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November 11, 2020

Retirement After the COVID-19 Pandemic

The COVID-19 pandemic and accompanying financial crisis leaves uncertainty for the 18 million Americans expected to retire in the next five years. At the same time, research suggests that millions of U.S. workers are retiring early — a move that could jeopardize their long-term retirement goals.

November 10, 2020

New Resource for COVID-19: CDC/IDSA Real-Time Learning Network

The American Academy of Family Physicians has been selected by the CDC as a collaborator in the COVID-19 Real-Time Learning Network (RTLN). The RTLN is a collaborative effort led by the Infectious Diseases Society of America to provide access to the latest information on fighting COVID-19 by bringing together the many health care disciplines fighting this pandemic to share resources and best practices, and ultimately decrease the impact of COVID-19 and save lives.  The goal of the network is to bring value, support, and guidance to healthcare providers treating COVID-19 patients through education, communication and outreach.

November 3, 2020

CDC Digital Media Toolkit: 2020-21 Flu Season

Help spread the word on the importance of getting a flu vaccine by using the CDC’s recently released digital media toolkit for the 2020-21 flu season. FDA also released multiple reasons why it is important to get your flu vaccine, especially during the COVID-19 pandemic.  Read More

October 13, 2020

CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19

New recoupment terms allow providers and suppliers one additional year to start loan payments

CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.

“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema Verma. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.

CMS expanded the AAP Program on March 28, 2020, and gave these loans to health care providers and suppliers in order to combat the financial burden of the pandemic. CMS successfully paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished. In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment suppliers received advance payments totaling more than $8.5 billion.

Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. At the end of the 11-month period, recoupment will increase to 50% for another 6 months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of 4%.

The letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of 3 years, or, up to 5 years in the case of extreme hardship. Providers and suppliers are encouraged to contact their MAC for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the coming weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.

For More Information:

Fact Sheet
FAQs

September 9, 2020

On September 9, the Massachusetts Academy of Family Physicians in collaboration with the Massachusetts Medical Society, the Massachusetts Chapter of the American Academy of Pediatrics, and the Massachusetts Chapter of the American College of Physicians hosted a 90 minute Virtual Member Forum on COVID-19 and School Reopening. Dr. David Rosman, president, Massachusetts Medical Society and Dr. Michele Parker, president, Massachusetts Academy of Family Physician served as moderators.  

Jeffrey Riley, commissioner, Massachusetts Department of Elementary and Secondary Education; Dr. Lloyd Fisher, president, Massachusetts Chapter of the American Academy of Pediatrics; Dr. Elisa Choi, governor, Massachusetts Chapter of the American College of Physicians; Dr. Sandra Nelson, infectious disease specialist, Massachusetts General Hospital; and  Dr. Larry Madoff, medical director, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health shared perspectives on the benefits, risks and strategies for safe school reopening. The needs and challenges of schools in communities that struggle with socioeconomic factors of poverty and racial inequality were highlighted. The program recording, along with the slide deck and summary, are now available for MassAFP members to access via the link below.

August 4, 2020

CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries
CMS released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries. The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.  Read More



COVID-19: Laboratory Claims Requiring the NPI of the Ordering/Referring Professional
During the COVID-19 Public Health Emergency (PHE), CMS relaxed requirements for a limited number of laboratory tests required for a COVID-19 diagnosis. These tests do not require a practitioner order during the PHE. We added a new test to this list (PDF): CPT 87426  (Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).  Read More



HHS Protect Public Data Hub
This new hub aims to provide high quality, accessible, and timely information related to COVID-19.  It augments Healthdata.gov with non-government datasets from academia, nonprofit organizations, industry, hospitals, and facilities reporting from all 50 states and territories.  Read More

July 29, 2020

CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries
The Centers for Medicare & Medicaid Services today released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries.

The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.

The updated data confirm that the COVID-19 public health emergency is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities. This is due, in part, to the higher rates of chronic health conditions in these populations and issues related to the social determinants of health.

In response to the first Medicare data snapshot and related call to action from CMS Administrator Seema Verma on June 22, the CMS Office of Minority Health hosted three listening sessions with stakeholders who serve and represent racial and ethnic minority Medicare beneficiaries. These sessions provided helpful insight into ways in which CMS can address social risks and other barriers to health care that will help in our efforts to reduce health disparities.

The updated data on COVID-19 cases and hospitalizations of Medicare beneficiaries covers the period from January 1 to June 20, 2020. It is based on Medicare claims and encounter data CMS received by July 17, 2020.

Other key data points:

  • Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries.
  • Beneficiaries eligible for both Medicare and Medicaid – who often suffer from multiple chronic conditions and have low incomes – were hospitalized at a rate more than 4.5 times higher than beneficiaries with Medicare only (719 versus 153 per 100,000).
  • Beneficiaries with end-stage renal disease (ESRD) continue to be hospitalized at higher rates than other segments of the Medicare population, with 1,911 hospitalizations per 100,000 beneficiaries, compared with 241 per 100,000 for aged and 226 per 100,000 for disabled.
  • CMS paid $2.8 billion in Medicare fee-for-service claims for COVID-related hospitalizations, or an average of $25,255 per beneficiary.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

July 27, 2020

The Baker-Polito Administration announced an expansion of its “Stop the Spread” initiative, which provides free COVID-19 testing in targeted communities across the Commonwealth.

This expansion includes new testing sites in Agawam, Brockton, Methuen, Randolph, Revere, Springfield, Taunton and Worcester. The Administration previously launched free testing sites in Chelsea, Everett, Fall River, Lawrence, Lowell, Lynn, Marlborough and New Bedford, bringing the total number of communities served, with today’s expansion, to 16.

The Stop the Spread initiative is a data-driven focused effort to reduce the prevalence of COVID-19 in communities that are above the state average in total cases, positive test rate, and have experienced a decline in testing levels since April. All residents of these 16 communities, including asymptomatic individuals, are urged to use these sites to get tested. While these sites are being launched in these communities, they are open to all residents of the Commonwealth.

The population of the new cities in which the free testing will be conducted – Agawam, Brockton, Methuen, Randolph, Revere, Springfield, Taunton and Worcester – make up approximately 10% of the Commonwealth’s population. However, these communities have seen 15% of the Commonwealth’s positive tests in the last two weeks.

The statewide positive test rate over the past two weeks is approximately 1.7%, but in these 8 communities, the positivity rate is nearly 50% higher, at 2.3%.

Despite the continued elevated spread in these communities, total testing in these communities has declined over 20% since the end of April, while the statewide average has been flat over that time period. The total cases as a percentage of population for these communities is nearly double the state average.

Since launching Stop the Spread on July 10, 19,083 residents have been tested at these free testing sites. So far, the COVID-19 Command Center has received results back for 17,189 individuals, with a positivity rate just under 1.8%. The Command Center expects these numbers to change as additional testing results continue to come in.

The Administration’s first expansion of testing in 8 communities – Chelsea, Everett, Fall River, Lawrence, Lowell, Lynn, Marlborough and New Bedford – has successfully increased testing in those communities.

In the first week, testing in those 8 communities was up 48% over the week before those sites went live, and statewide, testing was up 24%.

Residents of the 16 communities can visit mass.gov/stopthespread to find testing locations, which will be available through August 14.

Residents are reminded that if they test positive for COVID-19, please answer the call when they are contacted by the Community Tracing Collaborative or their local board of health. Also, any individual who needs a safe place to isolate can call (617) 367-5150 to access an isolation and recovery site at no cost.

July 23, 2020

Advancing the Response to COVID-19: Sharing Promising Programs and Practices for Racial and Ethnic Minority Communities
Save the Date! Thurs., Sept. 17, 2020.
HHS Office of Minority Health (OMH) hosts this virtual symposium to highlight state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority populations.
Learn more here.

July 21, 2020

One-Stop Shop for COVID-19 Resources
CDC updated communication resources for videos, social media, PSAs, print resources, checklists, FAQs, and web resources.  In Spanish and other languages. 


Researchers Publish Encouraging Early Data on COVID-19 Vaccine
NIH Director, Dr. Francis Collins released this blog post describing the NIH-supported phase 1 human clinical trial for a COVID-19 vaccine. A phase 2 clinical trial is already well on its way to recruiting* 600 healthy adults.


Volunteer in a COVID-19 Clinical Study
Visit the COVID-19 Prevention Network (CoVPN) website to take the questionnaire and join the CoVPN Volunteer Screening Registry.


FDA’s Updated FAQs on COVID-19
The U.S. Food & Drug Administration updated their Frequently Asked Questions (FAQs) for the general public.  Also in Spanish.


HHS Issues Guidance on Civil Rights Protections Against Discrimination During COVID-19
HHS is issuing guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19.


NIMIC Initiative to Fight COVID-19 in Racial and Ethnic Minority Communities
The National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities (NIMIC) Initiative, a three-year cooperative agreement between HHS and the Morehouse School of Medicine, is expected to better serve racial, ethnic, rural, and socially vulnerable populations. 


Improving the Integration of CBOs: Building Relationships in Preparation for the Next Emergency
Community-based organizations (CBOs) are well positioned to partner with emergency management and public health entities to meet the needs of at-risk individuals during future public health emergencies. HHS released an e-guide to support the integration of these cross-sector partnerships into emergency public health strategies.  


Advance Care Planning: New Realities in Times of COVID-19
Leaving nothing in its path untouched, the COVID-19 public health emergency has impacted all aspects of health from the delivery of rural healthcare to an accelerated need for Advance Care Planning.


Community Health News
FCC Designates 988 for the National Suicide Prevention Lifeline
The Federal Communications Commission (FCC) adopted rules to establish 988 as the new, nationwide, 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.


Free VA COVID-19 Training: Strategies to Improve Provider Wellbeing and Resilience
Wednesday, July 22nd at 2:00 p.m., Register here.
Offered by the Department of Veteran Affairs’ VHA TRAIN, this webinar will feature a panel of providers reviewing the importance of health care provider wellness, as well as strategies to improve provider wellbeing and resilience. The training is open to both VA and non-VA clinicians. Continuing education credit is available for those who preregister.


