COVID-19 Resources

Stay up to date on the latest news and information on COVID-19 with resources including latest CDC/WHO/AAFP recommendations, payment information, telemedicine updates, office preparedness updates and more for Family Physicians.


August 4, 2020

1. CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries
CMS released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries. The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.  Read More

2. COVID-19: Laboratory Claims Requiring the NPI of the Ordering/Referring Professional
During the COVID-19 Public Health Emergency (PHE), CMS relaxed requirements for a limited number of laboratory tests required for a COVID-19 diagnosis. These tests do not require a practitioner order during the PHE. We added a new test to this list (PDF): CPT 87426  (Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).  Read More

3. Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426
CMS issued a new MLN Matters Article MM11927 on Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426 (PDF). Learn about this QW modifier for Infectious agent antigen detection by immunoassay technique by clinical laboratories.  Read More

4. HHS Protect Public Data Hub
This new hub aims to provide high quality, accessible, and timely information related to COVID-19.  It augments Healthdata.gov with non-government datasets from academia, nonprofit organizations, industry, hospitals, and facilities reporting from all 50 states and territories.  Read More


July 29, 2020

CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries
The Centers for Medicare & Medicaid Services today released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries.

The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.

The updated data confirm that the COVID-19 public health emergency is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities. This is due, in part, to the higher rates of chronic health conditions in these populations and issues related to the social determinants of health.

In response to the first Medicare data snapshot and related call to action from CMS Administrator Seema Verma on June 22, the CMS Office of Minority Health hosted three listening sessions with stakeholders who serve and represent racial and ethnic minority Medicare beneficiaries. These sessions provided helpful insight into ways in which CMS can address social risks and other barriers to health care that will help in our efforts to reduce health disparities.

The updated data on COVID-19 cases and hospitalizations of Medicare beneficiaries covers the period from January 1 to June 20, 2020. It is based on Medicare claims and encounter data CMS received by July 17, 2020.

Other key data points:

  • Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries.
  • Beneficiaries eligible for both Medicare and Medicaid – who often suffer from multiple chronic conditions and have low incomes – were hospitalized at a rate more than 4.5 times higher than beneficiaries with Medicare only (719 versus 153 per 100,000).
  • Beneficiaries with end-stage renal disease (ESRD) continue to be hospitalized at higher rates than other segments of the Medicare population, with 1,911 hospitalizations per 100,000 beneficiaries, compared with 241 per 100,000 for aged and 226 per 100,000 for disabled.
  • CMS paid $2.8 billion in Medicare fee-for-service claims for COVID-related hospitalizations, or an average of $25,255 per beneficiary.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf


July 23, 2020

Advancing the Response to COVID-19: Sharing Promising Programs and Practices for Racial and Ethnic Minority Communities

Save the Date! Thurs., Sept. 17, 2020.

HHS Office of Minority Health (OMH) hosts this virtual symposium to highlight state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority populations.

Learn more here.


July 21, 2020

One-Stop Shop for COVID-19 Resources
CDC updated communication resources for videos, social media, PSAs, print resources, checklists, FAQs, and web resources.  In Spanish and other languages. 


Researchers Publish Encouraging Early Data on COVID-19 Vaccine
NIH Director, Dr. Francis Collins released this blog post describing the NIH-supported phase 1 human clinical trial for a COVID-19 vaccine. A phase 2 clinical trial is already well on its way to recruiting* 600 healthy adults.


Volunteer in a COVID-19 Clinical Study
Visit the COVID-19 Prevention Network (CoVPN) website to take the questionnaire and join the CoVPN Volunteer Screening Registry.


FDA’s Updated FAQs on COVID-19
The U.S. Food & Drug Administration updated their Frequently Asked Questions (FAQs) for the general public.  Also in Spanish.


HHS Issues Guidance on Civil Rights Protections Against Discrimination During COVID-19
HHS is issuing guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19.


NIMIC Initiative to Fight COVID-19 in Racial and Ethnic Minority Communities
The National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities (NIMIC) Initiative, a three-year cooperative agreement between HHS and the Morehouse School of Medicine, is expected to better serve racial, ethnic, rural, and socially vulnerable populations. 


Improving the Integration of CBOs: Building Relationships in Preparation for the Next Emergency
Community-based organizations (CBOs) are well positioned to partner with emergency management and public health entities to meet the needs of at-risk individuals during future public health emergencies. HHS released an e-guide to support the integration of these cross-sector partnerships into emergency public health strategies.  


Advance Care Planning: New Realities in Times of COVID-19
Leaving nothing in its path untouched, the COVID-19 public health emergency has impacted all aspects of health from the delivery of rural healthcare to an accelerated need for Advance Care Planning.


Community Health News
FCC Designates 988 for the National Suicide Prevention Lifeline
The Federal Communications Commission (FCC) adopted rules to establish 988 as the new, nationwide, 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.


Free VA COVID-19 Training: Strategies to Improve Provider Wellbeing and Resilience
Wednesday, July 22nd at 2:00 p.m., Register here.
Offered by the Department of Veteran Affairs’ VHA TRAIN, this webinar will feature a panel of providers reviewing the importance of health care provider wellness, as well as strategies to improve provider wellbeing and resilience. The training is open to both VA and non-VA clinicians. Continuing education credit is available for those who preregister.


Coronavirus (COVID-19) Update: FDA Issues First Emergency Authorization for Sample Pooling in Diagnostic Testing

The U.S. Food and Drug Administration recently reissued an emergency use authorization (EUA) to Quest Diagnostics to authorize its Quest SARS-CoV-2 rRT-PCR test for use with pooled samples containing up to four individual swab specimens collected under observation. The Quest test is the first COVID-19 diagnostic test to be authorized for use with pooled samples.

Sample pooling is an important public health tool because it allows for more people to be tested quickly using fewer testing resources. Sample pooling does this by allowing multiple people – in this case four individuals – to be tested at once. The samples collected from these four individuals are then tested in a pool or “batch” using one test, rather than running each individual sample on its own test. If the pool is positive, it means that one or more of the individuals tested in that pool may be infected, so each of the samples in that pool are tested again individually. Because the samples are pooled, it is expected that fewer tests are run overall, meaning fewer testing supplies are used and more tests can be run at the same time allowing patients to receive their results more quickly in most cases. This testing strategy is most efficient in areas with low prevalence, meaning most results are expected to be negative.

“This EUA for sample pooling is an important step forward in getting more COVID-19 tests to more Americans more quickly while preserving testing supplies,” said FDA Commissioner Stephen M. Hahn, M.D. “Sample pooling becomes especially important as infection rates decline and we begin testing larger portions of the population.”

While there is a concern that combining samples may make it more difficult to detect positives, since pooling in the laboratory dilutes any viral material present in the samples, Quest’s validation data demonstrates that its test correctly identified all of the pooled samples that contained a positive sample. It is important to note that the Quest test, initially authorized on March 17, 2020, remains authorized to test individual samples collected by their health care provider from people with suspected COVID-19 infection. The test is also still authorized for use with individual nasal swab specimens that are self-collected at home or in a health care setting using an authorized home-collection kit when determined to be appropriate by a health care provider.

The FDA continues to work with a number of diagnostic test developers to facilitate new approaches and get additional tests to more Americans more quickly.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.


Expert: Face Masks Reduce Wearer’s COVID Infection Risk by 65% – by Ralph Ellis

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Wearing a facial covering not only curbs the spread of the coronavirus but reduces a mask wearer’s risk of catching the virus by 65%, said Dean Blumberg, MD, chief of pediatric infectious diseases at UC Davis Children’s Hospital.

Blumberg, speaking on a college livestream about the coronavirus, said that a “standard rectangular surgical mask … will decrease the risk of infection to the person wearing the mask by about 65%” and that homemade masks also “should work quite well.”

N95 masks are the most effective but should be reserved for medical personnel, he added.

The masks mainly provide a physical barrier to respiratory droplets that are about one-third the size of a human hair, he said. Those drops are one of the major ways the virus is transmitted.

“People who say ‘I don’t believe masks work’ are ignoring scientific evidence,” Blumberg said. “It’s not a belief system. It’s like saying, ‘I don’t believe in gravity.'”

“You’re being an irresponsible member of the community if you’re not wearing a mask. It’s like double-dipping in the guacamole. You’re not being nice to others.”

But even surgical masks are not airtight enough to create an effective barrier against much smaller aerosol particles, which are about 1/100th the size of a human hair, he said. The best defense against aerosol particles is social distancing and interacting with people outdoors.

“Studies in laboratory conditions now show the virus stays alive in aerosol form with a half-life on the scale of hours. It persists in the air,” said William Ristenpart, PhD, a professor of chemical engineering at UC Davis. “That’s why you want to be outdoors for any social situations if possible.” 

Enclosed places like bars are especially troublesome, he said, because “The louder you speak, the more expiratory aerosols you put out.”

Blumberg said scientists’ opinions about the effectiveness of masks have evolved since the pandemic began months ago.

Although more states and cities are issuing mask mandates as cases continue to surge in the U.S., the issue remains controversial. Wearing them was not universally recommended during the early days of the pandemic, partly to ensure health care workers had enough protective gear while shortages existed.


July 16, 2020

AMA telehealth/COVID survey

You are invited to complete the Telehealth Impact Study Provider Questionnaire by clicking on the link below.  The study has been approved by the Mayo Clinic IRB and is part of our efforts in the COVID-19 Healthcare Coalition to address the pandemic. Since COVID-19 started, we have experienced a significant shift towards telehealth.  The goal of this project is to learn more about your experience with telehealth to identify the challenges and barriers, as well as the benefits.

Building on existing research, your response will help inform additional resources needed across the industry and health care community, provide insights to federal and state policymakers, and identify gaps in current research. Respondent and organization information will remain confidential and will only be reported in aggregate. The findings will be shared and made available to all on the COVID-19 Healthcare Coalition website, as well as shared by the  various organizations participating in the Coalition Telehealth Workgroup.

The COVID-19 Healthcare Coalition is focused on understanding your experience of telehealth as an individual physician, nurse practitioner, or physician assistant.  The survey is expected to take up to 15-20 minutes and we ask that you complete the survey by August 13th, 2020.  Please remember to press submit when you get to the end of the survey.

We want to hear from as many clinicians as possible to inform our work. If you have colleagues who use telehealth, please consider forwarding this invitation to them.

Thank you in advance for your consideration and valuable insights. 

START SURVEY HERE


July 13, 2020

Join Our COVID-19 Workshop Series
IPRO QIN-QIO’s Workshop: Resiliency – Coping & Recovering During a Pandemic, July 16, 10:30-11 AM.
Resilience is the capacity to recover quickly from difficulties—so what does that look like across the health care spectrum during this pandemic? Join us as we discuss fostering community resilience and how it impacts those you serve.  Learn More & Register


Society of Critical Care Medicine free education, “Critical Care for non-ICU Clinicians”
SCCM’s Critical Care for the Non-ICU Clinician provides online education to healthcare professionals who could benefit from critical care training. Be prepared with these free resources.  Read More


Ventilator Simulator
Here is a link to a Ventilator Simulator (though it is directed towards pediatric patients, much of it is applicable broadly).


July 8, 2020

COVID-19 diagnosis coding explained in a flowchart
Diagnosis coding for COVID-19 is complicated, in part because the World Health Organization (WHO) created two diagnosis codes for COVID-19, but so far the United States has adopted only one. The WHO’s codes are as follows:

• U07.1 – COVID-19, virus identified (lab confirmed),

• U07.2 – COVID-19, virus not identified (clinically diagnosed). 

The WHO’s intent was for U07.1 to be assigned to cases with a lab-confirmed diagnosis and for U07.2 to be used for cases with a clinical diagnosis. The United States adopted U07.1 as an immediate, off-cycle update to the ICD-10 code set but did not adopt U07.2 because it was released later. Therefore, in the United States, the words “virus identified” are left out of the description for U07.1, which leaves room for interpretation about when to use the code.

The predicament

Without having a diagnosis code specifically for clinically diagnosed (rather than lab-confirmed) COVID-19, U.S. physicians are left without clear guidance.

How do we properly document and code for a patient who is clinically diagnosed? If we only use symptom codes, patients will most likely not be covered by their payers for COVID-19 care and they also will not be included in a disease registry. This is important because many payers are waiving any cost-share responsibility for patients diagnosed with COVID-19. However, in order for the claim to be accepted as a COVID-19 related service, it must have a COVID-19 related diagnosis code. Also, if the patient is in a disease registry, it allows for adequate follow-up, especially if we start to use serologic testing for patients. Sensitivity to the COVID-19 reverse transcriptase (RT-PCR), or diagnostic, tests has been reported to be 70% with a single respiratory swab.1 Consequently, in some instances, patients clinically appear to have COVID-19, but their RT-PCR is not positive until subsequent tests. These patients should be diagnosed with COVID-19, even though the initial labs were negative.

