American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

More Legislative and Regulatory Updates

CMS Releases 2020 MIPS Exception Applications Fact Sheet

Posted July 7, 2020

The Centers for Medicare & Medicaid Services (CMS) recently released the 2020 Quality Payment Program (QPP) Exception Applications Fact Sheet. The fact sheet explains how to apply two types of exceptions: the Promoting Interoperability (PI) Hardship Exception and the Extreme and Uncontrollable Circumstances Exception. If individual clinicians, groups, and virtual groups meet certain criteria for a PI exception or experience extreme and uncontrollable circumstances—such as a natural disaster or public health emergency (including the COVID-19 pandemic)—they can submit an application to reweight their Merit-based Incentive Payment System (MIPS) Quality, Cost, Improvement Activities, and/or PI performance categories.

The fact sheet also explains situations where the automatic extreme and uncontrollable circumstance policy would be applied to individual clinicians located in a CMS-designated area affected by an extreme and uncontrollable event during 2020. However, CMS has not yet announced the COVID-19 pandemic as a triggering event for the automatic extreme and uncontrollable circumstances policy for the 2020 MIPS performance year. Therefore, if your 2020 MIPS data collection and reporting has been disrupted by the COVID-19 pandemic, you should submit application(s) for the extreme and uncontrollable circumstances policies.

To learn more, view the 2020 MIPS Exceptions Applications Fact Sheet here. Additional questions can be directed to QualityDC@facs.org.

CMS Releases 2020 MIPS Exception Applications Fact Sheet

Posted June 30, 2020

The Centers for Medicare & Medicaid Services (CMS) recently released the 2020 Quality Payment Program (QPP) Exception Applications Fact Sheet. The fact sheet explains how to apply two types of exceptions: the Promoting Interoperability (PI) Hardship Exception and the Extreme and Uncontrollable Circumstances Exception. If individual clinicians, groups, and virtual groups meet certain criteria for a PI exception or experience extreme and uncontrollable circumstances—such as a natural disaster or public health emergency (including the COVID-19 pandemic)—they can submit an application to reweight their Merit-based Incentive Payment System (MIPS) Quality, Cost, Improvement Activities, and/or PI performance categories.

The fact sheet also explains situations where the automatic extreme and uncontrollable circumstance policy would be applied to individual clinicians located in a CMS-designated area affected by an extreme and uncontrollable event during 2020. However, CMS has not yet announced the COVID-19 pandemic as a triggering event for the automatic extreme and uncontrollable circumstances policy for the 2020 MIPS performance year. Therefore, if your 2020 MIPS data collection and reporting has been disrupted by the COVID-19 pandemic, you should submit application(s) for the extreme and uncontrollable circumstances policies.

To learn more, view the 2020 MIPS Exceptions Applications Fact Sheet here. Additional questions can be directed to QualityDC@facs.org.

ACS and 11 Other Surgical Organizations Launch Surgical Care Coalition to Stop Medicare Cuts

Posted June 23, 2020

The American College of Surgeons (ACS) announced June 18 that it is partnering with 11 other surgical associations to launch the Surgical Care Coalition. The mission of the coalition is to protect patients from disruptions in access to surgical care resulting from imminent cuts to Medicare payment.

The coalition is focused on getting Congress and the Administration to understand how these payment cuts will hurt patients and their care teams. These cuts threaten patients’ access to timely surgical care and will affect the quality of life for the people we care for every day.

Delayed operations during the COVID-19 crisis have negatively affected hospital finances and surgeons’ private practices—important small businesses in many communities. Based on a survey of U.S. surgeons, more than 5,000 members of our community anticipate that the pandemic and planned cuts could have serious consequences on their practices. Among the findings:

  • One in three private practice surgeons are concerned they will have to shut down.
  • 45 percent of surgeons have made a financial sacrifice by cutting their own pay or by paying employees despite falling revenues.
  • 35 percent of surgeons suffered negative financial consequences due to COVID-19, such as taking on debt and laying off or furloughing employees.

The Surgical Care Coalition is focused on putting these issues on the nation’s agenda and stopping the payment cuts to surgeons. We are asking Congress to step in and ensure Medicare patients continue to have the best access to the best care when they need it and where they need it.

We will share more information about ACS efforts to advocate for you on Capitol Hill as part of our new digital newsletter, Bulletin: Advocacy Brief, which will be published every other week starting in July.

Follow the coalition on Twitter and LinkedIn, and use your voice to oppose the Medicare payment cuts to protect your patients. 

*New Financial Resources Updates* from ACS Practice Protection Committee

Posted June 23, 2020

The American College of Surgeons (ACS) Practice Protection Committee recently made significant updates to the following portions of its “Financial Resources” document, particularly highlighting new funds for those providers who serve Medicaid and CHIP (Children’s Health Insurance Program) patients.

  • Paycheck Protection Program—New loan forgiveness application forms to include a shortened EZ form that is intended to significantly reduce the amount of paperwork required and make the application process more user friendly.
  • Economic Injury Disaster Loan Program—The Small Business Administration is again accepting applications for loans through this program, which can provide both rapid advances of up to $10,000 and larger loans with favorable terms.
  • Public Health and Social Services Emergency Fund—Application procedures for provider relief funds are now available for those who serve Medicaid and CHIP populations and have not previously received disbursements from this fund.

The document can be accessed here.

Newly Introduced Legislation Would Provide Liability Protections for Physicians Treating COVID-19 Patients

Posted June 16, 2020

The American College of Surgeons (ACS) supports legislation recently introduced by Reps. Phil Roe, MD (R-TN), and Lou Correa (D-CA), H.R. 5079, the Coronavirus Provider Protection Act. This legislation provides protections to surgeons and other health care professionals from unnecessary lawsuits as they care for patients during the COVID-19 pandemic. Read the ACS letter of support.

COVID-19 has had a profound impact on the health care landscape, yet surgeons continue to provide care and comfort to their patients. By providing necessary care without hesitation, many health care professionals are concerned about new liability risks. Take a moment to ask your representative to cosponsor this legislation to ensure that surgeons on the frontlines of this pandemic do not face unwarranted legal action for their efforts. For more information on liability issues, contact ACS Congressional Lobbyist Hannah Chargin at hchargin@facs.org.

ACS Signs Letters Urging Congressional Appropriators to Remove Ban on the Unique Patient Identifier

Posted June 16, 2020

As part of its ongoing advocacy efforts surrounding patient matching and the Unique Patient Identifier (UPI), the American College of Surgeons (ACS) joined more than 50 stakeholder organizations in urging leadership of the U.S. House and Senate Committee on Appropriations to remove language from the fiscal year 2021 Labor, Health and Human Services, Education, and Related Agencies appropriations bills. This provision prohibits the Department of Health and Human Services (HHS) from spending federal dollars to adopt a UPI. Removing the prohibition on the use of federal funds to establish a national UPI would provide HHS with the ability to evaluate a range of patient identification solutions, enabling the agency to explore potential challenges and identify cost-effective, scalable, and secure solutions that protect patient privacy. A UPI would help to ensure that surgeons have a more accurate and consistent means of linking patients to their health information across the continuum of care. The U.S. House of Representatives passed amendment language in 2020 repealing the 20-year ban, but that language did not pass the Senate. For more information, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.

President Signs Legislation to Increase Flexibility in the Paycheck Protection Program

Posted June 9, 2020

President Trump signed the Paycheck Protection Program (PPP) Flexibility Act June 4. This legislation will ease restrictions on the emergency small business loans intended to avert mass layoffs during the COVID-19 pandemic. Provisions of the law will relax rules for the $670 billion PPP, giving borrowers more time to spend funds received and to use those funds for a broader set of expenses while still qualifying to have all or a portion of the loan forgiven. More specifically, the PPP Flexibility Act does the following:

  • Extends the period for PPP loans from June 30, 2020, to December 31, 2020
  • Extends the period for loan forgiveness to the earlier of either 24 weeks after loan date or December 31, 2020
  • Extends the rehire exemption date to December 31, 2020, from the previous date of June 30, 2020
  • Decreases the forgiveness amount attributable to payroll costs from 75 percent to at least 60 percent and allows up to 40 percent to be attributable to nonpayroll costs

It has been reported that approximately $510 billion in loans have been approved through the PPP, and it is estimated that more than $120 billion remains available under the program. Lawmakers anticipate that relaxation of the rules could rekindle interest in the program.

Fellows are reminded that application for the PPP is accomplished via their local Small Business Administration-approved lender. Further information on the PPP is available on the Practice Protection Committee’s financial resources document.

Practice Protection Committee Webinar on Economic Survival Strategies Available for Viewing

Posted June 9, 2020

The American College of Surgeons (ACS) Practice Protection Committee (PPC) hosted a webinar June 3, which focused on its recently released document on Economic Survival Strategies in the COVID World. The purposes of the document and webinar are to help surgeons get their personal and business finances on stronger footing in the wake of the COVID-19 response and to help them be better prepared to weather future disruptions to their practice and finances. The document can be viewed online. ACS members who were unable to attend the webinar live can access it here.

In addition, the PPC recently updated its financial resources document, detailing the flexibility changes in the Paycheck Protection Program and the reporting requirements for the CARES Act Provider Relief fund. That document can be accessed here.

Don’t Miss It: ACS Practice Protection Committee Hosts Webinar on Economic Survival Strategies

Posted June 2, 2020

The American College of Surgeons (ACS) Practice Protection Committee reminds Fellows of the upcoming webinar at 8:00 pm Eastern Time Wednesday, June 3, to discuss its recently released document, Economic Survival Strategies in the COVID World. Register for the webinar here.

In addition, the committee’s original financial resources document was updated this week and can be found here.

Economic Survival Strategies in the COVID World: A Guide From the ACS Practice Protection Committee

Posted May 26, 2020

As part of its ongoing efforts to assist surgeons managing the intense financial burden placed upon them by the pandemic, the American College of Surgeons (ACS) Practice Protection Committee has built upon the Practical Suggestions and Options to Consider section of its resource document to provide a guide to economic survival strategies. The document can be found here and includes a set of key principles and a suggested process for Fellows to undertake based on an Excel spreadsheet exercise of personal and business finances. In addition, the committee has provided suggestions to consider based on which of three specific scenarios they believe most accurately describes their financial situation.

Download Economic Survival Strategies in the COVID World

Newly Introduced Legislation May Provide Financial Relief to Physician Practices

Posted May 26, 2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded the Centers for Medicare & Medicaid Services’ (CMS) Accelerated and Advance Payment (AAP) program to allow hospitals, physicians, and other Medicare-participating providers to apply for upfront payments from Medicare to help cover revenue shortfalls during the COVID-19 public health emergency. However, the American College of Surgeons (ACS) was dismayed that CMS’ plan for implementation has rendered the program unworkable for physician practices in the short term. CMS has since suspended the program, and the ACS believes modifications are necessary to ensure its usefulness for physicians. Read the College’s letters to the Senate and House.