Coronavirus (COVID-19) Update: FDA Issues First Emergency Authorization for Sample Pooling in Diagnostic Testing

The U.S. Food and Drug Administration recently reissued an emergency use authorization (EUA) to Quest Diagnostics to authorize its Quest SARS-CoV-2 rRT-PCR test for use with pooled samples containing up to four individual swab specimens collected under observation. The Quest test is the first COVID-19 diagnostic test to be authorized for use with pooled samples.

Sample pooling is an important public health tool because it allows for more people to be tested quickly using fewer testing resources. Sample pooling does this by allowing multiple people – in this case four individuals – to be tested at once. The samples collected from these four individuals are then tested in a pool or "batch" using one test, rather than running each individual sample on its own test. If the pool is positive, it means that one or more of the individuals tested in that pool may be infected, so each of the samples in that pool are tested again individually. Because the samples are pooled, it is expected that fewer tests are run overall, meaning fewer testing supplies are used and more tests can be run at the same time allowing patients to receive their results more quickly in most cases. This testing strategy is most efficient in areas with low prevalence, meaning most results are expected to be negative.

"This EUA for sample pooling is an important step forward in getting more COVID-19 tests to more Americans more quickly while preserving testing supplies," said FDA Commissioner Stephen M. Hahn, M.D. "Sample pooling becomes especially important as infection rates decline and we begin testing larger portions of the population."

While there is a concern that combining samples may make it more difficult to detect positives, since pooling in the laboratory dilutes any viral material present in the samples, Quest's validation data demonstrates that its test correctly identified all of the pooled samples that contained a positive sample. It is important to note that the Quest test, initially authorized on March 17, 2020, remains authorized to test individual samples collected by their health care provider from people with suspected COVID-19 infection. The test is also still authorized for use with individual nasal swab specimens that are self-collected at home or in a health care setting using an authorized home-collection kit when determined to be appropriate by a health care provider.

The FDA continues to work with a number of diagnostic test developers to facilitate new approaches and get additional tests to more Americans more quickly.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation's food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.


Expert: Face Masks Reduce Wearer's COVID Infection Risk by 65% - by Ralph Ellis

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Wearing a facial covering not only curbs the spread of the coronavirus but reduces a mask wearer's risk of catching the virus by 65%, said Dean Blumberg, MD, chief of pediatric infectious diseases at UC Davis Children's Hospital.

Blumberg, speaking on a college livestream about the coronavirus, said that a "standard rectangular surgical mask ... will decrease the risk of infection to the person wearing the mask by about 65%" and that homemade masks also "should work quite well."

N95 masks are the most effective but should be reserved for medical personnel, he added.

The masks mainly provide a physical barrier to respiratory droplets that are about one-third the size of a human hair, he said. Those drops are one of the major ways the virus is transmitted.

"People who say 'I don't believe masks work' are ignoring scientific evidence," Blumberg said. "It's not a belief system. It's like saying, 'I don't believe in gravity.'"

"You're being an irresponsible member of the community if you're not wearing a mask. It's like double-dipping in the guacamole. You're not being nice to others."

But even surgical masks are not airtight enough to create an effective barrier against much smaller aerosol particles, which are about 1/100th the size of a human hair, he said. The best defense against aerosol particles is social distancing and interacting with people outdoors.

"Studies in laboratory conditions now show the virus stays alive in aerosol form with a half-life on the scale of hours. It persists in the air," said William Ristenpart, PhD, a professor of chemical engineering at UC Davis. "That's why you want to be outdoors for any social situations if possible." 

Enclosed places like bars are especially troublesome, he said, because "The louder you speak, the more expiratory aerosols you put out."

Blumberg said scientists' opinions about the effectiveness of masks have evolved since the pandemic began months ago.

Although more states and cities are issuing mask mandates as cases continue to surge in the U.S., the issue remains controversial. Wearing them was not universally recommended during the early days of the pandemic, partly to ensure health care workers had enough protective gear while shortages existed.

July 16, 2020

AMA telehealth/COVID survey

You are invited to complete the Telehealth Impact Study Provider Questionnaire by clicking on the link below.  The study has been approved by the Mayo Clinic IRB and is part of our efforts in the COVID-19 Healthcare Coalition to address the pandemic. Since COVID-19 started, we have experienced a significant shift towards telehealth.  The goal of this project is to learn more about your experience with telehealth to identify the challenges and barriers, as well as the benefits.

Building on existing research, your response will help inform additional resources needed across the industry and health care community, provide insights to federal and state policymakers, and identify gaps in current research. Respondent and organization information will remain confidential and will only be reported in aggregate. The findings will be shared and made available to all on the COVID-19 Healthcare Coalition website, as well as shared by the  various organizations participating in the Coalition Telehealth Workgroup.

The COVID-19 Healthcare Coalition is focused on understanding your experience of telehealth as an individual physician, nurse practitioner, or physician assistant.  The survey is expected to take up to 15-20 minutes and we ask that you complete the survey by August 13th, 2020.  Please remember to press submit when you get to the end of the survey.

We want to hear from as many clinicians as possible to inform our work. If you have colleagues who use telehealth, please consider forwarding this invitation to them.

Thank you in advance for your consideration and valuable insights. 

July 13, 2020

Join Our COVID-19 Workshop Series
IPRO QIN-QIO's Workshop: Resiliency - Coping & Recovering During a Pandemic, July 16, 10:30-11 AM.
Resilience is the capacity to recover quickly from difficulties—so what does that look like across the health care spectrum during this pandemic? Join us as we discuss fostering community resilience and how it impacts those you serve.  Learn More & Register


Society of Critical Care Medicine free education, "Critical Care for non-ICU Clinicians"
SCCM's Critical Care for the Non-ICU Clinician provides online education to healthcare professionals who could benefit from critical care training. Be prepared with these free resources.  Read More


Ventilator Simulator
Here is a link to a Ventilator Simulator (though it is directed towards pediatric patients, much of it is applicable broadly).

July 8, 2020

COVID-19 diagnosis coding explained in a flowchart
Diagnosis coding for COVID-19 is complicated, in part because the World Health Organization (WHO) created two diagnosis codes for COVID-19, but so far the United States has adopted only one. The WHO’s codes are as follows:

• U07.1 – COVID-19, virus identified (lab confirmed),

• U07.2 – COVID-19, virus not identified (clinically diagnosed). 

The WHO’s intent was for U07.1 to be assigned to cases with a lab-confirmed diagnosis and for U07.2 to be used for cases with a clinical diagnosis. The United States adopted U07.1 as an immediate, off-cycle update to the ICD-10 code set but did not adopt U07.2 because it was released later. Therefore, in the United States, the words “virus identified” are left out of the description for U07.1, which leaves room for interpretation about when to use the code.

The predicament

Without having a diagnosis code specifically for clinically diagnosed (rather than lab-confirmed) COVID-19, U.S. physicians are left without clear guidance.

How do we properly document and code for a patient who is clinically diagnosed? If we only use symptom codes, patients will most likely not be covered by their payers for COVID-19 care and they also will not be included in a disease registry. This is important because many payers are waiving any cost-share responsibility for patients diagnosed with COVID-19. However, in order for the claim to be accepted as a COVID-19 related service, it must have a COVID-19 related diagnosis code. Also, if the patient is in a disease registry, it allows for adequate follow-up, especially if we start to use serologic testing for patients. Sensitivity to the COVID-19 reverse transcriptase (RT-PCR), or diagnostic, tests has been reported to be 70% with a single respiratory swab.1 Consequently, in some instances, patients clinically appear to have COVID-19, but their RT-PCR is not positive until subsequent tests. These patients should be diagnosed with COVID-19, even though the initial labs were negative.

Then there is the question of using serologic (antibody) testing for diagnosing COVID-19. At the time the ICD-10 code was introduced, only RT-PCR testing was available. Now, physicians have more access to serologic tests; however, there is the issue of how to interpret these tests and their use in diagnosing patients with COVID-19. According to the Centers for Disease Control and Prevention (CDC), serologic testing can be offered to support a diagnosis of COVID-19 for patients who present late. Patients presenting 9 to 14 days after illness onset can be tested with the antibody test, in addition to the RT-PCR test to maximize sensitivity.2 A positive serologic test result indicates past or present COVID-19 infection. But it could be a false positive; therefore, serologic testing should not be the only factor in diagnosing COVID-19.3

If a patient has clinical symptoms consistent with COVID-19 and/or has had exposure, and the patient has a negative COVID-19 RT-PCR test, how should the serologic test be interpreted? If the serologic test reveals IgM (-) and IgG (+), should the patient be diagnosed with COVID-19? If the patient has no symptoms or no known exposure, a negative COVID-19 RT-PCR test, and the serologic test reveals IgM (-) and IgG (+), should this patient be diagnosed with COVID-19? Or is there the need for a new ICD-10 code indicating previous infection or previous exposure identified by serology?

The recommendation

Without having a diagnosis code for both lab-confirmed COVID-19 and clinically diagnosed COVID-19, we only have one option: U07.1 – COVID-19. For purposes of vital statistics reporting, the CDC’s National Center for Health Statistics (NCHS) has confirmed that U07.1 can be used for both lab-confirmed and clinically diagnosed patients who have died.4 But the CDC’s broader guidance on coding for living patients again leaves room for interpretation. CDC has stated, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. In this context, ‘confirmation’ does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.”5The phrase “as documented by the provider” can be interpreted to mean as clinically diagnosed by the provider.

Different diagnosis algorithms can be used for diagnosing patients with COVID-19. Physicians should take prevalence and incidence in their own community into consideration when assigning a clinical diagnosis, especially in the absence of a positive test.

A flowchart

Here is a four-part flowchart that our organization developed to help physicians navigate these waters and properly assign diagnosis codes related to COVID-19 encounters. No one algorithm will fit every health care system. It may need to be tailored to your geographic location since prevalence and incidence vary greatly not only throughout the United States but even throughout states, where pockets of COVID-19 surges are emerging.


COVID-19: New and Expanded Flexibilities for RHCs & FQHCs during the Public Health Emergency
On July 6, CMS updated MLN Matters Article SE20016 to clarify how Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can apply the Cost Sharing (CS) modifier to preventive services furnished via telehealth. This update includes:

Additional claim examples
New section on the RHC Productivity Standard

July 7, 2020

Provider Relief Fund

HHS recently announced the additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs.  HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution.  Eligible providers must submit their data by July 20.
 