Then there is the question of using serologic (antibody) testing for diagnosing COVID-19. At the time the ICD-10 code was introduced, only RT-PCR testing was available. Now, physicians have more access to serologic tests; however, there is the issue of how to interpret these tests and their use in diagnosing patients with COVID-19. According to the Centers for Disease Control and Prevention (CDC), serologic testing can be offered to support a diagnosis of COVID-19 for patients who present late. Patients presenting 9 to 14 days after illness onset can be tested with the antibody test, in addition to the RT-PCR test to maximize sensitivity.2 A positive serologic test result indicates past or present COVID-19 infection. But it could be a false positive; therefore, serologic testing should not be the only factor in diagnosing COVID-19.3

If a patient has clinical symptoms consistent with COVID-19 and/or has had exposure, and the patient has a negative COVID-19 RT-PCR test, how should the serologic test be interpreted? If the serologic test reveals IgM (-) and IgG (+), should the patient be diagnosed with COVID-19? If the patient has no symptoms or no known exposure, a negative COVID-19 RT-PCR test, and the serologic test reveals IgM (-) and IgG (+), should this patient be diagnosed with COVID-19? Or is there the need for a new ICD-10 code indicating previous infection or previous exposure identified by serology?

The recommendation

Without having a diagnosis code for both lab-confirmed COVID-19 and clinically diagnosed COVID-19, we only have one option: U07.1 – COVID-19. For purposes of vital statistics reporting, the CDC’s National Center for Health Statistics (NCHS) has confirmed that U07.1 can be used for both lab-confirmed and clinically diagnosed patients who have died.4 But the CDC’s broader guidance on coding for living patients again leaves room for interpretation. CDC has stated, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. In this context, ‘confirmation’ does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.”5The phrase “as documented by the provider” can be interpreted to mean as clinically diagnosed by the provider.

Different diagnosis algorithms can be used for diagnosing patients with COVID-19. Physicians should take prevalence and incidence in their own community into consideration when assigning a clinical diagnosis, especially in the absence of a positive test.

A flowchart

Here is a four-part flowchart that our organization developed to help physicians navigate these waters and properly assign diagnosis codes related to COVID-19 encounters. No one algorithm will fit every health care system. It may need to be tailored to your geographic location since prevalence and incidence vary greatly not only throughout the United States but even throughout states, where pockets of COVID-19 surges are emerging.


COVID-19: New and Expanded Flexibilities for RHCs & FQHCs during the Public Health Emergency
On July 6, CMS updated MLN Matters Article SE20016 to clarify how Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can apply the Cost Sharing (CS) modifier to preventive services furnished via telehealth. This update includes:

Additional claim examples
New section on the RHC Productivity Standard


July 7, 2020

Provider Relief Fund
HHS recently announced the additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs.  HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution.  Eligible providers must submit their data by July 20.
 
Before applying through the Enhanced Provider Relief Fund Payment Portal, applicants can watch a webinar about the application process for Medicaid/CHIP providers.  An additional webinar is scheduled for Wednesday, July 8 at 4:00 pm, which you can register for here.  I also encourage you to review the most recent FAQs on the program and the Medicaid/CHIP targeted distribution here


July 2, 2020

A race to determine what drives COVID-19 severity
Efforts are ongoing to find which human or viral factors underpin whether a person with COVID-19 will develop severe symptoms. Clinical evidence linked to two viral lineages now provides key insights into this enigma.
https://www.nature.com/articles/d41586-020-01915-3


Journal of Hospital Medicine
All Hands on Deck: Learning to “Un-specialize” in the COVID-19 Pandemic
https://www.journalofhospitalmedicine.com/jhospmed/article/220370/hospital-medicine/all-hands-deck-learning-un-specialize-covid-19-pandemic


June 23, 2020

Explaining Operation Warp Speed

HHS released a Fact Sheet explaining Operation Warp Speed, a strategy that aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021, as part of a broader strategy to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.  Read More


HHS Awards $107.2 Million to Grow and Train the Health Workforce

HHS, through its Health Resources and Services Administration (HRSA), announced awards totaling $107.2 million to 310 recipients to increase the health workforce in rural and underserved communities aimed at improving the quality, distribution, and diversity of health professionals serving across the country.
        **Learn about other HRSA funding opportunitiesRead More


COVID-19: Vulnerable Populations and Palliative Care: Call for Social Justice Webinar

Thurs. July 9, 2020, 3:00 p.m. – Register here.
Presented by a CDC partner, speakers will address the central role of palliative care across all systems and provide a trauma-informed perspective in working with diverse and vulnerable people affected by the pandemic, as well as the critical importance of workforce education and training.  Read More


Alcohol and Substance Use

Increased stress can lead to increases in alcohol and substance use. If you or someone you care about is starting to use alcohol or other substances, or is increasing their use during the COVID-19 pandemic, CDC has released guidance and resources highlighting the basics of excessive use and what you can do to help.  Read More


June 22, 2020

COVID Swabs Available

Dr. Adena Greenbaum at the Baltimore City Health Department is trying to connect with Family Physicians in high prevalence areas of Baltimore to offer COVID swabs that they can run at the State Health Department lab.  If interested, email Dr. Greenbaum.


AAFP Member Advantage Partners with Hippo Education to Offer New Member-Exclusive Benefit

AAFP Member Advantage has partnered with Hippo Education to bring you their podcast, Primary Care Reviews and Perspectives, which keeps family medicine clinicians up to date with engaging monthly episodes. Designed with your busy schedule in mind, this exclusive member benefit includes the following perks:

Earn 42+ hours of CME credit
Receive 15% off purchase
Hosted by the most entertaining and astute educators in medicine
Short, easily digested chapters
Start listening today!


Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients

Today, the Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak. Original Medicare and Medicare Advantage plans will cover COVID-19 lab tests consistent with CDC guidance.


One Item That Makes Documentation Easier During a Telehealth Visit

Telehealth visits have spiked during the COVID-19 pandemic. But it’s hard to document a visit on a computer while you’re also using it to communicate with a patient via video. Adding this one item to your setup makes it easier to do both at the same time, leaving less work after clinic.


June 16, 2020

CMS COVID-19 Stakeholder Engagement Calls – Week of 6/15/20
CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page here.


CMS COVID-19 Office Hours Calls (Tuesdays at 5:00 – 6:00 PM)
Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls;
  • Rapidly Expand the Healthcare Workforce;
  • Put Patients Over Paperwork; and
  • Further Promote Telehealth in Medicare
  • This week’s Office Hours:

Tuesday, June 16th at 5:00 – 6:00 PM

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 4527348

Audio Webcast link


Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM)
Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

This week’s Lessons from the Front Lines:

Friday, June 19th at 12:30 – 2:00 PM

Toll Free Attendee Dial-In: 833-614-0820; Access Code: 2258722

Web Link


59 Mental Health Resources for Health Care Providers

Working in health care has its stressors, with irregular hours, understaffing, lack of resources and worrisome patient situations, to name a few. Addressing mental and physical health needs is always important for health care providers. But in times of crisis, when health systems and workers are stressed to the max, prioritizing one’s own well-being is all the more important.

Taking care of mind, body and spirit is crucial for health care providers to stay healthy and continue to provide care. The online resources below can help individuals stay mentally healthy, no matter the circumstances. Read More


June 11, 2020

  • Coronavirus and MDPCP​ Practices – As MDPCP practices, you play an important role in the health and safety of Marylanders.  In light of the continued increase in positive cases of novel Coronavirus (COVID-19) in Maryland, the Program Management Office will be providing guidance and updates here specific to primary care practices. The Coronavirus outbreak continues to be a rapidly developing situation in regard to cases, transmission and testing. Find guidance, resources and webinars here: https://health.maryland.gov/mdpcp/Pages/Coronavirus.aspx

  • Up-to-date information about the Hogan administration’s ongoing response to COVID-19 is available at https://governor.maryland.gov/coronavirus/

June 10, 2020

PCC’s June Webinar: Behavioral Health and Primary Care During and After COVID-19
 
Monday, June 29, 2020 • 2-3pm

The COVID-19 pandemic could lead to 75,000 additional deaths from alcohol and drug misuse and suicide, according to an analysis by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care released in early May and titled Projected Deaths of Despair From COVID-19. This research underscores the fact that the pandemic has created enormous behavioral health (BH) concerns that primary care in tandem with BH can help address now and as the country emerges from the pandemic. We’ll hear creative ideas from two of the authors of the Deaths of Despair brief as well as from a patient who also provides peer support. Join us as we discuss the steps the primary care community can take to avoid the deaths predicted in the report and meet the behavioral health needs arising from both the health and economic crises.

Speakers:

  • Jack Westfall, MD, MPH | Director, Robert Graham Center
  • Benjamin Miller, PsyD | Chief Strategy Officer, Well Being Trust
  • Kelly Davis | Director of Peer Advocacy, Supports, and Services, Mental Health America

Moderator:

  • Arthur C. Evans, Jr., PhD | Chief Executive Officer and Executive Vice President, American Psychological Association

REGISTER HERE


June 9, 2020

Maryland COVID data dashboards; including cases by county and zip, testing and deaths can be found here:  https://coronavirus.maryland.gov/


Maryland’s Resources for Health Care Professionals – The Maryland Department of Health offers an abundance of resources including updates resources for health care professionals as they become available here: https://coronavirus.maryland.gov/pages/provider-resources


MotherToBaby Launches First COVID-19 in Pregnancy Study
A new study conducted by birth defects research experts from the non-profit Organization of Teratology Information Specialists (OTIS) launches to examine the short and long-term effects of the novel COVID-19 virus in pregnancy and breastfeeding. The observational study will consist of phone calls over the course of volunteers’ pregnancies and post-delivery, and/or breastmilk samples, as well as a release of medical records related to the pregnancy and the infant’s development.  Read More


PRIORITY Study 
PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) is a nationwide study of pregnant or recently pregnant people who are either under investigation for Coronavirus infection (COVID-19) or have been confirmed to have COVID-19. This study is being done to help patients and healthcare providers better understand how COVID-19 impacts pregnant people and their newborns.  Read More


International Registry of Coronavirus Exposure in Pregnancy (IRCEP)
Join the Registry to help other women who are pregnant or contemplating becoming pregnant and who are or may be infected with the SARS-CoV-2 virus, the cause of COVID-19.


June 2, 2020

Maryland Dept. of Health FAQ for Primary Care Providers 


Personal Protective Equipment Resources

Need PPE and looking for Maryland supplier recommendations? Visit these sites for more information:


Maryland Testing Sites information:

Looking for testing sites to refer your patients to?

Patients require a provider order for referral to the testing sites listed. Physicians should reach out to their local hospital or consult the link to testing sites below. These sites are subject to host locations restrictions and availability.  Also, the State is piloting drive-through testing at several Vehicle Emissions Inspections Program (VEIP) locations – FAQs available here​.

For a current list of testing sites in Maryland, please click here.


AAFP Virtual Town Hall – June 3, 8-9pm

Join the AAFP and two physician-legislators as they discuss recent federal legislative trends impacting primary care practices related to COVID-19. Our panelists will review actions that Congress and the administration have taken so far, and discuss what can be expected in the coming weeks and months.


AAFP COVID-19 CME Webinar Series – June 10, 8-9pm

This bi-weekly CME series with course chair, Nina Ahmad, MD, former AAFP Vaccine Science Fellow and CDC Epidemic Intelligence Service Officer, will be joined by special guests to cover clinical topics and perspectives for COVID-19.
Enhance your patient care today and earn up to 2 additional AAFP Prescribed credits when you complete the Translation to Practice® (t2p®) process.


June 1, 2020

The AAFP Needs Your Help in Urging Congress to Stabilize, Strengthen, and Sustain Primary Care READ MORE


“I’m a physician during a pandemic. Please don’t ask me how I’m doing.”

When you ask me, “How are you doing?” this is why I have no answer.