Sens. Jeanne Shaheen (D-NH) and Michael Bennet (D-CO), along with Reps. Brad Schneider (D-IL) and Ron Kind (D-WI), recently introduced the Medicare Accelerated and Advanced Payments Improvement Act, H.R. 6837/S. 3750, which would greatly enhance the utility of the program by reducing interest rates (currently as high as 10.25 percent) to 1 percent and modifying repayment obligations to provide more time for physicians. The ACS supports this legislation, which would bring needed flexibility to the AAP program.

ACS Supports Telehealth Coverage for Patients Who Have ERISA Health Care Coverage

Posted May 26, 2020

The American College of Surgeons (ACS) supports legislation that Reps. Kim Schrier, MD (D-WA), and Phil Roe, MD (R-TN), and Sen. Tina Smith (D-MN) recently introduced—The Health Care at Home Act, H.R. 6644/S. 3741, which would establish payment parity for telehealth and in-office visits. More specifically, the legislation would require private payors, including employer-provided Employee Retirement Income Security Act (ERISA) plans, to reimburse telehealth services for normally covered benefits at the same rate as office visits during the COVID-19 public health emergency (PHE). Read the College’s letter here.

The Centers for Medicare & Medicaid Services (CMS) has made several important changes to ease regulatory barriers to telehealth and enforce payment parity for telehealth visits during the PHE; however, private payors, including employer-provided ERISA health plans, have not necessarily followed suit.

ACS Provides Testimony on Trauma, Cancer, and Patient Identification Appropriations to Senate Subcommittee

Posted May 26, 2020

The American College of Surgeons (ACS) recently provided written testimony to the U.S. Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies as the subcommittee plans for fiscal year 2021 appropriations. The ACS’ testimony outlined several appropriation-related priorities, including complete funding of $11.5 million for the MISSION ZERO program, increased funding for cancer prevention and research, funding specifically for public health research into firearm morbidity and mortality, and removal of a ban that prevents the Department of Health and Human Services from evaluating a range of patient identification solutions.

CMS Releases FY 2021 IPPS Proposed Rule Projecting $2 Billion Increase in Hospital Spending

Posted May 26, 2020

The Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2021 Medicare Inpatient Prospective Payment System (IPPS) proposed rule May 11. Under the provisions in this rule, CMS projects a more than $2 billion increase in total Medicare Part A spending on inpatient hospital services furnished October 1, 2020, to September 30, 2021.

CMS proposes to conduct a comprehensive review of its process for determining whether certain surgical procedures should be classified as operating room (OR) services—which are reimbursed at a higher rate than non-OR services—for the purposes of IPPS payment. The agency would review several factors, including Medicare claims data and relative resource requirements of various services to better recognize the complexity and costs of surgical procedures. CMS also proposes to provide additional reimbursement for certain new medical devices and technologies under the IPPS with the intent to reduce financial barriers to investment and adoption by hospitals.

CMS previously finalized a rule requiring that hospitals make publicly available their Medicare cost reports, which list various standard charge data for the clinical services performed at each hospital. The agency proposes to require hospitals to add more information to their cost reports, including median payor-specific charges per Medicare Severity Diagnosis Related Group (MS-DRG). CMS indicates that these market-based charge data may provide a more accurate estimate of relative hospital resources use across different MS-DRGs.

The agency proposes various changes to IPPS quality incentive programs. Some key proposals include minor changes to the Hospital Acquired Condition (HAC) Reduction Program and Hospital Readmissions Reduction Program (HRRP) applicable performance periods and validation processes to continue alignment of hospital quality programs. CMS also proposes to and incrementally increase the electronic Clinical Quality Measures data a hospital has to report under the Hospital Inpatient Quality Reporting (IQR) Program and the Promoting Interoperability (PI) program. Additionally, CMS opted not to make anticipated changes to the Hospital Quality Star Ratings methodology at this time.

The ACS is evaluating this proposed rule and will submit comments to CMS on policies relevant to surgeons and surgical patients. Read the proposed rule and related fact sheet. Contact regulatory@facs.org with questions.

CMSS Encourages Congress to Maintain and Sustain Health Care Workforce

Posted May 26, 2020

The Council of Medical Specialty Societies (CMSS), which includes the American College of Surgeons, sent a letter last week to U.S. congressional leaders recommending additional efforts to maintain the nation’s health care workforce by retaining physicians and scientists in the U.S. and by expediting entrance of physicians into the country. The letter notes that the U.S. health care system relies heavily on international medical graduates (IMGs), who represent more than 25 percent of the physician workforce in the U.S. These physicians are training or practicing here legally on a visa or other protected status. Nearly 21 million Americans live in an area where at least half of the physicians are foreign-trained. These highly qualified physicians are an important segment of the nation’s health care workforce in U.S. teaching hospitals and in medically underserved areas—especially during the COVID-19 pandemic. The nation will face numerous challenges in the coming months.

CMSS urges Congress to encourage the federal government to engage in the following activities:

  • Ensure that visa policies will continue to identify physicians as important for national security in terms of health
  • Continue and prioritize visa processing for physicians and medical residents
  • Expedite adjudications of extensions and changes of status for physicians and medical residents practicing or otherwise lawfully present in the U.S.

Read the letter here.

HHS Continues Efforts to Combat COVID-19

Posted May 26, 2020

The U.S. Department of Health and Human Services (HHS) and its agencies took the following actions last week to address the COVID-19 pandemic:

ICYMI: Listen to Webinar on Advocating for Your Financial Security in a Post-COVID-19 World

Posted May 19, 2020

The American College of Surgeons (ACS) May 14 hosted the third in a series of webinars during the COVID-19 crisis. This webinar, Advocating for Your Financial Security in a Post-COVID-19 World, focused on the key financial measures that the ACS is advocating in Washington, DC. Fellows can access the recordings of this webinar along with previous financial webinars here.

Loan Forgiveness Application Released for the Paycheck Protection Program

Posted May 19, 2020

The Small Business Administration and the Treasury Department on May 15 released the Paycheck Protection Program (PPP) Loan Forgiveness Application with detailed instructions for completing the application. The form and instructions inform borrowers how to apply for forgiveness of their PPP loans, consistent with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

The updated information and a link to the application can be found in the Practice Protection Committee’s Resource Document, which can be accessed here.

Contact Congress Today to Encourage Support for ACS Provisions in Next COVID-19 Legislation

Posted May 12, 2020

The U.S. House of Representatives plans to introduce COVID-19 legislation (CARES Act 2.0) later this week, and Congress needs to hear from you about important surgical priorities. The American College of Surgeons (ACS) continues to support the inclusion of several important provisions, but strong surgeon advocate participation from all ACS members is essential to ensuring that Congress considers these provisions in future COVID-19 legislation and that the health care system is prepared and reinforced during, and beyond, the pandemic. To ensure Congress hears surgery’s needs, contact your elected officials via SurgeonsVoice today and urge lawmakers to include ACS-supported provisions in future COVID-19 legislation. For more information, contact the ACS Division of Advocacy and Health Policy staff at ahp@facs.org.

Learn How to Advocate for Your Financial Security in a Post-COVID-19 World

Posted May 12, 2020

On Thursday, May 14, at 8:00 pm Eastern, the American College of Surgeons will host the third in a series of webinars during the COVID-19 crisis. This webinar, Advocating for Your Financial Security in a Post-COVID World, will focus on the key financial issues that the ACS is advocating in Washington, DC. Fellows can register for the webinar. Fellows can access the recordings of the previous financial webinars.

In addition, the American College of Surgeons Practice Protection Committee has updated its Financial Resources Available to Assist Surgeons and Medical Malpractice Resources. These resources, respectively, are available here and here.

Financial Resources Available to Assist Surgeons

Posted May 8, 2020

On Thursday, May 14, at 8:00 pm Eastern, the American College of Surgeons will host the third in a series of webinars during the COVID-19 crisis. This webinar, Advocating for Your Financial Security in a Post-COVID World, will focus on the key financial issues that the ACS is advocating in Washington, DC. Fellows can register for the webinar. Fellows can access the recordings of the previous financial webinars.

In addition, the American College of Surgeons Practice Protection Committee has updated its Financial Resources Available to Assist Surgeons and Medical Malpractice Resources. These resources, respectively, are available here and here.

Members of Congress Urge Inclusion of Mental Health Resources in Next COVID-19 Relief Package

Posted May 8, 2020

This week, Rep. Raja Krishnamoorthi (D-IL) and 90 other members of Congress sent a bipartisan letter to the U.S. House of Representatives leadership urging that future legislation aimed at addressing the COVID-19 pandemic include mental health resources for frontline health care personnel.

The bipartisan letter, which the American College of Surgeons (ACS) supports, specifically urges the establishment of a grant program within the U.S. Department of Health and Human Services (HHS) to allow health care employers or facilities to confidentially assess and treat the mental health of health care workers who are providing care to COVID-19 patients.

In addition, the letter calls for HHS to conduct a comprehensive study on health care personnel mental health and to find ways to mitigate the long-term psychological impact on health care professionals who have treated COVID-19 patients. For more information, contact ACS Senior Congressional Lobbyist Carrie Zlatos at czlatos@facs.org.

Congress Wants to Hear from You!

Posted May 8, 2020

In a recent survey, nearly 80 percent of congressional staff indicated that a couple dozen e-mail communications or 20–30 social media posts about a similar issue will get an office’s attention. Now more than ever, it’s important that Congress hears from American College of Surgeons (ACS) members and constituents. It is critical to continue to take action on important legislative priorities through SurgeonsVoice, share your stories, and make time to contact your elected officials about issues that are affecting you.

To learn more about “How to Engage Congress During the Coronavirus Outbreak,” watch the Congressional Management Foundation webinar recording or contact ACS Division of Advocacy and Health Policy staff at ahp@facs.org.

New CMS Rule Includes Policies to Ease Coverage and Reimbursement Requirements for Care

Posted May 5, 2020

The Centers for Medicare & Medicaid Services (CMS) released a second interim final rule with comment period (IFC) April 30, expanding on COVID-19-related regulatory flexibilities included in the agency’s first IFC issued March 30.

The rule introduces numerous new policies to ease coverage and reimbursement requirements for care provided during the national public health emergency (PHE), including the following provisions:

  • Waive the interactive video requirement for telephone evaluation and management (E/M) services and increase the payment rates for audio-only E/M services to match the payment rates of the established patient office/outpatient E/M
  • Enable facilities to increase their bed capacity without reducing Medicare payments to those facilities
  • Permit teaching hospitals to shift residents to other hospitals to meet COVID-19-related needs without reducing Medicare payments to those hospitals
  • Allow payment for outpatient hospital services, including wound care and drug administration, that are delivered in temporary expansion locations, such as patients’ homes, converted hotels, and parking lot tents
  • Maintain reimbursement rates under the Outpatient Prospective Payment System for services furnished by hospital outpatient departments that relocate off campus during the PHE

The changes made in this rule are retroactive to March 1 and are effective through the duration of the PHE declaration, unless otherwise specified.

