AMA: Medicare Policy Change on Telemedicine Enhances Nation's Digital Health Care Capacity
Statement Attributed To Patrice A. Harris, MD, MA, President, American Medical Association
March 17 - "Administrator Verma took strong steps today to enhance the nation's digital health care capacity during the COVID-19 pandemic by lifting Medicare restrictions on the use of certain telemedicine services. The American Medical Association (AMA) applauds this important Medicare policy change to support social distancing measures that slow the spread of the novel coronavirus, while providing safe screening and treatment to patients through remote care. The Centers for Medicare & Medicaid Services (CMS) also noted that penalties will not be imposed on physicians using telehealth in the event of noncompliance with regulatory requirements under the Health Insurance Portability and Accountability Act. The AMA had urged the administration to be flexible and the steps CMS has taken demonstrate the agency was listening.
"The use of telemedicine and remote care services are critical to the management of the COVID-19, while also ensuring uninterrupted care for 100 million Americans with chronic conditions. The AMA encourages any private payers that are not already covering telehealth services to remove those limitations now. The AMA stands ready to help physicians expand their use of telemedicine and continues to invest in resources that provide physicians with a proven path for integrating telemedicine and digital health technologies into patient care.
"The AMA offers the Quick Guide to Telemedicine in Practice, a new resource to help mobilize remote care with implementation tips, as well as a reference to Current Procedural Terminology (CPT®) codes for reporting telemedicine and remote care services. The AMA also offers an education module in the AMA's STEPS Forward™ that can help physicians use telemedicine in practice, and the Digital Health Implementation Playbook with a 12-steps process for adopting remote monitoring of patients outside the traditional clinical environment."
NCPA Sends Small Business Pharmacy Recommendations to Coronavirus Task Force
March 17 - The National Community Pharmacists Association today reiterated to Vice President Mike Pence and members of the administration's Coronavirus Task Force how community pharmacy is ready and willing to assist with fighting the pandemic, as well as allowances needed in order for small business neighborhood pharmacies to continue to provide life-saving assistance to patients in this time of emergency. This follows a March 2 letter sent by NCPA to the U.S. Department of Health and Human Services' top emergency preparedness official offering community pharmacy's assistance.
NCPA recommendations include allowing independent community pharmacists to test for COVID-19; provide home delivery services; test for influenza and strep; and vaccinate for influenza, pneumonia and COVID-19, once a vaccine is developed. However, in order to remain viable and keep doors open to provide continued access and care, NCPA emphasized that independent community pharmacists need an immediate suspension of all pharmacy direct and indirect remuneration fees that pharmacy benefit managers assess on pharmacies. These post point-of-sale claw backs are wreaking havoc on the business operations of community pharmacies. NCPA's full list of recommendations and needs can be found here.
NCPA CEO B. Douglas Hoey, pharmacist, MBA, said, "Community pharmacies are open and ready to assist with ongoing efforts to fight the coronavirus pandemic. Unleashing our capabilities and utilizing our relationships with patients are the best ways to communicate and engage with rural and underserved communities in particular, as independent community pharmacists are trusted, well-established health care providers. We urge Vice President Pence and members of the Coronavirus Task Force to tap into the full potential of community pharmacy as part of the administration's response to this national emergency by empowering pharmacies to realize their full potential and allowing them to shed administrative burdens restricting patient care."
Williamson Medical Center Coronavirus (COVID-19) Statement
March 16 - In an effort to stay up-to-date with the most current recommendations from the United States Surgeon General and the American College of Surgeons, Williamson Medical Center has decided to cancel elective procedures starting this Wednesday, March 18 until further notice.
Elective procedures are those that are pre-scheduled and non-urgent, and if postponed, would not threaten the life or overall health of the patient. We remain fully equipped and able to handle all emergency and medically necessary procedures as we normally would.
Physicians and their staff will be contacting patients affected by this change, and will provide support as needed to these patients until procedures may be rescheduled.
Your health is always our priority, and Williamson Medical Center is fully prepared and confident in the measures we have taken to protect our patients and staff while continuing to serve the healthcare needs of our community.
COVID-19 is a virus that should be taken seriously with a levelheaded, fact-based approach. Working together as a community in exercising precautionary measures will help us curtail the spread of this virus and protect those among us who are elderly or with underlying health conditions who are always most vulnerable to sickness of any kind.
For questions regarding scheduled elective surgeries, patients should call his or her physician. To stay informed about COVID-19 visit www.CDC.gov or call the Tennessee Department of Health patient hotline at 877-857-2945 with questions.
AHA, AMA & ANA SEND JOINT LETTER TO CONGRESS ON CORONAVIRUS STIMULUS PACKAGE
March 16
Dear Speaker Pelosi and Majority Leader McConnell:
The first emergency supplemental funding package for the 2019 novel coronavirus (COVID-19), aimed at public health preparedness and response and the development of a vaccine was an important first step as our nation develops a comprehensive response to the growing threat of COVID-19. We have already seen the initial impact that COVID-19 presents to our homeland, including our nation's health, economy and social stability.
Hospitals, health systems, physicians and nurses throughout the nation are preparing for, and in nearly every state responding to, community spread of COVID-19. As Congress considers developing an economic stimulus package, we urge you to ensure that it includes a comprehensive funding strategy to ensure that hospitals, health systems, physicians and nurses are viable and directly supported for preparedness and response.
As health care providers on the front lines, hospitals, health systems, physicians and nurses are taking care of patients with COVID-19 and preparing for a potential outbreak in every community. Ensuring the safe care for patients, protecting health care professionals providing patient care, and supporting the health and safety of communities demand the combined efforts of the public health system, front line health care providers, and federal, state and local governments.
America's front line health care providers seek sufficient financial support for the following:
- To quickly update, train staff on and implement pandemic preparedness plans to respond to COVID-19 in all health care settings.
- Obtain scarce supplies, including personal protective equipment (PPE), essential for protecting front line health care professionals and testing supplies.
- Rapidly ramp up infection control and triage training for health care professionals in all health care settings, especially in light of growing supply chain shortages.
- Provide housing, care and monitoring of patients who do not require hospitalization but must remain isolated to better ensure that hospital capacity is preserved for acutely ill patients who require hospitalization. This includes persons with suspected or confirmed COVID-19 infections who experience mild to moderate symptoms and who are not able to care for themselves at home.
- Construct or retrofit separate areas to screen and treat large numbers of persons with suspected COVID-19 infections. This includes construction of isolation facilities in or around hospital emergency departments to assess potentially large numbers of persons under investigation for COVID-19 infection.
- Address the financial impacts of cancellations of elective surgeries and procedures due to shortages of PPE, other medical supplies and need to keep beds available for COVID-19 patients, as well as patient cancellations due to fear of COVID-19 in health care facilities. Such cancellations could have devastating financial implications for hospitals, physicians and nurses already at financial risk and may limit access to care.
- Plan for, train on, and implement expanded telemedicine and telehealth capabilities to ensure that appropriate care can be provided to individuals in their homes or residential facilities when social distancing measures are used to reduce community spread of COVID-19.
- Increase the numbers of patient care beds to provide surge capacity using temporary structures, such as temporary hospitals that are deployed in a pandemic.
- Cover the increased costs associated with higher staffing levels, backfilling staff when necessary (due to unavailable staff or greater need for staff) and special infectious disease units needed to care for patients with suspected or confirmed COVID-19 infection.
As schools and childcare facilities shut down during community spread of coronavirus, hospitals may need to provide alternatives so that physicians, nurses and other staff with young children can come to work. This step will be essential in ensuring adequate staffing for caring for the most seriously ill in our communities.
We are committed to maintaining a strong collaborative effort with all stakeholders to respond to the public health emergency that COVID-19 presents. We respectfully ask that Congress provide additional supplemental emergency funding of at least $1 billion during this critical window of time when we are able to best prepare and respond to this outbreak. We also urge that supplemental funding not be offset by cutting other health programs.
We look forward to continuing to work with you during this critical time to protect the health of our nation.
Sincerely,
/s/ /s/ /s/
Richard J. Pollack James L. Madara Loressa Cole
President and CEO CEO and Executive Vice President Enterprise CEO
AHA AMA ANA
MAJOR HOSPITAL ASSOCIATIONS SEND LETTER TO SURGEON GENERAL ON ELECTIVE SURGERIES
March 15
Vice Admiral Jerome M. Adams, M.D. United States Surgeon General Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201
Dear Dr. Adams:
On behalf of America's hospitals, we are writing to assure you and the nation's leadership that hospitals across the country are actively preparing, planning, and executing our emergency plans to stop the threat of COVID-19, and to provide the medical care that the American people will expect and need during this national emergency.
We deeply appreciate the actions the Administration, as well as Congress, have taken to combat COVID-19, and to recognize and reinforce the front-line role that local caregivers play in their communities. We are acutely aware of the potential for a rapid escalation of COVID-19 cases that could stress the capacity of hospitals to care for those suffering from this virus. Weeks ago, when cases were first reported, hospitals began taking every conceivable step to prepare for that challenge.
At the same time, we are concerned about recent comments by government officials that could be interpreted as recommending that hospitals immediately stop performing "elective" surgeries without clear agreement on how we classify various levels of necessary care. We agree that the crisis as it develops may require the curtailment of the least critical or time-sensitive hospital services, but any curtailment must be nuanced to meet the needs of all severely ill patients. Our patients will be best served by carefully evaluating and prioritizing gradients of "elective" care to ensure that the most time-sensitive medically necessary care can be delivered by physicians and hospitals.