Four days a week, I have a (currently mostly virtual) primary care practice taking care of manageable problems, trying to teach folks how to take care of their chronic health conditions so they can continue to function and stave off catastrophic complications and premature death, and doing my best to address the anxieties of a traumatized, worried, frightened, mourning population through uncertain times, to say the least. Much of this work is (still) unpaid, and many people are avoiding everything medical these days, so revenues are way down (to be honest, independent primary care was struggling badly long before this pandemic came along) and the bills that I can’t pay are piling up.READ MORE


An excerpt from Board Chair John Cullen, MD’s Leader voices blog:

In our first virtual week of action, the Academy is calling on Congress to stabilize, strengthen and sustain primary care. We are urging members to amplify that message by posting short videos on your social media channels, tagging your members of Congress (and the Academy), and using the hashtag #StabilizeStrengthenSustain. Without limiting our scope to the number of members who can attend a live, two-day event, our more than 136,000 members can speak to legislators en masse during the course of an entire week, starting June 1.

AAFP officers have already posted videos you can use as examples to drive home our three-part call to action.

Highlighting the first part of our message, President-elect Ada Stewart, M.D.,(www.youtube.com) of Columbia, S.C., calls on Congress to stabilize primary care by passing H.R. 6837(www.congress.gov) and S. 3750,(www.congress.gov) a pair of bills that would reinstate the Medicare Accelerated and Advance Payment program for Part B providers and improve loan terms. She also declares that Congress should set aside at least $20 billion of provider relief funds from the Coronavirus Aid, Relief and Economic Security Act for primary care physicians.

In his video, AAFP President Gary LeRoy, M.D.,(www.youtube.com) calls on Congress to strengthen primary care by ensuring that CMS implements scheduled increases for Medicare evaluation and management payments as planned on Jan. 1. He also urges legislators to enact the Kids’ Access to Primary Care Act of 2020,(www.congress.gov) which would bring Medicaid payment rates to parity with those of Medicare. LeRoy notes that more than half of his patients in Dayton, Ohio, rely on Medicaid.

And in my video,(youtu.be) I highlight the financial strain on our practices and called for prospective payment systems that would better sustain primary care. This could be achieved by expanding, and improving funding for, CMS’ upcoming Primary Care First program or adopting the AAFP’s Advanced Primary Care Alternative Payment Model.(38 page PDF)

The AAFP has resources — detailed talking points and backgrounders for participants, sample tweets and tips for recording video messages optimal for social media — in its Family Medicine Action Network community.

For members who would prefer to write to their members of Congress, the Academy also has created distinct Speak Out resources that reflect the same three priorities:

Finally, please join us at 8p.m. on June 3 when Reps. Ami Bera, M.D., D-Calif., and Phil Roe, M.D., R-Tenn., are expected to participate in our weekly Virtual Town Hall meeting.  

Take action, and make your voice heard.

John Cullen, M.D., is Board chair of the AAFP.


May 28, 2020

Late yesterday, Governor Hogan held a press conference announcing another 14-day downward trend of key metrics allowing the State to take additional steps to complete Stage 1 of the recovery plan.  Maryland has reached its goal of performing 10,000 tests per day.  It has conducted a total of 300,444 tests statewide.  Two additional testing sites will open in Prince George’s County this week.  The State’s contact tracing program is fully operational with a 500% increase in tracing capacity and more than 1,400 case investigators statewide.  The State is tracking up to 1,000 cases and 10,000 contacts daily.  This gives the State the ability to take a closer and more accurate look at positivity rates, which is a key metric for recovery.  Maryland’s positivity rate peaked at 26.9%, but now sits at 12.8%.  Positivity rates in Baltimore City and Baltimore County are below the State average, while Prince George’s County and Montgomery County, though having dropped more than 50% from their respective peaks, remain above the State average.  The statewide average daily death rate has dropped by more than 50% from peak and total hospitalizations are down 22% from peak.  Just in the past 14 days, hospitalizations are down 17%.  ICU confinements have been on a steady plateau since April 29th. 

All of the State’s progress allows for safely moving forward with completion of Stage 1 of the recovery plan.  Effective Friday, May 29th, restaurants and social organizations (e.g. VFW, American Legion, Elks Club, etc.) can open for outdoor dining following strict guidelines of no more than 6 people at a table, single use of disposable menus, sanitization procedures for seating and surfaces, safe distance between tables, and staff training in COVID-19 safety guidelines.  Governor Hogan urged the closure of certain streets in Baltimore City, Annapolis, and Bethesda to help expand restaurant footprints allowing for safer outdoor dining to help struggling restaurants survive the crisis.  In addition, youth sports, day camps, outdoor pools, and drive-in movie theaters may reopen, but must follow CDC guidelines.

Maryland’s COVID-19 recovery team will continue to watch all of the data.  If encouraging trends continue into next week, the State can begin to enter Stage 2 of recovery, which would mean a lifting of the order and allowing nonessential businesses to reopen.  Governor Hogan again encouraged Marylanders to stay home, avoid crowds, telework, wear masks, practice physical distancing, and avoid public transit.

Detailed info and guidelines are available at open.maryland.gov/backtobusiness


Three-Part Practice Management CME Webinar Series starts TONIGHT!
Sustaining Telehealth in Family Medicine: Today and Tomorrow

Register Here

Speakers:

  • William ‘Chuck’ Thornbury, MD – Family Physician, Glasgow, KY
  • Jen Brull, MD – Post Rock Family Medicine, Plainville, KS

Moderator: Greg Griggs, MPA, CAE, Executive Vice President, North Carolina Academy of Family Physicians

Objectives:

  • Learn how frontline practices have quickly harnessed telehealth services to optimize practice revenue during this period of extreme health delivery interruption
  • Hear practical telehealth strategies that address topics ranging from patient communication and documentation, to workflow and payment processing
  • Understand how family physicians and their care teams can successfully incorporate telehealth services permanently into their post-COVID-19 workflow.

AAFP’s COVID-19 Latest Updates Page:  https://www.aafp.org/patient-care/emergency/2019-coronavirus/COVID-19-Latest.html?intcmp=nCoV_car_dpanCoV_promo_pos3


CMS is hosting it’s next COVID-19 conference call on Friday, May 29th from 12:30-2:00pm. Lessons from the Front Lines: COVID-19
Friday, May 29th at 12:30 – 2:00 PM

Toll Free Attendee Dial-In: 877-251-0301

Access Code: 6350189

Weblink

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page.


May 26, 2020

Personal Protective Equipment Resources

Need PPE and looking for Maryland supplier recommendations? Visit these sites for more information:


Maryland Testing Sites information:

Looking for testing sites to refer your patients to?

Patients require a provider order for referral to the testing sites listed. Physicians should reach out to their local hospital or consult the link to testing sites below. These sites are subject to host locations restrictions and availability.  Also, the State is piloting drive-through testing at several Vehicle Emissions Inspections Program (VEIP) locations – FAQs available here​.

For a current list of testing sites in Maryland, please click here.


Mental Health in a Time of COVID-19 Webinar Series

Part 3: Task-Shifting To Address Increasing Challenges

Tues., May 26th, 12:00pm, Register here

“Task-shifting” is a term used to describe when non-mental health professionals are trained to use specific skills when addressing mental health concerns. With the expected increase of mental health challenges related to COVID-19, our third webinar in this series will highlight faith-based and community groups that are using online training and resources to develop mental health skills in their leaders.

This webinar series addresses overwhelming stress the COVID-19 experience is placing on people and communities. 

·         Part 1: “Preparing Leaders to Address the Challenges,” (webcast April 28, 2020, download the recording).  

·         Part 2: “When Trauma, Fear, and Anxiety Become Overwhelming,” (webcast May 12, 2020, download the recording). 

·         Part 3: “Task-shifting to Address Increasing Challenges,” May 26 at 12 pm ET. , Register here

·         Part 4: “Connecting Spirituality to Mental Health Services in the Midst of the Crisis,” June 9 at 12 pm ET. Registration opening soon


Medicare Payment for COVID-19 Diagnostic Tests

Earlier this year, CMS took action to ensure America’s patients, health care facilities, and clinical laboratories were prepared to respond to COVID-19. To help increase testing, CMS developed two codes that laboratories can use to bill for certain COVID-19 lab tests, including serology tests. CMS has updated its guidance to include payment details for additional CPT codes created by the American Medical Association. There is no cost-sharing for Medicare patients.

Guidance


AAFP CME Updates: Managing COVID-19 with Limited Resources: A Rural Family Physician’s Experience


REMINDER: For the most up to date information on COVID-19 please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html. Please note: The COVID-19 pandemic is affecting healthcare seeking behavior. The number of persons and their reasons for seeking care in the outpatient and ED settings is changing. These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution. CDC is tracking the COVID-19 pandemic in a weekly publication called COVIDView.


May 19, 2020

From MD Department of Human Services Social Services Administration – Child Welfare Assistance due to COVID-19

The COVID-19 public health emergency has had a large impact on our families, increasing stress and leading to a host of challenges to their health and well-being.  Primary care providers are increasingly serving families whose economic and social needs are escalating due to COVID-19. Asking about social needs—rather than waiting for families to volunteer this information—is critical to addressing early childhood adversity. 

Additionally, with the public health emergency calling for physical spacing and the closure of many institutions such as schools, mandated and other potential reporters of abuse and neglect are not able to observe and intervene.  The state’s jurisdictions are receiving fewer reports from day-care workers, teachers, coaches, counselors and medical professionals, at a time when families are experiencing unprecedented changes and hardships.  

The mission of the Maryland Department of Human Services, Social Services Administration (SSA) and the twenty-four local departments of social services is to prevent child abuse and neglect, protect vulnerable children and to preserve and strengthen families. The local departments in every county and Baltimore City continue to be available to receive and respond to referrals, not only for the abuse and/or neglect of children but also for families who are in need of supportive services from the community.

Two Practice Bulletins produced by Chapin Hall at the University of Chicago, a research center dedicated to promoting the well-being of children, youth, and families are available. These Bulletins contain evidence-based tips on how health care providers can sensitively and effectively engage families about their social needs and referrals to ensure that they get the services they need.   

1)    Conversations with Families to Assess Needs provides thoroughly sourced practice recommendations for having empathetic conversations with families to assess social needs that could have health impacts.

2)    Community Resources for Patient Referrals outlines strategies for health care providers to identify the services that patients and their families need.

As Marylanders, we are all in these challenging times together.  There are myriad resources available in the community to assist families, and include:

The Family Tree’s 24-hour Parenting HelpLine: 1-800-243-7337

United Way of Maryland 211 Helpline: Call or text your Zip Code to 898-211

National Suicide Hotline: 1-800-784-2433 or 1-800-273-8255 

National Domestic Violence Hotline: 1-800-799-SAFE or online at https://www.thehotline.org/  

Local Department of Social Services In-Home Services: online at http://dhs.maryland.gov/local-offices/

Maryland Food Bank: 410-737-8282

Lastly, the Maryland Department of Human Services has a web page listing possible signs of maltreatment: http://dhs.maryland.gov/knowthesigns


Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2020 Update — Revised

A revised MLN Matters Article MM11661 on Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2020 Update (PDF) is available. Learn about revised relative value units for codes 99441, 99442, and 99443 and additional information for codes G2025 and G0071.


How to Use the Medicare Coverage Database — Revised

A revised How to Use The Medicare Coverage Database Medicare Learning Network Booklet is available. Learn how to:

  • Navigate the database
  • Search indexes
  • Download reports

Medicare Clarifies Recognition of Interstate License Compacts

A new MLN Matters Special Edition Article SE20008 on Medicare Clarifies Recognition of Interstate License Compacts (PDF) is available. Learn about recognition of interstate license compacts as valid and full licenses.


Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)

A new MLN Matters Article MM11784 on Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (PDF) is available. Learn about implementation of the new April 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule amounts.


International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–October 2020 Update

A new MLN Matters Article MM11749 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–October 2020 Update (PDF) is available. Learn about updated ICD-10 conversions and codes.


May 18, 2020

The Maryland Department of Health recognizes that primary care providers play an important role in the health and safety of the citizens of Maryland. Visit their website for the most up to date guidance and resources.

https://health.maryland.gov/mdpcp/Pages/Coronavirus.aspx


May 14, 2020

1] UM Support for Community Providers – Upcoming Webinars Next Week

Over the past couple of weeks, several community providers have reached out requesting additional information clinically on COVID-19 and  also research trials that are ongoing at UMMS so that they may engage their patients.  In response, the University of Maryland School of Medicine (UMSOM) Center for Vaccine Development and Global Health, the University of Maryland Children’s Hospital, and UMMS Physician Liaison group, brings to the community the following webinars below.  

a)      May 19, 2020 at 6pm-7pm – Support for Pediatric Providers during the COVID-19 Pandemic Webinar;  Dr. Steven Czinn, professor and chairman or the Department of Pediatrics from University of Maryland School of Medicine (UMSOM) and University of Maryland Children’s Hospital (UMCH) will co-host this webinar along with Center for Vaccine Development and Global Health.  

REGISTRATION LINK: https://attendee.gotowebinar.com/register/5549245487720556814

Guest speaker:

Dr. James Campbell,

Professor of Pediatrics

University of Maryland School of Medicine

Center for Vaccine Development and Global Health

Dr. Campbell is a pediatric infectious disease specialist. He has been a principal investigator on numerous pediatric vaccine trials both domestically and internationally. He is a respiratory virus expert and an expert on other infectious diseases impacting children. He will share what we are seeing pertaining to an alarming decline in pediatric vaccinations in our COVID-19 world and potential impact within the community.

b)       May 21, 2020 at  6pm-7pm- Session 2- Support for Community Providers- COVID-19 – Ask the Experts Panel with the UMSOM Center for Vaccine Development and Global Health;  During this time, we will have several guest speakers join our panel and provide an overview of the COVID-19 research trials at Center for Vaccine Development and Global Health and the most up-to-date information of COVID-19.

REGISTRATION LINK: https://attendee.gotowebinar.com/register/1468832492852534795

Guest Speakers:
Kathleen Neuzil MD, MPH, FIDSA

Myron M. Levine, MD Professor in Vaccinology

University of Maryland School of Medicine

Director, Center for Vaccine Development and Global Health

Miriam Laufer, MD, MPH 

Professor of Pediatrics

University of Maryland School of Medicine

Center for Vaccine Development and Global Health

Wilbur Chen, MD, MS

Associate Professor of Medicine

University of Maryland School of Medicine

Center for Vaccine Development and Global Health

Topics:

·         Overview of COVID-19 and challenges/processes with re-entry after shutdown

o    Wilbur Chen, MD, MS

·         Overview of the vaccine research landscape, timing, our trials, what we should see going forward

o    Kathleen Neuzil MD, MPH, FIDSA

·         Overview of COVID-19 therapies and research, what is currently being test, what’s up next timing etc.

o    Miriam Laufer, MD, MPH  

2] COVID-19 Workshop Series Update

Don’t forget to register for the CMS webinar today. Learn how to enroll in and report data for the National Healthcare Safety Network (NHSN) COVID-19 module.

Missed last week’s webinar? View our May 7 webinar recording and slides.

Stay tuned! Our workshop series continues next Thursday, May 21.

3] Public Health Recommendations for Community-Related Exposure

Current guidance based on community exposure, for asymptomatic persons exposed to persons with known or suspected COVID-19 or possible COVID-19

Travelers, health care workers and critical infrastructure workers should follow guidance that include special consideration for these groups. CDC’s recommendations for community-related exposures are provided below. Individuals should always follow guidance of the state and local authorities.

Current guidance based on community exposure, for asymptomatic persons exposed to persons with known or suspected COVID-19 or possible COVID-19.

Person
Exposure to
Recommended Precautions for the Public
Household member
Intimate partner
Individual providing care in a household without using recommended infection control precautions
Individual who has had close contact (< 6 feet)** for a prolonged period of time ***
Person with symptomatic COVID-19 during period from 48 hours before symptoms onset until meets criteria for discontinuing home isolation
(can be a laboratory-confirmed disease or a clinically compatible illness in a state or territory with widespread community transmission)
Stay home until 14 days after last exposure and maintain social distance (at least 6 feet) from others at all times
Self-monitor for symptoms Check temperature twice a day
Watch for fever*, cough, or shortness of breath
Avoid contact with people at higher risk for severe illness (unless they live in the same home and had same exposure)
Follow CDC guidance if symptoms develop
All U.S. residents, other than those with a known risk exposureknown risk exposure
Possible unrecognized COVID-19 exposures in U.S. communities
Be alert for symptoms Watch for fever*, cough, or shortness of breath
Take temperature if symptoms develop
Practice social distancing Maintain 6 feet of distance from others
Stay out of crowded places
Follow CDC guidance if symptoms develop

COVID-19: Office Hours Call — May 14
Thursday, May 14 from 5-6pm

Hospitals, health systems, and providers: Ask CMS questions about our temporary actions that empower you to:

Increase hospital capacity – CMS Hospitals Without Walls
Rapidly expand the health care workforce
Put patients over paperwork
Promote telehealth
To Participate:

Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
Or, call 833-614-0820; Access Passcode: 5688374


COVID-19: Lessons from the Front Lines Call — May 15
Friday, May 15 from 12:30 to 2pm

These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.

To Participate:

Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
Or, call 877-251-0301; Access Code: 8983296

For More Information:

Coronavirus.gov
CMS Current Emergencies website
Podcast and Transcripts webpage: Audio recordings and transcripts


May 13, 2020

1] AAFP advocating for financial relief for Family Physicians

https://www.aafp.org/patient-care/emergency/2019-coronavirus/financial-relief.html

2] Telehealth Codes covered by CMS

An Excel spreadsheet that represents all codes covered by CMS for telehealth is available.

3] Price Transparency: Requirement to Post Cash Prices Online for COVID-19 Diagnostic Testing

The Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a number of provisions to provide relief to the public from issues caused by the pandemic, including price transparency for COVID -19 testing. Section 3202(b) of the CARES Act requires providers of diagnostic tests for COVID-19 to post the cash price for a COVID-19 diagnostic test on their website from March 27 through the end of the public health emergency. For more information, see the FAQs.


May 12, 2020

1] Mental Health in a Time of COVID-19 Webinar Series was launched. Part 1: Preparing Leaders to Address the Challenges was Recorded.

You can Register Here for Part 2: When Trauma, Fear, Anxiety Become Overwhelming, scheduled for Tuesday, May 12, 12:00pm. 

As a result of COVID-19, many may experience increases in negative emotions like fear and anxiety. For some, the event may be traumatic in and of itself or lead to individuals remembering trauma from the past. Faith and community leaders themselves may even be experiencing some of these challenges. This webinar will help participants know how to acknowledge and respond to higher levels of fear and anxiety in individuals. It will also help leaders ask the appropriate questions to consider the impact of trauma in people’s lives. Lastly, it will suggest strategies for how faith and community leaders can respond.

2] CMS Releases Additional Waivers for Hospitals and Other Facilities 

CMS continues to release waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency (PHE). CMS recently provided additional blanket waivers for the duration of the PHE that:

  • Expand hospitals’ ability to offer long-term care services (“swing beds”);
  • Waive distance requirements, market share, and bed requirements for Sole Community Hospitals;
  • Waive certain eligibility requirements for Medicare-Dependent, Small Rural Hospitals (MDHs); and
  • Update specific life safety code requirements for hospitals, hospice, and long-term care facilities.

Emergency Declaration Blanket Waivers

3] Telehealth Video: Medicare Coverage and Payment of Virtual Services

CMS updated a video that answers common questions about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency. New information includes how CMS adds services to the list of telehealth services, additional practitioners that can provide telehealth services, and the distant site services that Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can provide. Further, the video includes information about audio-only telehealth services, telehealth services that hospitals, nursing homes and home health agencies can provide, along with how to correctly bill for telehealth services.

4] Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing

CMS published information for pharmacies and other suppliers that wish to enroll in Medicare temporarily as independent clinical diagnostic laboratories to help address the need for COVID-19 testing. Interested pharmacies and suppliers will need to apply for a Clinical Laboratory Improvement Amendments (CLIA) certificate. CMS wants to ensure that laboratories located in the United States applying for a CLIA certificate are able to begin testing for COVID-19 as quickly as possible.

MLN Matters Article


May 11, 2020

CDC updated guidelines for “Persons Who have NOT had COVID-19 Symptoms but Tested Positive and are Under Isolation” last weekend (03 May 2020). There are two approaches to ending home isolation in those without symptoms:

Test-Based Strategy: “Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart”

Time-Based Strategy: “At least 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test.”

Sources:
www.cdc.gov/coronavirus/2019-ncov/hcp/…
www.cdc.gov/coronavirus/2019-nCoV/hcp/…



2] CMS COVID-19 Lessons from the Front Lines:

Friday, May 8th at 12:30 – 2:00PM

Toll Free Attendee Dial-In: 877-251-0301; Access Code: 9146779

Web Link

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page.


3] AAFP COVID-19 Member Exchange – New Amazon Site for Medical Supplies and PPE:

Amazon Business has created a website specifically for the purchase of medical supplies and PPE. All you need to do is login with or create an Amazon Business account. If you create a new account it can take up to 48 hours to be pre-vetted and given permission to purchase through the site. Learn more in the AAFP COVID-19 Member Exchange.


4] AAFP CME Updates: Managing the COVID-19 Crisis: A Nursing Facility Physician’s Perspective

As COVID-19 infections spike across the country, the impact of outbreaks among vulnerable patients in nursing facilities remain a major concern. Join Course Chair Nina Ahmad, MD, and Everett Schlam MD, for “Managing the COVID-19 Crisis: A Nursing Facility Physician’s Perspective”, to hear his experiences in trying to prevent patient exposure, structure resources to provide appropriate care management of patients with mild symptoms, and implementing appropriate precautions to protect staff in a nursing home environment.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

Join the live webinar on Friday, May 8th at 8pm via the links below:

Facebook

YouTube

Twitter

AAFP continues to add new CME sessions on COVID-19 topics regularly here, where you can find links to previous COVID-19 CME webinars as well as the extensive COVID-19 Pandemic Self-Study Series. All of these activities are free to AAFP members. On May 12th, a new session on COVID-19 Testing will launch in the self-study series.  Please let AAFP know if there are Pandemic related topics you feel we should address in our CME sessions that we haven’t.

5] AMENDED DIRECTIVE AND ORDER REGARDING VARIOUS HEALTHCARE MATTERS

Robert R. Neall, Secretary of Health, authorized the following actions for the prevention and control of COVID-19 under the Governor’s Declaration of Catastrophic Health Emergency. This Directive and Order replaces and supersedes the Directives and Orders Regarding Various Healthcare Matters, dated April 5, and March 23, 2020 and the Directive and Order regarding Availability of Testing dated March 20, 2020. READ MORE


May 6, 2020

1] CMS increases payment rates for audio-only telehealth

The CMS has increased reimbursement rates for audio-only telemedicine to match those for in-person visits, a move the AAFP has supported since the beginning of the COVID-19 pandemic. The Academy and other medical groups sent a letter to congressional leaders saying flexibility was needed to ensure care for vulnerable populations, noting that some patients, including seniors, have access to phones but not video-enabled telehealth apps.

Full Story: AAFP News

2] Patient care and practice flowCDC COVID-19 Phone Advice Line Tools and Algorithm (Printer-friendly version)

  • Phone Script pp. 2-5
  • Clinical Decision Algorithm to Guide Care Advice pp. 6-11

3] Staff education & resourcesCDC Interim Guidance for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19 (Printer-friendly version)

4] Health Resources and Services Administration (HRSA) recently launched COVID-19 Uninsured Program Portal where health care providers who have conducted COVID-19 testing of uninsured individuals for COVID-19 or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims for reimbursement. 

Providers will be reimbursed, generally at Medicare rates, subject to available funding. Steps will involve:

–         Enrolling as a provider participant

–          Checking patient eligibility

–          Submitting patient information,

–          Submitting claims,

–          Receiving payment via direct deposit.

To learn more about the program, including the registration and claim submission process, go to COVIDUninsuredClaim.HRSA.gov. HRSA also developed a video overview of the program. In addition, providers can access real-time technical support, as well as service and payment support, by calling the Provider Support Line at 866-569-3522. The hours of operation are 8 a.m. to 8 p.m. Monday through Friday in your local time zone

Please do not hesitate to reach out to HRSA’s Office of Regional Operations with questions, concerns, or requests for support and engagement. 

5] CRISP CRS COVID-19 Vulnerability Index: Using Medicare and Medicaid claims data for Maryland patients and population health analytics vendor Socially Determined’s COVID-19 Social Susceptibility Index, CRISP has created a list of members who could be at a higher risk. The COVID-19 Vulnerability Index (CVI) has been included for higher risk patients in the MDPCP Likelihood of Avoidable Hospital Events (Pre-AH tool) for CTO and practice beneficiaries.  Demonstration Webinar

The aim of the index is to assist care teams in identifying the most vulnerable patients for proactive outreach and support.

6] Equipment & Testing

  • PPE Emergency Form: PPE Emergency Medical Material Request Form **Please submit form to your Local Health Department
  • The State is piloting drive-thru testing at several Vehicle Emissions Inspections Program (VEIP) locations (VEIP Testing Sites FAQs **Updated 4/28/20)
  • Non-Office Based Testing Sites (Information as of 4/27/20; Patients require a provider order for referral. Providers should reach out to their local hospital or consult the link to testing sites below. These sites are subject to host locations restrictions and availability.)

7] Telemedicine

9] Call for additional COVID-19 Personnel

10] Webinars: MDPCP is still offering webinars. If you have any questions or topics of interest, please complete this survey.  You complete this survey if you are interested in participating in the Provider Panel on Fridays


Wednesday, May 6
 (5:00 pm – 6:00 pm) – *Special guest: Behavioral Health Administration*

Social Needs and COVID-19Thursday, May 7 (5:00 pm – 6:00 pm) 
 

Friday, May 8 (12:00 pm – 1:00 pm) – *Special guests: Provider Panel*

Advance Care Planning and COVID-19Thursday, May 21 (5:00 pm – 6:00 pm)


May 5, 2020

Reminder: CDC has most up to date COVID-19 Information

For the most up to date information on COVID-19 please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html. Please note: The COVID-19 pandemic is affecting healthcare seeking behavior. The number of persons and their reasons for seeking care in the outpatient and ED settings is changing. These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution. More detailed interpretation of data and more COVID-19 specific information can be found in COVIDView.


May 4, 2020

1] National Academy of Science: Helping People With Addiction Stay Connected During COVID-19 (Webinar #1)

May 7, 2020 | 11 am to 12:30 pm https://nam.edu/programs/action-collaborative-on-countering-the-u-s-opioid-epidemic/treatment-webinar-series/

This free 90-minute webinar will provide insights on issues of access to addiction treatment and targeted guidance on how to effectively keep patients connected to treatment during the COVID-19 pandemic. This webinar has been approved for 1.5 hours of AMA PRA Category 1 credits.

2] CMS Medical Learning Network: New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) MLN Matters Article

A revised Medical Learning Network Matters Special Edition Article SE20016 on New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) is available. Learn new information on billing for distant site telehealth services during the COVID-19 PHE, including:

·         New telehealth services that can be provided by RHCs and FQHCs, including audio only telephone evaluation and management services

·         Revised bed count methodology for determining the exemption to the RHC payment limit for provider-based RHCs.

3] Rasky Partners Releases Updated Briefing May 1st: Update on Federal Stimulus Efforts in Response to COVID-19

Rasky Partners continues to be immersed in how the federal government is responding to the COVID-19 pandemic and what that means for various stakeholders. For the latest information, intelligence and analysis regarding additional stimulus efforts in a concise, easy to understand briefing, click here.

4] HHS Begins Distribution of Payments to Rural Providers (and Hospitals with High COVID-19 Admissions)

On May 1, the Department of Health and Human Services (HHS) is processing payments from the Provider Relief Fund to hospitals with large numbers of COVID-19 inpatient admissions through April 10, 2020, and to rural providers in support of the national response to COVID-19. 

“These new payments are being distributed to healthcare providers who have been hardest hit by the virus: $12 billion to facilities admitting large numbers of COVID-19 patients and $10 billion to providers in rural areas, who are already working on narrow margins,” said HHS Secretary Alex Azar. “HHS has put these funds out as quickly as possible, after gathering data to ensure that they are going to the providers who need them the most. With another $75 billion recently appropriated by Congress, the Trump Administration will continue doing everything we can to support America’s heroic healthcare providers on the frontlines of this war on the virus.”

5] Rural Distribution: 

Rural hospitals, many of whom were operating on thin margins prior to COVID-19, have also been particularly devastated by this pandemic. As healthy patients delay care and cancel elective services, rural hospitals are struggling to keep their doors open.  

Recipients of the $10 billion rural distribution will include, rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers located in rural areas. 

Hospitals and RHCs will each receive a minimum base payment plus a percent of their annual expenses. This expense-based method accounts for operating cost and lost revenue incurred by rural hospitals for both inpatient and outpatient services. The base payment will account for RHCs with no reported Medicare claims, such as pediatric RHCs, and CHCs lacking expense data, by ensuring that all clinical, non-hospital sites receive a minimum level of support no less than $100,000, with additional payment based on operating expenses. Rural acute care general hospitals and CAHs will receive a minimum level of support of no less than $1,000,000, with additional payment based on operating expenses.

Eligible providers will begin receiving funds in the coming days via direct deposit, based on the physical address of the facilities as reported to the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), regardless of their affiliation with organizations based in urban areas.

View the state-by-state breakdown.

HHS and the Administration are continuing to work rapidly on additional targeted distributions to some providers including skilled nursing facilities, dentists, and providers that solely take Medicaid.

Visit hhs.gov/providerrelief for additional information.

6] New Frequently Asked Questions on EMTALA

CMS issued Frequently Asked Questions (FAQs) clarifying requirements and considerations for hospitals and other providers related to the Emergency Medical Treatment and Labor Act (EMTALA) during the COVID-19 pandemic. The FAQs address questions around patient presentation to the emergency department, EMTALA applicability across facility types, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, and other topics.

Frequently Asked Questions

7] Guidance Available on Telehealth and HHS-Operated Risk Adjustment for Individual and Small Group Health Insurance Health Plans

In response to the increased need for providing telehealth due to COVID-19, CMS has given additional consideration to telehealth services in HHS-operated risk adjustment for issuers in the individual and small group health insurance markets inside and outside the Marketplaces. CMS’ new guidance clarifies which telehealth services are valid for HHS-operated risk adjustment data submission in light of the COVID-19 pandemic.

Frequently Asked Questions

8] Dear Clinician: CMS Adds New COVID-19 Clinical Trials Improvement Activity to the Quality Payment Program

CMS issued a letter thanking clinicians for their ongoing efforts to treat patients and combat COVID-19 and shared additional details on the new Merit-Based Incentive Payment System (MIPS) improvement activity. As announced earlier this month, clinicians who participate in a COVID-19 clinical trial and report their findings to a clinical data repository or registry many now earn credit in MIPS under the Improvement Activities performance category for the 2020 performance period by attesting to this new activity.

Dear Clinician Letter


May 1, 2020

1] Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

At President Trump’s direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, on April 30, 2020, the Centers for Medicare & Medicaid Services, issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.

Full press release

2] New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) MLN Matters Article

A revised MLN Matters Special Edition Article SE20016 on New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) is available. Learn new information on billing for distant site telehealth services during the COVID-19 PHE, including:

  • New telehealth services that can be provided by RHCs and FQHCs, including audio only telephone evaluation and management services
  • Revised bed count methodology for determining the exemption to the RHC payment limit for provider-based RHCs

3] AAFP Friday CME: Managing the COVID-19 Crisis: An Emergency Room Family Physician’s Perspective

Join us today on Friday, May 1st at 8pm for Managing the COVID-19 Crisis: An Emergency Room Family Physician’s Perspective. Course Chair Nina Ahmad, MD, and Robert Dachs, MD, FAAFP, a New York Emergency Room Physician, will discuss his firsthand experiences in managing COVID-19 patients. Discover strategies that have worked and those that needed to be modified based on observation.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

You can join the webinar via the links below:

Facebook

YouTube

Twitter

4] AFP Has a New COVID-19 Resource Page

Find all of the information you need about the COVID-19 pandemic here. It contains useful content from AFP, FPM, and Annals of Family Medicine, as well as “COVID-19 Daily Research Briefs” to summarize the latest evidence on this evolving topic. The site is being updated regularly so check back often.


April 30, 2020

AAFP Virtual Town Hall COVID-19 On Demand

Did you miss an AAFP’s Virtual Town Hall on COVID-19 weekly session? Now you can watch it anytime, anywhere — on demand. Plus, earn AAFP Prescribed credit.

AAFP leadership and experts field questions and provide the most current information on how you and your practice can weather this health care crisis.

AAFP President Gary LeRoy, MD, FAAFP
AAFP SVP Julie Wood, MD, MPH, FAAFP

ON DEMAND HERE


April 29, 2020

1] Reminder from AAFP: Town Hall tonight | Earn CME

COVID-19 has exposed some of the health disparities that exist in the U.S. Join AAFP President Gary LeRoy MD, Santina Wheat MD, AAFP Director, Center for Diversity and Health Equity Danielle Jones and me tomorrow at 8 p.m. We’ll discuss the social, economic and health inequities that place vulnerable populations at an increased risk of complications from COVID-19 and identify potential mitigation strategies for improving health outcomes in this group during the pandemic.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

 You can join the Town Hall via the links below:

Facebook

Youtube

Twitter

2] CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.


April 28, 2020

1] CMS Releases COVID-19 Toolkit to Accelerate State Use of Telehealth in Medicaid and CHIP

CMS released a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the COVID-19 pandemic. The toolkit will help states identify policies that may impede the rapid deployment of telehealth when providing care. This release builds on the agency’s swift actions to ensure that Americans can access the health care services they need through electronic and virtual means, minimizing travel to healthcare facilities and supporting efforts to limit community spread of the virus.

Press Release

Toolkit


2] Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know

With the rise in COVID-19 cases and the need for surge planning, acquiring basic ventilator management skills is now essential for many family physician learners. AAFP is adding additional CME activities each week here. In addition, new information to our journal website is added each day, including a daily COVID-19 research brief here.

3] Enrichment Credit

We know that you are diligently working to keep up on COVID-19. Did you know that all of the reading and independent study that you are doing can be counted as CME credit? This independent study can be claimed as Professional Enrichment credit. Simply go to www.aafp.org/mycme choose the Report CME tab and look for Professional Enrichment in the Self-Directed Learning Activities section. Limited to 25 AAFP Elective credits per three-year re-election cycle.


April 27, 2020

1] Governor outlines Roadmap to Recovery

Friday, 4/24, Governor Hogan outlined his Roadmap to Recovery for the State.  Here is a summary of what he said:

  • The State will continue to look for a 14-day downward trend in key numbers before loosening of restrictions will move forward:  1) the # of hospitalizations, and 2) the # of ICU admissions, and 3) the # of deaths.  A one day increase in any number does not require that the 14 day count start over; rather, it is the trend the Governor will focus on.
  • These numbers continue to rise at present, though Dr. Inglesby of JHU also said other numbers have begun to plateau.
  • The Governor outlined “Building Blocks” that will be the foundation for the 3 Stages of Re-opening set out below:
    • Expanded Testing
    • Increased Hospital Surge Capacity
    • Adequate PPE Supply
    • Increased Contact Tracing
  • The 3 Stages of reopening are below.  These will occur gradually and require that the Building Blocks above remain in place:
    • Stage 1:  Lifting Stay @ Home Order; reopen some small businesses; allow outdoor recreation and other low risk activities; elective surgeries allowed; more flexibility in non-surge areas
    • Stage 2:  Increase limit on social gathering; bars and restaurants reopening with safety restrictions; non-essential workers begin to return
    • Stage 3:  Large gatherings allowed; high capacity bars and restaurants reopening; family visits to nursing homes allowed.
  • The Governor will rely on input from various industries on the details of how various industries will reopen.

2] ACTION REQUIRED to receive additional provider relief funds

Last week the Department of Health and Human Services (HHS) announced its plans for distributing the remainder of the provider relief funds authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. At the time, they indicated an additional $20 billion was being allocated to Medicare providers – both independent providers and health care/hospital systems. This weekend, we received more details about how the funding will be distributed.

Unlike the first round of funding, you need to take action to receive any money from this allocation. It is important that you act quickly to submit the necessary information as we anticipate this money will go quickly.
·         To get stared, you’ll need your practice’s Taxpayer Identification Number or TIN.

·         For details about what information you need to complete the application visit the CARES Act Provider Relief Fund Application Guide

·         To apply, visit the CARES Provider Relief Fund Payment Portal.

·         If you have questions, visit the General Distribution Portal FAQs or call the CARES Provider Relief line at 866-569-3522.
Again, we encourage you to complete this information as soon as possible to increase your chances of getting money from this latest funding allocation.

3] CDC Rural Health Site

Visit the CDC site for rural-specific information and while you are there listen to the –updates for Rural Health Partners, Stakeholders, and Communities on the 2019 Coronavirus Disease Response– webinar series.

4] CDC COVID-19 Most Up-to-Date Resources

For the most up to date information on COVID-19 please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html. Please note: The COVID-19 pandemic is affecting healthcare seeking behavior. The number of persons and their reasons for seeking care in the outpatient and ED settings is changing. These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution. More detailed interpretation of data and more COVID-19 specific information can be found in COVIDView.