Before applying through the Enhanced Provider Relief Fund Payment Portal, applicants can watch a webinar about the application process for Medicaid/CHIP providers.  An additional webinar is scheduled for Wednesday, July 8 at 4:00 pm, which you can register for here.  I also encourage you to review the most recent FAQs on the program and the Medicaid/CHIP targeted distribution here
 

July 2, 2020

A race to determine what drives COVID-19 severity
Efforts are ongoing to find which human or viral factors underpin whether a person with COVID-19 will develop severe symptoms. Clinical evidence linked to two viral lineages now provides key insights into this enigma.
https://www.nature.com/articles/d41586-020-01915-3


Journal of Hospital Medicine
All Hands on Deck: Learning to “Un-specialize” in the COVID-19 Pandemic
https://www.journalofhospitalmedicine.com/jhospmed/article/220370/hospital-medicine/all-hands-deck-learning-un-specialize-covid-19-pandemic

June 23, 2020

Explaining Operation Warp Speed

HHS released a Fact Sheet explaining Operation Warp Speed, a strategy that aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021, as part of a broader strategy to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.  Read More


HHS Awards $107.2 Million to Grow and Train the Health Workforce

HHS, through its Health Resources and Services Administration (HRSA), announced awards totaling $107.2 million to 310 recipients to increase the health workforce in rural and underserved communities aimed at improving the quality, distribution, and diversity of health professionals serving across the country.
        **Learn about other HRSA funding opportunitiesRead More


COVID-19: Vulnerable Populations and Palliative Care: Call for Social Justice Webinar

Thurs. July 9, 2020, 3:00 p.m. - Register here.
Presented by a CDC partner, speakers will address the central role of palliative care across all systems and provide a trauma-informed perspective in working with diverse and vulnerable people affected by the pandemic, as well as the critical importance of workforce education and training.  Read More


Alcohol and Substance Use

Increased stress can lead to increases in alcohol and substance use. If you or someone you care about is starting to use alcohol or other substances, or is increasing their use during the COVID-19 pandemic, CDC has released guidance and resources highlighting the basics of excessive use and what you can do to help.  Read More

June 22, 2020

Resources you can use from the Commonwealth

Mass.gov has a list of guidance and resources for all healthcare providers now in one place. The website includes information ranging from Massachusetts COVID-19 Health Care Provider Financial Relief Package to Flexibilities for Substance Use Disorder Treatment Services to MassHealth Provider Resource: Telephone and Internet Connectivity for Telehealth and much more. Many of the resources have been updated this month. See the full listing here.


PCC's June Webinar: Behavioral Health and Primary Care During and After COVID-19
 
Monday, June 29, 2020 • 2-3pm

The COVID-19 pandemic could lead to 75,000 additional deaths from alcohol and drug misuse and suicide, according to an analysis by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care released in early May and titled Projected Deaths of Despair From COVID-19. This research underscores the fact that the pandemic has created enormous behavioral health (BH) concerns that primary care in tandem with BH can help address now and as the country emerges from the pandemic. We’ll hear creative ideas from two of the authors of the Deaths of Despair brief as well as from a patient who also provides peer support. Join us as we discuss the steps the primary care community can take to avoid the deaths predicted in the report and meet the behavioral health needs arising from both the health and economic crises.

Speakers:

Jack Westfall, MD, MPH | Director, Robert Graham Center
Benjamin Miller, PsyD | Chief Strategy Officer, Well Being Trust
Kelly Davis | Director of Peer Advocacy, Supports, and Services, Mental Health America
Moderator:

Arthur C. Evans, Jr., PhD | Chief Executive Officer and Executive Vice President, American Psychological Association

REGISTER HERE


AAFP Member Advantage Partners with Hippo Education to Offer New Member-Exclusive Benefit

AAFP Member Advantage has partnered with Hippo Education to bring you their podcast, Primary Care Reviews and Perspectives, which keeps family medicine clinicians up to date with engaging monthly episodes. Designed with your busy schedule in mind, this exclusive member benefit includes the following perks:

Earn 42+ hours of CME credit
Receive 15% off purchase
Hosted by the most entertaining and astute educators in medicine
Short, easily digested chapters
Start listening today!


Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients

Today, the Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak. Original Medicare and Medicare Advantage plans will cover COVID-19 lab tests consistent with CDC guidance.


One Item That Makes Documentation Easier During a Telehealth Visit

Telehealth visits have spiked during the COVID-19 pandemic. But it’s hard to document a visit on a computer while you’re also using it to communicate with a patient via video. Adding this one item to your setup makes it easier to do both at the same time, leaving less work after clinic.

June 16, 2020

CMS COVID-19 Stakeholder Engagement Calls – Week of 6/15/20
CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page here.


CMS COVID-19 Office Hours Calls (Tuesdays at 5:00 – 6:00 PM)
Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls;
  • Rapidly Expand the Healthcare Workforce;
  • Put Patients Over Paperwork; and
  • Further Promote Telehealth in Medicare
  • This week’s Office Hours:

Tuesday, June 16th at 5:00 – 6:00 PM

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 4527348

Audio Webcast link


Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM)
Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

This week’s Lessons from the Front Lines:

Friday, June 19th at 12:30 – 2:00 PM

Toll Free Attendee Dial-In: 833-614-0820; Access Code: 2258722

Web Link

June 11, 2020

Information about testing in Massachusetts, including testing sites and supplies can be found here.


COVID-19 Response and Reporting information can be found on the Mass.gov website here. The dashboard found on this page includes daily and cumulative data on:

  • Confirmed cases
  • Testing by date
  • Cases by hospital, county, and age/sex/ethnicity
  • Hospitalizations
  • Deaths
  • Hospital capacity and census

June 10, 2020

PCC's June Webinar: Behavioral Health and Primary Care During and After COVID-19
 
Monday, June 29, 2020 • 2-3pm

The COVID-19 pandemic could lead to 75,000 additional deaths from alcohol and drug misuse and suicide, according to an analysis by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care released in early May and titled Projected Deaths of Despair From COVID-19. This research underscores the fact that the pandemic has created enormous behavioral health (BH) concerns that primary care in tandem with BH can help address now and as the country emerges from the pandemic. We’ll hear creative ideas from two of the authors of the Deaths of Despair brief as well as from a patient who also provides peer support. Join us as we discuss the steps the primary care community can take to avoid the deaths predicted in the report and meet the behavioral health needs arising from both the health and economic crises.

Speakers:

  • Jack Westfall, MD, MPH | Director, Robert Graham Center
  • Benjamin Miller, PsyD | Chief Strategy Officer, Well Being Trust
  • Kelly Davis | Director of Peer Advocacy, Supports, and Services, Mental Health America

Moderator:

  • Arthur C. Evans, Jr., PhD | Chief Executive Officer and Executive Vice President, American Psychological Association

June 9, 2020

Reopening Massachusetts
The Baker-Polito Administration’s comprehensive plan to safely reopen the Massachusetts economy, get people back to work, and ease social restrictions while minimizing the health impacts of COVID-19. Learn More


Most current Massachusetts
Specific news and updates can be found here.


MotherToBaby Launches First COVID-19 in Pregnancy Study
A new study conducted by birth defects research experts from the non-profit Organization of Teratology Information Specialists (OTIS) launches to examine the short and long-term effects of the novel COVID-19 virus in pregnancy and breastfeeding. The observational study will consist of phone calls over the course of volunteers’ pregnancies and post-delivery, and/or breastmilk samples, as well as a release of medical records related to the pregnancy and the infant’s development.  Read More


PRIORITY Study 
PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) is a nationwide study of pregnant or recently pregnant people who are either under investigation for Coronavirus infection (COVID-19) or have been confirmed to have COVID-19. This study is being done to help patients and healthcare providers better understand how COVID-19 impacts pregnant people and their newborns.  Read More


International Registry of Coronavirus Exposure in Pregnancy (IRCEP)
Join the Registry to help other women who are pregnant or contemplating becoming pregnant and who are or may be infected with the SARS-CoV-2 virus, the cause of COVID-19.

June 2, 2020

Governor Baker’s plan for re-opening Massachusetts

Governor Baker began his press conference on Monday, June 1 with an update on the Commonwealth’s economic reopening plan.

The Governor announced that he has signed an executive order clarifying what businesses can open during Phase 2 of reopening. On Saturday, June 6th the Governor will announce when Phase 2 of the economic reopening plan can begin. The earliest opening date is Monday, June 8th.

Governor Baker said that Phase 2 will focus on retail and recreational summer camps. Guidelines allow businesses that are categorized under Phase 2 to enter their establishments to prepare for reopening. Baker highlighted summer camps by saying that they will be able to operate with activity restrictions and limited openings for groups that are smaller than 12.

Announcements and guidelines within the executive order can be found here.


AAFP Virtual Town Hall – June 3, 8-9pm

Join the AAFP and two physician-legislators as they discuss recent federal legislative trends impacting primary care practices related to COVID-19. Our panelists will review actions that Congress and the administration have taken so far, and discuss what can be expected in the coming weeks and months.


AAFP COVID-19 CME Webinar Series – June 10, 8-9pm

This bi-weekly CME series with course chair, Nina Ahmad, MD, former AAFP Vaccine Science Fellow and CDC Epidemic Intelligence Service Officer, will be joined by special guests to cover clinical topics and perspectives for COVID-19.
Enhance your patient care today and earn up to 2 additional AAFP Prescribed credits when you complete the Translation to Practice® (t2p®) process.

June 1, 2020

The AAFP Needs Your Help in Urging Congress to Stabilize, Strengthen, and Sustain Primary Care


"I’m a physician during a pandemic. Please don’t ask me how I’m doing."

When you ask me, “How are you doing?” this is why I have no answer.

Four days a week, I have a (currently mostly virtual) primary care practice taking care of manageable problems, trying to teach folks how to take care of their chronic health conditions so they can continue to function and stave off catastrophic complications and premature death, and doing my best to address the anxieties of a traumatized, worried, frightened, mourning population through uncertain times, to say the least. Much of this work is (still) unpaid, and many people are avoiding everything medical these days, so revenues are way down (to be honest, independent primary care was struggling badly long before this pandemic came along) and the bills that I can’t pay are piling up.


An excerpt from Board Chair John Cullen, MD’s Leader voices blog:

In our first virtual week of action, the Academy is calling on Congress to stabilize, strengthen and sustain primary care. We are urging members to amplify that message by posting short videos on your social media channels, tagging your members of Congress (and the Academy), and using the hashtag #StabilizeStrengthenSustain. Without limiting our scope to the number of members who can attend a live, two-day event, our more than 136,000 members can speak to legislators en masse during the course of an entire week, starting June 1.

AAFP officers have already posted videos you can use as examples to drive home our three-part call to action.

Highlighting the first part of our message, President-elect Ada Stewart, M.D.,(www.youtube.com) of Columbia, S.C., calls on Congress to stabilize primary care by passing H.R. 6837(www.congress.gov) and S. 3750,(www.congress.gov) a pair of bills that would reinstate the Medicare Accelerated and Advance Payment program for Part B providers and improve loan terms. She also declares that Congress should set aside at least $20 billion of provider relief funds from the Coronavirus Aid, Relief and Economic Security Act for primary care physicians.

In his video, AAFP President Gary LeRoy, M.D.,(www.youtube.com) calls on Congress to strengthen primary care by ensuring that CMS implements scheduled increases for Medicare evaluation and management payments as planned on Jan. 1. He also urges legislators to enact the Kids' Access to Primary Care Act of 2020,(www.congress.gov) which would bring Medicaid payment rates to parity with those of Medicare. LeRoy notes that more than half of his patients in Dayton, Ohio, rely on Medicaid.

And in my video,(youtu.be)I highlight the financial strain on our practices and called for prospective payment systems that would better sustain primary care. This could be achieved by expanding, and improving funding for, CMS' upcoming Primary Care First program or adopting the AAFP's Advanced Primary Care Alternative Payment Model.(38 page PDF)

The AAFP has resources -- detailed talking points and backgrounders for participants, sample tweets and tips for recording video messages optimal for social media -- in its Family Medicine Action Network community.

For members who would prefer to write to their members of Congress, the Academy also has created distinct Speak Out resources that reflect the same three priorities:

Finally, please join us at 8p.m. on June 3 when Reps. Ami Bera, M.D., D-Calif., and Phil Roe, M.D., R-Tenn., are expected to participate in our weekly Virtual Town Hall meeting.  

Take action, and make your voice heard.

John Cullen, M.D., is Board chair of the AAFP.

May 28, 2020

Governor Baker’s Update

Governor Baker gave his daily COVID-19 update late this afternoon at UMass Lowell. The Governor started out the press conference saying that the continue decline in COVID-19 numbers suggests not only that spread is contained but that the people of Massachusetts are following the guidelines for social distancing, masks and other measures.

The Governor and Lieutenant Governor Karyn Polito joined UMass Lowell Chancellor Jacquie Moloney to tour UMass Lowell’s Fabric Discovery Center; a Manufacturing Emergency Response Team (M-ERT) funding recipient conducting high volume screening of locally produced personal protective equipment (PPE) for FDA approval. Baker spoke very highly of the M-ERT program and highlighted the product testing being done at UMass Lowell. The Fabric Discovery Center got $130,781 in M-ERT funds to screen materials for N95 respirators, gowns and masks. The Governor said that without the kind of testing and screening that UMass Lowell is conducting that it would take a lot longer to produce quality PPE.

Governor Baker just wrapped up his daily update at MBTA’s Maverick Station in East Boston. The Governor reported that as of yesterday, the COVID-19 test positive rate was 8.6% and 2,100 patients are being hospitalized for COVID-19. The Governor said that the Commonwealth is seeing steady progress but will continue to carefully monitor public health data to guide the reopening process.

Governor Baker, Transportation Secretary Stephanie Pollack, and MBTA General Manager Steve Poftak gave the daily update at Maverick Station today in order to highlight the MBTA’s work during the public health emergency. The MBTA has seen record low numbers since the Governor issued a stay at home order back in March. Baker reported that due to low numbers of riders, MBTA crews have been able to replace 2,200 feet of track from Maverick Station to Aquarium Station. This project was scheduled to be conducted over multiple weekends this summer, but the MBTA did “a very quick pivot” and was able to do all the work in two weeks, which is two months sooner than scheduled.

MBTA officials reported that face coverings must be worn while riding the T. Currently, about 60% of the regular T schedule is running and according to officials that matches the current demand.

https://www.mass.gov/covid19-updates


REMINDER: COVID-19 public health guidance and directives from the CDC and Mass Dept of Public Health.

https://www.mass.gov/info-details/covid-19-public-health-guidance-and-directives


AAFP’s COVID-19 Latest Updates Page:  https://www.aafp.org/patient-care/emergency/2019-coronavirus/COVID-19-Latest.html?intcmp=nCoV_car_dpanCoV_promo_pos3


CMS is hosting it’s next COVID-19 conference call on Friday, May 29th from 12:30-2:00pm. Lessons from the Front Lines: COVID-19
Friday, May 29th at 12:30 – 2:00 PM

Toll Free Attendee Dial-In: 877-251-0301

Access Code: 6350189

Weblink

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page.

May 26, 2020

MassAFP and tMED Coalition news

Late last week, Blue Cross Blue Shield announced that it has processed more than one million telehealth claims in the nine weeks since changing its policy to expand coverage for telephone and virtual visits at no cost to members during the COVID-19 crisis. This announcement was thrilling to the coalition and the leaders of the group.

MassAFP has been a member of Massachusetts Telemedicine Coalition (tMED)for the last 4 years. tMED is a coalition of 27 healthcare, consumer, and business organizations. Together with this coaltion, state legislation to advance and promote access to telemedicine services for patients in the commonwealth as been submitted. The bill, entitled “An Act Advancing and Expanding Access to Telemedicine Services” H991 / S612


Encouraging Vaccination During the COVID-19 Pandemic

The COVID-19 pandemic continues to have an impact on clinical preventive services, including routine immunizations. Based on data from the Massachusetts Immunization Information System (MIIS), state-supplied vaccine ordering has decreased by as much as 60%. The MDPH Immunization Division supports healthcare providers who maintain access to clinical services in environments that are safe for all. We would like to share some strategies for addressing well-child and sick visits while maintaining immunization services, and also address proper storage and handling of state-supplied vaccines.
 
Well-child visits should occur in-person when possible. However, COVID-19 activity in communities may limit pediatric well visits. If your facility is still able to conduct well-child visits, we urge you to continue to vaccinate children on schedule. All providers should wear a facemask and other PPE, as appropriate, and patients over 2 years of age should wear a facemask or cloth face covering, if possible, to help limit the spread of the coronavirus. Vaccines for Children (VFC) compliance site visits are suspended; however regional Quality Assurance Analysts are contacting providers to ask questions with a limited scope.
 
The following is a compilation of suggestions from the Centers for Disease Control and Prevention (CDC), professional organizations, and providers about how to facilitate vaccination during the pandemic, while protecting patients and staff. Pediatricians should inform families about the strategies they are implementing to assure safety.
 
Separation of visits
·     Stagger scheduling of well-child and sick visits. In particular, schedule well visits for the morning, when the office has the lowest chance of contamination.

·     Stagger scheduling of patients by age groups, concentrating on newborn and well-baby visits, up to age 2, in the morning, and well child or adolescent physicals in the afternoon.

·     Create separate areas for sick visits and well visits, including separate entrances and exits, if possible.

·     Consider working with other practices in your organization or community to hold well visits in a place other than your typical location.

·     If your practice has more than one location, consider designating one for well visits and one for sick visits.

 
Avoiding missed opportunities
·     Continue to check immunization records of patients who arrive for sick visits. In some cases, patients can continue to be immunized.

·     Use a combined telehealth/in-person visit, performing most of the visit via telehealth, so the patient needs to visit the office only for measurements and immunizations.

·     Now, or upon re-opening, pediatricians should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in-person appointments, inclusive of newborns, infants, children, and adolescents. Pediatricians should work with families to bring children up to date as quickly as possible.

 
Limiting potential exposure
·     Allot more time for each visit to allow for vigorous cleaning and disinfecting.

·     Decrease the number of appointments for each time slot, to decrease the number of people in the office at any one time.

·     Reduce the number of people in waiting rooms by checking-in patients remotely and have them wait outside or in their car until they can be brought directly into an exam room.

·     Limit visitors to the office by allowing only one adult for each patient.

 
Alternative vaccination locations
·     If there is space, consider setting up a stationary mobile van or tent to serve as an exam room. Patients can receive care without entering your clinic.

·     If there is access, consider using a mobile van or ambulance to conduct home visits. Patients would enter the van/ambulance for exams and vaccinations.

·     Please contact the Vaccine Management Unit for temporary vaccine storage guidance. The following items are required for temporary vaccine storage:

o Hard-sided cooler
o Water bottles
o Corrugated cardboard
o Bubble wrap
o Additional Digital Data Logger (DDL). When possible, sites should use a back-up DDL, but the Vaccine Management Unit has a limited supply of additional DDLs that can be made available for temporary vaccine storage.
·     Sites that plan on setting up temporary vaccine storage must upload DDL reports weekly

 
State-supplied vaccine storage and handling considerations during/after temporary provider closings
·     Call the Vaccine Management Unit for any temporary provider closings.

·     Continue to upload digital data logger reports monthly as long as possible. If not possible, contact the Vaccine Management Unit.

·     Prior to resuming administering state-supplied vaccines, review and upload digital data logger data to ensure that there are no temperature excursions.

·     The Vaccine Management Unit is open, and remote staff are still processing orders and are available to answer questions and troubleshoot storage and handling issues. 
 
Resources

·     CDC Immunization Schedule Changes and Guidance - Includes changes to the immunization recommendations for children and adults, due to the COVID-19 pandemic

·     AAP Guidance on Providing Pediatric Well-Care during COVID-19

·     AAFP COVID-19 Guidance for Family Physicians on Preventive and Non-Urgent Care

·     American College of Physicians (ACP), Statement on Non-Urgent In-Person Medical Care

·     Children’s Hospital of Philadelphia: News & Views: Are You Still Vaccinating During the Coronavirus Pandemic?