While modeling predicts a surge of the number of serious COVID-19 cases that will need hospital care, the hospital system must continue to balance the needs of caring for patients with COVID-19 while providing vital services to others in the community who need care. Hospitals, their physicians, and staff will be called on to treat many patients with emergency or immediate and serious needs: many patients, such as those with cancer or a need for cardiac surgery, will not be able to postpone medical interventions. Where possible, we cannot completely cease caring for illness in our community that is not directly related to the COVID-19 crisis. Our ability to respond to patients must not be prevented by arbitrary directives.
These efforts will depend upon both public and private efforts as we have discussed. The health system will need your continued attention to improving both the availability and accessibility of testing and the personal protective equipment necessary for hospitals to keep cases of COVID-19 at manageable levels. We also must begin now to secure other critical elements of the supply chain (eg, ventilators).
It is imperative to note that "elective" simply means a procedure is scheduled rather than a response to an emergency. For example, "elective" surgeries could include replacement of a faulty heart valve, removal of a serious cancerous tumor, or a pediatric hernia repair. Often, if
these types of procedures are delayed or canceled, the person's condition gets rapidly worse and can even be life threatening. This is particularly true with children who are all in an active phase of their life growth and development. The resulting decline in their health could make them more vulnerable to COVID-19.
A blanket directive to cancel elective and non-urgent procedures usurps the proper role of the physicians caring for patients and their families, collaborating closely with the hospital, to
determine what is in the patient's best interests. Instead, elective and non-urgent procedures, both those in an operating room and in other areas where the procedure can be safely performed, should be based on a case-by-case evaluation of many factors, including:
Current and projected COVID-19 cases in the facility and in the surrounding area. Where community spread exists, we support a general framework of curtailing elective surgeries that would not threaten the life or health of the patient. We believe that a patient's physician in consultation with the hospital, patient, and other professionals is in the best position to evaluate and make this decision;
- Supply of personal protective equipment, staffing availability and bed availability;
- Urgency of the procedure;
- Whether the patient is well enough for a procedure, including age and underlying health factors, particularly given the risks of concurrent COVID-19 infection; and
- Clinical judgment of patient needs and the situation at hand.
Hospitals, working side-by-side with their physician partners and other caregivers, will continue to provide needed care and procedures where it is safe to do so, prioritizing care that, if delayed, could negatively affect the patient's health outcome, harm the patient, or lead to disability or death.
We respectfully request that you take our concerns into consideration and clarify the previous comments.
Hospitals are here to protect and promote the health of all Americans, and we embrace our mission to be there 24/7 for all who walk through our doors. Preparing to respond to disasters is not new to hospitals. Our communities are counting on us to be there for them and all their health care needs during the COVID-19 pandemic.
Sincerely,
American Hospital Association Association of American Medical Colleges Children's Hospital Association
HOSPITAL ASSOCIATIONS URGE CONGRESS TO SUSPEND MEDICARE SEQUESTER
Dear Speaker Pelosi and Majority Leader McConnell:
March 15 - America's hospitals deeply appreciate Congress's swift and effective efforts to combat the COVID-19 crisis. Your recent bipartisan action provides much needed assistance for patients and hospitals, especially our workforce on the front lines of this pandemic, and reassures all Americans of Congress's unwavering commitment to take the actions needed to ensure their health and safety.
As you work towards the next legislative package and consider additional actions to assist hospitals and other health care providers and caregivers, we strongly recommend that you suspend the Medicare sequester for at least the duration of the pandemic. This action alone will provide immediate, significant relief across-the-board, and will signal continued Congressional support for the hard work that lies ahead for all of us.
As MedPAC has documented, most recently with its March Report to Congress issued last week, Medicare payments to hospitals fall far below the cost of care and have been deeply negative for well over a decade. The Medicare sequester, which reduces payments for most benefits by two percent, is a major contributor to these underpayments. Indeed, MedPAC has argued against the Medicare sequester, "because it reduces payments for all sectors by 2 percent without regard to payment adequacy."
Suspending the sequester and restoring those payments will provide a much-needed jolt of confidence not just for hospitals, but for physicians, post-acute providers, Medicare Advantage plans and so many others who rely on Medicare as a trusted partner. It would replace an arbitrary cut with the flexibility desperately needed to respond to the evolving demands of this pandemic, and would help assure our patients, especially seniors, of Congress's commitment to their needs.
Sincerely,
American Hospital Association Association of American Medical Colleges Federation of American Hospitals
Williamson Medical Center
Hospital Designates COVID-19 Isolation Wing
March 12 - Williamson Medical Center continues to stay up-to-date on the most current COVID-19 guidelines from the Tennessee Department of Health, Centers for Disease Control (CDC), and World Health Organization. We are taking the necessary precautions to protect our patients and staff while continuing to serve the healthcare needs of our community, and are deploying strategies that work best in our facilities in response to the changing situation.
In light of the additional confirmed cases in Middle Tennessee, and in expectation of new COVID-19 cases, we have converted a wing of the hospital into an isolation unit for the potential treatment of COVID-19 patients. We are assessing other locations within the hospital that may also be converted to additional isolation units if necessary. We have also implemented a screening and intake process in our Emergency Room.