drug Enforcement Administration (DEA) has announced that for the duration of the COVID-19 public health emergency, DEA-registered practitioners may prescribe controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided that all of the following conditions are met:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.
- The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
- The practitioner is acting in accordance with applicable federal and state law.
If these conditions are met, the prescription may be issued either electronically (in accordance with DEA rules for e-prescribing controlled substances in schedules II-V), by calling in an emergency schedule II prescription to the pharmacy or by calling in a schedule III-V prescription to the pharmacy.
Additional information is available here.
The DEA call center has temporarily suspended its phone operations due to the pandemic. Help with DEA registration issues is available by email.
Registrants and others can register their e-mail address to obtain up-to-date information concerning DEA's response to COVID-19 here.
To keep health care workers and patients safe amid the COVID-19 pandemic, the AMA has designed several resources to support physicians and practices in the safe delivery of care to their patients:
- AMA quick guide to telemedicine in practice: This guide supports physicians and practices in expediting the implementation of telemedicine. Check the AMA steps forward telehealth module on how to get started.
- Caring for our caregivers during COVID-19: This resource provides practical guidance for health care administrators and leadership to support the safety and well-being of clinical care teams.
- JAMA interviews and resources: Browse the JAMA Network COVID-19 collection, including Q&As with NIAID's Anthony Fauci, MD, an interactive map of the outbreak courtesy of The Johns Hopkins Center for Systems Science and Engineering, and past publications on vaccine development, infection control, and public health preparedness.
- Non-essential care in private practices: This resource provides guidance to support physicians and practices in developing policies and procedures to triage non-urgent patient requests appropriately.
- Tips for keeping your practice in business during the COVID-19 pandemic: Physician practices managing patients during the COVID-19 pandemic are confronting new and unique operational and business challenges. This checklist provides high-level guidance for practice owners and administrators.
For more resources and up-to-date developments, visit the COVID-19 physician guide.
The Office of the National Coordinator for Health Information Technology (ONC) recently released its draft Federal Health IT Strategic Plan 2020-2025. The plan outlines the federal government's intent to use health information technology over the next five years to promote the secure access of electronic health information. The plan is not regulatory but describes how agency officials will prioritize resources, align and coordinate efforts across agencies, signal priorities to the private sector, and benchmark and assess change over time. The AMA supports ONC's vision but believes a clearer direction is needed. The plan outlines an ambitious set of priorities but in total lists over 70 individual strategies, objectives and principles.
In comments to ONC, the AMA recommends the agency focus on the immediate needs of patients and physicians, including reducing unnecessary regulatory burdens, documentation requirements, and steps to increase physicians' return on their time and resource investments. The AMA also recommends ONC include a strategy to protect patients from discrimination, stigma and exploitation, and promote equitable access to tools and resources that protect health information. The AMA will continue working with ONC, in coordination with other federal agencies, on the implementation of its Federal Health IT Strategic Plan.
Many state policymakers, with guidance from medical societies, are working quickly to ensure continued access to care in this rapidly changing environment. The AMA has compiled a list of state policy options for governors, Medicaid directors and insurance regulators to consider as they address COVID-19. This document will be updated regularly as new ideas and best practices emerge.
Please continue sharing executive orders, bulletins and policy changes from your state with AMA staff (firstname.lastname@example.org) so they can be made available as resources to other states.
This week, CMS approved 1135 waivers to address COVID-19 in 21 additional states: Alabama, Arizona, California, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, North Dakota, Rhode Island, South Dakota and Virginia. CMS had approved 1135 waivers in Florida and Washington last week.
The waiver approvals allow state flexibility in six main categories – suspending prior authorization in fee-for-service Medicaid, extending pre-existing prior authorizations, waiving certain provider enrollment requirements, suspending PASRR Level I and Level II assessments, permitting services to be provided in alternative settings, and delaying timelines for fair hearings and appeals. A resource on these waivers is available through the AMA's COVID-19 resource center.