5] New COVID-19 resource for non-English speaking patients
Introducing a new COVID-19 resource that makes information more accessible to communities with limited English proficiency.  Available from Communities Concerned for Immigrants and Refugees it provides infographics, posters and videos on hand washing, face covering and symptoms checker in more than 40 languages.   

Resources By Language
https://ccirkc.com/covid-19-resources-language


April 22, 2020

1] FRIDAY, 4/24 CME webinar – Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know

With the rise in COVID-19 cases and the need for surge planning, acquiring basic ventilator management skills is now essential for many family physician learners.

On Friday, April 24 at 8:00 PM, join our Course Chair, Nina Ahmad, MD and critical care/ respiratory care physician, Gregory Botz, MD for: Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know and Do.

Viewers can ask their questions live and earn 1 CME credit for participating. Members on the AAFP COVID-19 Rapid Response Member Exchange can reply to the thread that went out this morning from Dr. Clif Knight with any questions you would like to pose to the Faculty Chair and Guest.

Facebook: www.facebook.com/familymed/videos/517077152293100

You can join the webinar via the links below:

YouTube: www.youtube.com/watch?v=CyUyVIUll3s

Twitter: twitter.com/aafp

AAFP is adding additional CME activities each week at www.aafp.org/patient-care/emergency/2019-coronavirus/… 

In addition, new information to our journal website is added each day, including a daily COVID-19 research brief at www.aafp.org/journals/afp/explore/…  

2] HHS Targeted Relief Fund Data Submission Communication

The CARES Act appropriated $100 billion to establish a Provider Relief Fund. This Fund, administered by the Secretary of Health and Human Services (HHS), is being used to distribute payments to health care entities across the country that have been affected by the coronavirus. To date, $30 billion has been distributed generally to health care entities across the country. HHS will soon make targeted distributions to hospitals and other facilities that have been particularly affected by the increased burden of caring for those with the coronavirus. To inform how these funds are distributed, click here.


April 21, 2020

Trump Administration Champions Reporting of COVID-19 Clinical Trial Data through Quality Payment Program, Announces New Clinical Trials Improvement Activity
Improved availability of data key to driving improvement in patient care and development of innovative practices

The Centers for Medicare & Medicaid Services (CMS) is encouraging clinicians who participate in the Quality Payment Program (QPP), such as physicians, physician assistants, nurse practitioners, and others, to contribute to scientific research and evidence to fight the Coronavirus Disease 2019 (COVID-19) pandemic. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS), a performance-based track of QPP that incentivizes quality and value, for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. This action will provide vital data to help drive improvement in patient care and develop innovative best practices to manage the spread of COVID-19 within communities.

“The best scientific and medical minds in the world are working night and day to find treatments to combat Coronavirus,” said CMS Administrator Seema Verma. “But without solid data, their efforts are liable to run up against a brick wall. At the direction of President Trump, CMS is supporting efforts of researchers to obtain solid, actionable data to accelerate the development of new treatments and our understanding of the coronavirus.  Today’s action encourages clinicians to report data that will help us monitor the spread of the virus, find innovative medical solutions, and unleash scientific discovery as we seek to overcome this terrible disease.”

In order to receive credit for the new MIPS COVID-19 Clinical Trials improvement activity, clinicians must attest that they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study.  

The new improvement activity provides flexibility in the type of clinical trial, which could include the traditional double-blind placebo-controlled trial to an adaptive or pragmatic design that flexes to workflow and clinical practice. It also carries a high weight from a scoring perspective. This means that clinicians who report this activity will automatically earn half of the total credit needed to earn a maximum score in the MIPS improvement activities performance category, which counts as 15 percent of the MIPS final score.

For example, clinical trials could include those conducted by the National Institute of Health (NIH). Clinicians could also report through a clinical data repository, such as Oracle’s COVID-19 Therapeutic Learning System. Oracle has developed and donated a system to the U.S. government that allows clinicians and patients at no cost to record the effectiveness of promising COVID-19 drug therapies. Having clinicians use an open source data tool to submit their findings will bring the results of their research to the forefront of healthcare much faster, leading to improvements in care delivery and the ability to treat COVID-19 patients.

This action, along with the unprecedented regulatory flexibilities recently introduced, is just one part of the agency’s efforts to address the COVID-19 pandemic. CMS, in coordination with the White House Coronavirus Task Force, remains committed to  reducing regulator burden and supporting clinicians, stakeholders, and the health care community to identify unique solutions that enhance care for patients and further mitigate the spread of the virus. 

This action, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov.  For information specific to CMS, please visit the Current Emergencies Website.

To view a database of privately and publicly funded clinical studies currently being conducted on corona virus visit:  https://clinicaltrials.gov/


April 20, 2020

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19

Sunday, April 19, the Centers for Medicare & Medicaid Services issues new recommendations specifically targeted to communities that are in Phase 1 of the Guidelines for President Trump’s Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures. The new CMS guidelines recommend a gradual transition and encourage health care providers to coordinate with local and state public health officials, and to review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity when making the decision to re-start or increase in-person care.

The new recommendations can be found here: https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

The Guidelines for Opening Up America Again can be found here: https://www.whitehouse.gov/openingamerica/#criteria


April 16, 2020

1] AAFP Discount for Interact’s Telehealth Rapid Ramp-Up Online Course

With the COVID-19 Pandemic, the need to quickly provide quality telehealth services grows every day. For Primary Care Physicians, telehealth not only protects the communities you serve, but also provides additional income while office visits are down as a result of stay-at-home orders in effect across the country.  At Interact, we recognize this need and would like to extend an offer to AAFP members during these trying times. That’s why we are offering 20% off our $49, 30-minute Telehealth Rapid Ramp-Up Course to members using the code AAFPsaves at checkout.  Whether you are new to telehealth or are already providing those services to your patients, there is something to gain from taking this 30-minute online course. Telehealth is here to stay, and most providers don’t just want to “do” telehealth, they want to do it well. Our course focuses on the aspects of providing telehealth that may not come naturally to providers but are a major part of the patient experience.

Use code AAFP saves at checkout to receive 20% off our $49 Telehealth Online Course! GET THE COURSE HERE


2] Trump Administration Announces Expanded Coverage for Essential Diagnostic Services Amid COVID-19 Public Health Emergency

CMS, together with the Departments of Labor and the Treasury, issued guidance to ensure Americans with private health insurance have coverage of COVID-19 diagnostic testing and certain other related services, including antibody testing, at no cost. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. As part of the effort to slow the spread of the virus, this guidance is another action the Trump Administration is taking to remove financial barriers for Americans to receive necessary COVID-19 tests and health services, as well as encourage the use of antibody testing that may help to enable health care workers and other Americans to get back to work more quickly.

Press Release
Guidance


3] You are invited to CMS “Office Hours” on COVID-19, Thursday, April 16th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls
  • Rapidly Expand the Healthcare Workforce
  • Put Patients Over Paperwork
  • Further Promote Telehealth in Medicare
  • We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A

Dial in details are below:

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 6168487

Audio Webcast link

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. 

You are welcome to share this invitation with your colleagues and membership.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


4] Joint Letter to Gov Hogan on Immunity for COVID 19 Treatment

MDAFP, along with other specialty societies, have joined with MedChi in putting together a joint letter from the provider community asking for an additional Executive Order on the issue of immunity for providers who are caring for COVID 19 patients.  While there is some immunity provided under existing statute, it has limitations.  The letter asks for an Order that strengthens and clarifies the protections.


April 15, 2020

1] President Donald J. Trump is committed to taking any and all necessary steps to protect the lives, health, and safety of the American people.

During the COVID-19 crisis, the White House Office of National Drug Control Policy (ONDCP) is leading efforts to ensure that prevention, treatment, recovery support services, and safe and effective pain management remain available nationwide. The Trump Administration is mobilizing the Federal Government to ensure the approximately 20 million Americans who struggle with the disease of addiction can access and continue to receive treatment and recovery support services, while keeping themselves and healthcare professionals safe from unnecessary exposure to COVID-19.

Full Fact Sheet

2] COVID-19 Federal Rural Resource Guide

USDA’s COVID-19 Listing of Federal Programs That Can Help Rural Communities, Organizations, and Residents Impacted by COVID-19. USDA has taken a number of steps to help rural communities impacted by COVID-19 click here to learn more.  


April 14, 2020

1] CMS Office Hours on COVID-19 – April 14

You are invited to CMS “Office Hours” on COVID-19, Tuesday, April 14th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.
Toll-Free Attendee Dial In: 833-614-0820
Event Plus Passcode: 2395745

Audio Webcast link: https://protect2.fireeye.com/url?k=bb0ee1a3-e75ac888-bb0ed09c-0cc47a6d17cc-633c7d24779f39dc&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1883

You can find a copy of the full press release and related materials here:  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

2] AAFP’s COVID-19 Rapid Response Member Exchange Update

There’s a new event on COVID-19 Rapid Response Member Exchange – check it out today!

Managing the COVID-19 Crisis: Maintaining the emotional health of you, your team, and your patients

Event Start Date: 04-17-2020 19:00 Central Standard Time

If you’re interested in joining the Rapid Response Member Exchange, sign up here


April 13, 2020

1] COVID-19: Dear Clinician Letter

CMS posted a letter to clinicians that outlines a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information. 
Letter (PDF)

2] CMS Issues New Wave of Infection Control Guidance to Protect Patients and Healthcare Workers from COVID-19

CMS issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will 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.

 Press Release

3] Updated Questions and Answers on COVID-19 

Review CMS’ updated FAQs to equip the American health care system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Check this resource often as CMS updates it on a regular basis – we insert the date at the end of each FAQ when it is new or updated.

4] Using CS Modifier When Cost-Sharing is Waived 

This clarifies a prior message that appeared in our April 7, 2020 Special Edition.

CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services.  Previously, CMS made available the CS modifier for the gulf oil spill in 2010; however, CMS recently repurposed the CS modifier for COVID-19 purposes. Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount.  Additionally, they should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

5] Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration)

Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration. The suspension is effective for claims with dates of service from May 1 through December 31, 2020.

6] Trump Administration Acts to Ensure U.S. Healthcare Facilities Can Maximize Frontline Workforces to Confront COVID-19 Crisis

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic.

These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.

For a fact sheet detailing additional information on the waivers announced today and previously, go to: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf


7] Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Starting April 13, CMS beneficiary eligibility transactions will return the Pneumococcal Pneumonia Vaccination (PPV) Date(s) of Service (DOS) for HCPCS codes 90670 and 90732 when a beneficiary has already received the service. Eligibility transactions will also return the related National Provider Identifier (NPI): Institutional NPI for Part A or rendering NPI for Part B to help you better coordinate care. See the MLN Matters Article (PDF) for more information. 

8] Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19

CMS is offering multiple flexibilities to provide relief to clinicians responding to the 2019 Novel Coronavirus (COVID-19) pandemic. In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30 at 8 pm ET, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

If you are a MIPS eligible clinician and do not submit any MIPS data by April 30, you will not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. You will be automatically identified and will receive a neutral payment adjustment for the 2021 MIPS payment year. Note: We updated the Participation Status Tool, so you can see if the policy is automatically applied. 

We are also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups. An application submitted by April 30, citing COVID-19 will override any previous data submission.

For More Information:

9] CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

The Centers for Medicare & Medicaid Services (CMS) has delivered nearly $34 billion in the past week to the health care providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.

“Health care providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same funds used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how health care providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet (PDF). Providers can also contact their Medicare Administrative Contractor for any questions.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

10] COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations

CMS recently updated recommendations to postpone non-essential surgeries and other procedures to conserve critical health care resources and limit exposure of patients and staff to COVID-19. Developed in collaboration with medical societies and associations, the recommendations outline a tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition. 
Recommendations 


April 9, 2020

CMS Office Hours on COVID-19: April 9th

You are invited to CMS “Office Hours” on COVID-19, Thursday, April 9th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:Increase Hospital Capacity – CMS Hospitals Without Walls;Rapidly Expand the Healthcare Workforce;Put Patients Over Paperwork; andFurther Promote Telehealth in MedicareWe encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A.Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820
Event Plus Passcode: 1881716
Audio Webcast link

You can find a copy of the full press release and related materials here.

