COVID-19 Update May 5, 2020
COVID-19 Map – Johns Hopkins Coronavirus Resource Center
CMS Announces Pay Parity for Audio-Only Telephone Visits
The Centers for Medicare & Medicaid Services said it will bump up payments for audio-only telephone consultations to match payments made for office and outpatients visits.
The new rule would increase payments for audio-only telephone consultations from $14-$41 to about $46-$110, CMS said in a media release.
The rule change was part of a broad package of waivers and rules shifts that were brought forward Thursday by CMS in to facilitate testing and expand access to telehealth.
Over 1,600 Undisclosed Deaths Reported at NY Nursing Homes
New Health Department statistics released late Monday included the previously undisclosed deaths of more than 1,600 people who were presumed to have died of the virus at nursing homes but who had not received a confirmed diagnosis. By May 3, according to the new data, 4,813 people had died of the virus at nursing homes. The new data did not include nursing home residents who died in hospitals.
The number of deaths of nursing home residents, either at homes or in hospitals, was 3,025 on April 28, and approximately 100 more people died at nursing homes from April 29 to May 2, according to state figures.
Gary Holmes, a Health Department spokesman, said officials had revised the state’s system for gathering and evaluating data from homes and that figures would probably continue to be revised. “This crisis and our response to it continues to evolve,” he said. “And the unprecedented amount and specificity of data we are providing to the public will continue to evolve with it.”
David C. Grabowski, a Harvard University researcher who studies nursing homes, said that when the final data is in, nursing homes will probably account for about half of all of the Covid-19 deaths in every state, as they already do in Massachusetts, New Jersey and Pennsylvania, among others.
In New York State, even with the new presumed deaths added, nursing homes account for about 25 percent of the state’s fatalities. The homes hit the hardest have been in New York City and its suburbs. Homes in the Bronx had 215 confirmed virus deaths and 446 deaths the virus was presumed to have caused. In Queens, the new numbers showed 358 confirmed deaths and 476 presumed deaths.
Nursing homes had fought the release of death counts for individual facilities, arguing that a large toll might not indicate poor infection control and might scare families unnecessarily. (NYT, 5/5)
Empire Advancing Payments to Certain Independent Primary Care Physicians
To support these essential providers during the COVID-19 crisis, Empire is advancing payments to certain independent primary care physician organizations and multi-specialty groups that include primary care. Empire (and Anthem) will offer these payments to hundreds of physician organizations across the country, beginning in May.
Dr. Art Fougner, President of the Medical Society of the State of New York, applauds Empire and Anthem, its parent company, for this action for physicians during the pandemic.
“With physicians reporting dramatic drops in patient visits and revenue in our collective response to the Covid-19 pandemic, we thank Empire Blue Cross for implementing a program to help its network physicians with an advance payment program. It will provide a lifeline to these practices until regular patient visits can resume.
“We are also aware that United and CDPHP have, importantly, also adopted advance programs. We urge other health insurers to similarly work with their network physicians to implement advance payment programs.”
Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York
Pandemic Hurting Primary Care Practices
The coronavirus pandemic has ravaged primary-care practices and physicians are saying they may have to close or sell their practices without more financial relief. The pandemic has highlighted existing disparities in primary-care reimbursement, and expanded telehealth options have not compensated for a massive drop in volume.
Primary-care physicians also complain that they have been disadvantaged by an important federal grant funding formula and CMS recently cut off a loan program designed to help with cash flow. Restrictions on nonemergency procedures and care have decimated in-person volumes, and providers are concerned that patients may be hesitant to return to practices even after restrictions are lifted.
Atrius Health delivers care to 745,000 patients across 31 practices in Massachusetts. The group averaged about 22,000 encounters per week in its internal medicine and pediatrics departments in 2019. Last week, the group logged 4,000 video and 9,600 in-person visits, for a 38% drop in volume. But that is an improvement from mid-March, when video visits were “almost zero. “Telehealth is helping restore some revenue, but reimbursement varies by medium, state and payer. Some practices have struggled to make the sudden transition with outdated equipment.
Most practices have gotten some grant money from the $50 billion HHS distributed from the Coronavirus Aid, Relief, and Economic Security Act’s provider relief fund. But the funding allocation is based on the “net patient revenue” metric in cost reports, which experts say favors specialists who demand higher reimbursement rates than primary-care providers. Some practices also took advantage of Medicare advance payments to help them maintain cash flow, but the loans must be repaid. CMS begins recouping the funds after four months by garnishing Medicare reimbursement. If the loan is not fully repaid in seven months, then the loans begin to accrue interest far higher than market rates.
CMS suddenly suspended the Medicare advance payment program April 16, though it is still accepting applications for Medicare Part A providers. The agency said it distributed more than $40 billion to nearly 24,000 Medicare Part B providers and suppliers and was pulling back on the program because “of historical direct payments made available” through the CARES Act. “Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs,” the agency noted in a fact sheet.
Primary-care advocates are also pushing to allow CMS to pay family medicine practices in monthly, per-patient installments. (Modern Healthcare,5/2)
NYT: Projects Steady Increase in COVID-19 Cases This Month
An internal White House document obtained by The New York Times projects a steady increase in COVID-19 cases this month, with the daily death toll hitting about 3,000 by June 1. At present, about 1,750 COVID-19 deaths are occurring each day. The document also projects about 200,000 new cases daily by the end of May, a large jump from the roughly 25,000 daily cases occurring now.
A researcher at Baltimore-based Johns Hopkins University conducted the preliminary analysis and shared it with FEMA “to aid in scenario planning — not to be used as forecasts,” Joshua Sharfstein, MD, the school’s vice dean of public health practice, told Bloomberg. The White House has distanced itself from the analysis, which was dated May 1 and contains seals for both HHS and the Department of Homeland Security.
“This is not a White House document, nor has it been presented to the Coronavirus Task Force or gone through interagency vetting,” Judd Deere, a spokesperson for the White House, said in a statement to Bloomberg. “This data is not reflective of any of the modeling done by the task force or data that the task force has analyzed.”
DOH: New Guidance for Medicaid Physicians re Use of Telehealth
The Department of Health has released updated guidance for Medicaid providers regarding the use of Telehealth, including Telephonic, services during the COVID-19 State of Emergency. The accompanying Frequently Asked Questions document has also been updated. These documents are available on the Department of Health website here or via the links below.
A summary of the changes is provided below.
- Clarification regarding payment parity for telehealth and telephonic services
- Provides additional details regarding billing and coding instructions, including POS and Modifier codes to use in each of the telephonic billing lanes
- Clarifies definitions of telehealth, telemedicine, and telephonic services.
- Clarifies billing rules for Article 28 services with a Professional Component
- Revises billing rules for FQHCs to allow wrap payments for licensed practitioners providing services via telehealth or telephone
- Clarifies requirements for Medicaid Managed Care Plans
- Provides additional links to other resources
The intent of this guidance is to provide broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent it is appropriate for the care of the member.
Telehealth services will be reimbursed at parity with existing off-site visit payments (clinics) or face-to-face visits (i.e., 100% of Medicaid payment rates). This guidance relaxes rules on the types of clinicians, facilities, and services eligible for billing under telehealth rules.
May 20, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
Mental Health and COVID-19 for Health Professionals
Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Just like we need to take extra precautions to protect ourselves from the risk of being infected by COVID-19, we also need to be concerned about psychological risks for health professionals. Faculty for this program is Craig Katz, MD.
Registration is now open for this webinar.
To view the companion pieces to this webinar, be sure to go here and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.