Yesterday, CMS announced an unprecedented level of Blanket Waivers and Regulatory changes to allow healthcare organizations to better deal with the COVID-19 pandemic. Many states had requested these waivers and been granted them, but now it applies to any state. AHIP has said that payers will follow suit in overwhelmed areas. AHIP has collated many of the payer’s response to COVID-19.
The biggest news amidst all the changes is true payment parity for telehealth (see page 15 of the IFC for the specific details – Thanks Travis Broome). If the telehealth visit is replacing an in-person visit, then CMS will pay the same as they would for an in-person visit. This is going to have the biggest impact on revenue for healthcare organizations and is a good change that I hope will last far past COVID-19. Not to mention we need commercial payors to adopt it as well.
The expansion of location options with the same hospital reimbursement and the ability to utilize an expanded health care workforce just makes sense given the situation. Not to mention the relaxation of various audit and reporting requirements including the MIPS 2019 and 2020 reporting delay and exemptions that we covered earlier.
I am interested to see how the exemption to allow hospitals to provide staff benefits including daily meals, laundry service for personal clothing, child care services is going to play out. Especially given even healthcare organizations like Intermountain who reportedly have a year’s worth of cash in the bank have announced pay cuts for doctors and nurse practitioners. Anne Zieger previously highlighted the financial losses hospitals are facing amidst COVID-19 and the lack of elective procedures. If a hospital is facing a loss and making pay cuts, are they going to be able to provide extra services?
Before we dive into more of the specific details of the waivers and regulatory changes, here’s a good image that summarizes the regulatory changes made by CMS to help deal with COVID-19:
If you want to dive into all the details, you can do that here, here, and here. Below you’ll find the excerpts I found most interesting and useful. Plus, it’s worth noting that all of these defer to state laws which still have to be considered before implementing any of the changes below. They also only apply for the duration of the “public health emergency.”
- CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration
- CMS will now temporarily permit non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff.
- CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital.
- During the public health emergency, ambulances can transport patients to a wider range of locations when other transportation is not medically appropriate.
- Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms.
- In addition, hospitals can bill for services provided outside their four walls.
- CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan.
- CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician.
- CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.
- CMS will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.
- Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need
- Hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.
- CMS is providing temporary relief from many audit and reporting requirements
- Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth.
- Providers can bill for telehealth visits at the same rate as in-person visits.
- CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.
- CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease.
- Clinicians can provide remote patient monitoring services for patients, no matter if it is for the COVID-19 disease or a chronic condition.
- Providers also can evaluate beneficiaries who have audio phones only.
Which of these changes are going to have the biggest impact for good on your organization? Is there anything they missed?
Just to round out the news coming out of HHS, Vice President Pence has asked all hospitals to share a daily 2019 COVID-19 Report with HHS. The reporting mechanism is an excel spreadsheet sent by the hospital by email to HHS. Is it just me or is this the best we can do? Doesn’t it raise a lot of questions about validating the data and which hospital is sending the data. Has the email been spoofed? And lots of other security and data reliability questions.
You’d think CMS could have at least come up with some special form for submission along with a way to validate the organization, but no. An email with a spreadsheet is the best we could do. Kind of sad really, but at least they’re acknowledging that hospitals are the ones who have the real data we need to understand what’s really happening with COVID-19.
Also, ONC has put together a full list of COVID-19 Tools and Resources for the Health IT and clinical community. We’ve covered most of them in our COVID-19 Health IT Coverage, but I was interested in the Interoperability Standards Advisory and the Interoperability for COVID-19 resources.