A fact sheet about the April 30 IFC is available on the CMS website. Contact regulatory@facs.org with questions.

CARES Act Provider Relief—Missing Checks?

Posted May 5, 2020

Were you expecting to receive a CARES Act provider relief fund payment but have yet to receive your check? The first $30 billion disbursement of the Public Health and Social Services Emergency Fund occurred between April 10 and April 17. If you believe you were eligible but did not receive this payment, tell us your story.

Practice Protection Committee Updates Resource Document to Reflect Payor Changes

Posted May 1, 2020

The American College of Surgeons (ACS) Practice Protection Committee has updated its resource document to reflect the suspension of the Medicare Advance Payment Program, the second round of disbursement grants from the Public Health and Social Services Emergency Fund, and an ACS-developed document on commercial insurance coverage for telehealth services.

CMS Announces Increase in Payment for Audio-Only Telehealth E/Ms

Posted May 1, 2020

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that the agency will increase the payment rate for the following audio-only evaluation and management (E/M) services: 99441, 99442, and 99443 to match the payment rates of the established patient office/outpatient E/Ms 99212, 99213, and 99214, respectively. As a result, payments would increase for the audio-only services from a range of about $14–$41 to about $46–$110. The new payment rates are retroactive to March 1.

CMS’ action responds to concerns from stakeholders, including the American College of Surgeons (ACS), expressing concern that in many cases, the video component of the virtual billing requirements are challenging for both patients and physicians. Some patients, such as the elderly or people those living in rural areas, may only have telephones with audio capabilities, or may be unable to easily use video communication because of Internet connectivity issues. Moreover, many physicians did not use telehealth prior to the COVID-related telehealth waivers, so they do not have the necessary tools in place to render such services. Visit the ACS telehealth resources page for more information on telehealth.

American College of Surgeons Tracks Health Policy for Access to Surgical Care in Newly Uninsured

Posted May 1, 2020

More than 30 million American are now unemployed as a result of the economic consequences of the COVID-19 lockdown. Along with losing income from being unemployed, many patients have lost their health insurance. The short-term options for retaining health insurance involve COBRA coverage. COBRA allows individuals to continue their insurance if they agree to pay the entire insurance premium—their previous portion of the cost as well as their former employer’s portion. Without an income, it is an extreme hardship for most individuals to afford their COBRA insurance.

The short-term policy solutions for patient access to care with the newly uninsured in a pandemic such as COVID-19 present challenges for federal and state policies. The American College of Surgeons (ACS) recognizes that without policy solutions patient access to surgical care will decrease and patients will postpone much-needed care until an insurance solution becomes available.

Congress and the White House are exploring options to assist individuals and improve access to care for the newly uninsured. COBRA does not seem to be a viable option for patients who have limited income. Some policy experts have proposed a temporary pandemic federal program to cover COBRA costs. Payment of COBRA premiums is an expensive solution and draws criticisms from congressional fiscal hawks. The White House approaches the problem through COVID-19 funding and use of the current coverage systems at the state level. The White House established the current COVID-19 funding for hospitals to provide payments for all COVID-19 related care during the crisis. This is a start but falls short for patients who have non-COVID-19 related conditions that need care. Another option involves the Affordable Care Act (ACA). In states that expanded Medicaid under the Affordable Care Act, loss of employment is a qualifying event for off cycle ACA enrollment into health insurance coverage through the Healthcare.gov website. This means newly uninsured patients do not have to wait for the open enrollment period and they qualify to apply for insurance coverage immediately. Their cost for coverage will depend on their remaining income and unemployment subsidies. Some patients may qualify for full coverage. Non-expansion states have open Medicaid enrollment on a monthly basis for those who qualify. One other policy conversation talks about proposing a Medicare-for-all for individuals who were previously insured and then lost their employment and health insurance because of COVID-19.

All these efforts are short-term considerations for aiding the newly uninsured and to assist in restoring access to appropriate and necessary medical and surgical care. These efforts are to bridge health care insurance across the chasm created by the pandemic. The ACS remains actively engaged in assuring as many patients as possible have uninterrupted medical insurance which affords patients access to needed surgical care.

What lies beyond the COVID-19 pandemic? The long view for health insurance will become visible in the upcoming presidential election. The COVID-19 pandemic has revealed uncertainties for health care and insurance. The health care debates will resurface based on people’s experience from the pandemic and the newly uninsured. It has had a serious impact on proper access to surgical care. It is difficult to predict the direction of the future debate. In a presidential election year, it is almost certain to reinvigorate the national discourse surrounding universal health care insurance or discussions of Medicare-for-all for every American life.

In Case You Missed It: Practice Protection Committee Hosted Second Webinar

Posted May 1, 2020

The American College of Surgeons Practice Protection Committee hosted its second webinar Monday, April 27, which focused on contractual considerations, hospital relations, and an update on financial resources.

ACS Releases New Telehealth Resources

Posted April 28, 2020

The use of telehealth and other virtual services is critical to reducing exposure to the COVID-19 virus and ensuring continuity of care for individuals with chronic conditions during this public health emergency (PHE). To help surgeons navigate and integrate virtual services into their practices and enhance their ability to safely care for patients during the COVID-19 pandemic, the ACS has developed resources that describe coverage and reimbursement rules for virtual services from both Medicare and private payors; Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules applicable to telehealth during the PHE; and various telehealth products available for use by physicians. For more information, contact Lauren Foe at lfoe@facs.org.

Practice Protection Committee Hosts Webinar on Contracts and Financial Resources

Posted April 28, 2020

The American College of Surgeons (ACS) Practice Protection Committee hosted its second webinar Monday night. The theme of this webinar was Contractual Considerations and Hospital Relations. An update on available financial resources also was provided. Among the topics discussed relative to financial resources was the Centers for Medicare & Medicaid Services’ April 26 announcement of an abrupt halt to the Medicare Advance Payments Program.

Attorney Stacy L. Cook, partner at Barnes and Thornburg, LLC, presented information on questions and concerns surgeons may have relative to provisions in their employment contracts or contracts for professional services. In addition, former ACS Board of Regents Chairs Michael Zinner, MD, FACS, and Julie Freischlag, MD, FACS, along with Peter Austin, Chief Operating Officer, Jefferson Regional Medical Center, Pine Bluff, AR, answered questions about how their institutions have sought to maintain surgeon employment during the pandemic as well as on other topics related to hospital relationships. A recording of the webinar can be found here.

Surgical Coalition Urges Delay of Payment, Health IT Rules

Posted April 28, 2020

The 21 members of the Surgical Coalition sent a letter April 24 to the U.S. Department of Health & Human Services, the Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator (ONC) for Health Information Technology requesting delayed implementation of certain regulations in light of the COVID-19 public health emergency (PHE). The letter centers on the Quality Payment Program (QPP), the interoperability of health care records, and other health information technology (IT) issues.

QPP recommendations are as follows:

  • Extend the automatic extreme and uncontrollable circumstances policy for all QPP participants for the calendar year (CY) 2020 performance year to allow physicians time to rebuild their practices post-COVID-19.
  • Delay implementation of the new Merit-based Incentive Payment System Value Pathways framework to reduce burdens on physicians during the public health emergency and allow extra time for clear programmatic details to be developed.
  • No public reporting of QPP data for the 2019 or 2020 performance years.

Comments on CMS’ final rule on Advancing Interoperability and Patient Access to Health Data are as follows:

  • Delay public reporting of clinicians’ responses to the Promoting Interoperability information blocking attestation on Physician Compare and eliminate requirements to report on the 2019 and 2020 performance years.
  • Delay for one year the policy that requires the public reporting of digital contact information in the CMS National Plan and Provider Enumeration System.

Comments on the ONC final rule on Interoperability, Information Blocking, and the ONC Health IT Certification Program include:

  • Delay information blocking enforcement for at least six months, which would make the information blocking policy applicable, at the earliest, within 12 months after the rule is published in the Federal Register.
  • Take into consideration the PHE and any associated delays in the enforcement of the information blocking provisions when determining the appropriate type and implementation date of provider disincentives through future rulemaking.

HHS Offers Guidance on Payment, Testing, PPE, and Other Critical Issues

Posted April 28, 2020

The U.S. Department of Health and Human Services (HHS) April 27 issued updates on various issues of concern to health care professionals at this time. A summary can be found here:

Provider portal open to bill for uninsured: The Health Resources and Services Administration launched a new COVID-19 Uninsured Program Portal, allowing health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4 to request claims reimbursement. Providers can access the portal at COVIDUninsuredClaim.HRSA.gov and there is also an FAQ document on the portal and information for providers.

Expanding serological testing capacity: BARDA and InBios International, Inc. have partnered to expedite development for serological tests to identify asymptomatic or recovered cases of COVID-19. The Food and Drug Administration (FDA) also approved four emergency use authorizations (EUA) from Abbott Laboratories, DiaSorin, Ortho-Clinical Diagnostics, and Autobio Diagnostics, Inc.

Collecting and distributing blood plasma: BARDA is supporting America’s Blood Centers to coordinating the collection and distribution of convalescent plasma for therapeutic use in treating COVID-19 hospitalized patients.

Update on therapeutics: The Centers for Disease Control and Prevention (CDC) updated its Information for Clinicians on Investigational Therapeutics for Patients with COVID-19. Individuals seeking information about registered clinical trials for COVID-19 in the U.S. are encouraged to go to www.clinicaltrials.gov.

Distribution of cloth face coverings: Federal agencies are distributing cloth face coverings as part of a multi-prong approach to reopen American economic activity while continuing to limit spread of COVID-19. As of April 26, 32.5 million cloth face coverings are being processed and distributed to state, local, tribal, private sector, and federal entities.

Face mask updates: The FDA is reissuing its EUA letter on face masks to clarify that face masks, including cloth face coverings, are authorized to be used by health care personnel only as source control.

PPE preservation best practices: The Federal Emergency Management Agency (FEMA) released a factsheet on best practices for preserving personal protective equipment (PPE), while ensuring the protection of workers during the COVID-19 pandemic response.

Reusing filtering facepiece respirators: The Occupational Safety and Health Administration released guidance on the reuse of filtering facepiece respirators that have been decontaminated through certain methods. This guidance applies in workplaces in which workers need respirators to protect against exposure to infectious agents that could be inhaled into the respiratory system, including during care of patients with suspected or confirmed COVID-19 infection and other activities that could result in respiratory exposure to SARS-CoV-2.

