The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.
“Healthcare providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”
The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.
The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.
The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same fund used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement.
The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.
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The coronavirus (COVID-19) has had a significant impact on healthcare at home providers’ ability to see or care for patients, and the much-publicized lack of personal protective equipment (PPE) is a very real issue, according to findings of a survey conducted by healthcare technology leader Axxess.
More than 80 percent of respondents said the virus has had an impact on their organization’s ability to see or care for patients, and three-fourths of respondents said they do not have adequate PPE for staff.
The survey of thousands of home-based care providers from organizations of all sizes from March 25-30 confirmed that agencies have a critical need for PPE, including N95 masks, gloves, face masks, gowns and hand sanitizer.”
In addition, billing or cash flow has been interrupted for nearly 60 percent of respondents’ organizations, and more than half of respondents indicated their organization has experienced staffing challenges as an impact of the virus.
“Understanding how challenged providers are at this uncertain time, we appreciate everyone who took the time to help provide visibility into the needs of the industry,” said John Olajide, founder and CEO of Axxess. “Our brief survey was designed to give a voice to our heroes on the frontlines of caring for those most vulnerable to coronavirus.”
The survey, which included respondents from all levels of organizations, including management and caregivers directly working with patients and clients, showed nearly half of respondents have a negative view of coronavirus’ (COVID-19) eventual impact on their business.
The long-term impact of coronavirus (COVID-19) on the industry is less certain, with about a third of respondents feeling it would ultimately be positive, a third feeling it would be negative and about a third having neutral feelings.
“I am incredibly proud to be part of such a caring community,” Olajide said. “We can’t know how long this crisis will last, but it should be reassuring to all of us that we are all working together and demonstrating leadership, providing expertise, displaying innovation and sharing resources.”
The full survey report is available in the Axxess COVID-19 Resource Center.
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence; AHIMA.
Release of patient information during COVID-19
What insiders have long known has become clear during the COVID-19 pandemic: health data is a vital element of health care, including efforts to curb the pandemic. Of course, that data is important to patients, providers, and healthcare staff. And even during COVID-19, if a patient wants to access their data, release of information services (ROI) teams must comply with a strict set of processes set forth by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These regulations ensure that patients retain safe and secure control of their personal health information and record requests are timely, accurate, and complete.
So, what should providers and patients expect during this time? For years, patients have been able to walk into a provider’s office or a health records office and request a copy of their records. During a stay at home order, however, that’s not such a good idea.
The American Health Information Management Association (AHIMA) recommends that organizations temporarily suspend walk-in access for medical records inquiries during COVID-19. Organizations should work closely with their ROI vendor (if they have one) to ensure continuity, while also displaying signage on doors and windows to redirect patients and families to alternative resources. In addition, it would be prudent to post process changes to the organization’s website and through automated messaging systems, while alerting the patient access staff.
It’s important for organizations to provide patients and their families with alternate record request options during COVID-19. All requests via phone should be authorized by health information staff who witness and document it in the patient’s record. And voicemails should be directed to a patient portal so they can be returned.
And just how can a health professional be assured they’re talking to a patient or one of their relatives? They should ask the caller to verify their patient demographic data such as a date of birth, home address or the last four digits of a social security number (if applicable). Other examples of data may include cell phone numbers, nicknames or another reliable data source that is consistently collected.
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Response from Art Papier, MD, CEO, VisualDx
As the public is ordered to stay home to flatten the curve, healthcare systems are tasked to ‘raise the line’ by increasing staffing, adding beds, and moving to a telehealth model to keep patients out of hospitals. Clinicians who are not on the frontlines of the COVID-19 response are being asked to help assist the rest of medicine. During these virtual care visits, it’s critical for these clinicians to utilize clinician decision support software to aid in diagnosis and keep as many patients out of the acute care setting. These software systems can not only help triage cases of COVID-19 but also help quickly and accurately treat patients presenting with other conditions that still require care. Clinical decision support also supplements telehealth services to improve the patient experience, ease patient anxieties, and reduce some administrative burden for providers.
Response from Chris Caulfield, RN, NP-C, co-founder and chief nursing officer, IntelyCare
As a result of COVID-19, demand for healthcare professionals is at an all-time high, with nurses on the front lines providing care to patients in need. In this unprecedented time, nursing and other healthcare professionals need their provider organizations more than ever to support and protect them. One significant aspect of keeping nurses and their patients safe is COVID-19 education. The virus is rapidly evolving and nurses don’t always have time to find and walk through new COVID-19 protocols before each shift. Organizations can offer and promote online learning so that nurses can complete training on their devices and on their own time, and so facilities can ensure the entire workforce is well-equipped to treat and prevent the spread of COVID-19.
