March 27, 2020: National Advocacy Update

The COVID-19 pandemic represents an enormous threat to public health and an extreme challenge to health care workers on the front lines. The AMA is advocating at all levels of government to ensure physicians have the tools they need to provide the patient care that is so critical.

Echoing the urgent pleas from physicians and members of the Federation, the AMA is urging the administration to provide more personal protective equipment (PPE) and testing components which are critical to treating the surge of COVID-19 cases. AMA is pressing for the urgent activation of every power in the arsenal of the federal government to alleviate dangerous shortages of essential medical supplies.

PPE and testing

On March 21 in a joint letter to President Donald Trump, the AMA, the American Hospital Association (AHA) and the American Nurses Association (ANA) asked that the Defense Production Act be used to increase the domestic production of medical supplies and equipment desperately needed for all front-line providers. AMA also wrote to congressional leadership on March 18 urging the federal government to expeditiously move to spur massive, increased production of supplies, along with distribution and access to gowns, masks, gloves, testing kits, testing swabs and respiratory machines.

Direct financial support for practices

On March 25 the AMA, along with over 95 medical specialty societies and every state medical society (including Washington, D.C.), sent a sign-on letter to congressional leadership asking that financial support for physician practices be included in any economic stimulus package. In addition, combining forces again with the AHA and ANA, the AMA asked Congress for $100 billion to support front-line health care personnel and providers with a stabilization fund for emergency expenses related to COVID-19. The organizations also asked for funding to provide childcare to health care workers and funding to expand surge capacity so that moderately ill patients can be moved to outpatient facilities.

Telehealth

Telehealth has quickly become an essential tool for physicians in this crisis. The AMA has long been a champion of expanding Medicare telehealth coverage and played a key role in ensuring that provisions in the first COVID-19 supplemental legislation significantly expanded Medicare telehealth coverage for the duration of the emergency. This expansion has already had a transformative impact on patient access to care by keeping less severely ill patients out of the emergency room. Medicare will now pay for two-way audio-visual communications between physicians and patients through widely available consumer products, such as smart phones. In addition, physicians can now use tools like Facetime and Skype for telehealth without worrying about Health Insurance Portability and Accountability Act penalties. The AMA will continue to press the Centers for Medicare & Medicaid Services (CMS) for additional telehealth guidance and will also continue to work with private insurers to mirror new Medicare flexibility for telemedicine.

Coding guidance

Additionally, the AMA fast-tracked new Current Procedural Terminology (CPT®) codes for COVID-19 and is providing new guidance on special coding advice related to COVID-19. One resource outlines coding scenarios (PDF) designed to help health care professionals apply best coding practices. The scenarios include telehealth services for all patients.

Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for an E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19, and is directed to come to a physician's office or physician's group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to an E/M visit), and is directed to come to the physician's office for testing; and more. There is a quick-reference flowchart that outlines CPT® reporting for COVID-19 testing (PDF). A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19.

Workforce issues

To expand the physician workforce to meet the challenge our health care system now faces, the AMA is urging the State Department to open visa processing at embassies worldwide for physicians seeking to join U.S. residency programs starting in July and publicly confirm that J-1 physicians are permitted to be redeployed to new rotations within the host training institution to the COVID-19 pandemic. The AMA is also urging that extensions and changes of status for foreign national doctors currently in the U.S. be expedited. The AMA will continue advocating on the federal and state levels to support patients and physicians during this public health emergency by removing obstacles to guidance and treatment. The AMA COVID-19 Advocacy Progress Report offers a comprehensive view of the AMA's work to team up with the essential partners in health care to reach the highest levels of government, and visit the AMA's COVID-19 web page for additional resources.

The Drug Enforcement Administration (DEA) has announced that for the duration of the COVID-19 public health emergency, DEA-registered practitioners may prescribe controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided that all of the following conditions are met:

1. The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.
2. The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
3. The practitioner is acting in accordance with applicable federal and state law.

If these conditions are met, the prescription may be issued either electronically (in accordance with DEA rules for e-prescribing controlled substances in schedules II-V), by calling in an emergency schedule II prescription to the pharmacy or by calling in a schedule III-V prescription to the pharmacy. Learn more. The DEA call center has temporarily suspended its phone operations due to the pandemic. Help with DEA registration issues is available by email. Registrants and others can register their e-mail address to obtain up-to-date information concerning DEA's response to COVID-19.

To keep health care workers and patients safe amid the COVID-19 pandemic, the AMA has designed several resources to support physicians and practices in the safe delivery of care to their patients:

• AMA quick guide to telemedicine in practice: This guide supports physicians and practices in expediting the implementation of telemedicine. Check the AMA steps forward telehealth module on how to get started.
• Caring for our caregivers during COVID-19: This resource provides practical guidance for health care administrators and leadership to support the safety and well-being of clinical care teams.
• JAMA interviews and resources: Browse the JAMA Network COVID-19 collection, including Q&As with NIAID's Anthony Fauci, MD, an interactive map of the outbreak courtesy of The Johns Hopkins Center for Systems Science and Engineering, and past publications on vaccine development, infection control, and public health preparedness.
• Non-essential care in private practices: This resource provides guidance to support physicians and practices in developing policies and procedures to triage non-urgent patient requests appropriately.
• Tips for keeping your practice in business during the COVID-19 pandemic: Physician practices managing patients during the COVID-19 pandemic are confronting new and unique operational and business challenges. This checklist provides high-level guidance for practice owners and administrators.

For more resources and up-to-date developments, visit the COVID-19 physician guide.

The Office of the National Coordinator for Health Information Technology (ONC) recently released its draft Federal Health IT Strategic Plan 2020-2025. The plan outlines the federal government's intent to use health information technology over the next five years to promote the secure access of electronic health information. The plan is not regulatory but describes how agency officials will prioritize resources, align and coordinate efforts across agencies, signal priorities to the private sector, and benchmark and assess change over time. The AMA supports ONC's vision but believes a clearer direction is needed. The plan outlines an ambitious set of priorities but in total lists over 70 individual strategies, objectives and principles. In comments to ONC, the AMA recommends the agency focus on the immediate needs of patients and physicians, including reducing unnecessary regulatory burdens, documentation requirements, and steps to increase physicians' return on their time and resource investments. The AMA also recommends ONC include a strategy to protect patients from discrimination, stigma and exploitation, and promote equitable access to tools and resources that protect health information. The AMA will continue working with ONC, in coordination with other federal agencies, on the implementation of its Federal Health IT Strategic Plan.

• March 27, 2020: Advocacy spotlight on What's in the stimulus package 
• March 27, 2020: State Advocacy Update