CMS suspending Medicare Advance and Accelerated Payment Program: The Centers for Medicare & Medicaid Services (CMS) is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments. Beginning April 26, CMS stopped accepting any new applications for the Advance Payment Program and will be reevaluating all pending and new applications. More information on the program can be found here.

Mental health grants: SAMHSA (Substance Abuse and Mental Health Services Agency) announced that grants have been awarded to increase access to and to improve the quality of community mental and substance use disorder (SUD) treatment services through the expansion of Certified Community Behavioral Health Clinics (CCBHC). The fiscal year 2020 CCBHC Expansion Grants include $200 million in annually appropriated funding and $250 million in emergency COVID-19 funding. The grant awards are listed on the SAMHSA website.

Pausing nursing home Five Star Quality Rating System: CMS announced via a memo that the inspection domain of the Nursing Home Compare website will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers. In addition, CMS is releasing information that shows the average number of staff each nursing home has on-site, each day (nursing staff and total staff), and aggregated by state and nationally. Along with these announcements, CMS released a list of Frequently Asked Questions to clarify certain actions the agency has taken related to visitation, surveys, waivers, and other guidance.

Waiver flexibility: CMS has approved more than 125 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Arizona, Illinois, Iowa, Louisiana, Maine, Maryland, Nebraska, New Mexico, North Carolina, Oregon, Rhode Island, and Washington. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time.

Infection control guidance to home health agencies: CMS issued guidance to respond to questions from Medicare & Medicaid Home Health Agencies and Religious Nonmedical Healthcare Institutions. The guidance addresses the COVID-19 outbreak and minimizing transmission to other individuals.

Congress Replenishes Funds for Federal Loan Relief Programs

Posted April 24, 2020

Initial funding for both the Paycheck Protection Program (PPP) and the Economic Injury Disaster Loan Program (EIDL) was expended April 16. On April 21, the Senate passed The Paycheck Protection Program and Health Care Enhancement Act, which appropriated an additional $321 billion for PPP loans and an additional $60 billion for the EIDL loan program. The House of Representatives passed the legislation April 23, and President Trump signed it into law today. Set aside in the $321 billion of additional funds approved for the PPP is $60 billion for small- to medium-sized banks and other financial institutions. The legislation also includes an additional $75 billion for the Public Health and Social Services Emergency Fund.

HHS Makes Second Round of Disbursements from the Public Health and Social Services Emergency Fund

Posted April 24, 2020

The U.S. Department of Health and Human Services (HHS) announced April 22 that it will begin disbursing a second round of payments, totaling $20 billion, to providers April 24 from the Public Health and Social Services Emergency Fund. These funds will augment the initial allocation of $30 billion disbursed April 10. The specific announcement can be found here. In a statement, HHS Secretary Alex Azar said, “The $20 billion will be allocated so that providers’ share of the whole $50 billion is based on the net patient revenue they received from all sources in 2018. This will entail a significant rebalancing for many providers.” It is expected that this rebalancing will address the concerns previously expressed by providers who have a lesser percentage of receipts from Medicare, including children’s hospitals, pediatric specialists, and obstetricians-gynecologists. Surgeons are reminded that recipients of the funds have to certify through a portal within 30 days or return the money.

Surgeons are encouraged to read the American College of Surgeons Practice Protection Committee’s Resource Document found here for the latest information on Medicare advance payments, small business loans, and granted federal funds.

Practice Protection Committee Continues to Address Financial Effects of COVID-19

Posted April 24, 2020

The American College of Surgeons (ACS) Practice Protection Committee met this week and discussed a variety of issues that are affecting surgeons’ economic situation, including legislation to replenish funds for the Paycheck Protection Program and the Economic Injury Disaster Loan Program, as well as the growing financial impact the COVID-19 pandemic is having on employed surgeons.

More than 250 surgeons participated in the committee’s webinar on April 16, which included a robust discussion of financial resources available to surgeons and a segment devoted to practical tips and suggestions for all to consider during these unprecedented times.

The Practice Protection Committee will host its next webinar, Contractual Considerations, Hospital Relations, and COVID-19 Financial Resources, Monday, April 27, at 7:00 pm Eastern Time.

In addition to providing an update on the federal financial resources programs, segments of Monday’s webinar will include a discussion of physician contracts provided by Stacy L. Cook, Partner, Barnes and Thornburgh, LLP, and a discussion of hospital relations led by former ACS Board of Regents Chairs, Michael Zinner, MD, FACS, Chief Executive Officer and Executive Medical Director, Miami Cancer Institute, FL, and Julie Freischlag, MD, FACS, Chief Executive Officer, Wake Forest Baptist Health, and Dean, Wake Forest School of Medicine, Winston-Salem, NC. Drs. Zinner and Freischlag will be joined by Peter Austin, Vice-President and Chief Operating Officer, Jefferson Regional Medical Center in Pine Bluff, AR. Mr. Austin’s father, William Austin, MD, FACS, is an otolaryngologist in McComb, MS, and a long-time Fellow of the College.

ACS Fellows can register for the webinar here.

Surgical Coalition Sends Letter Outlining Payment Issues Affected by COVID-19

Posted April 24, 2020

The American College of Surgeons and 21 other members of the Surgical Coalition sent a letter April 21 to the Secretary of the U.S. Department of Health and Human Services and the Administrator of the Centers for Medicare & Medicaid Services. The letter covers the seven areas related to COVID-19 summarized below:

Telehealth and other non-face-to-face services

  • Align dates for all policies expanding telehealth benefits during the public health emergency (PHE) to become retroactively effective March 1, 2020
  • Allow office/outpatient evaluation and management codes to be billed as telehealth services, even if those services are delivered via audio only.
  • Establish corresponding G-codes that describe new patient encounters for communication technology-based services with code descriptors referring specifically to an established patient

Accelerated and Advance Payments Program

  • Extend repayment time frame for “all other Part A providers and Part B suppliers” to match the one-year repayment time frame of inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals

Prior authorization

  • Suspend prior authorization and other utilization management requirements under the Medicare fee-for-service, Medicare Advantage, and Part D programs for the duration of the PHE

Global surgery data collection

  • Waive the requirement to report Current Procedural Terminology code 99024 throughout the PHE
  • Refrain from using data collected during the PHE to analyze the number of postoperative visits with 10- and 90-day global codes

Preoperative history and physical requirements

  • Waive the hospital Medicare condition of participation for inpatient elective procedures during the PHE to reduce administrative burden and enable physicians to exercise their own medical judgment to determine when such an examination is necessary

PPE/essential medical equipment distribution and access

  • Coordinate with the Federal Emergency Management Agency, the White House, and other agencies to streamline the personal protective equipment (PPE) distribution process, create a centralized equipment coordination unit, and share distribution data

Public Health and Social Services Emergency Fund

  • Provide additional support and immediate relief to providers when determining the disbursement of the remaining portion of the fund to ensure that a sufficient clinical workforce is available throughout the pandemic and thereafter

Contact Congress to Encourage Support for ACS Provisions in Future COVID-19 Legislation

Posted April 24, 2020

Physicians across the country continue to serve on the frontlines battling COVID-19. As Congress proposes additional legislative solutions to address the pandemic, the American College of Surgeons (ACS) supports the inclusion of the following provisions in future COVID-19 legislation:

  • Financial assistance and relief for physicians and facilities
  • Refinements to the Medicare Accelerated and Advance Payment Program
  • Relief from scheduled cuts to Medicare physician payment
  • Reauthorization of the Health Professional Shortage Areas Surgical Incentive Payment program
  • Medical liability protections for physicians
  • Student loan relief for physicians
  • Supply chain support for lifesaving medical equipment.

Your participation is critical to ensure that Congress considers these important provisions and that the health care community remains supported, protected, and equipped during this crisis. Contact Congress via SurgeonsVoice today and urge lawmakers to include ACS-supported provisions in future COVID-19-related legislation. For more information, contact the ACS Division of Advocacy and Health Policy at ahp@facs.org.

ACS Supports Federal Liability Protections

Posted April 24, 2020

In addition to the Surgical Coalition letter led by the American College of Surgeon (ACS), the ACS supports a letter to congressional leadership from the Health Coalition on Liability and Access (HCLA) concerning immunity for frontline providers. The letter encourages Congress to adopt legislation that provides health care professionals and facilities with immunity from civil liability for their good faith efforts to treat patients during the COVID-19 pandemic.

During this crisis, surgeons are being asked to provide treatment outside their general practice area, come out of retirement to address shortages, treat without adequate personal protective equipment, and delay elective operations. These situations pose substantial liability risk yet are unavoidable as health care professionals fight this pandemic. Action at the federal level would provide uniform protections to providers, maintain protection for victims of gross negligence or willful misconduct, and avert a patchwork of state liability laws leading to unequal treatment of surgeons who provide care on the frontlines.

For more information on liability reform, visit the Medical Liability Reform page or contact Hannah Chargin, ACS Congressional Lobbyist at hchargin@facs.org.

Contact Your Insurer for Details About Liability Premium Relief

Posted April 24, 2020

It is the American College of Surgeons’ understanding that there is no formal, consistent position on premium relief among the various medical liability insurance carriers. However, many carriers have indicated that if a practice suspended its services during the outbreak, then insurers were either refunding policy premiums or issuing credits applicable when practice resumed or at the time the policy was renewed. For deferral of policy premium payments, many states have issued directives regarding such, and others were willing to discuss with their insureds on a case-by-case basis. Fellows should contact their individual liability insurance carrier to discuss available options. Click here for a list of the websites of carriers.

Medical Malpractice and COVID-19: A Comparative Law Review

Posted April 24, 2020

Wilson Elser has compiled information on the state laws in all 50 states and the District of Columbia with respect to modifications to statutes regulating medical malpractice liability. It can be found here.

Oklahoma Chapter Sends Letter to Governor Regarding Resumption of Elective Operations

Posted April 21, 2020

The Oklahoma Chapter of the American College of Surgeons sent a letter April 17 to Gov. J. Kevin Stitt in response to his Executive Order to resume elective operations in the state starting April 24. The chapter leadership cautioned the governor and encouraged him to maintain the order to limit surgery until May 15. View an updated list of governors’ orders.

Practice Protection Committee Hosts Webinar and Updates Resource Document

Posted April 17, 2020

The American College of Surgeons Practice Protection Committee hosted a webinar Thursday, April 16, outlining the various federal financial resources available to surgeons during the pandemic. Members of the committee also addressed practical suggestions and options to consider in the process of maintaining the viability of their practices during these unprecedented times. The committee anticipates conducting additional webinars in the future.