Another way to protect facilities, staff, and patients from unnecessary exposure to COVID-19 is the implementation of an online symptom screening that enables workers to remotely verify whether or not they are experiencing COVID-19 symptoms. Nurses that are experiencing COVID-19 symptoms can be removed from the shift without penalty, which can prevent the further spread of the virus to other nurses and the vulnerable populations they’re treating.
Response from Erin Jospe, MD, chief medical officer, Kyruus
With health systems needing to respond nimbly to the rapidly evolving landscape of caring for patients in the midst of a public health crisis, the key, as with any crisis, is to pursue a plan of action with thought and purpose. At a time when the majority of people seek healthcare information and services online, this principle and plan must extend to the role of digital access. The promise of digital technology is to leverage it creatively as a force multiplier, and to do so with an eye toward minimizing friction in care delivery and enabling the safest care possible. In the ambulatory setting, there are three distinct populations we need to think about servicing this way.
The first is the general population needing guidance on safely assessing their health while physically staying in their homes if at all possible. This is best achieved through the interplay of screening tools and virtual assistants with appropriate triaging for 1) those who can safely obtain self-care instruction 2) those who should have additional assessment through a combination of virtual appointments and direction for screening tests if warranted and 3) those who require immediate direction to the closest hospital or care facility. Screening engagement platforms, in conjunction with telemedicine, can decompress call centers, thereby freeing up staff, and help keep more patients safely at home.
In addition, more clinical staff can work remotely to provide virtual visits, maximizing the use of dwindling PPE resources for those who continue to serve on the front lines in direct patient contact. Digital technology can thus similarly benefit this second population, your health system staff and clinicians, by respecting their need for technology that works for and with them, promotes their physical safety, and conserves increasingly limited resources.
The third key population is patients with non-COVID medical needs, who require attention and outreach to help maintain their health. Digital platforms (e.g., telemedicine, automated outreach) can play an important role in keeping these patients well-informed, monitored, and safe, with clear access to information, both static and offered dynamically through real-time interactions when needed. Furthermore, those with chronic conditions that can become increasingly complex if left unchecked and where compliance issues may be exacerbated due to economic pressures, must be supported during this time even in the absence of acute symptoms – for their own well-being and to minimize the need to compete for scarce complex care resources.
While we all struggle to act quickly under these exceptional circumstances, using your digital investments to speak creatively to the needs of these populations is not only possible, it is necessary.
A team of healthcare professionals and evidence-based medical experts at EBSCO Information Services (EBSCO) has launched a COVID-19 portal which aggregates real-time information updates from authoritative sources to provide information on all aspects of the COVID-19 pandemic.
The portal was created to meet the needs of the healthcare information community in a time when information is released at a rapid rate, from all areas of the knowledge ecosystem. The COVID-19 portal provides researchers and healthcare professionals with consolidated access to real-time, credible information. Librarians and information professionals are also called upon to suggest resources that should be added to the site.
EBSCO Information Services chief medical knowledge officer Brian S. Alper, MD, MSPH, FAAFP, FAMIA, says the portal was developed to provide useful information to many professionals seeking information about COVID-19. “This is a time of massive and rapid information demand.
By creating this portal, we are responding to the needs of many sectors of society by making COVID-19 information available for a diverse set of users. To meet this great need, we have enabled information professionals and others to contribute — to leverage their expertise developing collections and vetting sources — which we’ve made possible through this portal.”
The portal was created in collaboration with EBSCO’s Stacks division. Stacks Founder and EBSCO Information Services vice president of SaaS product and technology Kristin Delwo says the portal is an evolving platform that aims to include all trusted resources to best meet the needs of the online research community. “At its simplest level, the COVID-19 portal is a way to help people share and find information. As experts in clinical content, EBSCO is well positioned to curate a site of this magnitude and to understand the best curators of this valuable content.”
The EBSCO Clinical Decisions division provides clinical decision support resources to healthcare institutions around the world. The COVID-19 portal is one of several ways that EBSCO has made healthcare information accessible during the pandemic. DynaMed, EBSCO’s clinical decision support tool, has made its COVID-19 clinical topic open, offering easy access to evidence-based information related to treatment that is updated daily.