To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

April 7, 2020

1] Lessons from The Front Lines: Listen to recorded call hosted by CMS Administrator

On April 3, CMS Administrator Seema Verma, Deborah Birx, MD, White House Coronavirus Task Force, and officials from the FDA, CDC, and FEMA participated in a call on COVID-19 Flexibilities. Several physician guests on the front lines presented best practices from their COVID-19 experience(s). You can listen to the conversation here.

2] Opportunities for COVID-19 related CME activities

AAFP has been developing additional CME accredited activities regularly including the Town Hall sessions, self-study case studies, and a webinar series. Links to all these COVID-19 related activities can be found at www.aafp.org/cme/browse/topic.tag-covid-19.html   

AAFP will continue to add more CME activities each week.

3] CMS COVID-19 Update Call Today

Tuesday, April 7 from 2 to 3pm

Register for Medicare Learning Network events. Registration closes at 12pm.

CMS update on recent actions taken to address the COVID-19 public health emergency.

Target Audience: All Medicare fee-for-service providers and interested stakeholders.

4] New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Video

5] COVID-19: Expanded Use of Ambulance Origin/Destination Modifiers

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

  • Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)
  • Community mental health centers
  • Federally Qualified Health Centers (FQHCs)
  • Rural health clinics (RHCs)
  • Physicians’ offices
  • Urgent care facilities
  • Ambulatory Surgery Centers (ASCs)
  • Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
  • Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

  • Modifier D – Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
  • Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
  • Modifier H – Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
  • Modifier N – Alternative care site for SNF
  • Modifier P – Physician’s office
  • Modifier R – Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.

The University of Maryland Medical System (UMMS) will stand-up and operate an alternate care facility in a Baltimore City hotel to reduce the strain on hospitals as a result of surging demand on healthcare services from the COVID-19 pandemic. The hotel will accommodate individuals no longer requiring acute inpatient care but with constrained placement options due to chronic and acute care requiring further observation as well as isolation or quarantine secondary to COVID-19. 

The proposed site will have 440 individual rooms. Patients currently will be coming from UMMC and MTC. The facility will be operated as an ambulatory unit with Epic EHR capabilities. Patients will be staying a few days until more permanent housing and transitional care can be arranged.


April 6, 2020

1] New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Video

2] Update on: AAP Report on Initial Guidance: Management of Infants Born to Mothers with COVID-19

The AAP has recently published a new report, “Initial Guidance: Management of Infants Born to Mothers with COVID-19” addressing the care of infants whose mothers have suspected or confirmed coronavirus disease 2019 (COVID-19).

Please see the related AAP News article for more details.

3] Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients. Guidance

4] Providers Needed | COVID-19, Maryland

Like many states across the nation, Maryland is preparing for a possible surge of COVID-19 patients.  Johns Hopkins is working with the state and the University of Maryland to erect an Alternate Care Site at the Baltimore Convention Center (ACS BCC).  The ACS BCC is planned to open by mid-April and is intended to be used as a post-acute treatment facility.

Johns Hopkins is working on the recruitment, contracting, and credentialing of temporary Physicians and Advanced Practitioners. Compensation will be provided. We are reaching out to you in hopes that there are interested parties within your organization who may be willing to temporarily assist in treating patients recovering from COVID-19.  Please see the attached job posting for details. 

Licensed providers interested in temporarily assisting in the treatment of patients recovering from COVID-19, should submit their current CV and a copy of their license to the following email:ProvidersforCOVID19@jhmi.edu  

5] An important CDC Webinar for Rural Stakeholders and Communities to be held Wednesday, April 8

  • CDC Update for Rural Stakeholders and Communities on the COVID-19 Response
  • Webinar Presentation on Wednesday, April 8 at 4:00 pm.
  • Presenter: Dr. Jay Butler, Deputy Director for Infectious Diseases, CDC

The Centers for Disease Control and Prevention (CDC) will share guidance with partners, public health practitioners, health care providers, and others working to protect the health of rural communities.  

REGISTRATION REQUIRED: https://www.zoomgov.com/webinar/register/WN_c7OYhtMORraMfh7Exp0dBg


April 2, 2020

1] Recordings for CMS National Stakeholder Calls on COVID-19

CMS has been hosting regular calls with a variety of clinicians, hospitals, and other facilities in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, we are happy to share that you can access recordings of the calls along with transcripts on the following link: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. We will continue to host calls and share information through our list serves and media. 

To keep up with the important work of the White House Coronavirus Task Force in response to COVID-19, visit https:/www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


2] New Executive Order

Governor Hogan issued a new executive order to authorize additional telehealth services.

https://governor.maryland.gov/wp-content/uploads/2020/04/Telehealth-Amended-4.1.20.pdf


April 1, 2020

1] CMS Granting Key Flexibilities:  Yesterday, CMS released an array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The new rules allow hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility. CMS also posted a complete summary of the flexibilities provided to all physicians and clinicians to help clarify current allowable and billable practices. CMS also approved two additional Section 1135 waivers today, bringing the total of approved waivers to 40 states.

2] Granting Financial Relief for Medicare Providers: Over the weekend, CMS provided financial relief to Medicare providers by expanding their accelerated and advance payment program to help ensure that they have resources needed to combat COVID-19. Accelerated and advance Medicare payments provide emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.

3] Providing Guidance for Healthcare Professionals: CDC added to their FAQ document for healthcare professionals additional information on drugs and investigational therapies to address common questions and misperceptions on available and approved drugs to treat COVID-19. CDC also released guidelines and a decision algorithm for how to guide care advice and messages with evaluating and triaging potential patients.

4] Obtaining Funding from FEMA for Emergency Medical Care Activities: The FEMA COVID-19 Emergency Protective Measures Fact Sheet included a list of eligible emergency medical care activities. This fact sheet provides additional guidance related to the eligibility of emergency medical care activities as an emergency protective measure under the Emergency Declaration and any Major Disaster Declaration authorizing Public Assistance (PA) for COVID-19.

5] Ensuring Providers Can Practice at Health Centers and Free Clinics: HRSA has released information on updated Federal Tort Claims Act policies for providers in health centers and free clinics to enable them to treat patients in these settings in an effort to prevent, prepare or respond to COVID-19.


March 31, 2020

1] Make plans to join AAFP’s Virtual Town Hall Wednesday 4/1 from 8-9pm

 AAFP President Dr. Gary LeRoy and AAFP SVP Advocacy Shawn Martin will join me to provide an overview of recently announced CMS accelerated payments, the CARES Act and what you can be doing now to position yourself to receive relief funding, followed by an open Q&A session. 

Remember, Live CME credit is available for participating on Wednesday. 

You can join the Town Hall via the links below:

Facebook – www.facebook.com/familymed/videos/527211657978924

YouTube – www.youtube.com/watch?v=c1PMGhsKKP4

Twitter: twitter.com/aafp


2] IMPORTANT NEWS FROM CMS

The Centers for Medicare & Medicaid Services (CMS)  is issuing an unprecedented set of  temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.

Highlights of the temporary actions announced by CMS today:

  • Temporary changes apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration.
  • Local hospitals and healthcare systems are empowered to:
  1. Increase Hospital Capacity – CMS Hospitals Without Walls
  • Expanding capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.
  1. Rapidly Expand the Healthcare Workforce
  • Allowing hospitals and healthcare systems to increase workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules.
  1. Put Patients Over Paperwork 
  • Eliminating paperwork requirements to allow clinicians to spend more time with patients
  1. Further Promote Telehealth in Medicare.
  • Allowing for more than 80 additional services to be furnished to Medicare beneficiaries via telehealth.

More information: 

Press release :  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

Background information on the waivers and rule changes,  https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

COVID-19 waivers and guidance, and the Interim Final Rule,  https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.  

White House Coronavirus Task Force  www.coronavirus.gov.  

Complete and updated list of CMS actions Current Emergencies Website.

IPRO QIN-QIO: https://qi.ipro.org


3] Medicare Payment for Telephone (only) Visits

Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced a series of changes to Medicare benefit and payment policies.  Included in the announcement was a change in payment policy whereby CMS will begin paying for telephone-only visits conducted by physicians.  

Achieving this change in payment policy has been a priority for the AAFP and we specifically requested this policy change in a letter www.aafp.org/dam/AAFP/documents/advocacy/health_it/… to CMS.

You can read about the new CMS policies here –> Additional Background:Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge | CMS.

The AAFP will have more information and guidance on this change in payment policy today. This will be important, for example, because CMS is not permitting 99211-215 services via telehealth audio only, they are paying for previously non-billable telephone visit codes 99441-43.

You may want to add your home address to your Medicare Enrollment if you are providing telehealth services from your home.

www.cms.gov/files/document/…

Can the distant site practitioner furnish Medicare telehealth services from their home? Or do they have to be in a medical facility?

There are no payment restrictions on distant site practitioners furnishing Medicare telehealth services from their home. The practitioner is required to update their Medicare enrollment with the home location. The practitioner can add their home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline. It would be effective immediately so practitioners could continue providing care without a disruption. More details about this enrollment requirement can be found at 42 CFR 424.516. If the physician or non-physician practitioner reassigns their benefits to a clinic/group practice, the clinic/group practice is required to update their Medicare enrollment with the individuals’ home location. The clinic/group practice can add the individual’s home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline.


4] Mental Health in a public health crisis

Mental Health Technology Transfer Center (MHTTC) Network Resources

Public health emergencies such as COVID-19 have a significant impact on people with mental illness, their families, and caregivers; the mental health workforce; and the mental health treatment system. They also cause stress and anxiety across the population. Visit the MHTTC website for webinars, products, and resources that can be useful when coping with the effects of widespread public health crises. 


5] CMS Financial Relief Program for Medicare Providers
Press release: www.cms.gov/newsroom/press-releases/…

Fact sheet: www.cms.gov/files/document/…


March 30, 2020

1] Frequently Asked Questions – Maryland COVID-19 

Emergency Relief Fund Programs for Businesses

Do you have any programs to help 1099 contractors?

How do I demonstrate the impact on my business?

I don’t have employees, so I don’t have unemployment insurance or a number, but that information is required to submit the application. What should I do?

What programs do you have? How do I apply?

What is an NAICS code? How do I find my NAICS code?

What financial statements should I include?

Will tax returns work for financial statements?

Are credit card statements acceptable for financial statements?

What is the estimated turnaround time for approvals and release of funds?

Where is my application? How can I access it?

If I can’t answer every starred item on the application, would I qualify?

Which types of legal entities are eligible to apply?

Does the company have to be based in Maryland? What if it’s based in another state and has operations and employees in Maryland?

Does my business qualify?

Where can I find more information on the impact of COVID-19 on business in Maryland?

I have another question. Who can I contact?


2] Accelerated/Advance Payments for Medicare Providers

On March 28 the Centers for Medicare and Medicaid Services (CMS) announced that they would immediately implement a new Accelerate and Advance Medicare Payment policy to assist family physicians and other Medicare Part A and Part B providers and suppliers. Again, family physicians who meet the qualifying criteria are eligible for these accelerated and advanced Medicare payments.  This is the policy that the AAFP asked CMS to implement earlier this week.

Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request.    Here is information on how to apply – you must go through your regional contractor

FACT SHEET: EXPANSION OF THE ACCELERATED AND ADVANCE PAYMENTS PROGRAM FOR PROVIDERS AND SUPPLIERS DURING COVID-19 EMERGENCY

You can find a copy of the fact sheet here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

You can find a copy of the press release here: https://www.cms.gov/newsroom/press-releases/trump-administration-provides-financial-relief-medicare-providers


3] Quality Payment Program and Quality Reporting Program/Value Based Purchasing Program COVID-19 Relief

On March 22, 2020, CMS announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to the 2019 Novel Coronavirus (COVID-19). This memorandum and factsheet supplements and provides additional guidance to health care providers with regard to the announcement. CMS has extended the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline from March 31 by 30 days to April 30, 2020. This and other efforts are to provide relief to clinicians responding to the COVID-19 pandemic. In addition, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30, 2020 deadline.

You can find a copy of the memo here:  Memo

You can find a copy of the fact sheet here:  Fact Sheet


4] Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

On March 27, CMS issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency.  Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.


5] CARES Act signed 

On Friday March 27 Congress passed and the President signed the CARES Act, a $2 trillion relief package that provides much needed economic relief for American families and businesses who are hurting through no fault of their own. This legislation will provide assistance to America’s heroic healthcare workers who are on the frontlines of this outbreak, including $100 billion which will go to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic, $27 billion which will go to bolstering life-saving capabilities, including developing vaccines and the development, purchase, and distribution of critical supplies and $45 billion which will go to the Federal Emergency Management Agency Disaster Relief Fund, more than doubling the amount available to support the President’s Emergency and Disaster Declarations to empower State, local, and tribal leaders to effectively respond.

