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Axne, Fitzpatrick Lead Call for Expanded Telehealth Services for Seniors during COVID-19 Pandemic

Bipartisan letter to CMS seeks to ensure coverage for the full range of essential hearing, speech, and language services

Today, Rep. Cindy Axne (IA-03) and Rep. Brian Fitzpatrick (PA-01) led a letter with 32 other colleagues to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, urging her to expand Medicare telehealth coverage of valuable audiology and speech-language pathology during the coronavirus (COVID-19) pandemic. 

“At a time when individuals with hearing, communication, and swallowing disorders face even higher risk for isolation and depression, Medicare beneficiaries must have access to appropriate diagnostic…

3 reasons telehealth is here to stay

The question isn’t if telemedicine has a future, but rather how ubiquitous it will be in our healthcare system moving forward.

Covid-19 has catapulted medicine into a new, virtual world. Although telemedicine has been around for years, it’s quickly transitioned in the last 6 months from a “nice-to-have” for medical practices, to a real necessity. Today, physicians rely on telemedicine to see their patients, as well as diagnose and treat minor and chronic conditions.

But what happens when the pandemic comes to an end? Is telemedicine a flash in the Internet pan, or is it here to stay?

A webinar from HealthSparq offers analysis on a consumer sentiment study on…

Bullish on Broadband: Time to Get Your Grant Proposals Ready

Before Covid-19, pursuing Federal broadband grant funds was orderly and straightforward. Some grants paid for broadband infrastructure that was restricted to school premises. Federal grants funded healthcare-related broadband in public hospitals and clinics. Other agency programs funded broadband in city and county offices, libraries, and public facilities. A couple of smaller agencies funded residential and business broadband limited to a few states. 

Then the pandemic hit. The internet groaned under the strain of massive re-routing of data traffic as office workers became permanent telecommuters, widespread distance learning became an overnight reality, and…

5 changes CMS should make to 2021 Medicare payment schedule

The AMA is warning the Centers for Medicare & Medicaid Services (CMS) that rate-cutting provisions in its proposed 2021 Medicare physician payment schedule pose “a very real threat to the ability of many physicians to deliver health care services to their patients.”

CMS has proposed new office-visit policies that should result in a significant reduction in administrative burdens and provide better recognition of the resources utilized in such visits. But, citing budget-neutrality requirements, CMS is proposing to offset these positive changes by cutting payment rates for some physicians by nearly 11%.

The AMA sent detailed comments to CMS on its proposed rule, urging the agency to use its authority to waive the budget-neutrality requirements and avert the cuts that will be deeply problematic for physician practices that have experienced severe reductions in revenue during the COVID-19 pandemic.

“Our comments are intended to ensure physicians can continue providing the highest quality care for Medicare beneficiaries during and after this public health emergency,” said AMA President Susan R. Bailey, MD. “To achieve this, we recommend that CMS prevent the steep budget-neutrality cuts that are pending.”

Dr. Bailey also called on CMS to continue its “forward-looking changes for telehealth patients” that allowed so many to continue receiving care without having to leave their homes.

The AMA’s 93-page letter to CMS Administrator Seema Verma includes many recommendations, warnings and applause—though five issues were specifically highlighted.

Don’t offset positive change with harmful cuts. The AMA strongly supports implementation of proposed improvements related to coding and payment for evaluation and management (E/M) physician office-visit services. But the AMA strongly opposes drastic cuts—in the name of budget neutrality—to payments for specialists with few office visits such as radiologists, pathologists, general surgeons, critical care physicians and anesthesiologists.

Surveys and claims analysis suggest that physician practice revenue dropped by at least 50% between March and May, AMA Executive Vice President and CEO James L. Madara, MD, told Verma in the AMA comment letter. He added that it is “a reasonable assumption” that practice revenue has been reduced by a minimum of 25% from the norm between June and August.

“These challenges highlight the urgent need for CMS to ensure practices facing severe economic strain and uncertainty can continue meeting the needs of patients during and after the public health emergency,” Dr. Madara wrote.

His recommendations include:

  • Waiving the budget-neutrality requirement.
  • If cuts won’t be waived, phasing in cuts over multiple years.
  • Lessening the impact of budget-neutrality adjustments by factoring in previous overestimates of health care spending.

Treat all physicians fairly. The AMA opposes CMS’ decision not to incorporate the revised office and outpatient E/M values in the global surgical codes, as this treats the same physician work differently based on whether the service is a stand-alone or post-operative visit.