EBSCO has also developed a healthcare resource center to provide open access to the content it provides to medical, nursing and allied health professionals.
To learn more, visit covid-19.ebscomedical.com.
In a new survey conducted by Kareo, independent medical practices and billing companies shared the unprecedented challenges created for them and their patients by the coronavirus pandemic. More than 600 medical practices and 140 medical billing companies were interviewed by Kareo in late March.
The research uncovered the immediate actions medical practices and clinics are taking to ensure patient access to care through telemedicine solutions with 75% reporting either a current telemedicine option or the intent to deploy one soon. The survey also highlighted the risks to patients and independent medical practices with 9% of respondents reporting practice closures with many more concerned about potential practice closures as patient office visits plummet due to “stay at home” orders and other concerns. As Kareo was publishing these survey results, the Coronavirus Aid, Relief and Economic Security (CARES) Act was signed into law, potentially providing a lifeline to the most severely impacted medical practices.
By mid-March, independent healthcare professionals were already facing the practice and personal impacts of the coronavirus pandemic, with 28% of practices only offering telemedicine visits and 9% of practices already closed, with many more concerned about the risk of future closure. While 63% of practices were still delivering on-site care, most of these practices were exploring options to move to hybrid or exclusively telemedicine-based care.
Kareo’s ongoing analysis of actual patient encounters across over 50,000 medical providers, found that by late March independent medical practices has experienced an approximately 35% decline in patient volume, raising alarm around both the apparent inability for patients to access care and the operational viability of medical practices if this trend continues.
Kareo’s research also highlighted the impact felt by the more than 5,000 medical billing companies across the country, with these service providers reporting immediate impacts on their businesses due to precipitous decline in medical practice patient volume. These companies play a critical role in the healthcare ecosystem by providing medical billing expertise that is essential for the financial viability of many independent medical practices. Financial risk to these service providers creates another risk for medical practices to manage as practice volumes ultimately return to normal.
To address “stay at home” orders and patient concerns about face-to-face medical encounters, healthcare professionals have rapidly turned to telemedicine solutions. By mid-March, fully 41% of independent medical practices reported offering telemedicine, up from 22% reported in Kareo’s State of the Independent Practice Report in late 2018.
An additional 34% reported current efforts to deploy telemedicine options, which ultimately will result in the vast majority (75%) of medical practices providing remote care solutions. In the third week of March, Kareo saw a 500% week-over-week increase in telemedicine visits while working to accommodate an over 3,000% increase in telemedicine adoption.
The easing of regulatory requirements related to telemedicine security and functionality allowed medical practices to access a broader set of possible telemedicine solutions, ranging from medically-specific options like Kareo Telemedicine that are HIPAA compliant and fully integrated with the broader patient engagement, electronic health record, and billing technology platform all the way to general video call technology such as Apple FaceTime. Easing Medicare, Medicaid and commercial insurance reimbursement requirements for telemedicine also supported the rapid pivot to virtual-care and are essential in supporting the financial viability of medical practices and their supporting medical billers.
“Independent medical practices stand as the cornerstone of the U.S. healthcare system and are responsible for more than two-thirds of annual patient visits,” said Dan Rodrigues, founder and CEO of Kareo. “Yet our research shows that even doctors are not immune to the economic impact of the coronavirus pandemic. Telemedicine and the CARES Act provide critical lifelines to ensure independent practices remain available to their patients through this crisis.”
There are several government programs that practices can take advantage of to ease financial burdens and maintain their current staff levels. Small business loans, tax relief, Medicare payment advances and grants are a few of the options currently available. In combination, these programs can help ensure that independent medical practices and clinics emerge from the COVID-19 pandemic with minimal damage to the long-term viability of their business.
The CARES Act expands eligibility for loans under Section 7(a) of the Small Business Act and authorizes the Small Business Administration to make $349 billion in Section 7(a) loans. The CARES Act also offers an employee retention tax credit (Employee Retention Credit) designed to encourage eligible employers to keep employees on their payroll. The Centers for Medicare & Medicaid Services (CMS) has expanded their current Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. Details on the eligibility, and the request process are outlined in the Expansion of the Accelerated and Advance Payment Program fact sheet. The expansion of these programs is also only for the duration of the public health emergency. For more information on resources available to help with the COVID-19 crisis, visit Kareo.com/covid-19.
Response from Avi Price, COO, Uniper Care.
