AMA, ISMA, others seek more health care business aid
ISMA has joined the AMA in asking congressional leaders to protect patients’ access to medical care through additional federal support for physician practices that have been hurt by the COVID-19 pandemic.

In a letter sent Wednesday, the AMA, ISMA and 139 other physician organizations express appreciation for the financial support, policy changes and regulatory accommodations Congress has already made to allow physicians to respond to the COVID-19 pandemic but say additional action is needed.

“Given the magnitude of the growing revenue shortfalls confronting physician practices across the country, we continue to need your support to preserve their viability so they can meet the needs of all patients,” the letter says.

The letter calls on lawmakers to consider several types of support for physicians in responding to the COVID-19 pandemic, including an adjustment of Medicare and Medicaid payment provisions, expanded financial support for practices, more small-business loan funding, telemedicine service coverage for ERISA group health plans, expansion of small-business loan funding, financial relief for medical students and residents contributing to patient care, and additional medical liability protections.

Specifics of those proposals are as follows: Medicare Accelerated and Advance Payment Program
  • Postpone recoupment until 365 days after the advance payment is issued.
  • Reduce the per-claim recoupment amount from 100% to 25%.
  • Extend the repayment period for physicians to at least two years.
  • Waive the interest that accrues during the extended payment period.
  • Authorize the Department of Health and Human Services (HHS) to issue more than one advance payment.
Medicare and Medicaid payments
  • Implement a positive Medicare payment update for physicians from 2020 to 2025, similar to those approved for other providers under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
  • Increase Medicaid and TRICARE payment rates to assure parity with Medicare fee-for-service payments for the duration of the public health emergency.
  • Waive budget neutrality for the Medicare payment changes for evaluation and management (E/M) services that will be implemented on Jan. 1, 2021.
  • Extend sequestration relief through Dec. 31, 2021, to continue providing financial relief as physician practices resume normal operations.
Direct financial support
  • Authorize more direct financial support, grants, interest-free loans and other mechanisms, such as a 9/11-type COVID fund, for physician practices of all sizes. These programs should:
    o Reimburse expenses such as payroll costs and other overhead costs.
    o Reimburse payments to outside firms for billing and IT purposes, especially for small practices.
  • Enact provisions, such as those in the Immediate Relief for Rural Facilities and Providers Act (S. 3559), that would:
    o Provide an emergency, one-time grant for all providers and ambulatory surgery centers equal to their total payroll from Jan. 1 to April 1, 2019.
    o Include all overhead costs.
Small business loans
  • Provide additional funding for newly authorized and expanded small business loans under the Small Business Administration, including the already-depleted Payroll Protection Program (PPP).
  • Expand eligibility to include physician practices with more than one location but with 500 employees or less per location by applying the exception that covers Accommodation and Food Services Industry businesses that meet the same description.
  • Extend to physician practices the affiliation rule waiver that has already been applied to the Accommodation and Food Services Industry.
Require ERISA group health plans to provide coverage for the same telehealth and telephone services being covered by Medicare during the COVID-19 pandemic.

Support for resident physicians and students
  • Forgive at least $20,000 of federal student loans or offer $20,000 of tuition relief for residents and medical students who graduated early.
  • Offer the same loan forgiveness or tuition relief third- and fourth-year medical students who are either:
    o Willing and competent to begin providing early direct patient care for patients with COVID-19
    o Responding to the pandemic in significant ways through research, public health, and telemedicine.
  • Allow flexibility in CMS’ GME reimbursement to hospitals, to accommodate variations in training due to the COVID-19 response. This flexibility should:
    o Lengthen the initial residency period for residents to allow them to extend their training, if necessary, to meet program and board certification requirements.
    o Expand the reimbursement cap at institutions where residents must extend their training to support an increased number of residents as new trainees begin while existing trainees remain to complete their programs.
Emergency Medical Treatment and Labor Act (EMTALA)
Clarify the HHS Secretary’s ability to issue waivers under section 1135 of the Social Security Act so that state and local protocols may be adopted to provide more nimble methods to address the pandemic.

Consider broader liability protections for physicians and other clinicians and the facilities in which they practice as these professionals step up to treat COVID-19 under unprecedented conditions.

For additional details, read the complete letter here.

As always, ISMA will continue to keep members informed of response to these proposals and any additional developments.