April 10, 2020
Issue SpotlightFinancial assistance for physician practices provided in the CARES Act
The recently enacted Coronavirus Aid, Relief and Economic Security (CARES) Act established or expanded several loan programs intended to provide liquidity to businesses including physician practices. These provisions include:
- The Paycheck Protection Act (PPP) for small businesses which authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. Loan amounts will be forgiven so long as proceeds are used to cover payroll costs, mortgage interest, rent and utility costs over the eight-week period after the loan is made and employee compensation levels are maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee.
- The Coronavirus Economic Stabilization Act (CESA) authorizes the Secretary of the Treasury to make loans, loan guarantees, other investments and subsidies to provide liquidity for mid-sized businesses between 500 and 10,000 employees for losses incurred as a result of COVID-19. These loans will have an annualized rate no greater than 2% with no principal or interest due for at least six months, but these loans will not be eligible for forgiveness.
- Economic Injury Disaster Loans (EIDL) are available to physician practices with no more than 500 employees. EIDLs are lower interest loans of up to $2 million with principal and interest deferment available for up to four years. They can be used to pay for expenses that could have been met had the disaster not occurred, including payroll and operating expenses.
- Small Business Debt Relief Program will provide immediate debt relief to small businesses with non-disaster Small Business Administration (SBA) loans. SBA will cover all loan payments on these loans including principal, interest and fees for six months. New borrowers are eligible for this relief if they take out loans within six months of the President signing the law. More information on how to apply for a small business loan is available on the SBA's Coronavirus (COVID-19): Small Business Guidance & Loan Resources website and at the U.S. Department of Treasury's website.
The Borrower Application Form for the new small business loan program is available and small businesses and sole proprietors can begin applying. Physicians can also contact their local SBA District Office.
- Apply for an SBA loan
- View the interim Final Rule
- View the Treasury FAQ
- Contact your local SBA district office
For more information on the loans and other financial assistance available for physician practices click here.
Additional resources on the CARES Act
Access a full suite of AMA resources on additional provisions in the CARES Act:
- Overview summary of the CARES Act
- Medicare advance payments overview and FAQ
- Telehealth fact sheet and quick-start guide
- Liability protections
- Centers for Medicare & Medicaid Services (CMS) payment policies and regulatory flexibilities
- Operational and strategic resources for physician practices
The U.S. Department of Health and Human Services (HHS) is sending out the first $30 billion of a planned $100 billion in financial relief that Congress allocated to hospitals, physician practices and other health care organizations.
The relief comes under the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act and reflects the recommendations made to HHS Secretary Alex Azar by the AMA and 139 other medical societies.
This initial $30 billion in CARES Act relief is being directed to hospitals and physician practices in direct proportion to their share of Medicare fee-for-service (FFS) spending. The total amount of Medicare FFS spending in 2019 was $484 billion. Hypothetically, if a Medicare provider with a taxpayer ID number (TIN) accounted for 1% of total Medicare FFS spending in 2019, the TIN would receive 1% of the $30 billion.
The AMA and others specifically recommended that the emergency financial relief be tied to physicians' Medicare FFS spending from a portion of 2019, prior to financial battering inflicted by the COVID-19 global pandemic.
"The AMA is working to help all physicians who are facing remarkable, unforeseen challenges due to COVID-19," said AMA President Patrice A. Harris, MD, MA.
At a White House coronavirus task force briefing earlier this week, Centers for Medicare & Medicaid Services Administrator Seema Verma indicated that a subsequent distribution from the emergency fund will be directed to pediatricians, children's hospitals and others who rely on Medicaid.
All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. the funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description. Read more.
On April 3, in coordination with the American Academy of Family Physicians, the American Academy of Pediatrics, the Association of American Indian Physicians, the National Council of Asian Pacific Islanders, the National Medical Association and the National Hispanic Medical Association, AMA sent a letter to HHS Secretary Alex Azar imploring HHS agencies to coordinate comprehensive collection and public dissemination of COVID-19 testing, hospitalizations, and mortality rates by race and ethnicity and patients' preferred spoken and written language. Given the long history of inequitable and fatal impact that pandemics have had on marginalized, minoritized and medically underserved populations—including communities of color and those with limited English proficiency—such data will be helpful to physicians in their coordination of resources to provide timely and equitable care for all patient populations.
AMA sent a letter to Vice President Mike Pence and Acting Director of U.S. Citizenship and Immigration Services Kenneth Cuccinelli urging that international medical graduates (IMG) currently practicing in the U.S. with an active license, and an approved immigrant petition, be permitted to apply and quickly receive authorization to work at multiple locations and facilities with a broader range of medical services for the duration of the COVID-19 pandemic.
Non-U.S. citizen IMGs play a critical role in providing health care to many Americans: nearly 21 million people live in areas of the country where foreign-trained physicians account for half of the physician workforce. At a time when health care workers are urgently needed, many IMG physicians are severely restricted by where they are permitted to work and the type of care they can provide under the terms of their H-1B visas. Some nonimmigrant-status physicians have seen their normal worksites close or have been furloughed, and as a result, have been unable to work at a time when their services have never been more needed. Allowing the thousands of IMGs to maintain their lawful immigration status, and expanding the type of work they can do, will provide greater access to health care for millions of Americans in this time of urgent need.
