COVID-19 eNews March 25, 2020
The state reports 30,811 confirmed cases, and 285 deaths statewide, as of Wednesday morning, including 17,856 cases in New York City; 4,691 in Westchester County; 3,285 in Nassau County; 2,260 in Suffolk County; 968 in Rockland County; 638 in Orange County; 153 in Dutchess County; 152 in Albany County; 122 in Erie County; and 118 in Monroe County.
NYS DOH Update Tomorrow Thursday 1-2 PM
Please join the NYS Department of Health Thursday March 26th at 1-2PM for A COVID-19 Update for Healthcare Providers. To accommodate the large number of participants, our webinar will be streaming via YouTube Live:
The CDC’s tracker of US COVID-19 cases. The CDC regularly updates their tracker with newly confirmed cases, including a state-by-state breakdown.
The WHO’s COVID-19 myth busters. This page clarifies common misconceptions about the virus and includes downloadable graphics staff can post on their units.
MSSNY President Dr. Art Fougner’s Editorial Appeared in Yesterday’s Empire Report
As I drove into the parking lot, I couldn’t help noticing the lack of cars. Thanks to the SARS CoV2 virus, hunkering down is now the new normal. Yet through it all, physicians are answering the call, adapting as only they can to the fluid situation. This is not without a cost. As in Italy, the healthcare workers casualties are mounting all too quickly. What hasn’t been emphasized enough is that those professionals are, much like the elderly and the immune-compromised, a very high-risk group for serious complications. And yet, as the FDNY and NYPD on September 11, your physicians, nurses and others are running to the fire while others are running away. Just the other day, one thousand retired medical personnel volunteered to back up beleaguered doctors and nurses on the front lines.
There’s a serious problem, however. We are all short of Personal Protective Equipment. We need this yesterday. Doctors seeing seriously ill patients without adequate protection and supplies is akin to firemen attempting to fight fire without hoses and water. And still, your doctors and nurses are hitting the ground running every day. This indomitable spirit should be an example to us all.
So, when you see a doctor or nurse, give them a hearty Thank You – an air high five or corona forearm bump will do. NY’s Healthcare Team is fighting the good fight for us all. In the words of Winston Churchill, “Never have so many owed so much to so few.” http://empirereportnewyork.com/arthur-fougner-doctor-new-york-our-finest-hour/
Art Fougner, MD
High Points of Gov. Cuomo’s Announcement
Some points from the on-going Governor’s announcement.
- NYC currently implementing social distancing plan:
– closing streets to traffic for pedestrian use.
– playground density reduction mandates.
– no close contact sports, such as basketball.
– if not followed, playgrounds will shut down.
- Evidence is showing that the density control plan is working. The doubling of hospitalization rates is spreading out across more days than earlier in the week.
- As of today, PPE demand is satisfied for the next couple of weeks, but 3 weeks out there will again be a need.
– Federal Government committed 4,000 ventilators (yesterday, the number was 400).
– still working with feds for more ventilators, and still looking into splitting ventilators.
– Governor states that they have purchased everything that can be purchased.
- 40,000 responses from “Surge Healthcare Force”, the reserve healthcare workforce
-6,175 mental health professionals signed up (hotline 1-844-863-9314) to provide services.
– Working with feds to find vendors and using Defense Production Act to maximize production.
– Working with feds on a rolling deployment plan (mentioned yesterday as a request) to meet needs of hot spots as they arise. Redeployment of equipment, and personnel as state’s needs decline.
- Governor described the $2 Trillion bill as “terrible” for NY. $3.8B for NYS, and $1.3B for NYC.
(Moe Auster, Senior VP MSSNY Govt. Affairs)
Executive Order: Physicians Immune from Civil Liability for COVID-19 Services
As part of an Executive Order, Governor Cuomo announced physicians and other health care practitioners would be “immune from civil liability for any injury or death alleged to have been sustained directly as a result of an act or omission by such medical professional in the course of providing medical services in support of the State’s response to the COVID-19 outbreak, unless it is established that such injury or death was caused by the gross negligence of such medical professional”.