·     Recommended Immunization Schedules for Children and Adults, United States, 2020, CDC, 2/20

·     Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR, May 8, 2020

May 20, 2020

Resources you can use from the Commonwealth

Mass.gov has a list of guidance and resources for all healthcare providers now in one place. The website includes information ranging from Massachusetts COVID-19 Health Care Provider Financial Relief Package to Flexibilities for Substance Use Disorder Treatment Services to MassHealth Provider Resource: Telephone and Internet Connectivity for Telehealth and much more. Many of the resources have been updated this month. See the full listing here.

May 14, 2020

COVID-19 Workshop Series Update

Don't forget to register for the CMS webinar today. Learn how to enroll in and report data for the National Healthcare Safety Network (NHSN) COVID-19 module.

Missed last week's webinar? View our May 7 webinar recording and slides.

Stay tuned! Our workshop series continues next Thursday, May 21.


Public Health Recommendations for Community-Related Exposure

Current guidance based on community exposure, for asymptomatic persons exposed to persons with known or suspected COVID-19 or possible COVID-19

Travelers, health care workers and critical infrastructure workers should follow guidance that include special consideration for these groups. CDC's recommendations for community-related exposures are provided below. Individuals should always follow guidance of the state and local authorities.

Current guidance based on community exposure, for asymptomatic persons exposed to persons with known or suspected COVID-19 or possible COVID-19.

PersonExposure ToRecommended Precautions for the Public
Household memberPerson with symptomatic COVID-19 during period from 48 hours before symptoms onset until meets criteria for discontinuing home isolation Stay home until 14 days after last exposure and maintain social distance (at least 6 feet) from others at all times
Intimate partner(can be a laboratory-confirmed disease or a clinically compatible illness in a state or territory with widespread community transmission) Self-monitor for symptoms
Individual providing care in a household without using recommended infection control precautionsPossible unrecognized COVID-19 exposures in U.S. communities Check temperature twice a day
Individual who has had close contact (< 6 feet)** for a prolonged period of time *** Watch for fever*, cough, or shortness of breath
All U.S. residents, other than those with a known risk exposure Avoid contact with people at higher risk for severe illness (unless they live in the same home and had same exposure)
Follow CDC guidance if symptoms develop
Be alert for symptoms
Watch for fever*, cough, or shortness of breath
Take temperature if symptoms develop
Practice social distancing
Maintain 6 feet of distance from others
Stay out of crowded places
Follow CDC guidance if symptoms develop

May 11, 2020

CDC updated guidelines for "Persons Who have NOT had COVID-19 Symptoms but Tested Positive and are Under Isolation" last weekend (03 May 2020). There are two approaches to ending home isolation in those without symptoms:

Test-Based Strategy: "Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart"

Time-Based Strategy: "At least 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test."

Sources:
www.cdc.gov/coronavirus/2019-ncov/hcp/...


www.cdc.gov/coronavirus/2019-nCoV/hcp/...

Patient care and practice flow: CDC COVID-19 Phone Advice Line Tools and Algorithm (Printer-friendly version)

Phone Script pp. 2-5
Clinical Decision Algorithm to Guide Care Advice pp. 6-11



Staff education & resources: CDC Interim Guidance for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19 (Printer-friendly version)



Health Resources and Services Administration (HRSA) recently launched COVID-19 Uninsured Program Portal where health care providers who have conducted COVID-19 testing of uninsured individuals for COVID-19 or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims for reimbursement. 

Providers will be reimbursed, generally at Medicare rates, subject to available funding. Steps will involve:

  • Enrolling as a provider participant
  • Checking patient eligibility
  • Submitting patient information
  • Submitting claims
  • Receiving payment via direct deposit

To learn more about the program, including the registration and claim submission process, go to COVIDUninsuredClaim.HRSA.gov. HRSA also developed a video overview of the program. In addition, providers can access real-time technical support, as well as service and payment support, by calling the Provider Support Line at 866-569-3522. The hours of operation are 8 a.m. to 8 p.m. Monday through Friday in your local time zone

Please do not hesitate to reach out to HRSA’s Office of Regional Operations with questions, concerns, or requests for support and engagement.

May 4, 2020

HHS Begins Distribution of Payments to Rural Providers (and Hospitals with High COVID-19 Admissions)

On May 1, the Department of Health and Human Services (HHS) is processing payments from the Provider Relief Fund to hospitals with large numbers of COVID-19 inpatient admissions through April 10, 2020, and to rural providers in support of the national response to COVID-19.

“These new payments are being distributed to healthcare providers who have been hardest hit by the virus: $12 billion to facilities admitting large numbers of COVID-19 patients and $10 billion to providers in rural areas, who are already working on narrow margins,” said HHS Secretary Alex Azar. “HHS has put these funds out as quickly as possible, after gathering data to ensure that they are going to the providers who need them the most. With another $75 billion recently appropriated by Congress, the Trump Administration will continue doing everything we can to support America’s heroic healthcare providers on the frontlines of this war on the virus.”



Rural Distribution: 

Rural hospitals, many of whom were operating on thin margins prior to COVID-19, have also been particularly devastated by this pandemic. As healthy patients delay care and cancel elective services, rural hospitals are struggling to keep their doors open.  

Recipients of the $10 billion rural distribution will include, rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers located in rural areas. 

Hospitals and RHCs will each receive a minimum base payment plus a percent of their annual expenses. This expense-based method accounts for operating cost and lost revenue incurred by rural hospitals for both inpatient and outpatient services. The base payment will account for RHCs with no reported Medicare claims, such as pediatric RHCs, and CHCs lacking expense data, by ensuring that all clinical, non-hospital sites receive a minimum level of support no less than $100,000, with additional payment based on operating expenses. Rural acute care general hospitals and CAHs will receive a minimum level of support of no less than $1,000,000, with additional payment based on operating expenses.

Eligible providers will begin receiving funds in the coming days via direct deposit, based on the physical address of the facilities as reported to the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), regardless of their affiliation with organizations based in urban areas.

View the state-by-state breakdown.

HHS and the Administration are continuing to work rapidly on additional targeted distributions to some providers including skilled nursing facilities, dentists, and providers that solely take Medicaid.

Visit hhs.gov/providerrelief for additional information.



Guidance Available on Telehealth and HHS-Operated Risk Adjustment for Individual and Small Group Health Insurance Health Plans

In response to the increased need for providing telehealth due to COVID-19, CMS has given additional consideration to telehealth services in HHS-operated risk adjustment for issuers in the individual and small group health insurance markets inside and outside the Marketplaces. CMS’ new guidance clarifies which telehealth services are valid for HHS-operated risk adjustment data submission in light of the COVID-19 pandemic.

Frequently Asked Questions

May 1, 2020

Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

At President Trump’s direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, on April 30, 2020, the Centers for Medicare & Medicaid Services, issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.

Full press release



New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) MLN Matters Article

A revised MLN Matters Special Edition Article SE20016 on New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) is available. Learn new information on billing for distant site telehealth services during the COVID-19 PHE, including:

  • New telehealth services that can be provided by RHCs and FQHCs, including audio only telephone evaluation and management services
  • Revised bed count methodology for determining the exemption to the RHC payment limit for provider-based RHCs


AAFP Friday CME: Managing the COVID-19 Crisis: An Emergency Room Family Physician's Perspective

Join us today on Friday, May 1st at 8pm for Managing the COVID-19 Crisis: An Emergency Room Family Physician's Perspective. Course Chair Nina Ahmad, MD, and Robert Dachs, MD, FAAFP, a New York Emergency Room Physician, will discuss his firsthand experiences in managing COVID-19 patients. Discover strategies that have worked and those that needed to be modified based on observation.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

You can join the webinar via the links below:

Facebook

YouTube

Twitter



AFP Has a New COVID-19 Resource Page

Find all of the information you need about the COVID-19 pandemic here. It contains useful content from AFP, FPM, and Annals of Family Medicine, as well as "COVID-19 Daily Research Briefs" to summarize the latest evidence on this evolving topic. The site is being updated regularly so check back often.

April 30, 2020

AAFP Virtual Town Hall COVID-19 On Demand

Did you miss an AAFP's Virtual Town Hall on COVID-19 weekly session? Now you can watch it anytime, anywhere — on demand. Plus, earn AAFP Prescribed credit.

AAFP leadership and experts field questions and provide the most current information on how you and your practice can weather this health care crisis.

AAFP President Gary LeRoy, MD, FAAFP
AAFP SVP Julie Wood, MD, MPH, FAAFP

April 27, 2020

ACTION REQUIRED to receive additional provider relief funds

Last week the Department of Health and Human Services (HHS) announced its plans for distributing the remainder of the provider relief funds authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. At the time, they indicated an additional $20 billion was being allocated to Medicare providers – both independent providers and health care/hospital systems. This weekend, we received more details about how the funding will be distributed.

Unlike the first round of funding, you need to take action to receive any money from this allocation. It is important that you act quickly to submit the necessary information as we anticipate this money will go quickly.

Again, we encourage you to complete this information as soon as possible to increase your chances of getting money from this latest funding allocation.



CDC Rural Health Site

Visit the CDC site for rural-specific information and while you are there listen to the --updates for Rural Health Partners, Stakeholders, and Communities on the 2019 Coronavirus Disease Response-- webinar series.



CDC COVID-19 Most Up-to-Date Resources

For the most up to date information on COVID-19 please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html. Please note: The COVID-19 pandemic is affecting healthcare seeking behavior. The number of persons and their reasons for seeking care in the outpatient and ED settings is changing. These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution. More detailed interpretation of data and more COVID-19 specific information can be found in COVIDView.



New COVID-19 resource for non-English speaking patients

Introducing a new COVID-19 resource that makes information more accessible to communities with limited English proficiency.  Available from Communities Concerned for Immigrants and Refugees it provides infographics, posters and videos on hand washing, face covering and symptoms checker in more than 40 languages.   