In addition, the committee’s resource document has been updated to include information about the funds disbursed to surgeons from the Public Health and Social Services Emergency Fund, an additional resource for surgeons who provide telemedicine services, as well as a list of links to medical liability insurance providers outlining alterations in their coverage and payment policies. That document can be found here.

Has Your Governor Issued an Executive Order Regarding Elective Surgery?

Posted April 17, 2020

A number of state governors and the mayor of the District of Columbia have issued executive orders regarding elective and nonemergent surgery during the COVID-19 outbreak. These orders range from a call to action that providers postpone elective procedures for a period to ensure the availability of personal protective equipment during the crisis with no specified penalties for violations, to orders that warn of imprisonment of violators. View a list of the executive orders, a summary of their mandates, and the dates in which they are in effect here.

Public Health and Social Services Emergency Fund Payments

Posted April 17, 2020

U.S. Department of Health and Human Services has added $100 billion to the Public Health and Social Services Emergency Fund to be used to support health care-related expenses or lost revenue attributable to COVID-19. Physicians and hospitals started receiving funding from an initial $30 billion disbursement on April 10. These payments are not loans and are not required to be repaid. But in order to keep the funds, recipients must attest that they meet the Terms and Conditions through a portal within 30 days of receiving the funds. Surgeons who believe they are eligible but did not receive a payment should contact UnitedHealth Group’s Provider Relations at 866-569-3522 about eligibility, whether a payment has been issued, and where the payment was sent. Contact regulatory@facs.org with additional questions.

DEA Declares Exception to 5 Percent Dosage Limit

Posted April 17, 2020

In order to sustain access to prescription medications in the U.S. during the COVID-19 pandemic, the U.S. Drug Enforcement Administration (DEA) has issued a general exception to the 5 percent limit for dispensing controlled substances.

The exception allows practitioners that are DEA-registered dispensers to distribute limited amounts of controlled substances to another practitioner for distribution to patients. This temporary exception to 21 CFR 1307.11 is in effect until the Secretary of Health and Human Services declares that the public health emergency has ended, unless the DEA specifies an earlier date or otherwise modifies or withdraws this exception. Once this exception expires, practitioners must again comply with the 5 percent rule and all other aspects of 21 CFR 1307.11. The exception does not negate practitioners from continuing to abide by all security, record keeping, and other applicable DEA requirements, especially those related to the distribution of schedule I or II controlled substances.

Liability Protections for Emergency Response: The Network for Public Health Law

Posted April 17, 2020

The Network for Public Health Law (Western Region Office) has developed an updated document summarizing legal liability protections for emergency medical/public health responses at the federal and state levels.

Texas Chapters Join Texas Medical Association in Calling on Governor to Promote Accountable Care

Posted April 17, 2020

The Texas Medical Association and several state specialty societies—including the North and South Texas Chapters of the American College of Surgeons—sent a letter to Gov. Greg Abbott (R-TX) April 13, requesting a “multipoint plan to promote accountable care and enhance physician practice viability.”

The letter includes nine requests organized into the following three categories:

  • Across-the-board relief: Implement advanced payment models to provide reliable cash flow to physicians and providers throughout the pandemic
  • Medicaid: Advocate for federal funding to boost Medicaid physician payment rates to Medicare parity
  • Insurance carriers acting as administrators: Encourage insurers to offer self-insured products that remove barriers to COVID-19 treatment and expand availability of telemedicine services

The letter noted an over-reliance on hospital-based and emergency room care that should be reserved for critically ill patients, particularly during the pandemic, and asked for the governor’s assistance in helping Texas physicians in their provision of quality health care.

Surgical Coalition Offers Recommendations for Next COVID-19 Relief Package

Posted April 14, 2020

The American College of Surgeons (ACS) and 22 members of the ACS-led Surgical Coalition sent a letter April 13 to the leadership of the U.S. Congress making requests for the next COVID-19 legislative package. Read more about specific points included here.

  • Targeted relief for physicians and their practices through the inclusion of the Immediate Relief for Rural Facilities and Providers Act (H.R. 6365/S. 3559), which will assist in supporting physician-owned small businesses.
  • Refinements to the Medicare Accelerated and Advance Payment Program, specifically lowering the interest rate on balances due at the end of the recoupment period to 0 percent, as well as other necessary changes.
  • Congressional action to provide critical support for practices recovering from the pandemic that are facing substantial payment reductions in the coming months. The Surgical Coalition urged Congress to waive the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for the finalized evaluation and management (E/M) code proposal, including increasing the E/M postoperative visits for 10- and 90-day global services for at least five years.
  • Medical liability protections for physicians on the frontlines of treating COVID-19 patients.
  • Student loan relief for physicians who treat COVID-19 patients.
  • Further supply chain support for lifesaving equipment, such as personal protective equipment, including face masks, gowns, N95 respirators, ventilators, and extracorporeal membrane oxygenation.

The ACS will continue to partner with the Surgical Coalition and other physician specialty organizations to ensure Congress receives a united and well-supported message. The timing of the next COVID-19 relief package is unclear at present, but Congress is poised to legislate on the impact of COVID-19 in the coming months.

For more information regarding COVID-19 and congressional legislation, contact Kristin McDonald, Manager of Legislative and Political Affairs, at kmcdonald@facs.org.

CMS Begins Disbursement of Relief Funds

Posted April 14, 2020

As noted in the lead story of the April 10 issue of the Bulletin: ACS COVID-19 Updates, the Centers for Medicare & Medicaid Services (CMS) has begun disbursing $30 billion in grants directly to providers with no action necessary on the part of providers to receive those funds. The $30 billion in funds disbursed last week is just a portion of the $100 billion Public Health and Social Services Emergency Fund. Payments to providers were deposited into accounts based on Taxpayer Identification Numbers. The payment amount received was calculated based on a percentage of the provider’s 2019 Medicare receipts. The specific announcement including the formula of how much each individual received, how the payments were made, and other details regarding the program can be found here.

CMS Developing Strategies for Targeted Disbursements

Posted April 14, 2020

In the press release from April 10 noting the beginning of the delivery of the initial $30 billion of relief funds, the Centers for Medicare & Medicaid Services (CMS) stated it was rapidly working on additional targeted distributions. These targeted disbursements will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement, and those providers who predominantly serve the Medicaid population. That press release can be viewed here. Based on this information, it is anticipated that providers without many receipts from Medicare (such as children’s hospitals, pediatric specialists, obstetricians/gynecologists) will be addressed in subsequent targeted distributions of funding. Details are pending.

Study Shows Projected Economic Impact of COVID-19 Inpatient Stays

Posted April 14 2020

COVID-19 is exacting heavy economic and social costs around the world. In the U.S., one area of great concern is the potential cost of inpatient services for patients with the disease. A study by FAIR Health draws on its database of more than 30 billion private health insurance claims, as well as estimates of Medicare and Medicaid costs, to project U.S. costs for COVID-19 patients requiring inpatient care. Estimates are based on International Classification of Diseases, 10th edition (ICD-10) procedure codes and revenue associated with influenza and pneumonia, then, as an alternative, on the basis of diagnosis-related groups (DRGs) associated with pneumonia. The study also examines telehealth codes commonly used for respiratory infections and their costs.

Practice Protection Committee Continues to Address Financial Issues Related to COVID-19

Posted April 10, 2020

In its efforts to provide resources and practical suggestions for surgeons to consider as they strive to combat the financial pressures resulting from the COVID-19 pandemic, the Practice Protection Committee met this week by videoconference and has developed an updated resource document found here.

Fellows will find information and links to application information for three federal programs that provide financial resources, a list of questions to consider for discussion with their professional tax advisor, a document to assist surgeons who provide telehealth services, and perhaps most importantly, a section on practical suggestions and options to consider using in these unprecedented times. The group’s work will continue with additions and updates to the document provided as new information on the federal financial assistance programs, their strategic deployment and other resources are developed.

Financial Resources Available to Assist Surgeons

The American College of Surgeons reminds Fellows that there are several federal loan programs available at present to assist them in maintaining the financial viability of their practices during the pandemic. Following are updates, additional resources, and information related to some of these options.

  1. If a large portion of your income is from Medicare and/or you need to receive funds quickly, then you may want to consider contacting your Medicare Administrative Contractor to take advantage of the Medicare Advance Payments Program. This program allows you to request up to three months of Medicare payments. These payments are essentially an interest-free loan against future Medicare claims. Applicants who receive advance payments will continue to bill and receive payments normally for 120 days; after that, all billed claims will automatically be used to offset their advance payment balance. The entire balance must be repaid within 210 days of when it was received.

Since its inception on March 30, 2020, the program has delivered more than $34 billion in funds to providers.

More information about this program can be found here.

  1. If the possibility of having your loan forgiven is important to you, then you should consider the Paycheck Protection Program (PPP). This program is intended to help businesses maintain operations and keep their staff on payroll. The program is limited to those entities with 500 or fewer employees. If the loan funds are used for the specified allowable purposes such as payroll, mortgage interest, rent, or utilities, up to the full amount may be forgiven. Congress initially included $349 billion for this program as part of a small business loan package in the $2.2 trillion coronavirus stimulus package that passed late last month. Since applications from small business and sole proprietorships began to be accepted on April 3, 2020, reports from the field indicate the application is somewhat complex and cumbersome. Fellows should consider enlisting the services of their professional tax advisor for the application process.

Application for the PPP is submitted through your local SBA-affiliated bank or financial institution.
Fellows considering this option are encouraged to apply as soon as possible because of the current funding cap. However, there are reports that Congress plans to add additional funds to the program.

Please see a list of Frequently Asked Questions prepared by Hart Health Strategies for the American College of Surgeons here: Small Business – PPP FAQ

  1. Among the other provisions included in the series of recent congressional actions to assist small business was a shoring up of resources and expanding of the availability of loans directly through the SBA and the Economic Injury Disaster Loan (EIDL) program.

The SBA’s EIDL program provides small businesses with working capital loans of up to $2 million for vital economic support designed to help overcome loss of revenue. Small business owners in all 50 states; Washington, DC; and U.S. territories are eligible to apply. Note that while these loans have favorable terms, they are not forgiven.

As noted previously, this program is administered directly through the SBA itself, NOT your local bank or SBA-approved lender. It should be noted that the EIDL program is also limited to entities with 500 or fewer employees.

Fellows may learn more about EDILs and apply here.

Tax Provisions Could Help Ease Financial Stress

In addition to loans and advance payments through the SBA and the Centers for Medicare & Medicaid Services, there may be flexibility available through the Internal Revenue Service that could temporarily free operating capital or even offset prior years’ profits with losses caused by COVID-19. Following are questions and tax provisions that Fellows should consider discussing with their tax professional to see if they apply to their individual situation.