The Trump administration temporarily changed the policy for Centers for Medicare & Medicaid Services (CMS) allowing healthcare providers to have phone-only visits with patients, which is a major breakthrough in the industry and one that was not allowed before.
With the coronavirus being spread throughout the United States, the administration understands the importance of social distancing and the pivotal role that telehealth will play in keeping patients healthy. What is necessary to support the amount of patients today is an economically sustainable, scalable and immediate telecare solution that is available to anyone, regardless of income, age, or location.
The way to keep the general population healthy, is in a fight to flatten the curve and protect most specifically older adults and those at-risk from COVID-19. Telehealth is likely the most effective way to provide care to those who need it and minimize exposure to the virus for the both the patient and the doctor. Right now the hospital systems are overwhelmed with the sudden influx of patients from this virus and telecare’s primary role is to treat patients remotely, reducing the pressure being put on the hospital systems.
Another important factor is the effects that social isolation has placed on older adults and how that will impact their overall physical and mental well-being. We created Uniper to provide a familiar service for older adults, right on their TV screens, mobile phone or desktop to have access to life: their communities, friends, family and physicians so that they can obtain much needed care, from a distance.
Uniper is designed to be economically sustainable, scalable, and accessible to anyone that needs it to help them thrive during these unusual times.
By Josh Horwitz, COO, Enzoic.
Healthcare employees are on the frontlines of the coronavirus pandemic, in many cases working extended hours under extremely taxing circumstances in an effort to treat the growing number of infected patients. In this environment, it’s critical that everyone is cognizant of an unfortunate reality of our times: hackers are always looking for ways to capitalize on a crisis.
As Forbes’ Thomas Brewster put it, the last few weeks have seen “…an avalanche of digital threats piggybacking on the coronavirus pandemic,” and these are only likely to increase as the international community continues to grapple with the virus. With scams ranging the gamut from a coronavirus tracker that installs malware onto visitors’ devices to takeover of teleconferencing software to fraudulent company discounts or services related to the coronavirus, there is no shortage of ways bad actors are seeking to exploit consumers’ fear and confusion.
As such, it’s important that hospitals and healthcare institutions help employees safeguard their data and ensure they are cognizant of the increased security threats associated with the pandemic. Following are a few tips to consider:
- A rise in phishing scams. As mentioned above, many hackers are employing phishing scams to pose as companies offering a legitimate coronavirus-related service in an attempt to trick recipients into sharing credit card information or other personal data. The good news is that there are some common characteristics associated with phishing attacks that people can use to vet these communications. For example, encourage employees to check for grammar, punctuation and formatting errors as these are often phishing red flags. It’s also important to review links before actually clicking on them and look for things that appear odd such as dashes, extra characters, or additional letters and numbers. Another good practice is to check the email address itself to see if it contains multiple numbers or letters. Finally, encourage employees to always reach out to the company in question to determine the authenticity of an offer before clicking on any links if they harbor doubts.
- Increased online shopping: With more shopping taking place online, particularly for healthcare employees working long hours, the importance of strong, unique passwords is more critical than ever. It’s extremely common for people to create simple passwords that they share across multiple accounts. However, if those credentials have been leaked in a previous breach, hackers can easily use them to access these accounts and all the data they contain. Healthcare institutions must stress the significant vulnerability of this poor password practice, and encourage employees to review existing passwords and ensure any new accounts they create are protected by strong, unique credentials. Password manager solutions can be extremely helpful, particularly for people who are setting up numerous new online accounts in response to “Stay Home” orders.
- An uptick in connectivity: With people working from home or participating in remote learning programs, many families are experiencing an increase in internet connectivity. This undoubtedly puts a strain on bandwidth, but it also introduces some security vulnerabilities. For example, what if a child accidentally downloads malware on the home network? And are connected devices like voice assistants or smart TVs protected by unique passwords, or do they still have the default factory settings? It’s important that employees are aware of the threats that can arise with greater connectivity and ensure they take steps to address them. It’s also essential that hospitals insist employees use their VPN whenever accessing work-related systems or data from home to keep this information protected.
In addition to the considerations outlined above, it’s also important that healthcare employees keep an eye on the evolving cybersecurity landscape as it relates to the pandemic. It’s likely that hackers will continue to find new ways to exploit the situation for their own nefarious purposes. As employees work diligently to combat coronavirus, it’s essential that hospitals remind them to keep their personal information safe.