Resources By Language
https://ccirkc.com/covid-19-resources-language

April 22, 2020

FRIDAY, 4/24 CME webinar - Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know

With the rise in COVID-19 cases and the need for surge planning, acquiring basic ventilator management skills is now essential for many family physician learners.

On Friday, April 24 at 8:00 PM, join our Course Chair, Nina Ahmad, MD and critical care/ respiratory care physician, Gregory Botz, MD for: Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know and Do.

Viewers can ask their questions live and earn 1 CME credit for participating. Members on the AAFP COVID-19 Rapid Response Member Exchange can reply to the thread that went out this morning from Dr. Clif Knight with any questions you would like to pose to the Faculty Chair and Guest.

You can join the webinar via the links below:

Facebook

YouTube

Twitter

AAFP is adding additional CME activities each week here.

In addition, new information to our journal website is added each day, including a daily COVID-19 research brief here.


HHS Targeted Relief Fund Data Submission Communication

The CARES Act appropriated $100 billion to establish a Provider Relief Fund. This Fund, administered by the Secretary of Health and Human Services (HHS), is being used to distribute payments to health care entities across the country that have been affected by the coronavirus. To date, $30 billion has been distributed generally to health care entities across the country. HHS will soon make targeted distributions to hospitals and other facilities that have been particularly affected by the increased burden of caring for those with the coronavirus. To inform how these funds are distributed, click here.

April 21, 2020

Revised Crisis Standards of Care Planning Guidance

A Crisis Standards of Care Advisory Committee was convened by the Commissioner of Public Health to prepare guidance in the event of the potential scarcity of necessary medical treatment resources in the Commonwealth caused by a surge in need due to the number of people suffering from COVID-19. This Committee included medical experts and ethicists from across the Commonwealth, representing both large academic medical centers and community hospitals and charged with expeditiously developing recommendations for ethical, equitable and transparent guidelines for providing acute care during a crisis.


Trump Administration Champions Reporting of COVID-19 Clinical Trial Data through Quality Payment Program, Announces New Clinical Trials Improvement Activity
Improved availability of data key to driving improvement in patient care and development of innovative practices

The Centers for Medicare & Medicaid Services (CMS) is encouraging clinicians who participate in the Quality Payment Program (QPP), such as physicians, physician assistants, nurse practitioners, and others, to contribute to scientific research and evidence to fight the Coronavirus Disease 2019 (COVID-19) pandemic. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS), a performance-based track of QPP that incentivizes quality and value, for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. This action will provide vital data to help drive improvement in patient care and develop innovative best practices to manage the spread of COVID-19 within communities.

“The best scientific and medical minds in the world are working night and day to find treatments to combat Coronavirus,” said CMS Administrator Seema Verma. “But without solid data, their efforts are liable to run up against a brick wall. At the direction of President Trump, CMS is supporting efforts of researchers to obtain solid, actionable data to accelerate the development of new treatments and our understanding of the coronavirus.  Today’s action encourages clinicians to report data that will help us monitor the spread of the virus, find innovative medical solutions, and unleash scientific discovery as we seek to overcome this terrible disease.”

In order to receive credit for the new MIPS COVID-19 Clinical Trials improvement activity, clinicians must attest that they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study.  

The new improvement activity provides flexibility in the type of clinical trial, which could include the traditional double-blind placebo-controlled trial to an adaptive or pragmatic design that flexes to workflow and clinical practice. It also carries a high weight from a scoring perspective. This means that clinicians who report this activity will automatically earn half of the total credit needed to earn a maximum score in the MIPS improvement activities performance category, which counts as 15 percent of the MIPS final score.

For example, clinical trials could include those conducted by the National Institute of Health (NIH). Clinicians could also report through a clinical data repository, such as Oracle’s COVID-19 Therapeutic Learning System. Oracle has developed and donated a system to the U.S. government that allows clinicians and patients at no cost to record the effectiveness of promising COVID-19 drug therapies. Having clinicians use an open source data tool to submit their findings will bring the results of their research to the forefront of healthcare much faster, leading to improvements in care delivery and the ability to treat COVID-19 patients.

This action, along with the unprecedented regulatory flexibilities recently introduced, is just one part of the agency’s efforts to address the COVID-19 pandemic. CMS, in coordination with the White House Coronavirus Task Force, remains committed to  reducing regulator burden and supporting clinicians, stakeholders, and the health care community to identify unique solutions that enhance care for patients and further mitigate the spread of the virus. 

This action, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov.  For information specific to CMS, please visit the Current Emergencies Website.

To view a database of privately and publicly funded clinical studies currently being conducted on corona virus visit:  https://clinicaltrials.gov/

April 15, 2020

President Donald J. Trump is committed to taking any and all necessary steps to protect the lives, health, and safety of the American people.

During the COVID-19 crisis, the White House Office of National Drug Control Policy (ONDCP) is leading efforts to ensure that prevention, treatment, recovery support services, and safe and effective pain management remain available nationwide. The Trump Administration is mobilizing the Federal Government to ensure the approximately 20 million Americans who struggle with the disease of addiction can access and continue to receive treatment and recovery support services, while keeping themselves and healthcare professionals safe from unnecessary exposure to COVID-19.


COVID-19 Federal Rural Resource Guide

USDA’s COVID-19 Listing of Federal Programs That Can Help Rural Communities, Organizations, and Residents Impacted by COVID-19. USDA has taken a number of steps to help rural communities impacted by COVID-19, click here to learn more.  

April 14, 2020

AAFP’s COVID-19 Rapid Response Member Exchange Update

There's a new event on COVID-19 Rapid Response Member Exchange - check it out today!

Managing the COVID-19 Crisis: Maintaining the emotional health of you, your team, and your patients

Event Start Date: 04-17-2020 @ 8pm

If you’re interested in joining the Rapid Response Member Exchange, sign up here.

April 9, 2020

Pandemic Highlights the Need for Full-scope FPs
by MaryAnn Dakkak, M.D., M.S.P.H.

When the COVID-19 crisis arrived in Boston, family physicians were among the first to mobilize. Family medicine attendings were pulled from clinic and dispersed to work on inpatient medicine floors and to cover additional obstetrics backup. As someone relatively young and healthy, and with school-aged children who are relatively independent, I was assigned to lead a COVID-19 team at my 300-bed safety-net hospital.

The learning curve has been steep and complicated, with changing algorithms and recommendations. When I started that week, I preferentially placed our first pregnant patient who tested positive for COVID-19 onto my service. My reasoning was this: one exam, one exposure and done.  READ MORE


Mayor Walsh’s COVID-19 press briefing on April 7, 2020.

Numbers:
As of Monday, April 6, in Massachusetts: 13,837 cases of coronavirus, 260 deaths; Boston residents: 2035 cases, 203 recovered, 19 deaths. 
BCEC Medical Center will open this week:

It has 1,000 beds for COVID-19 patients: 500 for homeless individuals and 500 for general hospital overflow. It includes 6 acute care suites; a physical therapy suite; 52 nurses stations and 48 bathroom facilities. 
The Center is a collaboration between the City, State, Partners HealthCare, and Boston Health Care for the Homeless, and others. 

Appeal for staff: Partners is seeking healthcare providers, including: registered nurses, advanced practice providers, physical and occupational therapists, pharmacists, and providers with experience in respiratory care. Providers who wish to work at the BCEC can go to partners.org.

Disease Containment Strike Team formed: 
This team draws from the Boston Public Health Commission, the Age Strong Commission, and the Disabilities Commission.
It supports our work with the state to protect long-term care facilities, nursing homes, group homes, and other high-risk places. 
If there are more than 2 cases identified at a facility, the team will go in to slow the spread, mitigate the situation, and support staff in their response.
The Team makes contact within 24 hours of learning of a positive case and works to implement strategies over the next 24 hours. 

We are ready to expedite expanded morgue capacity at hospitals:
Unfortunately, we are going to see more loss of life and hospitals have told us they expect to need added capacity at their morgues. 
I’ve spoken to major hospitals to let them know that we are ready to support this process, including expediting permits.
Any operations associated with this need will not be visible to the public.

50th Annual Pride events and parade postponed until June 2021: 
This was a joint decision between the City of Boston and Boston Pride.
Health and safety is the priority. In addition to general distancing needs, many Pride events center seniors and immunocompromised individuals. 

Additional transportation support for healthcare workers: 
If a healthcare worker gets a parking ticket, such as overstaying a meter, the City will waive the ticket upon appeal, if the person shares a copy of their work ID. Appeals can be conducted virtually. This policy applies retroactively, such as if a healthcare worker got a ticket last week.  The only exceptions are safety violations—such as parking in front of a hydrant, or in a handicapped space without a placard. These regulations are in effect for the duration of the public health  emergency.


In addition, we’ve created maps on the City’s website to help hospital staff find municipal lots and garages with free, reduced, or reserved spaces.  We are also ready to provide certain BPS parking lots for hospital staff use if needed. Warning to seniors and others about COVID-related scams.  The Boston Police Department and FBI are warning community members to be on guard for scammers seeking personal information as a precondition for federal aid. To be clear, the U.S. government is not sending emails or phone calls asking for personal information in exchange for federal aid. City tax due dates delayed and late fees waived.  Consistent with state legislation enacted last week, the City of Boston has extended the due date for property tax bills in Boston from May 1 until June 1 to give residents more flexibility.  The City is waiving interest on late property tax and motor vehicle excise tax payments until June 30, if the bill was originally due after March 10, meaning any resident who is facing a late fine for not paying their excise bill on time will have a grace period with no late fees until June 30.  The due date for filing residential and personal exemptions is extended from April 1 to June 1. 

