The 2019 Novel Coronavirus (COVID-19) outbreak is a complex, unprecedented, and rapidly evolving health event. To help providers stay updated in this challenging time, we’ve compiled a list of useful resources ranging from health information to legal and governmental updates.
Resources for Providers from the Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS)
The CDC has compiled a page for healthcare professionals for use during the COVID-19 outbreak, which includes resources such as:
- Sequence for Putting on and Removing Personal Protective Equipment (PPE)
- Guidance and Resources on Healthcare Supply of Personal Protective Equipment
- Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings
- Reporting a PUI or Laboratory-Confirmed Case for COVID-19
These concise guides are designed to give providers the most up-to-date information available. The CDC also recently released a Coronavirus (COVID-19) Partner Toolkit. This resource includes materials for clinicians, Medicare beneficiaries, patients, and other parties.
CMS issued guidance for reopening healthcare centers to provide non-emergent, non-COVID (NCC) care. The phased recommendations detail best practices for testing, PPE and supplies, workforce availability, sanitation protocols, and further considerations to reduce the risk of transmission. “Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider,” said CMS Administrator Seema Verma.
CMS also published a complementary, patient-focused guide. Recommendations encouraged patients to seek — and not postpone — necessary care, consider telehealth, wear a face covering, and discuss getting tested for COVID-19 “before going for care.”
Additionally, Johns Hopkins University & Medicine has designed a real-time COVID-19 tracker to monitor nationwide and worldwide cases, deaths, and recoveries.
Information on Updated Telehealth Procedures
Telehealth can help keep patients and providers safe while preserving social distancing. Under emergency updates to telehealth policies, Medicare will now reimburse providers for various telehealth services at the same rate as in-person visits.
The Department of Health and Human Services (HHS) is also relaxing certain HIPAA requirements to facilitate telehealth and sharing of COVID-19 information. For example, providers can use their personal smartphones or devices for virtual visits. Furthermore, these rules apply even when providers are diagnosing and treating conditions other than COVID-19, a benefit for patients seeking care or continuing treatment while social distancing. For a list of telehealth services providers may offer, consult CMS’ “List of Telehealth Services.”
HHS has also relaxed the “originating site” requirement for telehealth, which is the “site where a patient is located at the time health care services are provided via a telecommunications system.” This will enable providers and patients to communicate more easily by waiving geographic requirements, allowing patients to televisit from “any healthcare facility and in their home.” As Graham Galka, Senior Vice President of Strategy & Innovation at Privia Health, noted, this measure helps to “reduce administrative barriers.” Previously, patients were required to be “in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.”
CMS has compiled a “General Provider Telehealth and Telemedicine Tool Kit” to facilitate telehealth’s adoption. This library includes many helpful resources, including 1135 waiver information, state statutes, general policy guidance, and more. Similarly, the agency published an additional telehealth toolkit for Medicaid and the Children’s Health Insurance Program (CHIP).
For additional information on documentation requirements and evaluation and management (E/M) services, the American Academy of Family Physicians has published a helpful guide, “Using Telehealth to Care for Patients During the COVID-19 Pandemic.”
The HHS Office for Civil Rights (OCR) also announced that it will “exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” The announcement notes that healthcare providers should not use public-facing video communication platforms (such as Facebook Live, TikTok, etc.). However, providers may use applications such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype … without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules.” While permissible at a national level, Galka advises that providers looking to expand their telehealth capabilities “get a HIPAA-compliant platform” to avoid putting “patients’ information at risk.”
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which took effect on March 27, made some important changes to telehealth. It allows a high-deductible health plan with a health savings account to cover telehealth services prior to a patient reaching the deductible, thereby increasing patient access. The Act also provides telehealth flexibility, including eliminating the requirement that the physician or other professional has treated the patient during the past three years.
“For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners [who] can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services,” CMS said in an announcement. The announcement also included provisions for billing services, originating sites, increased reimbursements for telephone visits, and more.
CMS has updated and shared a helpful video that answers many questions concerning expanded telehealth services for Medicare beneficiaries, information on audio-only visits, and instructions for proper billing of telehealth services.
Recent Policy Changes
On April 30, CMS announced a “second round of sweeping changes” to support the healthcare system. The changes added new “rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries,” such as removing the requirement for a provider to order “COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis.” Furthermore, pharmacists can now perform “certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law.” CMS will also cover “certain serology (antibody) tests.” Similarly, the CDC released consolidated recommendations for COVID-19 testing and data reporting guidance, including “interim testing guidelines for nursing home residents and healthcare personnel, as well as testing strategy options for high-density critical infrastructure workplaces after a COVID-19 case is identified. These recommendations compile and update previous testing guidance.”
The agency took multiple steps to increase hospital capacity and “set up temporary expansion sites to help address patient needs” as part of the Hospitals Without Walls initiative. Additional measures were taken to bolster the healthcare workforce by “cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for.” These changes allow for new capabilities for certain home-health practitioners, occupational therapy assistants, and medical staff at ambulatory surgery centers.
The announcement also altered the Medicare Shared Savings Program (MSSP) to give accountable care organizations (ACOs) “greater financial stability and predictability.” The ongoing adjustments are designed to ensure participating ACOs “will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic.” The agency has also forgone the “the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year.” An interim final rule removed COVID-19-related spending from performance calculations for the MSSP.
Information on Funding and Loans
Congress has passed several bills to help reduce the financial impact of COVID-19 with many provisions targeted to healthcare providers’ specific needs.