 

  • Is my practice eligible for the employee retention tax credit? This is a refundable Social Security tax credit equal to 50 percent of qualified employee wages (up to $10,000 of wages for each employee); however, small businesses that take SBA loans like those made available by the PPP are not eligible. More information can be found here.
  • Does it make sense for me to defer the Social Security portion of employer payroll taxes owed for the period between March 27, 2020 and December 31, 2020? (Note that the deferred amount must be repaid, with 50 percent of the deferred amount due by December 31, 2021, and the remainder to be paid by December 31, 2022.)
  • Do any of the modifications of Net Operating Loss rules (such as allowing them to offset 100 percent of taxable income or to be carried back for five years) apply to my practice?
  • Can I benefit from the temporary increase of the business interest expense limitation to 50 percent of adjustable taxable income for tax years 2019 and 2020?
  • Does my practice have excess business losses for tax years 2018, 2019, and 2020 that can be used due to the suspension of limitations for pass-through entities and sole proprietorships?
  • Can I claim 100 percent bonus depreciation for real estate and leasehold improvements placed in service after 2017?
  • Are there other less common flexibilities such as greater limits on charitable deductions, alternative minimum tax credit refunds, or funding of defined benefit pensions that might apply to my situation?

Commercial insurance coverage for telehealth services
For surgeons actively engaged in the provision of telehealth services, the following document from the American Academy of Orthopaedic Surgeons provides a comprehensive list of commercial health plan payors and their coverage policies for telemedicine services during the pandemic.

Practical Suggestions and Options to Consider in Weathering the Storm

The American College of Surgeons has been closely monitoring both the development of the federal response to the COVID-19 epidemic and how the programs and regulations coming out of Washington, DC, are being used by surgeons. In addition to the federal response, there are a number of tips and strategies that Fellows have developed for their practices. Following is a collection of practical suggestions, tools, tactics, and options that other surgeons have used as part of their own individual response to the financial circumstances created by the ongoing COVID-19 pandemic.

  • Make an appointment with your tax professional and/or financial advisor and seek their advice. (Consider bringing the list of tax questions provided previously with you.)
  • Try to keep staff on the payroll by limiting the number of staff in the office at any one time.
  • Take advantage of and apply for financial resources made available to small businesses by recent congressional action taken in response to the pandemic. (See previous Financial Resources section.)
  • Consider speaking with your malpractice insurance provider and ask about deferring payment of premium for a negotiated period of time.
  • When funds from the Medicare Advance Payment Program or SBA loans (PPP or EIDLs) are received, treat those funds as general receipts and carefully document where they are expended.
  • The current experience of surgeons indicates that the Medicare Advance Payment Program likely represents the best option for receipt of funds in the shortest period of time after application.
  • The PPP could be beneficial for those who qualify, because proceeds from the loan used for approved purposes may be forgiven. Although Congress may increase the amount of funds available, Fellows are urged to complete their applications as soon as possible to ensure the funds are not depleted before they are able to take advantage of this program.
  • For those applying for a loan through the PPP, engagement of your tax professional has been found to be helpful by those who have already completed applications. The application is complex, and true benefit is obtained by seeking professional assistance.
  • For those providers who receive a loan through the PPP, keeping accurate records of expenses that can be counted toward the loan forgiveness provisions is imperative. Specifically, those expenses include payroll, mortgage interest, rent, and utilities. Again, it should be noted that up to the full loan amount may be forgiven if the proceeds are used to keep staff on payroll and proper documentation is maintained.
  • If receiving Medicare Advance Payment, create a plan for payback based on conservative projected accounts receivable and practice expenses.
  • Consider applying for the SBA's Economic Injury Disaster Loan in case it is needed to support cash flow for your practice when Medicare Advance payment paybacks are due. Simply, pay off the loan if you do not need to use it.
  • In order to preserve your personal assets and retirement savings through this crisis, consider avoiding loans that use those assets as collateral.

Apply for an Accelerated or Advance Payment from CMS

Posted April 10, 2020

The Centers for Medicare & Medicaid Services (CMS) has delivered close to $34 billion in the past week to health care providers as part of its Accelerated and Advance Payments Program. These payments are intended, in part, to provide relief to providers who are delaying nonessential elective operations. Under this program, health care providers, including physicians, can receive three months of their Medicare reimbursement as an interest-free loan that they must repay. If the loan is not repaid in the specified timeframe the physician will be required to repay a lump sum with interest. The Fact Sheet on the Accelerated and Advance Payment Program describes the process and how to submit a request. Contact regulatory@facs.org with questions.

Federal Communication Commission Announces COVID-19 Telehealth Programs

Posted April 10, 2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted March 27, included $200 million in funding for the Federal Communications Commission (FCC) to establish an emergency program allowing health care providers access to capital to purchase the services and devices necessary to provide care via telehealth. In addition, the FCC separately allocated $100 million to create a Connected Care Pilot Program, which will provide funding to cover 85 percent of the costs of broadband connectivity.

Telehealth Program Funding

The FCC will award up to $1 million per eligible health care provider applicant to purchase telecommunications services, information services, and devices necessary to provide critical connected care services, whether for treatment of coronavirus or other health conditions during the coronavirus pandemic. Eligible providers include: postsecondary educational institutions that offer health care instruction, teaching hospitals, and medical schools; community health centers or health centers that provide health care to migrants; local health departments or agencies; community mental health centers; not-for-profit hospitals; rural health clinics; skilled nursing facilities; or consortia of health care providers that comprise one or more facilities that fall into the first seven categories.

The FCC has identified minimum information required in the applications, which must be submitted through the agency’s online Electronic Comment Filing System (ECFS) under WC Docket No. 20-89. Applications must be addressed to the FCC Secretary, Office of the Secretary, FCC. The FCC will issue a notice announcing when applicants can begin submitting applications.

Federation of State Medical Boards highlights the rulings of each state’s medical board

Center for Connected Health Policy outlines current state laws and reimbursement policies by state

Center for Connected Health Policy’s legislative and regulatory tracking tool

Connected Care Pilot Program

The Connected Care Pilot Program will help eligible health care providers defray the costs of services and equipment, including:

  • Paying for broadband Internet access services for their patients
  • Paying for the health care provider’s own broadband data connections as needed to enable broadband connections with their patients (but not with other health care providers)
  • Purchasing other connected care information services
  • Buying certain types of network equipment, such as routers and servers, but not end-user or medical equipment

The FCC order with detailed information regarding the Telehealth Program and Connected Care Pilot Program, including application requirements, can be accessed here. To learn more, read the FCC press release.

Kansas Medical Mutual Insurance Company Answers Liability Coverage Question

Posted April 10, 2020

The Kansas Medical Society (KMS) has received questions from physicians who are concerned that they may be asked to provide care outside of their usual practice setting or specialty during the COVID-19 pandemic. KMS reached out to the Kansas Medical Mutual Insurance Company (KAMMCO) for advice.

KAMMCO recognizes that physicians and other health care professionals may be faced with situations during the COVID-19 pandemic crisis that they may consider to be outside their traditional specialty training or expertise. Each physician will have to make his or her own determination as to the level of comfort and competency regarding the clinical situations in which the physician is placed.

Notwithstanding, subject to the terms and conditions of a physician’s particular insurance policy, most companies, like KAMMCO, provide coverage that is not specialty or geographically specific, as long as the care is delivered within the U.S. If the physician or health care provider is a Kansas resident and in compliance with the Kansas Health Care Stabilization Fund (Fund), the Fund also will provide coverage anywhere in the U.S. that the professional is licensed to provide care. KAMMCO appreciates this situation creates much stress among physicians and other health care professionals as to the potential liability they may be assuming during these extraordinary circumstances and encourages providers to check with their insurer if they have any questions about coverage limitations, and so on.

KMS is working with KAMMCO and the Kansas Hospital Association to develop a legislative proposal that would provide liability protection to health care professionals while they are in good faith delivering care related to the COVID-19 emergency. It is unclear at this point when the legislature will return to the capitol to complete the 2020 session.

Physician Groups Call Upon HHS to Provide Financial Relief to Providers

Posted April 8, 2020

The American College of Surgeons, the American Medical Association, and other organizations that represent the health care community sent a letter April 7 to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar requesting immediate financial assistance for physicians on the front lines during the COVID-19 pandemic. The letter notes that physicians across the country are taking heroic action to treat COVID-19 patients, providing ongoing care for patients with chronic conditions and urgent needs, and incurring significant financial losses due to postponing nonessential procedures and visits. Specifically, the organizations urge HHS to provide one month of revenue to each physician, nurse practitioner, and physician assistant enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses.

Congress intended to provide relief to physician practices that are suffering financial loss because of COVID-19 by designating funding in the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act. The statute requires HHS to interpret eligibility for the funding broadly to include all physicians who are experiencing revenue losses and non-reimbursable expenses as a result of the COVID-19 pandemic.

New Medicaid Waivers Empower States to Treat Pandemic Patients

Posted April 8, 2020

The Centers for Medicare & Medicaid Services (CMS) approved its 44th 1135 waiver April 3, providing regulatory relief to states so that they can effectively ensure COVID-19 patients have access to care. The expedited application and approval process of these waivers empowers state governments to temporarily suspend prior authorization requirements, provide beneficiaries more time for appeals and fair hearings, relax rules to more quickly enroll providers, and allow out-of-state providers to bill for services delivered to Medicaid beneficiaries, among other allowances.

CMS also updated its frequently asked questions (FAQs) for state agencies that administer Medicaid and for the Children’s Health Insurance Program. The updated FAQs address eligibility requirements, benefit expansion, cost sharing, and financing.

Connecticut Governor Extends Liability Protections

Posted April 8, 2020

Connecticut Gov. Ned Lamont issued an Executive Order April 5 that would extend protection from civil liability for actions or omissions in support of the state's COVID-19 Response. Under the Executive Order, any health care professional or health care facility is immune from civil liability for any injury or death allegedly sustained because of a health care practitioner’s or health care facility's acts or omissions undertaken in good faith while providing services in support of the state's COVID-19 response. These acts or omissions include those resulting from a lack of resources because of the COVID-19 pandemic, which thereby rendered the health care professional or health care facility unable to provide the level or manner of care that otherwise would have been required.

CMS Further Amends Extreme and Uncontrollable Circumstances Policies for the QPP 2019 Performance Year

Posted April 8, 2020

The Centers for Medicare & Medicaid Services (CMS) March 30 released the Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PHE) interim final rule with comment (IFC). The IFC includes updates to the Extreme and Uncontrollable Circumstances policies for the Medicare Shared Savings Program Accountable Care Organizations (ACOs) and the Merit-based Incentive Payment System (MIPS) for the 2019 performance year to implement additional relief for the Quality Payment Program (QPP) in conjunction with the data submission deadline extensions and other exemptions announced on March 23.