The AMA supports the recommendation by the AMA/Specialty Society RVS Update Committee (RUC) that post-operative visits should be valued equivalent to stand-alone visits. The AMA also advises postponing implementation of the office visit add-on code until it can be better defined by the Current Procedural Terminology (CPT®) Editorial Panel.

Maintain policies that fostered telehealth use. During the COVID-19 pandemic, demand for telehealth services has skyrocketed, and the AMA urges CMS to make permanent several temporary policies that facilitated telehealth growth so physicians can adapt their practices, protect health information to maintain patient trust, and get paid adequately while maintaining patient access to care.

These include removing geographic and site-of-service restrictions and continuing to cover telehealth services at the same rate as in-person visits at least through the end of the year following the year in which the pandemic ends. This includes audio-only visits.

Implement CPT code covering COVID-19 safety protocols. CMS should implement and pay for new CPT code 99072 that was sparked by the public health response to COVID-19. The additional supplies and clinical staff time needed to perform safety protocols described by code 99072 allow for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients and health care professionals.

Keep improving Quality Payment Program. CMS has listened to physicians by introducing improvements to the Medicare Quality Payment Program (QPP), and the AMA appreciates proposals to introduce a more clinically relevant, less burdensome approach to the Merit-based Incentive Payment System (MIPS).

The AMA supports flexibilities that CMS implemented for MIPS during the COVID-19 emergency and urges the agency to continue these policies through 2021 as the ongoing pandemic disrupts fair and accurate evaluation of physician performance.

“Physicians have made unique sacrifices during the pandemic,” Dr. Bailey said.

“They have faced personal dangers often without enough personal protective equipment,” she added. “We need to keep these changes in place as COVID is still presenting challenges every day.”

The final payment schedule is expected to be released Dec. 1, which is 30 days later than usual.

The AMA is warning the Centers for Medicare & Medicaid Services (CMS) that rate-cutting provisions in its proposed 2021 Medicare physician payment schedule pose “a very real threat to the ability of many physicians to deliver health care services to their patients.”

CMS has proposed new office-visit policies that should result in a significant reduction in administrative burdens and provide better recognition of the resources utilized in such visits. But, citing budget-neutrality requirements, CMS is proposing to offset these positive changes by cutting payment rates for some physicians by nearly 11%.

The AMA sent detailed comments to…

Telehealth Went from Nice to Have to Here to Stay

Telehealth was available prior to COVID-19 but its use certainly wasn’t as widespread as it is today.


Telemedicine has been used for some time in the U.S. and has been preferable to some, worrisome to others.  Now that the COVID-19 pandemic has hit, it seems to have quickly become the norm and seems to be here to stay.  Data shows that by the end of April 2020, telemedicine visits had jumped to roughly one million visits per week.  This includes the use of teletherapy, which prior to…

What Are the 10 Factors to Patient Satisfaction With Telehealth?

While clinical outcomes and changes to provider workflows are on the top of that last, a benchmark often overlooked by new users is patient satisfaction. If the patient isn’t happy with the experience, or his or her…

J.D. Power’s 2020 Telehealth Satisfaction Study identifies 10 key performance indicators that providers should use to ensure patient satisfaction.

By Eric Wicklund

October 09, 2020 – One of the challenges of creating a sustainable telehealth platform is figuring out what to measure and how to measure it.

While clinical outcomes and changes to provider workflows are on the top of that last, a benchmark often overlooked by new users is patient satisfaction. If the patient isn’t happy with the experience, or his or her…

HHS announces $20 billion in new relief funding but there will be no legislation before the election

Eligible providers will get payment of 2% of annual revenue from patient care plus an add-on payment.

New COVID-19 relief funding is being released.

The Trump Administration has announced $20 billion in new funding for providers fighting COVID-19, but the president has ended negotiations with Democratic leaders over a new relief package until after the November 3 election.

Eligible providers will get payment of 2% of annual revenue from patient care plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.

Providers that have already received provider relief fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. 

Previously ineligible providers, such as those who began practicing in 2020, will also be invited to apply, and an expanded group of behavioral health providers will also be eligible for relief payments.

WHY THIS MATTERS

Providers will have through November 6 to apply, but the Department of Health and Human Services is urging all eligible providers to apply early and not wait until the last day or week of the application period. 

Applying early will help to expedite HHS’s review process and payment calculations, and ultimately accelerate the distribution of all payments. HHS said it recognizes that many providers continue to struggle financially from COVID-19’s impact. 

