The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law in March, has provided a lifeline for many businesses — including healthcare organizations. Amid the grim reality of medical equipment shortages and limited hospital beds, the CARES Act provides the healthcare industry much-needed relief.
Considering a significant number of practices are struggling to keep their doors open, and hospitals have experienced significant revenue loss from elective procedures being cancelled or postponed, the act has been pivotal in providing critical aid.
However, at over 800 pages, understanding the full impact of the act can be challenging. Below, I’m sharing how the CARES Act can benefit healthcare providers, as well as additional steps medical practices can take today to ensure the financial security of their organizations.
What You Need to Know About the PPP
By now, the Paycheck Protection Program (PPP) has been in place for a few weeks, and many healthcare practices with fewer than 500 employees have likely already submitted their applications. Whether you’ve already applied for the PPP or are weighing your options, here is some need-to-know information to consider.
At its core, the PPP gives businesses an incentive to keep their staff employed. Funds dispersed from this program can be used to cover up to eight weeks of payroll costs and other eligible expenses, such as rent, utilities and mortgage interest. This loan can provide practices with the necessary funds they need to keep their staff employed and continue serving their communities.
While the initial funding for the PPP from the CARES Act quickly ran out, another law passed in April 2020 provided another welcome injection of funding in the program.
By Juan Pablo Segura, president and co-founder, Babyscripts
Juan Pablo Segura
In the past several months, novel coronavirus 2019 (COVID-19) has risen from humble beginnings in a Wuhan farmer’s market to international status: dominating the news cycle, exhausting the world’s hand sanitizer resources, and generally monopolizing the mental real estate of the developed world.
As new cases continue to be identified in the U.S., politicians are giving coronavirus the attention it deserves, responding to initial accusations of inadequacy with proposals for funding and reimbursements for testing and other precautionary measures.
One of the primary targets of this emergency funding is telehealth. New York’s Governor Cuomo and the NY Department of Financial services released a directive encouraging insurers to develop telehealth programs with participating providers.
Arizona Rep. Ruben Gallego announced he was introducing a bill that would allow Medicaid to cover all COVID-19-related charges, including virtual appointments.
Major health industry groups like the Connected Health Initiative and the American Medical Association advocated for the Department of Health and Human Services to expand access to telehealth and offer Medicaid reimbursements for telemedicine in emergency situations.
Many have cited this pandemic as the “put me in coach” moment for telehealth — digital innovation that has lagged in adoption because of cumbersome restrictions, red tape, and lack of funding, among other things. And it’s obvious why telehealth is the tool for this moment.
At its most basic level, telehealth can provide accurate information about the virus — what it is, what the symptoms are, and how to protect against it. It’s low-hanging fruit in the rank of benefits, as disinformation seems to be spreading faster than the virus itself.
A local Costco suffered a run on toilet paper and paper towels, while the soap aisle remained surprisingly undisturbed: “Are we prepping for a snowstorm or a virus?” one shopper wondered.
A viral (no pun intended) tweet from CNN stated that “38% of Americans wouldn’t buy Corona beer ‘under any circumstances’ because of the coronavirus.” The tweet sparked a rash of sardonic responses. “Thirty-eight percent of Americans shouldn’t be allowed to roam free,” wrote one Twitter user.
The statistic was later debunked in a statement by the CEO of Corona, but it proves how quickly and easily even the most ridiculous rumors can take hold in panic mode.
The simple security of receiving information from a trusted care provider through a mobile app or text notification can dramatically reduce the panic that rises from disinformation, and clear up confusion around prevention and precautions (and what beer you should be avoiding).
Technology has changed a dramatic amount over the last ten years alone, and digital health is now ever-present. From telemedicine and health-related wearables to online medical providers and health resources, digital health is growing faster than ever.
Consumers are using digital resources to better manage their health levels, and medical facilities are using digital technology to track, manage, and improve the health of their patients. Now, patients do not even have to meet in person to get the treatments or advice they need.
Putting power back into the hands of the patient while giving doctors and medical professionals access to the tools and data they need; the rise of digital healthcare is something that cannot be ignored.
Digital Healthcare for the Individual
Consumers have access to more technology than ever before, and that’s good news for those in the healthcare sector. Now that consumers can easily buy a wide range of wearable technologies, they can monitor their health levels from anywhere, and provide their doctors with detailed information. Going further than external wearables like fitness trackers, we have also seen pacemakers with their own dedicated monitoring apps.
This unprecedented level of data gathering is proving vital for catching early signs of health issues. The health industry is being forced to keep up the pace of tech innovation simply because of the wide range of benefits that those new technologies bring.
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.
Maven, the largest telemedicine provider for women’s and family health, announced a new partnership with MassHealth, the Massachusetts, Medicaid and the Children’s Health Insurance Program. MassHealth will provide free telemedicine appointments for members with COVID-19 symptoms with Maven’s network obstetric/gynecologists, maternal fetal medicine specialist, pediatricians, family physicians, and general practitioners for women and families in Massachusetts.
MassHealth members will be connected through an online navigation tool to Maven providers through on-demand chat and video appointments 24 hours a day through the use of any web-enabled device.
“During the COVID-19 emergency, MassHealth has made unprecedented efforts to eliminate barriers to health care access, including expansive coverage of telehealth services,” said Acting Medicaid Director Amanda Cassel Kraft. “We are excited to announce this partnership with Maven ?to provide medical support to our members seeking guidance on COVID-19 symptoms or risk factors.”
In the wake of COVID-19, women and families are dealing with a myriad of health concerns, from managing conditions related to a high risk pregnancy to being discharged from hospitals soon after giving birth to caring for a newborn. Telehealth now plays an essential role in giving these women and families the support and care they need from the safety of their own homes.
“This pandemic has raised serious concerns for millions of women who are pregnant or have just given birth,” said Kate Ryder, founder and CEO of Maven. “We have doctors available around the clock to support MassHealth members and alleviate the burden on the healthcare system during this public health crisis. Massachusetts has long been a leader in healthcare and other states should look to their innovative response to this crisis as a model.”
With the incredible demand for care, trusted clinical data and information, and resources around COVID-19, Maven has developed dedicated COVID-19 resources. This includes:
Ongoing webinar series led by healthcare professionals to provide clinical updates on the rapidly evolving COVID-19 pandemic, answer member questions and address topics including pregnancy, fertility, anxiety and pediatrics. The next webinar will be held on Thursday, April 2 at 1:30 p.m. EST. Please register here.
Covid-19 support section in our member app for those looking to connect with specific providers.
Specific Maven provider in-app resources with the most up-to-date information regarding COVID-19.
The HIPAA waiver issued for telemedicine during COVID-19 is a game-changer for physicians now that CMS says virtual visits are reimbursable.
And now, telehealth is emerging as an effective and sustainable solution for precaution, prevention, and treatment to stem the spread of COVIS-19. But what do the new HIPAA waiver and CMS rule about telemedicine during COVID-19 mean?
According to Dr. Neil Baum, chief medical advisor at Vanguard Communications, professor of Clinical Urology at Tulane Medical School, and in clinical practice for 40+ years, the glass is half full.
“Telemedicine is a great opportunity for us to fill our glass and engage our patients in a way we never have before. We’re still able to practice good medicine without having to be face to face or touching a patient,” says Dr. Baum.
Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, primarily symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines.
For healthcare professionals, this news means that CMS now allows providers to be reimbursed for the vast majority of virtual visits using telemedicine during the COVID-19 pandemic. (Only a small number qualified for reimbursements as recently as March 14.)
Plus, no special software or extra expense for healthcare-specific hardware and software is needed. The tools are free and easy to use.
Below is a chart of the popular apps approved for telemedicine during COVID-19.
Dr. Baum says telemedicine will go a long way to enhancing a physician’s connection with patients and providing access to care but stresses the importance of documenting virtual visits and video conversations just as you would an in-office appointment.
“If you didn’t document, then you didn’t do it, and then you don’t get paid for it,” says Dr. Baum.
Use of telemedicine in the U.S. has been low to date. However, asexpected, it is expected that demand for these services will increase dramatically over the next few months because of the coronavirus (COVID-19) crisis, says GlobalData, a leading data and analytics company.
Telemedicine has been touted as a critical strategy during the COVID-19 emergency to limit the risk of person-to-person transmission of the virus, prevent emergency rooms from being inundated, reduce barriers to screening, and allowing those with moderate symptoms to be treated from home. Teladoc Health, a telehealth provider, announced that patient visit volume had increased by 50% since the previous week and was continuing to rise.
Kathryn Whitney, MSc, director of thematic analysis at GlobalData, said: “Prior to the COVID-19 crisis, telemedicine had never reached its full potential in the US, with several barriers preventing its widespread uptake. These include lack of reimbursement and restrictions affecting access for rural populations, general lack of awareness of these services, and the desire of the sick to see their physician in person.”
Since early March, regulations in the US governing the use of telemedicine have changed regularly, which will expand access to services during the COVID-19 emergency, particularly for Medicare beneficiaries who are deemed at high risk for the virus. In certain states, including California and New York, officials have also announced that payers must offer telehealth services as part of their emergency plans. In Massachusetts, payers must cover the COVID-19 testing and treatment via telehealth, and cannot impose cost sharing via co-pays, deductibles, or coinsurance, and prior authorization is not required to receive treatment via telehealth.
Whitney continues: “Recent changes to regulations by the U.S. government will remove many of the financial barriers to telehealth and drive the use of these services, particularly among older and vulnerable populations. People will also become more aware of these types of services, given amount of information being disseminated by the government, hospitals, healthcare systems and payers.
“As more U.S. cities and states begin to lock down and social distancing becomes the new normal for the foreseeable future, Americans are likely to change their views on telemedicine. With the ongoing risk of virus transmission, people will be eager to avoid hospitals and get screened and receive care from the safety of their own homes.”
By Dr. Jason Hallock, MD, chief medical officer, SOC Telemed.
Dr. Jason Hallock, MD
On March 13, President Trump declared the novel coronavirus (COVID-19) pandemic a national emergency. The declaration opens more than $42 billion in federal funding to combat the virus by expanding resources in key areas, including telehealth across the nation. While COVID-19 is novel there’s nothing new about telehealth solutions that are now moving to the forefront care in light of this virus.
Funding will support an increase in COVID-19 testing and expand telehealth services to virtually care for patients. HHS can waive licensing regulations to allow out-of-state physicians to treat patients via telehealth wherever outbreaks occur. And, critically, the declaration of emergency allows for $500 million in Medicare waivers for telehealth restrictions.
The action comes at a critical moment, as the U.S. health care system is confronted for the first time in its modern history with the possibility of a hospital capacity crisis. If too many COVID-19 positive cases descend on our hospitals at once, we could be in the unenviable position of lacking the onsite equipment, the beds, tests, staff and other resources to provide life-saving care for all. Such dark medical realities are already true elsewhere in the world.
As the contents of the national emergency declaration show, telemedicine is poised to play a key role in the fight against COVID-19. It’s not by accident.
While the virus spread rapidly to pandemic status, the reality is that the healthcare industry long anticipated the possibility of a fast-spreading global contagion. As we in the industry planned for the possibility of such an event, telemedicine was always among the solutions.
The role of telemedicine in the time of a pandemic is not an experiment or for use in a limited trial—it’s actively being used to treat COVID-19 today. In fact, the Centers for Disease Control and Prevention (CDC) continues to urge doctors and hospitals first to assess potentially infected patients remotely whenever possible, and to care for patients with mild COVID-19 symptoms from home using virtual check-ins.
Technology has changed a dramatic amount over the last ten years alone, and digital health is now ever-present. From telemedicine and health-related wearables to online medical providers and health resources, digital health is growing faster than ever.
Kathryn Whitney, MSc, director of thematic analysis at GlobalData, said: “Prior to the COVID-19 crisis, telemedicine had never reached its full potential in the US, with several barriers preventing its widespread uptake. These include lack of reimbursement and restrictions affecting access for rural populations, general lack of awareness of these services, and the desire of the sick to see their physician in person.”