Boston Resiliency Fund issues new grants:
On Monday, the Fund released $3 million to 29 organizations that provide essential services to front-line workers, health care providers, and families impacted by the public health emergency.  To date the Fund has raised over $22.7 million from more than 3,000 donors. Grants issued total: 
$4.7 million to provide Boston's children, families, and seniors with access to food and other basic needs. 
$3.7 million to expand the capacity of healthcare systems to serve the vulnerable and to provide childcare, food, and supports for healthcare and front-line workers.
$2 million for remote learning technology

Reminders about social/physical distancing: 
Local data shows that distancing in the next two weeks is critical to flattening the curve and saving lives. The City of Boston is asking community leaders, local organizations, and non-profit partners to push this message out to their networks.  
Residents are urged to stay home and avoid contact with others; stay at least 6 feet from other people at all times; and wash their hands and clean and sanitize surfaces frequently.  New measures in effect Monday, April 6 through Monday, May 4. Everyone should wear a face covering when outside of their home.  The City is providing face coverings to city employees who must work outside the home; and will provide advice and resources for anyone who needs help getting or making a covering. Employees who work in settings where personal protective equipment guidelines have already been issued should continue to use PPE in accordance with those guidelines. Advisory curfew, 9 p.m. - 6 a.m.  The Boston Public Health Commission issued a Public Health Advisory recommending people stay inside between 9 p.m. and 6 a.m. It applies to everyone except essential workers. Mayor Walsh urged people to use delivery services as much as possible if they are getting food from a restaurant after 9 p.m. We have resources for restaurants that want to get set up with a delivery service. 

New protocols at City Hall
City Hall is open to the public on Tuesdays and Fridays, 9 a.m. to 5 p.m. Everyone entering the building will be subject to screening for COVID symptoms, including elevated temperature. People should only come in for services that are absolutely necessary, and not available by phone or online, and you must call ahead to make an appointment. City Hall will also be closed to the public this coming Friday, April 10, in observance of Good Friday.  Parks, Sports facilities at all City parks, including basketball, tennis, and street hockey courts, are closed. People will still have access to open spaces. Police officers are empowered to disperse gatherings under the state advisory; they can order people to vacate closed sections of parks; and if necessary they will issue violations. 

April 8, 2020

Crisis Standards of Care Planning Guidance for the COVID-19 Pandemic

A Crisis Standards of Care Advisory Committee was convened by the Commissioner of Public Health to prepare guidance in the event of the potential scarcity of necessary medical treatment resources in the Commonwealth caused by a surge in need due to the number of people suffering from COVID-19. This Committee included medical experts and ethicists from across the Commonwealth, representing both large academic medical centers and community hospitals and charged with expeditiously developing recommendations for ethical, equitable and transparent guidelines for providing acute care during a crisis.

April 7, 2020

Opportunities for COVID-19 related CME activities

AAFP has been developing additional CME accredited activities regularly including the Town Hall sessions, self-study case studies, and a webinar series. Links to all these COVID-19 related activities can be found here.  AAFP will continue to add more CME activities each week.


New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.


COVID-19: Expanded Use of Ambulance Origin/Destination Modifiers

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)

  • Community mental health centers
  • Federally Qualified Health Centers (FQHCs)
  • Rural health clinics (RHCs)
  • Physicians’ offices
  • Urgent care facilities
  • Ambulatory Surgery Centers (ASCs)
  • Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
  • Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

  • Modifier D - Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
  • Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
  • Modifier H - Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
  • Modifier N - Alternative care site for SNF
  • Modifier P - Physician’s office
  • Modifier R - Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.

April 6, 2020

New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.  See video here.


Update on: AAP Report on Initial Guidance: Management of Infants Born to Mothers with COVID-19

The AAP has recently published a new report, “Initial Guidance: Management of Infants Born to Mothers with COVID-19” addressing the care of infants whose mothers have suspected or confirmed coronavirus disease 2019 (COVID-19).

Please see the related AAP News article for more details.


Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients. View guidance here.


An important CDC Webinar for Rural Stakeholders and Communities to be held Wednesday, April 8

  • CDC Update for Rural Stakeholders and Communities on the COVID-19 Response
  • Webinar Presentation on Wednesday, April 8 at 4:00pm
  • Presenter: Dr. Jay Butler, Deputy Director for Infectious Diseases, CDC

The Centers for Disease Control and Prevention (CDC) will share guidance with partners, public health practitioners, health care providers, and others working to protect the health of rural communities.  

REGISTRATION REQUIRED

April 2, 2020

Governor Baker’s Update

Governor Baker just wrapped up his daily press conference at the State House. Baker said Public Health officials expect between 47,000 and 172,000 infections in Massachusetts, that’s 0.7% to 2.5% of the total population in the Commonwealth. The fatality rate is expected to be 1.5% because of the lower population density, lower smoking rates and the fact that the Commonwealth enacted social distancing sooner. The Governor said these statistics came from data compared with stats in Wuhan, China. Baker reported that officials believe the hospital peak will be between April 10 and 20th.

The Governor said that three “field hospitals” will be set up in the Commonwealth. One of those facilities being the DCU Center in Worcester, where the Governor visited yesterday, with the other sites being considered are the Boston Convention and Exhibition Center, Joint Base Cape Cod and MassMutual building.

Baker announced that a shipment of N95 masks are coming from China and will land at Logan Airport later today. New York and Rhode Island will also get part of the shipment, but in total Massachusetts will receive roughly 1 million masks.

April 1, 2020

Rasky Partner’s briefing small business assistance:  Rasky Partners is one of the leading independent public relations and public affairs firms in the nation. Teams of experts are located in Washington D.C. and Boston and they offer clients strategic communications and public affairs counsel. Their team in the DC office has reviewed the COVID-19 Stimulus Package that was passed by the Federal Government and put together the attached document that details the relief opportunities for small/medium sized businesses and non-profits.  Read More


Providing Guidance for Healthcare Professionals: CDC added to their FAQ document for healthcare professionals additional information on drugs and investigational therapies to address common questions and misperceptions on available and approved drugs to treat COVID-19. CDC also released guidelines and a decision algorithm for how to guide care advice and messages with evaluating and triaging potential patients.

Obtaining Funding from FEMA for Emergency Medical Care Activities: The FEMA COVID-19 Emergency Protective Measures Fact Sheet included a list of eligible emergency medical care activities. This fact sheet provides additional guidance related to the eligibility of emergency medical care activities as an emergency protective measure under the Emergency Declaration and any Major Disaster Declaration authorizing Public Assistance (PA) for COVID-19.

Ensuring Providers Can Practice at Health Centers and Free Clinics: HRSA has released information on updated Federal Tort Claims Act policies for providers in health centers and free clinics to enable them to treat patients in these settings in an effort to prevent, prepare or respond to COVID-19.

March 31, 2020

Make plans to join AAFP’s Virtual Town Hall Wednesday 4/1 from 8-9pm. 

 AAFP President Dr. Gary LeRoy and AAFP SVP Advocacy Shawn Martin will join me to provide an overview of recently announced CMS accelerated payments, the CARES Act and what you can be doing now to position yourself to receive relief funding, followed by an open Q&A session. 

Remember, Live CME credit is available for participating on Wednesday. 

You can join the Town Hall via the links below:


Mental Health in a public health crisis

Mental Health Technology Transfer Center (MHTTC) Network Resources

Public health emergencies such as COVID-19 have a significant impact on people with mental illness, their families, and caregivers; the mental health workforce; and the mental health treatment system. They also cause stress and anxiety across the population. Visit the MHTTC website for webinars, products, and resources that can be useful when coping with the effects of widespread public health crises. 

March 30, 2020

Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

On March 27, CMS issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency.  Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.



CARES Act signed 

On Friday March 27 Congress passed and the President signed the CARES Act, a $2 trillion relief package that provides much needed economic relief for American families and businesses who are hurting through no fault of their own. This legislation will provide assistance to America’s heroic healthcare workers who are on the frontlines of this outbreak, including $100 billion which will go to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic, $27 billion which will go to bolstering life-saving capabilities, including developing vaccines and the development, purchase, and distribution of critical supplies and $45 billion which will go to the Federal Emergency Management Agency Disaster Relief Fund, more than doubling the amount available to support the President’s Emergency and Disaster Declarations to empower State, local, and tribal leaders to effectively respond.

More information will be coming from AAFP. Of interest, Sec. 3704 – Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period. Also adds FQHCs and RHCs as “distant site” providers for purposes of the COVID-19 telehealth waiver, allowing them to bill for telehealth services under the waiver.

March 27, 2020

The MDPH Immunization Division’s Vaccine Management Unit remains fully operational. All state-supplied vaccine orders continue to be processed and there should be no anticipated delays in vaccine shipments.
 
·     If your site is closing for an extended period of time or you have a change to your shipment hours, contact the Vaccine Management Unit immediately at 617-983-6828.
·     For Vaccine Storage and Handling issues, upload temperature logs directly into the Massachusetts Immunization Information System (MIIS). Do not fax urgent temperature logs to the Vaccine Management Unit.
·     When contacting the Vaccine Management Unit, make sure to leave a voice message with your name, direct contact number, and PIN. 

An important note from the CDC:

Maintaining Childhood Immunizations During COVID-19

The COVID-19 pandemic is changing rapidly and continues to affect communities across the United States differently. Some of the strategies used to slow the spread of disease in communities include postponing or cancelling non-urgent elective procedures and using telemedicine instead of face-to-face encounters for routine medical visits.
 
Ensuring the delivery of newborn and well-child care, including childhood immunization, requires different strategies. Healthcare providers in communities affected by COVID-19 are using strategies to separate well visits from sick visits.
Examples include:

·     Scheduling well visits in the morning and sick visits in the afternoon
·     Separating patients spatially, such as by placing patients with sick visits in different areas of the clinic or another location from patients with well visits. 
·     Collaborating with providers in the community to identify separate locations for holding well visits for children. 

Because of personal, practice, or community circumstances related to COVID-19, some providers may not be able to provide well child visits, including provision of immunizations, for all patients in their practice. If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible. CDC is monitoring the situation and will continue to provide guidance.