While this is a very welcome development, at the same time, the Executive Order also contains several very concerning short -term waiving of laws, including physician supervision requirements for Certified nurse anesthetists, physician assistants and nurse practitioners.
The Executive Order also contains provisions that directs the Health Commissioner to cancel all elective surgeries and procedures, in “all general hospitals, ambulatory surgery centers, office-based surgery practices and diagnostic and treatment centers to increase the number of beds available to patients”.
State/Federal Agencies Encourage PTs to Receive Treatment Via Telehealth
There have been a number of important steps taken over the last week to better enable physicians to treat their patients via telemedicine. This week, CMS announced it was implementing rules to temporarily waive the limitations on providing telemedicine for their Medicare patients.
Also, very importantly, the federal Office of Civil Rights announced it was relaxing enforcement of HIPAA rules such that a physician “that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients”, and that OCR will “not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency.”
This follows important steps taken by the New York State Department of Financial Services reminding insurers to cover telehealth services for patients including basic smart phone technology and waiving patient cost-sharing. They also noted they would be strongly encouraging self-insured plans operating in New York State not subject to state regulation to follow these coverage and cost-sharing rules. Moreover, a similar announcement was made by the New York State Department of Health including ensuring there is Medicaid and Medicaid Managed Care coverage for telephone visits.
In light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA).
Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules. However, the announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.
Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules.
Physicians should not use Facebook Live, Twitch, TikTok or other public-facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn’t confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.
Additional information can be found at this notice from Department of Health and Human Services (HHS).
Emergency Medical Aid and Telemedicine
- Emergency Adoption of Amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 (COVID-19 Telemedicine)
New Emergency Regulation Requiring Insurance Companies to Waive Cost-Sharing for In-Network Telehealth Visits
New Regulatory Actions State New Yorkers Do Not Have to Pay Copayments, Coinsurance, or Annual Deductibles for In-Network Telehealth Services
AMA: COVID-19 Physician Practice Resources
The COVID-19 physician and practice resources released by the AMA include:
- A Physicians Guide to COVID-19, to help physicians prepare their practices, address patient concerns, and provide answers to physicians’ top questions;
- An AMA COVID-19 online resource center, and a COVID-19 FAQ that are updated each day with the latest information on the COVID-19 epidemic;
- A Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care which can help achieve a dramatic increase in the nation’s telemedicine capacity;
- The AMA Journal of Medical Ethics published ethical guidance for physicians to help them in making determinations about how to combat COVID-19;
- The JAMA Network COVID-19 Resource Center for evidence-based, actionable resources, plus videos of firsthand accounts from physicians on the front lines;
- CME for physicians through the JAMA Network’s JN Learning website, including COVID-19 epidemiology, infection control and prevention recommendations
Executive Order of Suspension of Non-Essential Elective Surgeries
A directive was sent out by DOH to hospitals, ambulatory surgery centers, and office-based surgery centers to implement the Executive Order to suspend all non-essential elective surgeries.
Garfunkel Wild Webinar Operationalizing NYS Ban on Elective Surgery
New York State is banning elective procedures at hospitals and ASCs for the unforeseeable future. This webinar explored what the scope of these bans and some suggestion on how to operationalize.
AMA Releases Special Coding Advice Related to COVID-19
New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply the best coding practices. The scenarios include telehealth services for all patients.
Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19 and is directed to come to physician office or physician’s group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician office for testing; and more. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.
CDC: Clinician Outreach and Communication Activity (COCA)
COCA prepares clinicians to respond to emerging health threats and public health emergencies by communicating relevant, timely information related to disease outbreaks, disasters, terrorism events, and other health alerts.
FDA Expedites Treatment of Seriously Ill COVID-19 PTs with Experimental Plasma
In an unusual move, the Food and Drug Administration today announced that is making it easier for doctors to try an experimental treatment for COVID-19 patients that uses plasma from people who had the disease and recovered. There is scant evidence it works in people infected with the coronavirus, but the approach has been tried for other illnesses.
The idea is that this so-called convalescent plasma will contain antibodies to the virus that allowed the donor to recover to disease, and therefore should help patients who are sick.