The CARES Act includes the Small Business Administration’s (SBA) Paycheck Protection Program (PPP). This authorizes $349 billion in SBA guarantees of forgivable loans. This action is designed to:
- Expand business eligibility for the loans – Generally, businesses with not more than 500 employees or the applicable size standard for the industry as defined by the SBA, if higher, are eligible. This program waives the requirement of businesses to seek other sources of capital first, also known as the “credit elsewhere” requirement. To assess eligibility, lenders will determine whether a business was operational on February 15, 2020, and had employees for whom it paid salaries and payroll taxes.
- Modify the loan terms and requirements – The loan amounts are for up to 2.5x monthly payroll costs (averaged during the one year period before the loan), or $10 million, whichever is smaller. Proceeds may be used for payroll costs (excluding compensation of an individual employee in excess of an annual salary of $100,000, prorated for the covered period), group healthcare benefits, insurance premiums, mortgage, rent, and utility payments. Furthermore, the program doesn’t require collateral from businesses or owners or personal guarantees from owners. The interest rate is not to exceed 4 percent, and automatic deferments of principal and interest are allowed for at least six months, but not more than one year.
- Allow for some loan forgiveness – Loan forgiveness is equal to the amount spent during an eight-week period after the origination date of the loan on payroll costs as well as interest payment on mortgage, payment of rent on a lease, and utility services if incurred or begun before February 15, 2020. The forgiven amount is reduced proportionately by any reduction in employees compared to the prior year or a reduction of pay to employees beyond 25 percent of the prior year’s compensation. Borrowers who re-hire workers previously laid off will not be penalized for a reduced payroll at the beginning of the period. Amounts not forgiven will have a term up to 10 years. Loans forgiven will be considered canceled indebtedness.
- Streamline the loan process – The Treasury is able to approve new lenders, of which there were 800 as of March 28. The Act contains provisions to encourage banks to make the loans.
The CARES Act also appropriated $100 billion in grants to hospitals and other healthcare providers for COVID-19-related response costs. The Treasury published an example of a PPP Borrower Application Form. This Provider Relief Fund addresses “the economic impact on providers incurring additional expenses caring for COVID-19 patients” as “quickly and transparently as possible.” The $50 billion general allocation was distributed in two phases with the initial $30 billion distributed between April 10 and April 17 and the remaining $20 billion is being distributed beginning Friday, April 24. Additional allocations support treatment for the uninsured, high-impact areas, rural providers, the Indian Health Service, and more.
On April 24, President Trump approved an additional $75 billion in emergency funding for hospitals with the Paycheck Protection Program and Health Care Enhancement Act. One-third of this, or $25 billion, is “for expanding and administering COVID-19 testing for active infection and prior exposure as well as conducting surveillance and contact tracing,” Healthcare Dive reported.
While CMS delivered nearly $34 billion “to the healthcare providers on the frontlines” through the Accelerated and Advance Payment Programs, an update on April 26 noted that the agency will reevaluate the accelerated payments and suspend advanced payments. However, funding “will continue to be available to hospitals and other healthcare providers” through the Provider Relief Fund.
HHS modified rules for $50 billion in provider relief grants on June 2, the day before financial information was due. The Department required providers to return money to remain eligible for “full grant allocation but aren’t ready to accept the grant terms and conditions. Providers could re-apply for funds, and would then have 90 days to agree to the terms and conditions of the fund,” reported Modern Healthcare. To keep the funds, providers must submit an accounting of annual revenues. HHS later announced $15 billion in distributions to “providers that participate in state Medicaid and CHIP programs” and $10 billion for safety net hospitals.
Resources for Patients
Because people are worried about medical and financial issues related to COVID-19, ensuring patients have access to reliable information is critical. One poll from the Kaiser Family Foundation shows 40 percent of Americans say their lives have been disrupted, more than half of workers “are worried they will lose income due,” and 41 percent “worry they will put themselves at risk of coronavirus exposure because they can’t afford to stay home from work.” Providers can help calm these anxieties by sharing accurate, helpful information that patients can use.
Here are examples of five important facts for patients to know:
- Diseases can make anyone sick regardless of their race or ethnicity.
- Some people are at increased risk of getting COVID-19.
- People who have been in close contact with a person known to have COVID-19 or people who live in or have recently been in an area with ongoing spread are at an increased risk of exposure.
- Someone who has completed quarantine or has been released from isolation does not pose a risk of infection to other people.
- Know what symptoms to look for, when to seek medical advice, and how to identify “emergency warning signs.”
- A list of preventive behaviors for patients:
- Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Stay home when you are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
The CDC has put together a library of print resources that are available in multiple languages.
CMS has also published additional “Infection Control Guidance” based on CDC guidelines. These documents aim to “help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.” While the revised guidance largely focuses on dialysis facilities, it contains provisions for hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, and other settings. “For hospitals, psychiatric hospitals and CAHs, the revised guidance, for example, provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work policies,” the press release noted.
If you have a social media presence, you can use it to effectively share information with patients in a way that complies with social distancing measures. Sharing via social media also allows patients to share trusted and reliable information from healthcare providers with their friends and followers. This can help combat misinformation that can increase fear and anxiety. To assist, the CDC shared a Social Media Toolkit.
Finally, as demand for care continues to increase, many providers are likely to feel the effects of burnout. One useful tool is Headspace, a mindfulness app designed to lower stress. Headspace is providing the app free to all medical professionals who enter their National Provider Identifier (NPI) and email address.
Is there anything we’ve missed? Please let us know in the comments and we’ll do our best to update the article to answer your questions and address your concerns.