Dear Secretary Azar:
The undersigned organizations represent the hundreds of thousands of physicians who treat our nation's patients every day. We are writing to request immediate financial assistance for physicians across the country who are taking heroic action to treat patients with the novel coronavirus, providing ongoing care for patients with chronic conditions and urgent needs, and incurring significant financial losses due to postponing non-essential procedures and visits.
Congress intended to provide relief to physician practices who are suffering financial loss due to COVID- 19 by designating funding in the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act. The statute requires HHS to interpret eligibility for the funding broadly to include all physicians who are experiencing revenue losses and non-reimbursable expenses as a result of the COVID-19 pandemic.
Physician practices, depending on their location and specialty, face several hardships that we believe should qualify for help. For example, we have heard physicians who are caring for patients with COVID- 19 are staying in hotels or renting an apartment to protect their loved ones and maintain a proper social distance. Many physicians who practice in offices and ambulatory surgical centers are not seeing patients for non-essential visits and procedures to preserve medical supplies for treating patients with COVID-19 and to slow the community spread of the virus. We are also concerned that small practices are particularly vulnerable to financial ruin as they have less ready access to capital and are already operating on razor thin margins. In addition, we have heard from many large physician practices and faculty practice plans that have over 500 employees and will not qualify for the small business assistance in the CARES Act.
They are faced with the untenable position of laying off staff and physicians due to lower financial revenues while preparing for, and in some areas of the country, responding to a surge in patients with COVID-19.
We recommend HHS provide immediate relief to ensure a sufficient physician workforce is available in this country now and throughout the pandemic. Specifically, we urge HHS to provide one month of revenue to each physician (MD or DO), nurse practitioner, and physician assistant enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses. HHS should use an individual's average monthly payment amount from October-December 2019, which has been provided to the Medicare Administrative Contractors (MACs), as the basis for determining pre-pandemic monthly revenue. For most specialties, Medicare patients account for 35% of all patients, so to extrapolate to all patients, HHS should use three times the October-December 2019 average as the basis for issuing a payment. Certain specialties have fewer Medicare patients and should be adjusted upward accordingly: psychiatry (20%), allergy/immunology (15%), obstetrics/gynecology (15%), and pediatrics (5%).
Pediatricians, obstetrician-gynecologists, and allergists may have many patients insured by Medicaid but few or no patients with Medicare and will require a different approach. The funds are for the purpose of supporting physician practices in light of lost revenue, such as for paying salaries, benefits, and overhead and making necessary investments to continue providing care such as telehealth.
The CARES Act permits the Secretary to provide funding through a grant or other mechanism and we urge the Department to provide immediate financial relief by issuing funds via the MACs. We believe it will be expedient to administer, while also allowing proper oversight as funding would be based on Medicare claims data and utilize existing enrollment and payment protocols.
Physicians are continuing to put their patients' needs first to combat this unprecedented public health emergency. We urge you to support them against financial peril while they put their lives and businesses at risk.
Sincerely,
American Medical Association Academy of Physicians in Clinical Research
AMDA - The Society for Post-Acute and Long-Term Care Medicine American Academy of Allergy, Asthma & Immunology
American Academy of Cosmetic Surgery American Academy of Dermatology Association American Academy of Emergency Medicine
American Academy of Facial Plastic and Reconstructive Surgery American Academy of Family Physicians
American Academy of Neurology American Academy of Ophthalmology American Academy of Otolaryngic Allergy
American Academy of Otolaryngology- Head and Neck Surgery American Academy of Pain Medicine
American Academy of Physical Medicine and Rehabilitation American Academy of Sleep Medicine
American Association for Hand Surgery American Association for Physician Leadership
American Association of Child & Adolescent Psychiatry.
American Association of Clinical Endocrinologists American Association of Clinical Urologists American Association of Hip and Knee Surgeons American Association of Neurological Surgeons
American Association of Neuromuscular & Electrodiagnostic Medicine American Association of Orthopaedic Surgeons
American Association of Public Health Physicians American College of Allergy, Asthma and Immunology American College of Cardiology
American College of Chest Physicians American College of Medical Genetics and Genomics American College of Obstetricians and Gynecologists
American College of Osteopathic Internists
American College of Osteopathic Surgeons American College of Physicians
American College of Radiation Oncology American College of Radiology American College of Rheumatology American College of Surgeons
American Gastroenterological Association American Geriatrics Society
American Institute of Ultrasound in Medicine American Medical Group Association American Orthopaedic Foot & Ankle Society American Psychiatric Association
American Society for Clinical Pathology American Society for Gastrointestinal Endoscopy American Society for Laser Medicine and Surgery
American Society for Metabolic and Bariatric Surgery American Society for Radiation Oncology American Society for Surgery of the Hand
American Society of Anesthesiologists American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery American Society of Dermatopathology American Society of Echocardiography American Society of General Surgeons
American Society of Hematology American Society of Interventional Pain Physicians
American Society of Neuroimaging American Society of Neuroradiology American Society of Nuclear Cardiology American Society of Plastic Surgeons American Society of Retina Specialists American Urogynecologic Society American Urological Association American Vein & Lymphatic Society Association for Clinical Oncology Association of Academic Physiatrists College of American Pathologists Congress of Neurological Surgeons Endocrine Society
Heart Rhythm Society Infectious Diseases Society of America
International College of Surgeons - United States Section International Society for the Advancement of Spine Surgery Medical Group Management Association
National Association of Medical Examiners National Medical Association
North American Neuromodulation Society North American Spine Society
Renal Physicians Association
Society for Cardiovascular Angiography and Interventions Society of American Gastrointestinal and Endoscopic Surgeons Society of Gynecologic Oncology
Society of Hospital Medicine Society of Interventional Radiology Spine Intervention Society
The Society of Thoracic Surgeons
Medical Association of the State of Alabama Alaska State Medical Association
Arizona Medical Association Arkansas Medical Society California Medical Association Colorado Medical Society Connecticut State Medical Society Medical Society of Delaware
Medical Society of the District of Columbia Florida Medical Association Inc Medical Association of Georgia
Hawaii Medical Association Idaho Medical Association Illinois State Medical Society Indiana State Medical Association Iowa Medical Society
Kansas Medical Society Kentucky Medical Association Louisiana State Medical Society Maine Medical Association
MedChi, The Maryland State Medical Society Massachusetts Medical Society Michigan State Medical Society Minnesota Medical Association
Mississippi State Medical Association Missouri State Medical Association Montana Medical Association Nebraska Medical Association Nevada State Medical Association New Hampshire Medical Society Medical Society of New Jersey
New Mexico Medical Society Medical Society of the State of New York
North Carolina Medical Society North Dakota Medical Association Ohio State Medical Association Oklahoma State Medical Association
Oregon Medical Association Pennsylvania Medical Society Rhode Island Medical Society South Carolina Medical Association
South Dakota State Medical Association Tennessee Medical Association
Texas Medical Association Utah Medical Association Vermont Medical Society Medical Society of Virginia
Washington State Medical Association West Virginia State Medical Association Wisconsin Medical Society
Wyoming Medical Society