Behavioral health providers invested in telehealth after the Centers for Medicare and Medicaid Services allowed new telehealth flexibilities. Working with the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration has developed a list of the nation’s behavioral health providers now eligible for funding, which includes addiction counseling centers, mental health counselors and psychiatrists.

PAYMENT METHODOLOGY

All submissions will be reviewed to confirm they have received a provider relief fund payment equal to approximately 2% of patient care revenue from prior general distributions. Applicants that have not yet received such a payment will receive funding that equals 2% of patient care revenue.

An equitable add-on payment will consider a provider’s change in operating revenues from patient care and including expenses incurred related to coronavirus and payments already received through prior distributions.

THE LARGER TREND

HHS has issued an estimated $175 billion in relief funding to providers through prior distributions. 

Trump has blamed House Speaker Pelosi for the failure to reach a new agreement on coronavirus relief legislation while Democrats blame the president. Previous legislative relief discussions have fallen through due to the two sides being billions of dollars apart.

ON THE RECORD

“HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus,” said HHS Secretary Alex Azar. 

Ways and Means Committee Chairman Richard E. Neal (D-Mass.) said, “President Trump is turning his back on the American people in their hour of greatest need. Families are going hungry and losing their homes. More than 210,000 Americans have died of the virus, and cases are rising across the country. Our economy is in a deep recession. Yet the President is walking away from efforts to provide folks who are struggling with the relief they need to survive.”

Eligible providers will get payment of 2% of annual revenue from patient care plus an add-on payment.

New COVID-19 relief funding is being released.

The Trump Administration has announced $20 billion in new funding for providers fighting COVID-19, but the president has ended negotiations with Democratic leaders over a new relief package until after the November 3 election.

Eligible providers will get payment of 2% of annual revenue from patient care plus an add-on payment to account for revenue…

Revised Clinical Trial Rules During COVID-19 Pandemic Could Benefit Patients

The COVID-19 pandemic has led to new rules and expectations for clinical trials. Following guidance from federal agencies, institutions such as UT Southwestern adjusted clinical trial operations. To protect patient safety, changes such as utilizing remote consents, conducting telehealth study visits, and shipping oral study treatment to patients’ homes have streamlined the clinical trial participation process.

A survey of UTSW clinical research professionals found that most clinical trial coordinators, managers, and nurses report positive experiences with these COVID-related adjustments. In fact, a majority are in favor of keeping the new protocols even…

The American Telemedicine Association Leads the Industry Commenting on Medicare Updates to Telehealth Policy

This week, the comment period closed for the calendar year 2021 (CY21) Physician Fee Schedule (PFS) proposed by the Centers for Medicare & Medicaid Services (CMS). The PFS is an annual rule-making process through which CMS identifies codes and payment rates to be used to reimburse Medicare Part B physician services in the following calendar year. The CY21 PFS, published in the Federal Register in August, proposes significant changes to telehealth reimbursement within the Medicare program by adding new telehealth services, expanding access to types of telehealth providers, and updating rules for remote…

Medicaid Telehealth Policies States Can Make Permanent to Ensure Access for Children/Families

In response to the COVID-19 pandemic, state Medicaid agencies have temporarily expanded their telehealth coverage and reimbursement policies in varying degrees. States, providers, advocates and families recognize the important role that telehealth has played in maintaining access to care during the pandemic and are now turning to the difficult work of evaluating which components of a state’s temporary telehealth policies can be made permanent beyond the public health emergency. The following table provides…

For Home Care Agencies, Tracking ‘Total Cost of Care’ Is the Secret to Breaking into Narrow Networks

Home care agencies and their services have always been valuable to the patients they serve. But being able to demonstrate that value to payers requires more than just patient testimonials.

As the home care industry enters into an era filled with new tailwinds, including Medicare Advantage (MA) and managed care opportunities, providers need to create value propositions that make sense to payers.

Harvesting key data points is not just internally helpful for agencies. Being able to show what part a home care provider plays in keeping cost of care…

COVID-19 has shown us how scaling can accelerate innovation

The COVID-19 pandemic was a real turning point, not only for people, but also for businesses across the world. Organizations had to change their operating models overnight and adapt to new ways of working to ensure business continuity and to manage the demands of the pandemic. Organizations, especially in the most impacted sectors like healthcare, had to innovate quickly and develop new ways of working to meet the country’s most immediate needs.

As hospitals had to drastically increase capacity and shift their day-to-day operations to manage the escalating nature of the pandemic,…

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