For more information and updates, visit:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html

Beneficiary Notice Delivery Guidance in light of COVID-19

If you are treating a patient with suspected or confirmed COVID-19, CMS encourages the provider community to be diligent and safe while issuing the following beneficiary notices to beneficiaries receiving institutional care:

  • Important Message from Medicare   (IM)_CMS-10065
  • Detailed Notices of Discharge   (DND)_CMS-10066
  • Notice of Medicare Non-Coverage   (NOMNC)_CMS-10123
  • Detailed Explanation of Non-Coverage   (DENC)_CMS-10124
  • Medicare Outpatient Observation Notice   (MOON)_CMS-10611
  • Advance Beneficiary Notice of Non-Coverage   (ABN)_CMS-R-131
  • Skilled Nursing Advance Beneficiary Notice of Non-Coverage   (SNFABN)_CMS-10055
  • Hospital Issued Notices of Non-Coverage   (HINN)

In light of concerns related to COVID-19, current notice delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation. These procedures include: 

  • Hard copies of notices may be dropped off with a beneficiary by any hospital worker able to enter a room safely. A contact phone number should be provided for a beneficiary to ask questions about the notice, if the individual delivering the notice is unable to do so. If a hard copy of the notice cannot be dropped off, notices to beneficiaries may also delivered via email, if a beneficiary has access in the isolation room. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice, and when and to where the email was sent.
  • Notice delivery may be made via telephone or secure email to beneficiary representatives who are offsite. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice via telephone, and the time of the call, or when and to where the email was sent.

We encourage the provider community to review all of the specifics of notice delivery, as set forth in Chapter 30 of the Medicare Claims Processing Manual. https://www.cms.gov/media/137111

CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts.  A summary of recent CMS activities can be found here: https://www.cms.gov/newsroom/press-releases/cms-news-alert-march-26-2020

To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.

March 26, 2020

AAFP is working to build out resources to help you to address the stress (for our family physicians, their practice teams, and their families). There are just a few resources here at the moment, but we will be adding more. 

You can find those here: https://www.aafp.org/patient-care/emergency/2019-coronavirus/Covid-19-practice-management.html#well-being

ACOG have shared the following FAQ's with the latest guidance on COVID-19 care for maternity care.

You can find that here: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics

March 25, 2020

Materials for Homemade Surgical Masks

People who want to sew masks buy surgical drape from veterinary supply stores and use the patterns from several hospitals.  

Alternatively, vacuum bags have a similar filtration for droplets as surgical masks and could be sown as disposable masks.  Not n95 quality but it might be helpful for office or for family members caring for sick persons in the home. 

Thirdly, a cloth mask that can be washed and dried with a place for a disposable vacuum bag or coffee filter insert might be a reasonable option. See links on patterns below: 

Cambridge

ResearchGate

Providence Hospital Pattern

Valley View Hospital Pattern

Deaconess

Stanford Medicine

Smartairfilters.com


CDC Interim US Guidance on Risk and Exposures

Interim US Guidelines on Risk and Exposures

COCA Call about Underlying Medical Conditions and People at Higher Risk for Coronavirus Disease 2019 (COVID-19) is postponed to March 27, 2020, still Noon-1:00pm.

The archived version will be available later here.

If you use Facebook, please watch the webinar live or archived on Facebook Live.

To call in by phone use one of the following numbers plus the webinar ID.

Telephone: +1 646 876 9923 or +1 312 626 6799 or +1 301 715 8592 or +1 346 248 7799 or +1 669 900 6833 or +1 253 215 8782

Webinar ID: 963 649 423


COVID-19 Provider Enrollment Relief FAQs


On March 22, CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19, including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements.

A copy of the FAQs can be found here.

March 24, 2020

Surgical Innovation Fellowship - COVID-19: Our response to the N95 shortage



CMS Relaxes Quality Payment Program (QPP) (MIPS)

                The Centers for Medicare & Medicaid Services (CMS) has extended(www.cms.gov) the deadline to report data for the Merit-based Incentive Payment System (MIPS) 2019 performance year, as requested in a recent letter from the American Academy of Family Physicians. Practices now have until April 30, 2020, to submit data. The original deadline was March 31. This new deadline, part of the agency's response to COVID-19, also applies to participants in the Medicare Shared Savings Program (MSSP)


Administration for Community Living (a division of HHS): older adult related COVID-19 resources https://acl.gov/COVID-19



The SAMHSA-funded Technology Transfer Centers (TTC) link:

        https://www.samhsa.gov/technology-transfer-centers-ttc

        Region 3 TTCs: https://attcnetwork.org/centers/central-east-attc/home


Each region has a SAMHSA-funded TTC center for Addiction, Mental Health, and Prevention with a listserv, newsletter, archived and upcoming webinars and other free resources.



Today, Compassion Fatigue and the Behavioral Health Workforce, was posted:

http://uclaisap.org/html2/compassion-fatigue-behavioral-workforce-cip.html

This 5-part Curriculum Infusion Package (CIP) on Compassion Fatigue and the Behavioral Health Workforce was developed in 2020 by the Pacific Southwest Addiction Technology Transfer Center (PSATTC). The main developers included Nancy Roget, MS, Joyce Hartje, PhD, and Terra Hamblin, MA, with additional guidance and editing support provided by Beth Rutkowski, MPH, Thomas E. Freese, PhD, and Michael Shafer, PhD.


Compassion Fatigue Curriculum Infusion Package Slides

Part 1: The Behavioral Health Workforce

Part 2: Defining Compassion Fatigue and Related Conditions

Part 3: Burnout and Organizational Response

Part 4: Compassion Satisfaction and Self-Care

Part 5: Self-Care and Ethical Issues

The Compassion Fatigue CIP was created to help college and university faculty infuse brief, science-based content into existing substance use disorder-related course syllabi (e.g., foundation of addiction courses, ethics, counseling courses, etc.). Instructors can select the specific content to infuse throughout the duration of the course depending on specific needs of the learners. Each slide contains notes for the instructor to provide guidance as necessary. References are included for each slide and handouts when possible.

Part 1 provides a brief overview of the behavioral health workforce and associated shortages, and introduces the demands on the workforce. Part 2 focuses on compassion fatigue and secondary traumatic stress. Part 3 provides a brief overview of how organizations can help individuals avoid experiencing burnout. Part 4 focuses on actions that behavioral health professionals can take to prevent compassion fatigue. And Part 5 focuses on self-care as an ethical duty in order to manage compassion fatigue. 

The slide decks are designed to be used by academic faculty in behavioral health programs, trainers, behavioral health providers, and state/county agency staff members for a variety of audiences. If you require further information on this topic, please do not hesitate to contact the Pacific Southwest ATTC (http://www.psattc.org). You are free to use these slides and the pictures, but please give credit to the Pacific Southwest ATTC when using them by keeping the logo on each slide and referencing the Pacific Southwest ATTC at the beginning of your presentation. 

March 23, 2020

Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19)

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs.  For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. 

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period. 

You can find a copy of the press release here.

CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for pat

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing i response to COVID-19, please visit www.coronavirus.gov. For a complete and updated l CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov


New Tools To Help Speed States' Access to Emergency Flexibilities and Resources

The Trump Administration released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program. 

The tools include:

1115 Waiver Opportunity and Application Checklist
1135 Waiver Opportunity and Application Checklist
1915(c) Appendix K Template
Medicaid Disaster State Plan Amendment Template


COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations


The Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

You can find a copy of the press release here.

You can find a copy of the guidance here.



 ADDITIONAL RESOURCE LINKS

March 20, 2020

The Physicians Foundation Announces The Telehealth Initiative to Improve Access to Quality Health Care

The current COVID-19 crisis reinforces the need for physician access to practical resources that will enable them to operate telehealth services efficiently while facilitating positive care team and patient experiences. Through The Telehealth Initiative, physicians are able to participate in immersive evidence-based coaching that will help improve patient access, experience and outcomes while maintaining continuity of care when fully implemented. 

The program helps participating physicians redesign their practices to successfully provide telehealth services to their patients. Additionally, the Initiative is providing free, online access to resources to encourage all physicians to consider telehealth services in light of the COVID-19 pandemic. Telehealth will help physicians respond to surges in sick patients needing care and protect non-infected patients with other acute or chronic conditions from potential exposure to the virus. Resources available include:

·     Considering Telemedicine in the Wake of COVID-19? (TMA) 

·     Telemedicine: The Changing Shape of Care Webinar (TMA) 

·     Telemedicine Vendor Options (TMA) 

·     Telemedicine Vendor Evaluation Tool (TMA) 

·     Policies, Procedures and Forms for Telemedicine Services (TMA) 

·     Making Telemedicine Work: Learn How Physicians are Using Telemedicine (TMA) 

·     Telemedicine Payments Promised, Regulations Eased (TMA) 

·     Massachusetts FAQS: Prescribing During Remote Telemedicine Practice (MMS)

·     Telemedicine Quick Guide (AMA) 

·     Digital Health Implementation Playbook for Remote Patient Monitoring (AMA) 

·    Physician Innovation Network Telemedicine Discussion (AMA)

·     STEPS Forward™ Module on Telemedicine (AMA) 

March 19, 2020

March 18, 2020

DPH issued a guidance letter for testing of persons with suspect COVID-19 through the Massachusetts State Public Health Laboratory: COVID-19 PUI Criteria PDF | Doc


The Centers for Medicare & Medicaid Services (CMS) issued guidance to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) to protect the health and safety of Americans in response to the 2019 Novel Coronavirus (COVID-19) pandemic. PACE is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. CMS is putting out COVID-19 guidance to all types of healthcare providers and facilities. PACE is the latest area of focus because these organizations serve older adults who often have serious chronic medical conditions and therefore are at higher risk of serious illness from the virus.

You can find a copy of the press release here.

For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


Coverage and Reimbursement

CMS Fact Sheet on Medicare telehealth

CMS FAQs on Medicare telehealth

CMS chart on Medicare telehealth

CMS guidance on Medicaid telehealth

CMS state guidance on Medicaid telehealth

 

Practice Guidelines

AMA Quick Guide to Telemedicine in Practice

AMA Guidance for Ethical Practice in Telemedicine

American Telemedicine Association Practice Guidelines

American Health Information Management Association Telemedicine Toolkit

 

Technical Support/Misc.

Telemedicine Quick Set-up Guide in Response to COVID-19 National Emergency developed by Drs. Sylvia Romm, Adam Maghrabi, Tisha Rowe, Aditi Joshi

Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)

CMS update on Telehealth Payment


The Centers for Medicare & Medicaid Services (CMS) is taking action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Coronavirus (COVID-19) outbreak. CMS has released a Virtual Toolkit to help you stay up-to-date on CMS materials available on COVID-19.

For more information on COVID-19 visit:

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here Coronavirus.gov.  For information specific to CMS, please visit the Current Emergencies Website.

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