The AMA this week issued policy recommendations to help patients with an opioid use disorder (OUD), pain and harm reduction efforts amid the COVID-19 global outbreak. This is in addition to a new resource document focused on substance use disorders. These recommendations and resources are to help guide policymakers and reduce stress being experienced by patients with an opioid use disorder and pain, as well as support efforts to continue harm reduction efforts in communities across the United States.
The policy recommendations focus on three areas:
- Ensuring access to care for patients with an opioid use disorder
- Protecting patients with pain
- Harm reduction to help prevent overdose and spread of infectious disease
The AMA, American Pharmacists Association (APhA) and American Society of Health-System Pharmacists (ASHP) issued a joint statement this week on inappropriate ordering, prescribing or dispensing of medications to treat COVID-19.
The statement highlights the important role that physicians, pharmacists and health systems play in being just stewards of health care resources during times of emergency and national disaster. The joint statement is in response to reports of some physicians prophylactically prescribing medications currently identified as potential treatments for COVID-19 (e.g., chloroquine or hydroxychloroquine, azithromycin) for themselves, their families or their colleagues.
There also are reports that some pharmacies and hospitals have been purchasing excessive amounts of these medications in anticipation of potentially using them for COVID-19 prevention and treatment. The organizations strongly oppose these actions.
"The A.M.A. is calling for a stop to any inappropriate prescribing and ordering of medications, including chloroquine or hydroxychloroquine, and appealing to physicians and all health care professionals to follow the highest standards of professionalism and ethics," said AMA President Patrice A. Harris, MD, MA, to the New York Times.
The AMA and American Society of Addiction Medicine (ASAM) are recommending that states with declared states of emergency request blanket exceptions from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) that will help patients in an Opioid Treatment Program (OTP) during the COVID-19 pandemic.
The blanket exception will allow patients to obtain up to 28 days of take-home medication if they are stable, and up to 14 days for patients who are less stable but who the OTP believes can safely handle that level of medication.
The AMA and ASAM recommend that state medical societies urge their State Opioid Treatment Authority to make this request. This is an important step to help patients with opioid use disorder during this time of national emergency, and the AMA and ASAM will continue to communicate further steps.
For more information click here.
The Physicians Foundation, American Medical Association, Florida Medical Association, Massachusetts Medical Society and Texas Medical Association, announced the launch of the Telehealth Initiative, which helps physicians implement telehealth services. With the current COVID-19 crisis, the organizations moved up the initiative's launch to support physicians in their shift to telehealth models in efforts to reduce exposure and minimize surges in care facilities. Read the full press release here.
Note: Many events have been cancelled or postponed. Please be sure to check event websites for the most up-to-date information.
Telemedicine is a crucial way to deliver care and keep our health care workers, patients and vulnerable populations safe amid the COVID-19 pandemic. This discussion, sponsored by AMA's Physician Innovation Network (PIN), is designed to share best practices and the latest policy and payment updates to support physicians and practices in expediting the implementation of telemedicine, so care can continue to be provided to those who need it most. The discussion will open March 23 and remain ongoing. Join the conversation here.
April 14-16: Many sessions from the Rx Drug Abuse and Heroin Summit are now being held virtually. See this website for more details.
In light of ongoing developments with COVID-19, Bellin Health and the AMA have decided to cancel the Team-Based Care Training Camp at this time and refunds will be processed. Bellin Health and the AMA consider it a top priority to ensure the safety and well-being of the health care community, including event attendees and staff.
New dates will be selected to hold the Team-Based Care Training Camp and will be communicated once they are finalized. Check the conference website for more information.
For any questions please contact Tricia.Hendricks@bellin.org.
In light of the COVID-19 pandemic and the uncertainty it brings, the British Medical Association, AMA and the Canadian Medical Association have decided to postpone the International Conference on Physician Health™. The conference will be rescheduled the conference April 28 –April 30, 2021 at the same venue – The IET Savoy Place, London.
Further details of updated planning will be released as soon as possible, but authors who submitted abstracts will be contacted sometime in April 2020. The conference theme will remain "a vision for humanity in medicine."
For additional details, please view the conference website here.