CMS previously originally extended the 2019 data submission deadline for both MIPS and Shared Savings Program ACOs from March 31, 2020, to April 30, 2020, and will apply the automatic extreme and uncontrollable circumstances policy to MIPS eligible clinicians who submitted 2019 MIPS data as an individual for less than two performance categories and who are not part of a group that submitted data on behalf of its clinicians. These individuals will automatically receive a final score equal to the 2019 performance threshold, which will result in a neutral payment adjustment on covered professional services furnished in the 2021 payment year.

The IFC amends the MIPS extreme and uncontrollable circumstances policy as it applies to groups, virtual groups, and individual clinicians who are ineligible for automatic reweighting for 2019. As written, this policy does not automatically apply to groups, virtual groups, or individuals who submitted data on two or more categories, but they may apply for reweighting of the performance categories based on extreme and uncontrollable circumstances. To provide additional relief for these groups, CMS extended the deadline to apply for reweighting of the quality, cost, promoting interoperability, and improvement activities performance categories based on extreme and uncontrollable circumstances from December 31, 2019, to April 30, 2020. CMS also modified the policy to create an exception for MIPS eligible clinicians or groups that already submitted data for any performance categories but demonstrate that they have been adversely affected by the PHE. Under this exemption, the performance categories still would be reweighted and the previously submitted data would not void the application for reweighting.

In the IFC, CMS also amended the extreme and uncontrollable circumstances policy of the Shared Savings Program ACOs. Historically, this policy has not allowed for the determination that an ACO had been impacted by an extreme and uncontrollable circumstance if the quality reporting period had been extended, as it was for the 2019 performance year. To offer additional relief, CMS revised this policy so that CMS can more easily waive quality reporting requirements for ACOs for 2019. ACOs that are unable to report quality because of extreme and uncontrollable circumstances will have their quality score set at the mean quality performance score for all Medicare Shared Savings Program (MSSP) ACOs for the applicable performance year. For ACOs that can completely report all quality measures, CMS will use the higher of the ACOs’ quality performance score or the mean quality performance score for all MSSP ACOs. In terms of adjusting the amount of shared losses an ACO must pay back to CMS, CMS also determined that 100 percent of assigned beneficiaries for all Shared Savings Program ACOs will be determined to reside in an area affected by an extreme and uncontrollable circumstance and that the number of affected months will begin with March and continue through the end of the PHE.

CMS acknowledges that these provisions may be insufficient to provide the necessary relief for physicians who are affected by the PHE, and the agency may explore further policy changes in future rulemaking.

The American College of Surgeons is tracking all regulations offering relief to surgeons who participate in CMS quality programs and will continue to share updates as necessary. CMS released a fact sheet that discusses the provisions within the interim final rule. The full IFC text can be accessed here. All additional questions can be directed to QualityDC@facs.org.

ACS Practice Protection Committee

Posted April 4, 2020

The ACS Practice Protection Committee has been formed to address issues of economic viability that surgical practices are facing as a result of the extraordinary demands placed on them during the COVID-19 pandemic. This workgroup will be ongoing and active to help Fellows with the economic challenges that lie ahead as the situation evolves. With the assistance of ACS staff in the Washington office, the workgroup has put together a resource document specifically targeted at the various options available to provide a rapid infusion of operating capital into surgical practices.

Financial Support Options for Surgeons

Posted April 4, 2020

Recently, a series of actions have been taken by the Federal government to reduce the financial stress caused by the response to COVID-19. These include easier access to small business loans (including to individuals who would not have previously been eligible), loan forgiveness, advances on anticipated Medicare payments, and deferrals on certain loan and tax payments.

These programs have overlapping eligibility and differing requirements, so figuring out which ones apply or are best for your specific situation can seem daunting. However, these programs are meant to help businesses, including physician practices, stay afloat during this unique, time limited crisis, and are therefore designed to be as streamlined as possible with expedited decisions on whether you qualify. The resources provided here are for informational purposes, please confer with your accountant or tax advisor before taking any action.

To determine which program or programs may suit your situation, there are several questions to consider:

  1. Is a large portion of your practice’s income derived from Medicare?
    If so, you may want to take advantage of the Medicare Advance payments announced by CMS. However, be aware that Medicare will begin to withhold payments later in the year to balance the advance paid against your charges for services billed in the future.
  2. How much help do you or your practice need?
    Economic Injury Disaster Loans can provide up to $2 million, while Paycheck Protection Program (PPP) loans can provide 2.5 times your monthly payroll costs, up to $10 million. Medicare advance payments are based on previous Medicare billed charges.
  3. How quickly do you need to receive funds?
    Economic Injury Disaster Loans or Medicare Advance payments may be a good fit for those in need of a quick capital infusion to keep their practice viable.
  4. Are you trying to avoid furloughs or layoffs, or would you consider recalling furloughed staff before 30 June?
    The PPP is intended to help small businesses and keep them from laying off employees or reducing wages. The PPP may even apply to non-profits, sole proprietorships and independent contractors. These loans may also be fully or partially forgiven if used it to maintain staffing levels and salaries or to rehire furloughed employees during the crisis.

The government websites provided below have been improved, are updated frequently with regards to content, and have been found to be “user friendly” and intuitive.

Medicare Advance Payments Program

The Centers for Medicare and Medicare Services (CMS) recently expanded the Accelerated and Advance Payments Program. Surgeons and others may request advanced Medicare payments to address cash flow issues based on historical payments. You may request up to 3 months of Medicare payments by sending a request form directly to your MAC. These forms vary and will be found on your MAC’s website. To qualify, you must have billed Medicare for claims within 180 days and you may not be in bankruptcy, under active medical review or program integrity investigation, or have any outstanding delinquent Medicare overpayments. MACs have been directed to process requests within 7 days.

These payments are essentially an interest free loan against future Medicare claims. Applicants who receive advance payments will continue to bill and receive payments normally for 120 days, after that, all billed claims will automatically be used to offset their advance payment balance. The entire balance must be repaid within 210 days of when it was received.

More information about this program can be found here.

Economic Injury Disaster Loans

Among the provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act was a significant shoring up of resources and expanding of availability of loans via the Small Business Administration (SBA). One of these is the Economic Injury Disaster Loan program.

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support designed to help overcome the temporary loss of revenue. In response to the COVID-19 pandemic, small business owners in all 50 states, Washington DC, and U.S. territories are eligible to apply. Note that these loans may have favorable terms, but they are not forgiven.

Fellows may learn more about Economic Injury Disaster Loans and apply here.

This program is administered through the Small Business Administration.

This is an article describing one entrepreneur’s experience in applying for an Economic Injury Disaster Loan.

The Paycheck Protection Program

The Paycheck Protection Program or PPP is an expedited loan program intended to help businesses keep their doors open and their staff on payroll. If used for the allowed purposes such as payroll, mortgage interest, rent or utilities, up to the full amount may be forgiven.

According to recent SBA guidance, starting April 3, 2020, small businesses and sole proprietorships can apply. Starting April 10, 2020, independent contractors and self-employed individuals can apply. The SBA encourages eligible entities to apply as quickly as possible due to the funding cap.

The application for the PPP will be submitted through your local SBA affiliated bank or financial institution, but regardless of where you apply you are likely to be asked for the following documentation. Having this information ready will expedite the process:

  • 2019 IRS tax documents such as quarterly 940, 941 or 944 payroll tax reports.
  • The most recent 12 months of payroll information including gross wages for all employees and officers, paid time off, vacation pay, FMLA, and State and local tax information.
  • 2019 IRS form 1099s for any independent contractors that would otherwise be considered an employee.
  • Health insurance premiums cost for you and your employees (the portion paid for by the proprietor)
  • Cost of company funded contributions to retirement plans such as 401K or IRA plans.

Application form

More information about the Paycheck Protection Program may be found here.

Information specific to the PPP and non-profit 501(c)3 organizations can be found here.

Help for Those with Student Loans

Those with student loans may be eligible for relief, particularly if their loans are held by the federal government. More information from the Department of Education can be found here.

Additional Tax Help for Those Trying to Retain Employees

Surgeons may also have questions related to the tax provisions from recent congressional activity related to the pandemic. For specifics, we urge you to contact you tax professional or financial advisor.

There are certain tax provisions intended to help ease the burden of the COVID-19 crisis on small businesses. The Treasury Department and the Internal Revenue Service have launched an Employee Retention Credit, designed to encourage businesses to keep employees on their payroll. The refundable tax credit is 50% of up to $10,000 in wages paid by an eligible employer whose business has been financially impacted by COVID-19. More information can be found on the IRS website.

Employers may also be able to defer the Social Security portion their payroll taxes that would have been due for the 2020 tax year to 2021 and 2022. The first half of employer payroll taxes must be remitted by December 31, 2021, and the remaining amount is due by December 31, 2022. More information can be found here.

Again, we urge you to contact your tax professional for specific advice, especially since some of the tax provisions may be mutually exclusive with the PPP.

COVID-19 State Government Resources and Engagement

Posted April 4, 2020

Fellows and members of the American College of Surgeons (ACS) who want to know how their state governments and local chapters are responding to the COVID-19 pandemic can learn more here. This page provides links to websites that summarize state actions; the American Medical Association’s state advocacy center, with topics of interest including costs for testing, access to care, and telehealth, expanding Medicaid coverage, enforcement of existing responsibilities, workers’ compensation, and liability; information from the National Governors Association website; details about the status of individual state legislatures; use of SurgeonsVoice; and a list of state health departments and state health officials. Updates on ACS state chapter activities also are provided.

Federal Government Provides Financial Relief for Physicians

Posted March 31, 2020

The American College of Surgeon (ACS) Division of Advocacy and Health Policy has identified information regarding the Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, that provides some pathways for physicians to obtain financial assistance for their practices.

First, the Centers for Medicare & Medicare Services (CMS) has recently expanded the Accelerated and Advanced Payment Program. Surgeons and others may request advance Medicare payments to address cash flow issues based on historical payments. More information about this program can be found here and here.

In addition, relief for small businesses with 500 or fewer employees, including physicians’ practices, was included in the $2 trillion CARES Act legislation. The provisions include the appropriation of $562 million for Economic Injury Disaster Loans to ensure that the Small Business Administration (SBA) has adequate resources to assist businesses in need. The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million to provide vital economic support designed to help overcome the temporary loss of revenue. In response to the COVID-19 pandemic, small business owners in all 50 states, Washington, DC, and U.S. territories are eligible to apply.

Learn more about Economic Injury Disaster Loans and find the appropriate applications here.

New York Chapter Letter Underscores the Needs of Surgeons in a COVID-19 Epicenter

Posted March 31, 2020

In a March 28 letter to New York Gov. Andrew Cuomo, leaders of the New York Chapter of the American College of Surgeons (ACS) outlined several concerns regarding the COVID-19 pandemic in the following areas: personal protective equipment (PPE), interpretation of immunity, crisis standards, maintenance of emergency access to critical medical and surgical care, liability relief, and volunteer immunity.

