A message from KMA President Brent Wright, M.D.
“…I will prevent disease whenever I can, for prevention is preferable to cure.”
Hippocratic Oath – Modern Version
As we commemorate Doctor’s Day 2020, we find ourselves in a battle with an unseen enemy. The COVID-19 pandemic has taken the lives of thousands of people, many of whom have been brothers and sisters of our profession. We watch the countless requests for greater testing, more protective equipment, and greater insight into the treatment of a disease that has moved with a speed and fury that many can neither comprehend nor prepare.
Our challenge will not end with the current threat as humanity dissects the aftermath of what we have witnessed. Our knowledge and insight will be needed to drive society forward in a way that is both responsible and caring. As a physician, you are blessed with a gift that very few will ever know and for your dedication I am thankful.
Join me on this Doctor’s Day as we honor our profession, those who trained us, those who serve with us, those who are learning the art, and those whose efforts are remembered most nobly.
R. Brent Wright, MD
KMA President, 2019-2020
In Their Own Words: Lee Dossett, M.D.
KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, firstname.lastname@example.org.
For the last 2 weeks I have gotten an up-close look at how hospitals are dealing with the COVID-19 pandemic. As a member of the hospitalist leadership team at Baptist Health Lexington, I have been intimately involved in the daily preparations and execution of virus management plans. It has become evident that for these action plans to work, flexibility has to be a core value amongst providers. Coronavirus was on our radar in February, but by early March it became clear it would be something no hospital would escape.
Together with my partners in the ED, ICU, and infectious disease we developed screening and treatment protocols. We have used a variety of testing methods, public and private, with varying turnaround times. Ultimately, our goal is to have rapid in-house testing. When that occurs, it will help us create better guidance for patients regarding self-quarantine and help preserve PPE and resources in the hospital.
For right now we have designated specific floors that are completely negative pressure for rule out patients with a consistent group of nurses, staff, and physicians providing care. We have plans in place should volume increase. One of our biggest concerns is the preservation of PPE. Currently the hospital is well supplied, however we have enacted preservation strategies in preparation for any surge which may develop. This includes using telehealth options when clinically appropriate on admitted patients and a robust de-escalation of isolation as negative results come back.
From a clinical standpoint we have seen a wide range of ages, symptoms, and severity. Those who present to the emergency room with mild symptoms can be swabbed and discharged home with instructions for self-quarantine. Those who are sick enough to be in the hospital but hemodynamically stable can be admitted to a telemetry floor for close monitoring. If they show respiratory compromise they are watched in the ICU with the plan of early intubation in a controlled setting when necessary.
With delayed testing, we have found chest CTs to be very helpful with risk stratification. The pathognomonic changes of COVID-19 can develop rapidly, as seen by dramatic changes in one patient within 4 days. While the virus is most dangerous in the older population with co-morbidities, we have seen young and otherwise healthy individuals severely affected. We have also seen deaths unfortunately. It is extremely important to continue to stress social distancing and good hand hygiene to “flatten the curve” so that COVID does not overrun local and national hospital capacity.
State Legislature Responds to COVID-19 Pandemic
On Thursday, March 26, lawmakers returned to Frankfort after a week at home and resumed legislative work for one day only. The day’s activities were punctuated by the legislature enacting Senate Bill (SB) 150.
This legislation, initially a surprise billing measure introduced by Senator Ralph Alvarado, was stripped of the original language and revised to become an emergency COVID-19 relief bill that will provide Kentuckians, including the state’s health care providers, financial and regulatory assistance surrounding the novel coronavirus pandemic. SB150, a summary of which is available here, awaits the Governor’s signature.
Going forward, lawmakers will work a legislative day on Wednesday, April 1, before adjourning for a 10-day veto recess. Lawmakers will return for two days on April 14-15 to consider any veto overrides and finish other business.
U.S. Congress Passes COVID-19 Stimulus Package
On Friday, President Trump signed a $2 trillion stimulus and COVID-19 relief package into law. The final version, known as the CARES Act, contains billions of dollars in relief to health care providers. Provisions of interest to physicians and their practices include the following:
- Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
- $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
- Suspension of the 2% Medicare sequester in May through December 2020.
- Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
- A temporary waiver of the face-to-face visit requirement with home dialysis patients.
- Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
- Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.
A comprehensive summary of the CARES Act that was produced by the American Medical Association and is available here.
CMS Announces Expansion of Accelerated and Advance Payment Program
Centers for Medicare & Medicaid Services (CMS) announced an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat COVID-19. The program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act, provides emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, 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.
To qualify for accelerated or advance payments, the provider or supplier must:
- Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form,
- Not be in bankruptcy,
- Not be under active medical review or program integrity investigation, and
- Not have any outstanding delinquent Medicare overpayments.
An informational fact sheet on the accelerated/advance payment process and how to submit a request can be found here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.
UnitedHealthcare Expanding Telehealth to Audio-Only Services
UnitedHealthcare (UHC) is expanding telehealth services through June 18, 2020, for their Medicare Advantage, Medicaid, and commercial plans to make it easier for patients to connect with their health care provider during the COVID-19 emergency. UHC will reimburse both participating and non-participating providers who submit appropriate telehealth claims.
KMA has prepared a one-page guide to using telehealth with UnitedHealthcare for members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined apply to UnitedHealthcare plans only.
The UnitedHealthcare telehealth guide is available here.