CMS announced a number of new policies designed to help physicians and hospitals during the COVID-19 pandemic. The AMA released a statement applauding these actions, which include Medicare coverage for telephone services, significant additions to the list of covered telehealth services such as emergency visits and greater clarity on the use of remote patient monitoring for acute conditions like the novel coronavirus. More information here.
CMS will provide additional relief options for 2019 Merit-based Incentive Payment System (MIPS) reporting due to COVID-19. Practices can submit an Extreme and Uncontrollable Circumstances application until April 30. An application submitted between April 3 and April 30, citing COVID-19, will override any previous data submission. CMS has updated the QPP Participation Status Tool so eligible clinicians can see if the policy has been automatically applied.
Who should submit an application?
- Individual clinicians who started, but are unable to complete, their data submission
- Groups that started, but are unable to complete, their data submission
- Virtual groups that are unable to start or complete their data submission
For more information, please see the Quality Payment Program COVID-19 response fact sheet.
Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 a.m. - 8:00 p.m. Eastern time or by e-mail at: QPP@cms.hhs.gov. Those who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
The U.S. Drug Enforcement Administration (DEA) issued guidance to DEA-registered physicians providing new flexibility for managing patients with opioid use disorder. The AMA commends the DEA for this policy change and is continuing to advocate for greater access to treatment for patients with opioid use disorder and is urging governors to immediately adopt this new guidance.
The new guidance permits physicians and other health professionals with a waiver to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31 for the duration of the COVID-19 emergency. This guidance removes a considerable barrier for many patients during the national emergency and, importantly, allows them to remain at home.
As hospitals across the country face looming shortages of supportive controlled substances (CII) which are necessary to safely and effectively ventilate patients, the AMA, along with the American Hospital Association, American Society of Anesthesiologists, American Society of Health-System Pharmacists and Association for Clinical Oncology, called on the DEA to ensure that it is possible for suppliers to rapidly ramp up production to meet this urgent need. In a letter to Acting Administrator Uttam Dhillon, the AMA urged that the DEA maintain a policy of rapid flexible annual production quota (APQ) allocations for the duration of the declared national emergency and ensure that manufacturers and 503B outsourcing facilities are permitted to meet demand. Currently, fentanyl, morphine and hydromorphone all appear on the American Society for Health System Pharmacists (ASHP) drug shortage list. Within days of the letter, the DEA announced that it is increasing production quotas for manufacturers of controlled substance medications that are in high demand due to the COVID-19 pandemic, as well as imports of medications necessary for patients on ventilators.Back to Top
In response to the global COVID-19 pandemic and evidence showing that physical distancing is the only effective mechanism to stop the spread of the virus, the AMA sent a letter to the National Governors Association (NGA) urging all states to issue statewide stay-at-home orders.
The AMA also called on the NGA and all state governors to enact emergency orders to close non-essential businesses, limit non-essential activities and prohibit gatherings during this critical stage of conducting a uniform national response to the COVID-19 outbreak.
"In this urgent moment, it's time for all states to start enforcing physical distancing and stay-at-home policies, practices that are crucial in limiting the virus's long term effects on our country and health care system," said AMA CEO and EVP James L. Madara, MD. "That's why we're urging states that haven't yet implemented such orders take action immediately – because doing so will help slow the spread of the virus and save lives."
Patients in Minnesota with chronic pain, opioid use disorder and other medical diseases will have increased access to the medications they need thanks to a new law in Minnesota that greatly relaxes the state's refill limits on controlled substances.
The law, enacted as part of the COVID-19 global pandemic, allows Schedule II-V controlled substances to be dispensed for more than 30 days and removes existing refill limitations. These new policies are part of the AMA's top policy recommendations for states to help patients with chronic diseases to avoid leaving their homes during shelter-in-place to limit the spread of COVID-19. Read more about AMA's state policy recommendations here.
"The AMA applauds the Minnesota Medical Association and the Minnesota Legislature for its leadership in enacting this legislation and urges all states to take similar action," said AMA President Patrice A. Harris, MD, MA. "The AMA expects all pharmacies, pharmacy benefit management companies and health insurance companies doing business in the state of Minnesota to comply with the law and remove any restrictions that would interfere with this legislation."
For more information, please contact ARC@ama-assn.org.
In response to the COVID-19 public health emergency, the AMA is urging health plans to minimize treatment barriers related to prior authorization (PA). Some commercial insurers have temporarily adjusted their utilization management policies to include waiving PA for COVID-19 testing and treatment, suspending PA for patient transfers to less-intensive care settings and extending PA duration for elective procedures that will be rescheduled. However, PA policy changes vary widely across health plans and are rapidly evolving. To help physicians and practice staff track PA requirement updates in response to the COVID-19 pandemic, the AMA has created a resource summarizing major national health plans' PA policy modifications. This tool will be frequently updated as new information becomes available from insurers' network communications and websites.
Many of the PA program adjustments implemented by commercial plans align with state policy options that the AMA has developed in response to the COVID-19 crisis. The AMA's recommendations address a variety of advocacy issues pertaining to patients' access to and coverage of critical health care services under commercial health plans during the pandemic.
Expanding on its efforts to help physicians use technology to extend patient care beyond the walls of the medical office, the AMA updated its Digital Health Implementation Playbook Series to include a new physician guide for implementing real-time virtual visits between a clinician and a patient. For medical practices and health systems looking to integrate telemedicine as quickly as possible during the COVID-19 pandemic, the Playbook series offers best practices curated from experts in the field.
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 opened March 23 and remains 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.Back to Top