More information will be coming from AAFP. Of interest, Sec. 3704 – Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period. Also adds FQHCs and RHCs as “distant site” providers for purposes of the COVID-19 telehealth waiver, allowing them to bill for telehealth services under the waiver.


March 25, 2020

1] Materials for Homemade Surgical Masks

People who want to sew masks buy surgical drape from veterinary supply stores and use the patterns from several hospitals.  

Alternatively, vacuum bags have a similar filtration for droplets as surgical masks and could be sown as disposable masks.  Not n95 quality but it might be helpful for office or for family members caring for sick persons in the home. 

Thirdly, a cloth mask that can be washed and dried with a place for a disposable vacuum bag or coffee filter insert might be a reasonable option. See links on patterns below: 


2]CDC Interim US Guidance on Risk and Exposures:

Interim US Guidelines on Risk and Exposures

COCA Call about Underlying Medical Conditions and People at Higher Risk for Coronavirus Disease 2019 (COVID-19) is postponed to March 27, 2020, still Noon-1:00pm ET.

The archived version will be available later at https://emergency.cdc.gov/coca/calls/2020/callinfo_032420.asp

If you use Facebook, please watch the webinar live or archived on Facebook Live at https://www.facebook.com/CDCClinicianOutreachAndCommunicationActivity

To call in by phone use one of the following numbers plus the webinar ID.

Telephone: +1 646 876 9923 or +1 312 626 6799 or +1 301 715 8592 or +1 346 248 7799 or +1 669 900 6833 or +1 253 215 8782

Webinar ID: 963 649 423


3] Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

On March 22, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions, and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.

You can find a copy of the press release here: https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

CMS will continue monitoring the developing COVID-19 situation and assess options to provide additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit the coronavirus.gov webpage. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov.


4] COVID-19 Provider Enrollment Relief FAQs

On March 22, CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19, including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements.

A copy of the FAQs can be found here: https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf

These tools, and earlier CMS actions in response to the COVID-19 emergency, are all part of ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit the coronavirus.gov webpage. For a complete and updated list of CMS actions, guidance, and other information in response to COVID-19, please visit the Current Emergencies Website.


March 24, 2020

Surgical Innovation Fellowship – COVID-19: Our response to the N95 shortage


CMS Relaxes Quality Payment Program (QPP) (MIPS):

  • The Centers for Medicare & Medicaid Services (CMS) has extended(www.cms.gov) the deadline to report data for the Merit-based Incentive Payment System (MIPS) 2019 performance year, as requested in a recent letter from the American Academy of Family Physicians. Practices now have until April 30, 2020, to submit data. The original deadline was March 31. This new deadline, part of the agency’s response to COVID-19, also applies to participants in the Medicare Shared Savings Program (MSSP)

Administration for Community Living (a division of HHS): older adult related COVID-19 resources – https://acl.gov/COVID-19


The SAMHSA-funded Technology Transfer Centers (TTC) link:

Each region has a SAMHSA-funded TTC center for Addiction, Mental Health, and Prevention with a listserv, newsletter, archived and upcoming webinars and other free resources.

Today, Compassion Fatigue and the Behavioral Health Workforcewas posted

This 5-part Curriculum Infusion Package (CIP) on Compassion Fatigue and the Behavioral Health Workforce was developed in 2020 by the Pacific Southwest Addiction Technology Transfer Center (PSATTC). The main developers included Nancy Roget, MS, Joyce Hartje, PhD, and Terra Hamblin, MA, with additional guidance and editing support provided by Beth Rutkowski, MPH, Thomas E. Freese, PhD, and Michael Shafer, PhD.

Compassion Fatigue Curriculum Infusion Package Slides

Part 1: The Behavioral Health Workforce

Part 2: Defining Compassion Fatigue and Related Conditions

Part 3: Burnout and Organizational Response

Part 4: Compassion Satisfaction and Self-Care

Part 5: Self-Care and Ethical Issues

The Compassion Fatigue CIP was created to help college and university faculty infuse brief, science-based content into existing substance use disorder-related course syllabi (e.g., foundation of addiction courses, ethics, counseling courses, etc.). Instructors can select the specific content to infuse throughout the duration of the course depending on specific needs of the learners. Each slide contains notes for the instructor to provide guidance as necessary. References are included for each slide and handouts when possible.

Part 1 provides a brief overview of the behavioral health workforce and associated shortages, and introduces the demands on the workforce. Part 2 focuses on compassion fatigue and secondary traumatic stress. Part 3 provides a brief overview of how organizations can help individuals avoid experiencing burnout. Part 4 focuses on actions that behavioral health professionals can take to prevent compassion fatigue. And Part 5 focuses on self-care as an ethical duty in order to manage compassion fatigue. 

The slide decks are designed to be used by academic faculty in behavioral health programs, trainers, behavioral health providers, and state/county agency staff members for a variety of audiences. If you require further information on this topic, please do not hesitate to contact the Pacific Southwest ATTC (http://www.psattc.org). You are free to use these slides and the pictures, but please give credit to the Pacific Southwest ATTC when using them by keeping the logo on each slide and referencing the Pacific Southwest ATTC at the beginning of your presentation. 


4 Alcohol Withdrawal Infographic:


March 23, 2020

New Executive Orders:


Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19)

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs.  For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. 

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period. 

You can find a copy of the press release here.

CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for pat

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing i response to COVID-19, please visit www.coronavirus.gov. For a complete and updated l CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov


New Tools To Help Speed States’ Access to Emergency Flexibilities and Resources

The Trump Administration released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program. 

The tools include:

1115 Waiver Opportunity and Application Checklist
1135 Waiver Opportunity and Application Checklist
1915(c) Appendix K Template
Medicaid Disaster State Plan Amendment Template


Medicare Virtual Check-ins:   

Virtual Check-ins (G2012) enable a quick visit with a patient to determine if an in-person appointment should be scheduled. This Medicare service is never restricted by geographic location/originating site or other Medicare telehealth restrictions. Virtual Check-In’s are a brief (5-10 minutes of medical decision-making) technology-based communication (via phone or other digital device) for an established patient, not originating from a related E/M within prior 7 days and not leading to an E/M service within next 24 hours or soonest available appointment. 

Medicare E-Visits:

E-Visits (99421-99423 for physicians or G2061-G2063 for non-physician qualified professionals) are a non face-to-face (virtual) asynchronous encounter, initiated by an established patient, utilizing digital means to achieve the visit. It can include lab orders, prescriptions, diagnosis and treatment plan with cumulative time reported once in a 7-day period. This Medicare service is never restricted by geographic location/originating site or other Medicare telehealth restrictions. Communication exchanged must be permanently stored.


CMS Releases Telehealth Toolkits for General Practitioners and End-Stage Renal Disease (ESRD) Providers

The Centers for Medicare & Medicaid Services (CMS) released two comprehensive toolkits on telehealth that are specific to general practitioners as well as providers treating patients with End-Stage Renal Disease (ESRD).

Under President Trump’s leadership to respond to the need to limit the spread of COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. These benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.

Each toolkit contains electronic links to reliable sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. Many of these links will help providers learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.

You can find the Telehealth Toolkit for General Practitioners here.

You can find the End-Stage Renal Disease Providers Toolkit here.

CMS continues to monitor the developing COVID-19 situation and assess options to bring relief to clinicians. To keep up with the important work the Task Force is doing in response to COVID-19 visit the coronavirus.gov webpage. For complete and updated information specific to CMS, please visit the Current Emergencies Website.


COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations

The Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

You can find a copy of the press release here.

You can find a copy of the guidance here.


 ADDITIONAL RESOURCE LINKS
Medicare FFS Response to the Public Health Emergency on the Coronavirus

AAFP on Telemedicine – Includes Summary of Regulatory/Payment Changes


MARCH 20, 2020

Effective, 3/18, UnitedHealthcare has added flexibility to their telehealth policies to make it easier for patients to connect with their family physicians.  For the next 90 days, all eligible in-network medical providers who have the ability and want to connect with their patients through synchronous virtual care (live video-conferencing) can do so. UHC will waive member cost-sharing for COVID-19 related visits. This coverage applies to patients with UHC Medicare Advantage, Medicaid and commercial coverage.  

Medicare Frequently Asked Questions (March 17, 2020)


MARCH 19, 2020


MARCH 18, 2020

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued guidance to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) to protect the health and safety of Americans in response to the 2019 Novel Coronavirus (COVID-19) pandemic. PACE is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. CMS is putting out COVID-19 guidance to all types of healthcare providers and facilities. PACE is the latest area of focus because these organizations serve older adults who often have serious chronic medical conditions and therefore are at higher risk of serious illness from the virus.

You can find a copy of the press release here.

For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


Coverage and Reimbursement

CMS Fact Sheet on Medicare telehealth

CMS FAQs on Medicare telehealth

CMS chart on Medicare telehealth

CMS guidance on Medicaid telehealth

CMS state guidance on Medicaid telehealth


Legal

OIG Policy Statement on telehealth

OIG Fact Sheet on telehealth

AMA Chart of State Telehealth Laws


Practice Guidelines

New York State COVID-19 Telehealth Screening Recommendations developed by Drs. Daniel Choi, Carlos Zapata, Saya Nagori, Dhaval Bhanusali, Michelle Lin

AMA Quick Guide to Telemedicine in Practice

AMA Guidance for Ethical Practice in Telemedicine

American Telemedicine Association Practice Guidelines

American Health Information Management Association Telemedicine Toolkit

Technical Support/Misc.

Telemedicine Quick Set-up Guide in Response to COVID-19 National Emergency developed by Drs. Sylvia Romm, Adam Maghrabi, Tisha Rowe, Aditi Joshi


Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)

CMS update on Telehealth Payment


MARCH 17, 2020

On March 17, 2020, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

TRIAGE
For patients who call in or do a telehealth visit* and have severe symptoms (fever, unstable breathing), they should be recommended to go to an Emergency Department for evaluation (please call ahead and give SBAR to the ED).

For patients who have moderate symptoms (fever, cough, shortness of breath), there are a few places to recommend for people to get testing:

· MedStar PromptCare 410-230-7820 (can test walkins)

· Lifebridge 410-601-2222 (Sinai Hospital drive through testing opened 3/16/2020) 

· Maryland Dept of Health 410-767-6871 (will have updated list of test sites)

For patients who have mild symptoms and don’t meet testing criteria, we recommend self-quarantine and calling their PCP if symptoms worsen.

For patients who have no symptoms, but may have possible exposure, we are not testing them yet, but recommend calling if they become symptomatic.

TESTING
For patients who come into your office, you may want to screen them before the waiting room and bring patients to an isolation room if available.

If your office is able to procure the swabs with green tops and brown medium, you can collect these in office and send to LabCorp (Order #139900) or Quest (Order #87798). You or your staff should wear gown, N95 mask, face shield, and gloves for collection. 

Rooms should be vacant for 2 hours before cleaning with a bleach based cleaner.

Billing codes are:

  1. For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
  2. For suspected COVID-19, not confirmed or ruled out at the encounter, report codes for the presenting signs and symptoms. Do not report a code for coronavirus when this diagnosis is not stated in the medical record.
  3. For known exposure to COVID-19 (without diagnosis of COVID-19), report Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
  4. For suspected exposure to COVID-19 that is ruled out after evaluation, report Z03.818, “Encounter for observation for suspected exposure to other biological agents ruled out.”

TREATMENT
Currently there are no approved treatments for a COVID-19 infection, but a few have shown promise in small trials: favilavir (approved in China), remdesivir (blocks RNA dependent polymerase), chloroquine (blocks viral entry in endosome), corticosteroids (reduce inflammation).

A vaccine is at best months away. 

*TELEHEALTH
CMS guidance has allowed for billing of telehealth visits during this public health emergency, in order to provider medical visits for triage or follow up care. This should apply to Federally Qualified Health Centers as well (per this HRSA Program Assistance Letter from 1/27/20). If you need help with finding a suitable telehealth vendor, MedChi can help with this process. One vendor has offered free services for clinics for 30 days.

MEDICAL AID COLLABORATIVE
Some local Baltimore family physicians have started a Medical Aid Collaborative to help connect medical students with front line providers who are in need of childcare while schools are closed. If you are in need of childcare, please contact Dr Richard Bruno at rabruno@gmail.com and he will connect you with the group.

OTHER RESOURCES

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