Convalescent plasma been used in the past to treat outbreaks polio, measles, and mumps before a vaccine was available. More recently it’s has been used with some effectiveness to treat patients with SARS and Ebola.
In guidance to doctors, the FDA stated, “Given the public health emergency that the expanding COVID-19 outbreak presents, while clinical trials are being conducted, FDA is facilitating access to COVID-19 convalescent plasma for use in patients with serious or immediately life-threatening COVID-19 infections.” Doctors will still have to get FDA approval for individual patients to use the treatment, but if doctors need an answer in less than four hours, they can call the FDA Office of Emergency Operations for a verbal authorization.
The idea for using convalescent serum to treat COVID-19 has been championed by Arturo Cassadeval of the Johns Hopkins Bloomberg School of Public Health and Liise-anne Pirofski from the Albert Einstein College of Medicine.
Cassadeval has been interested in the use of convalescent serum to treat outbreaks of viral diseases throughout his career. In February, he wrote an op-ed piece for The Wall Street Journal suggesting it be used in the current outbreak. He followed that up with a scientific paper and then started hearing from doctors all over the country asking if they could participate in a clinical trial of the approach.
Cassadevall was hoping to hear from the FDA that it would give him approval to start a trial. The broader usage granted by FDA was a surprise.
“The FDA just opened the floodgates,” wrote Jeffrey Henderson, associate Professor of Medicine and Molecular Microbiology at Washington University School of Medicine in St. Louis in an email to NPR. “Our institution is scrambling to be ready to use this, as are many others, I’m sure.”
As with any unproven therapy, there are risks with the approach. The worst is that it could actually make patients sicker, a response known as antibody-dependent enhancement where the virus is actually helped to proliferate by a patient’s own immune system.
“I think we need to be cautious about using convalescent serum,” says Martin Zand, professor in the department of medicine and co-director of the Clinical & Translational Science Institute at the University of Rochester Medical Center. (NPR Mar 24 5:35PM)
Update on President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
CMS Outlines New Flexibilities Available to People with Medicare
On March 17, 2020, CMS announced that Fee For Service (FFS) Medicare is expanding coverage for Telehealth services, with an effective date of March 6, 2020. MLN Connects® Special Edition for Tuesday, March 17, 2020. Previously covered Telehealth services are now available to beneficiaries in their home environments, regardless of geographic location.
Our sole intent is to make the claim process as seamless as possible for the providers we serve. While we do not anticipate claim rejections and denials relative to these Telehealth claims, we urge providers to notify us immediately if any such problems are identified. We also advise providers that the NGS Provider Call Center does not have any further information on this issue at present.
NGS keenly recognizes the challenges providers are facing as the country deals with this current emergency and we assure you of our full support as we navigate through this time.
NGS remains fully committed to a prompt and successful implementation of the telehealth benefits as a result of these changes. Please continue to monitor this website (www.ngsmedicare.com) for additional information from CMS or NGS as it becomes available.
OIG Warns of COVID-19 Fraud Schemes
The US Department of Health and Human Services Office of Inspector General (OIG) released a fraud alert warning Medicare beneficiaries of potentially fraudulent schemes that take advantage of the fears surrounding the COVID-19 public health emergency. The OIG warns that fraudsters are targeting Medicare beneficiaries through telemarketing, social media and even in-person, door-to-door contact. According to the OIG, the fraudulent schemes often involve an offer of a COVID-19 test in exchange for an individual providing personal information. More on COVID-19 Fraud Schemes Here.
AMA Releases Special Coding Advice Related to COVID-19
New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply the best coding practices.
The scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19 and is directed to come to physician office or physician’s group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician office for testing; and more. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.
CVS To Waive Co-Pays for Aetna Member Coronavirus Hospitalizations
CVS Health said it will waive co-payments and related out-of-pocket cost-sharing of commercially insured Aetna members’ inpatient admissions related to the Coronavirus strain COVID-19. The move is among the more significant thus far among health insurance companies that are expanding coverage and eliminating plan member cost-sharing for everything from doctor office visits for Coronavirus tests to telehealth consultations for screening of the disease. (Forbes, March 25)