Calling for additional relief for physician practices and Medicaid

Andis Robeznieks , Senior News Writer

What’s the news: The nation’s private medical practice infrastructure has been severely damaged by the COVID-19 pandemic. To prevent further erosion of the country’s health care system, the AMA is asking Congress to provide additional financial relief, bolster federal support for the Medicaid program, and shield physicians against medical liability lawsuits that may stem from circumstances beyond their control.

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“Physician practices continue to struggle to meet the needs of their patients and staff as they confront revenue shortages from deferred patient visits and procedures as part of the system-wide effort to conserve personal protective equipment (PPE) and support the physical distancing that is necessary to curb community spread of COVID-19,” AMA CEO and Executive Vice President James L. Madara, MD, wrote in a letter to Senate leaders.

The AMA believes Senate legislation needs to include these provisions:

Modifications to Medicare’s Accelerated and Advance Payment (AAP) Program and wider distribution of payment from the Health and Human Services Emergency Relief Fund. Physicians appreciated modifications to the AAP Program  included in previous legislation and the flexibility provided to the program by the Centers for Medicare & Medicaid Services. But some statutory fixes are still needed.

These include:

  • Postponement of the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice.
  • Reduction of existing 10.25% interest rate accruing during the extended payment period to 1%.
  • Reduction of the per-claim recoupment amount from 100% to 25%.
  • Extension of the repayment period for physicians to two years.

The Health Care Provider Relief Fund, created by the Coronavirus Aid, Relief and Economic Security (CARES) Act, has been essential to maintaining the nation’s health care infrastructure by providing relief to physician practices and health care facilities facing severe revenue loss and increased expenses caused by the public health emergency.

But additional funds with a wider distribution are needed. Initial distribution supported Medicare-enrolled physicians and facilities, but help is needed for pediatric and OB-GYN practices and others with few if any Medicare patients.

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Why doctors support these COVID-19 relief provisions

Boost federal Medicaid support as rising unemployment challenges states’ ability to fund the program. Congress acted early in the COVID-19 emergency to temporarily raise federal support for Medicaid. But since then, about 39 million people lost their jobs.

State budgets are strained due to significant losses in tax revenue, explosive jumps in new unemployment claims, and dramatic growth in Medicaid enrollment.

“States will likely face significant shortfalls in coming years as a direct result of the COVID-19 pandemic, forcing them to enact deep Medicaid payment cuts just as physician practices are getting back on their feet and patients seek care for conditions left untreated during the public health emergency,” Dr. Madara warns Senate leaders in his letter.

Consider broad liability protections for physicians and other clinicians who treat COVID-19 patients under unprecedented conditions. Lawsuits may come months or even years after the current ordeal is over. These may stem from situations beyond physicians’ control such as:

  • The suspension of most elective in-person visits.
  • The need for physicians to provide care outside their general practice areas for which they may not have the most up-to-date knowledge.
  • Inadequate supplies of PPE that could result in the transmission of the virus from patient to physician and then to additional patients, or directly from one patient to another.
  • Shortages of equipment, such as ventilators, that can force facilities and physicians to ration care.
  • Inadequate testing.

Bipartisan legislation on this issue, the Coronavirus Provider Protection Act, has been introduced in the House by California Democrat Lou Correa and Tennessee Republican Phil Roe, MD.

“Physicians and other health care professionals are putting themselves at risk every day while facing shortages of medical supplies and safety equipment, as well as changing directives and guidance from all levels of government,” said AMA President Patrice A. Harris, MD, MA. “We commend Reps. Roe and Correa for recognizing that reasonable liability protections are in the best interest of our country as we continue to combat COVID-19 and begin to recover from this pandemic.”

Dr. Madara’s letter also notes that the availability of PPE, disinfectants, hand sanitizers, testing supplies and infection-control supplies remain a concern. Physicians reopening their practices cannot secure these needed supplies from the usual sources they have been using.

Congress should support developing a network of state, local, and regional clearinghouses to give physicians clear points of contact and listings of legitimate suppliers.

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Why it’s important: Physician practices directly benefit their local economies, but the nation’s financial crisis is having a brutal impact on these small businesses. The U.S. Bureau of Labor Statistics reports that 243,000 jobs were lost from physician offices in April, adding to the 12,000 that were lost in March.

“Given the continuing overhead and payroll costs, these physician practices are experiencing significant cash flow issues and need assistance to avoid an implosion of the private medical practice infrastructure,” Dr. Madara’s letter tells Senate leaders.

A staggering 97% of practices have experienced a negative financial impact directly or indirectly related to COVID-19, and less than half of primary care clinicians have enough patient volume and cash to stay open for the next four weeks, according to “Physician Practice Financial Sustainability During the COVID-19 Pandemic,” a recent webinar hosted by Henry Schein Medical featuring AMA experts.

While prospects for improvement may be promising as states lift restrictions on elective services, the ability to reopen safely needs to be ensured.

“We are hearing significant and growing concerns from our member physicians that they cannot secure needed supplies to safely reopen their practices and that they are unsure where to turn for further guidance and assistance,” Dr. Madara wrote.

What’s next: The House has already passed its own version of a “COVID 4.0” relief bill. Once the Senate passes its bill, the two sides will negotiate a final piece of legislation for both to consider.

The AMA has prepared a summary of the House-approved Health and Economic Recovery Omnibus Emergency Solutions Act” (HEROES Act).

Stay up to speed on the AMA’s COVID-19 advocacy efforts and track the pandemic with the AMA's COVID-19 resource center, which offers a library of resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization.