Author Archives: Zuzanna Walter

Physician’s Recession Guide: How to Protect Your Practice During COVID-19

April 29, 2020

Medical practices managing patients during the COVID-19 pandemic are being confronted with new and unique operational challenges as many have turned to telemedicine, bringing their services online to continue patient care. Other providers may find it increasingly difficult to continue conducting business in light of wide-scale cancellations of elective procedures and recommendations against in-person office appointments. Unprecedented economic fallout related to the virus outbreak is proving to be another significant concern facing the healthcare system.

In response to this complex issue faced by clinicians across the country, the American Medical Association has compiled a set of recommendations and guidelines on handling the financial and operational repercussions of the outbreak for practice owners and office administrators.

To better adapt practices to current demands and protect them from adverse financial impact at this time, medical professionals should consider the following important variables and strategic responses:

Insurance Coverage 

A critical first step to securing the medical practice is to ensure it is protected against COVID-19 related liabilities under business insurance policies. Whether the protection is part of insurance policies will determine the associated risks and help providers make vital business and operational decisions. Experts urge practices to contact their insurance brokers to obtain a complete copy of all insurance policies, understand government emergency orders and decrees, as well as to track losses and expenses incurred during this time for future claims.

Further, practitioners are urged to consult legal counsel for explanations of how they can exercise existing policies and how government orders impact business operations in their state. “You may need to notify professional liability carriers in the event practice providers are called upon to assist with emergency care, including outside of their normal clinical service arrangements,” the AMA adds in its latest guidelines.

In addition, the U.S. Department of Health and Human Services has published a declaration of liability protection against certain medical countermeasures related to COVID-19 which can be accessed here. 

Financial Obligations and Contingency Planning

To minimize potential economic risk, practices are encouraged to revise financial plans at this time and ensure their ongoing liquidity; this will hopefully protect those businesses suffering from a loss of clinical revenue due to cancelled procedures, decreasing outpatient visits, and partial or whole closures. It is recommended practices develop a financial contingency plan based on minimum cash flows needed to remain in operation, review existing loan documents and financial covenants, and determine if slowdown of business could trigger a default situation.

Practices should prioritize managing cash to the best extent possible and consider delaying payments of discretionary bonuses as well as other such payments. They may also choose to consider requesting forbearance, forgiveness, or a standstill from lenders and other creditors. Proactive communication with these third-parties can help ensure accommodations are granted during revenue disruptions.

Additionally, clinicians are urged to monitor resources as they become available concerning economic relief packages for business and workers affected by the outbreak; the U.S. Small Business Administration has already begun introducing low-interest loans while other organizations – such as United Way – have created COVID-19 relief funds to provide additional funding.

Current and Future Supply Needs 

In light of global shortages of essential medical supplies, such as personal protective equipment and respirators, practices are encouraged to evaluate their current and future supply needs. While a reduction in in-person office visits may decrease the number of interactions requiring the use of such equipment, practices should determine how much cash flow can be devoted to stocking up on essential supplies for the forthcoming months.

“While your business may be interrupted, you may also be called upon to triage patients outside of your normal workflow, so contact your supply vendors and, if necessary, your state and local health authorities to ensure that you are in the queue to receive necessary supplies,” the AMA recommends.

Continuing Business Operations 

A growing number of “shelter in place” orders and their extensions may impact the ability of medical practices to continue business operations. However, many of these orders designate healthcare services as essential businesses but publicly available guidance may remain unclear. Practitioners are urged to consult with local counsel to determine the implications of executive orders and how to apply them to their practice.

To further assist clinicians, the AMA provides two non-jurisdiction specific template letters that can be modified to suit the needs of each practice in COVID-19 related circumstances. These templates aim to function as a resource for providers who may encounter questions from authorities or resistance from employees who may not report to work due to “shelter in place” orders.

Regular Communication with Patients

Whether a practice is operating normally or offering digital medical services, it is currently essential to maintain regular communication with patients – in particular, those who may be at-risk of adverse health outcomes as a result of the disruption in healthcare. Reports reveal a silent sub-epidemic caused by COVID-19, that of an increasing number of patients forgoing needed medical care out of fear of contracting the virus in a hospital or medical facility. Patients need to be made aware of the COVID-19 prevention and safety protocols enforced at a practice or other healthcare center and be encouraged to stay in contact with their physicians via telehealth and to come in for in-person care when needed.

Administrative Resources

Despite interruptions in operations, many practices will still operate remotely. To assist healthcare providers in meeting immediate care needs while working from home, office administrators are encouraged to compile essential resources outlining best telemedicine practices. This includes putting in place methods of maintaining documentation protocols to obtain payments, including processes for collection of accounts, claims submissions, and other activities. More information regarding medical codes and scenario planning has been made available as part of the AMA’s resource hub.

Workflow and Digital Health Tools 

To protect staff members, conserve valuable equipment and supplies, and reduce the safety and liability risk to your practice, providers are urged to follow the latest guidance issued by governmental agencies when reviewing scheduled visits and choosing which appointments to postpone, cancel, or proceed with as usual.

Digital tools can assist providers by allowing them to continue conducting business remotely via telehealth services and remote patient monitoring. Following the CMS’ telemedicine toolkit can help physicians and practices utilize these technologies during the COVID-19 outbreak and provide insight into emerging policy changes and practice flexibilities.

 Employee Management 

Keeping employees updated and informed is essential to managing concerns about health and safety. Practices are encouraged to institute interim guidelines that aim to educate their employees, including outlining circumstances under which they should not report to work, contact information for relevant resources, and specify leave policies related to COVID-19.

Depending on revenue and cash flow challenges, practices may need to furlough or terminate non-essential employees. In these cases, practices should seek legal counsel to understand their obligations, requirements regarding communication of employment status, and identify workflow changes which may be necessary at this time.

While all practices may not be able to sustain each of their employees, healthcare staff is urgently needed at medical facilities across the nation – as such, administrators should identify external opportunities for their furloughed or terminated staff members when possible.

The CDC has issued interim guidance to assist business and employers in navigating the evolving situation, while the U.S. Department of Labor also released resources pertaining to employee furloughs and unemployment benefits.

The COVID-19 pandemic has prompted unprecedented policy and regulatory changes affecting the healthcare system nationwide; it is essential for medical professionals to stay current on the latest developments in requirements and afforded flexibilities. As the COVID-19 outbreak continues to evolve, federal guidance and relief efforts are forecasted to offer further support for front-line workers as well as those physicians whose practice has been affected by the pandemic. To access the latest recommendations for practices and physicians navigating patient care at this time, visit our COVID-19 Resource Hub.

The Rise of Eco-Anxiety

April 22, 2020

Uncontrollable wildfires, heatwaves, rising ocean levels, and other climate change conditions are contributing to a surge in “eco-anxiety” – a new subset of mental illness that is characterized by an intense fear of environmental damage or demise. This sense of anxiety is largely based on the predicted future state of the environment as related to human-induced change. While not the same as clinical anxiety disorder, eco-anxiety can worsen or trigger preexisting mental health conditions.

Per recent data, about 70% of people in the United States are worried about climate change, while over half feel “helpless” about the situation. More evidence is emerging suggesting people are experiencing severe or chronic anxiety due to a feeling of lack of control; they are frustrated and afraid while also feeling guilty and anxious about their personal impact on the environment, causing the latest surge in eco-anxiety cases in the Western world.

What is Eco-Anxiety?

First defined in 2017 by the American Psychiatric Association as a “chronic fear of environmental doom”, the disorder remains under investigation. Although not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, the condition is characterized by chronic or severe anxiety related to the current and future state of the environment.

The immediate effects of climate change – including damage to communities, food shortages, and reduced medical supplies – can not only harm physical wellbeing and displace populations, but can also prove to be a significant challenge on mental wellbeing. Gradual impacts of climate change, such as rising sea levels, warmer temperatures, and changes in seasonal patterns may lead to the development or worsening of chronic mental health symptoms. These can manifest as a mix of trauma and shock, post-traumatic stress disorder, anxiety, depression, substance abuse disorder, aggression, reduced feelings of autonomy, feelings of helplessness, and fatalism.

What Causes It?

For most individuals, eco-anxiety stems from experiencing or being at risk of experiencing climate-related consequences. The stress over losing housing or employment due to environmental changes can have a significant effect on an individual’s wellbeing, while chronic stress can raise the risk of several serious health conditions such as heart disease, hypertension, depression, and general anxiety disorder. This intensifying anxiety may also result from a growing awareness of the possibility of extreme weather events, the potential loss of livelihood or housing, fears for future generations, and increased feelings of helplessness.

Vulnerable Demographics

Some of the more vulnerable demographics for this condition include populations who reside in locations at risk for extreme weather – such as coastal towns and low-lying areas – and especially individuals who work in a field affected by environmental patterns such as fishing, tourism, and agriculture.

In addition, people who live in indigenous communities and rely on natural resources for their livelihood, tend to reside in more vulnerable geographic locations. They may face an increased fear of losing their housing, livelihood and cultural heritage which can be damaging to identity, belonging and a the greater sense of community.

First responders, emergency health care workers, and people who work in environmental jobs are more prone to developing eco-anxiety. Additionally, individuals with preexisting mental and physical conditions, children and young adults, people of lower socioeconomic status, and displaced or forced migrants may be more likely to experience the mental health condition.

As there is currently no clinical definition of eco-anxiety it may be difficult for health care practitioners to diagnose. However, if a patient is concerned about the environment to the point of interference with everyday activities or their ability to work or take care of themselves, they should be urged to speak to a mental health professional who may provide the necessary therapeutic support and be able to suggest effective coping mechanisms.

Experts in the field of eco-psychology, a branch of the medicine that evaluates psychological relationships with nature and their impact on identity, wellbeing and health, are working to better understand the newly-defined disorder and develop effective methods to alleviate its symptoms. A growing number of mental health practitioners are receiving training to help detect and manage fears related to eco-anxiety as its burden continues to increase. As part of this effort, the Climate Psychology Alliance is offering individual and group support for eco-anxiety sufferers as well as education for therapists, including free sessions over the phone or Skype.

What Private Practices Need to Know About the U.S. Relief Package

April 15, 2020

There is a dire need for financial support of healthcare providers and facilities as they continue to battle the COVID-19 pandemic, now affecting the United States the most drastically. In response, the President signed the bipartisan CARES Act on March 27, 2020, providing much-needed relief funds to hospitals and other healthcare providers on the frontlines of the fight against coronavirus. As part of the recently announced CARES Act, $100 billion will be appropriated to create a Public Health Social Service Emergency Fund with an ultimate goal of preventing, preparing for, and responding to the coronavirus outbreak both domestically and on an international scale.

Per the Act, funding will be dedicated to reimbursing healthcare-related expenses or lost revenue attributable to COVID-19 to alleviate some of the financial burden many providers are experiencing. Part of this relief payment will focus on ensuring that uninsured Americans have access to testing and treatment, and that medical professionals providing the care are reimbursed for their work. The Department of Health and Human Services has published detailed criteria for the process of distribution of funds under the Act as well as information about eligibility requirements, outlined below.

Immediate Relief Funding

Recognizing the urgent need for the delivery of financial relief, the HHS immediately infused $30 billion into the American healthcare system. Payments are slated to arrive via direct deposit beginning April 10, 2020 to eligible providers throughout the system. Note, these are direct payments, not loans and will not need to be repaid, the HHS emphasizes.

Eligibility for Immediate Relief Payments

Per guidance from the HHS, all facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible to receive payments from this initial rapid distribution. Payments to practices that are part of larger medical groups will be sent to the group’s central billing office, while all relief payments will be made to the billing organization according to its Taxpayer Identification Number (TIN).

In order to be eligible to receive these funds, providers must not seek to collect of out-of-pocket payments from a COVID-19 patient that are greater than what they would be otherwise had the care been provided by an in-network practitioner. If a practice had to halt business operations as a result of the COVID-19 outbreak, providers may still be eligible to receive funds if they provided diagnoses, testing, or care for patients with possible or confirmed cases of COVID-19. Per the HHS, “Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

The immediate relief payments hope to alleviate providers in hard-hit COVID-19 areas and those who are struggling to keep their practice open due to delayed care and widespread cancellations of elective procedures.

Payment Distributions 

Payment distributions will be based on the provider’s or practice’s share of total Medicare FFS reimbursements for the year 2019; that year, the total FFS payments were approximately $484 billion. Providers can estimate their anticipated payment by dividing their 2019 Medicare FFS (excluding Medicare Advantage) payments – which can be obtained from their organization’s revenue management system – by $484 billion and multiplying that ratio by $30 billion. 

Receiving Payments

In partnership with UnitedHealth Group (UHG), the HHS will provide rapid payments to eligible providers, as described above, to distribute the initial round of funding. Providers will be paid via their Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS) and can expect to receive payments via Optum Bank with “HHSPAYMENT” as the payment description. Providers who receive reimbursements from CMS via paper check can expect to receive a paper check in the mail within the next few weeks.

Providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 30 days of receipt. The Terms and Conditions of the funding can be found on the CMS website. If the payment is not returned within 30 days, the HHS will view this as an acceptance of the Terms and Conditions. However, if a provider does not wish to comply with the Terms and Conditions, they must contact HHS within 30 days of receipt of payment and then return the full payment to HHS.

Different Types of Providers

All relief payments are being made to providers according to their tax identification number (TIN). Large organizations will receive payments for each of their billing TINs that bill Medicare, and should look to the part of their organization that handles Medicare billing to identify details on Medicare payments for 2019. Employed physicians should not expect to receive an individual payment directly; instead, their employer’s organization will receive the relief payment as the billing organization. Similarly, individual physicians and providers in a group practice are unlikely to receive individual payments directly; the group practice will receive the relief fund payment as the billing organization. Solo practitioners who bill Medicare will receive a payment under the TIN they use to bill Medicare.

The Remaining $70 Billion 

As part of the $100 billion guaranteed by the CARES Act, the remaining $70 billion will be comprised of targeted distributions focused on providers in areas particularly impacted by the virus, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, as well as providers requesting reimbursement for the treatment of uninsured Americans. More guidance is expected on the structure of these payments in the coming weeks.

COVID-19 Medical Expenses

The federal government is taking measures to ensure Americans are not surprised by medical expenses and are protected against financial obstacles that might prevent them from seeking care or getting tested and treated for COVID-19. A portion of the Provider Relief Fund will be used to reimburse healthcare providers at Medicare rates for COVID-related treatment of the uninsured. However, providers are prohibited from “balance billing” any patient for COVID-related treatment in order to be eligible.

In addition, the Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing. Further, the government has secured commitments from private insurers – such as Humana, Cigna, UnitedHealthGroup, and the Blue Cross Blue Shield system – to waive cost-sharing payments for treatment related to COVID-19 for its members and make medical care more accessible.

Heavily anticipated by providers across the nation, the latest guidance helps to clarify eligibility, distribution, and payment concerns regarding the Provider Relief Fund. Eligible practices and providers may soon expect to receive payments from the immediate round of funding. In the meantime, medical professionals can access more information about and the latest developments concerning the CARES Act Provider Relief Fund here.