The letter, signed by New York Chapter President, Marina Kurian, MD, FACS, underscored the need for PPE in both hospitals and office settings, even with the increased engagement in telemedicine, and requested additional information on protocols for distribution of supplies.

The chapter also requested clarification on civil immunity protection, specifically regarding delayed treatment as a result of the governor’s executive order to postpone nonessential elective surgery.

The chapter asked that the governor’s office work with the ACS and critical care societies to establish crisis standards of care in the allocation of ventilators and other critical resources to help guide difficult decisions regarding access and to maintain professionalism and morale of health care professionals. The letter also called for policymakers to recognize other essential public health services (patients with injuries, heart attacks, strokes and so on), despite the overwhelming need of patients infected with the COVID-19 virus.

The chapter also requested a meaningful reduction in physician medical liability premiums for the duration of the pandemic or process for physicians to request a reduction in premiums based on individual circumstances.

Furthermore, the letter outlined the necessity of removing barriers that prohibit licensed surgeons and other qualified surgeons from outside the state from voluntarily administering care during the pandemic crisis.

The New York Chapter encourages surgeon-leaders to be proactive in communicating their specific needs and concerns to policymakers in their states.

Financial Relief for Surgeons: CARES Act Information

Posted March 30, 2020

In addition to the Bulletin: ACS COVID-19 newsletter we are sending to members, we are also rapidly sharing information related to your practice as we have it. To that end, the ACS Washington team has identified information regarding the Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on Friday, that provides some pathways for physicians to obtain financial assistance for their practices. We know many of you want to apply for this assistance if you are experiencing financial strains on your practice related to COVID-19.

First, the Centers for Medicare and Medicare Services (CMS) has recently expanded the Accelerated and Advanced Payment Program. Surgeons and others may request advanced Medicare payments to address cash flow issues based on historical payments. More information about this program can be found here and here.

In addition, relief for small businesses, including those run by physicians, was included in the $2 trillion CARES Act legislation. The provisions include the appropriation of $562 million for Economic Injury Disaster Loans to ensure that the Small Business Administration (SBA) has adequate resources to assist businesses in need.

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support designed to help overcome the temporary loss of revenue. In response to the COVID-19 pandemic, small business owners in all fifty states, Washington, DC, and U.S. territories are eligible to apply.

The CARES Act clarified that eligibility would be for those businesses of 500 employees or less at each business location.

Fellows may learn more about Economic Injury Disaster Loans and find the appropriate applications on the SBA website.

ACS continues to support all our surgeons who are serving their communities in the COVID-19 crisis and curtailing their normal clinical practices. ACS continues to remind the White House, Congress, the Department of Health and Human Services and CMS to support our surgeons so that when we recover from COVID-19, our surgical practices will recover, too.

CARES Act Provides Protections for Surgeons Affected by COVID-19

Posted March 28, 2020

Congress passed and President Trump sign into law The Coronavirus Aid, Relief and Economic Security (CARES) Act. Click here for a summary of some of the provisions of the legislation that may be most applicable to surgeons and their practices. Please note: Information regarding the application process, including implementation of how to apply for any financial assistance, has not been determined yet. We will include updates regarding this as soon as it is available.

Relief for small businesses run by physicians was included in the $2 trillion legislation Congress passed. The CARES Act modifies the 7(a) Small Business Administration (SBA) loan program in the following ways:

  1. Setting eligibility requirements at 500 employees or fewer
  2. Allowing 501(c)(3) non-profits to be eligible
  3. Increasing the maximum loan amount to $10 million
  4. Expanding allowable uses to include payroll support, employee salaries, and debt obligations

The modifications in the CARES Act also provide a process for loan forgiveness for certain payroll costs as well as mortgage, rent, and utilities.

The CARES Act includes $100 billion for health care services related to the COVID-19. Specifically, the funds are to prevent, prepare for, and respond to coronavirus, domestically or internationally, for necessary expenses to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus.

The Budget Control Act of 2011 (P.L. 112–2) requires mandatory across-the-board reductions in federal spending, also known as sequestration. When applied to Medicare, the sequester reduces payments to providers by 2 percent. The CARES Act temporarily lifts the sequester on Medicare from May 1 through December 31, 2020. Because of this provision, physicians treating Medicare beneficiaries will see payment rates increase by 2 percent during this time period.

The CARES Act extends federal Good Samaritan civil liability protections to interstate volunteers who are licensed in their home state to physicians who provide volunteer medical services during the public health emergency related to COVID-19.

The CARES Act also contains several telehealth provisions, which include the following:

  • Reauthorizes Health Resources and Services Administration (HRSA) grant programs that promote the use of telehealth technologies for health care delivery, education, and health information services
  • Allows high deductible insurance plans with a health savings account to cover telehealth services prior to a patient reaching the deductible
  • Removes restrictions that limited Medicare telehealth service situations where the physician or other professional has treated the patient in the past three years
  • Allows federally qualified and rural health centers to provide telehealth services to Medicare patients not located at the clinic
  • Expands telehealth services to include home dialysis, home care, and hospice care.

Surgical Coalition Sends Letter to Hill Requesting Relief for Rural Facilities

Posted March 28, 2020

The American College of Surgeons (ACS) and 22 other surgical groups that comprise the Surgical Coalition sent letters of support March 24 to the Senate and House of Representatives urging inclusion of the Immediate Relief for Rural Facilities and Providers Act of 2020 in the third COVID-19 relief package. Sponsors of the legislation were Sens. Michael Bennet (D-CO) and John Barrasso (R-WY), and Reps. Phil Roe, MD (R-TN), and Kim Schrier, MD (D-WA). The legislation proposed to provide emergency grants to physicians’ practices to alleviate strain resulting from the pandemic by making funds available for meeting office payroll expenses. The bill also provided for emergency low interest loans to enable practices to maintain or resume operations and restore the economic viability of the practice. In addition, the legislation proposed to provide financial resources to strengthen rural facilities during the public health crisis. Read the Senate letter and the House letter. Unfortunately, the act was not included in the third COVID-19 relief package. The ACS will continue to advocate for its inclusion in any subsequent legislation dealing with the pandemic.

CMS Eases Medicare Enrollment Requirements

Posted March 28, 2020

To increase the number of health care professionals available to respond to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services has eased Medicare Part B enrollment requirements for physicians and nonphysician practitioners (NPPs). The agency established toll-free hotlines at each Medicare Administrative Contractor (MAC) to allow providers to initiate temporary Medicare billing privileges, CMS also has waived several screening requirements—such as application fees, fingerprint-based criminal background checks and site visits—to enroll as a participant in the Part B program on a provisional basis.

MACs will attempt to screen and enroll providers by phone and will notify providers of their approval or rejection of temporary Medicare billing privileges during the phone conversation. Physicians and NPPs who fail the screening requirements will be denied temporary Medicare billing privileges and will not be reimbursed for services furnished to Medicare beneficiaries. Upon the lifting of the public health emergency declaration, providers must submit a complete enrollment application to establish full Medicare billing privileges.

Providers seeking temporary billing privileges should only call the hotline for their MAC. A full list of the toll-free hotline telephone numbers for each MAC is available in the agency’s COVID-19 Medicare Provider Enrollment FAQ document. For more information, contact Lauren Foe, American College of Surgeons Senior Regulatory Associate, at lfoe@facs.org.

Specialty Societies Request MACRA Relief During COVID-19 Pandemic

Posted March 24, 2020

The Council of Medical Specialty Societies (CMSS), which comprises 46 specialty societies, including the American College of Surgeons, and represents more than 800,000 U.S. physicians, has developed a letter in response to the Administration’s request for guidance on COVID-19. Among the requests that CMSS made was that the Centers for Medicare & Medicaid Services suspend MACRA (Medicare Access and Children’s Health Insurance Plan Reauthorization Act) reporting requirements and delay required reporting of the 2019 Merit-based Incentive Payment System.

CMS Announces Exceptions and Extensions on Reporting Requirements

Posted March 24, 2020

The Centers for Medicare & Medicaid Services (CMS) issued an announcement March 22 that provides relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs, including the 1.2 million clinicians in the Quality Payment Program (QPP) and on the front lines of the nation’s fight against COVID-19. Specifically, CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for the CMS programs including, physician payment programs. The new deadlines for the QPP are as follows:

Provider Programs

2019 Data Submission

2020 Data Submission

Quality Payment Program Merit-based Incentive Payment System (MIPS)

Deadline extended from March 31−April 30, 2020.

MIPS-eligible clinicians who have not submitted any MIPS data by April 30, 2020, will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.

CMS is evaluating options for providing relief around participation and data submission for 2020.

Medicare Shared Savings Program Accountable Care Organizations (ACOs)

For those programs with data submission deadlines in April and May 2020, data submission will be optional, based on the facility’s choice to report. In addition, no data-reflecting services provided January 1−June 30, 2020, will be used in CMS’ calculations for the Medicare quality reporting and value-based purchasing programs in order to reduce the data collection and reporting burden on providers responding to the COVID-19 pandemic.

CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. Details about task force’s response to COVID-19 are available at coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, go to the Current Emergencies website.

FDA Issues Guidance to Increase Availability of Ventilators

Posted March 24, 2020

The U.S. Food and Drug Administration (FDA) March 22 issued a guidance that outlines a policy intended to help increase availability of ventilators and their accessories as well as other respiratory devices during the COVID-19 pandemic. For details, see Enforcement Policy for Ventilators and Accessories and Other Respiratory Devices During the Coronavirus Disease-2019 (COVID-19) Public Health Emergency.

The policy fosters the continued availability of certain safe and effective medical devices while being flexible regarding manufacturer modifications made to ventilators, anesthesia gas machines, and other respiratory devices and their accessories, in response to the COVID-19 public health emergency.

This guidance letter provides recommendations for health care providers and facilities, based on the recently issued guidance, regarding the use of devices with patients who develop respiratory compromise from COVID-19 or other respiratory disorders. The FDA's recommendations are intended to augment specific controls and procedures developed by health care facilities and the Centers for Disease Control and Prevention.

Learn More about Your State’s Response to COVID-19

Posted March 24, 2020

Fellows and members of the American College of Surgeons (ACS) who want to know how their state governments are responding to the COVID-19 pandemic can learn more at Stateside.com. This site is updated daily.

Fellows and members who want to engage with their state officials and advocate specifically for state-based action, can refer to the following comprehensive list from the American Medical Association’s state advocacy center. Fellows may find the following issues from the list particularly pertinent:

Costs for Testing

  • Prohibit cost-sharing for diagnostic testing and cost-sharing related to testing including hospital, emergency department, urgent care and provider office visits.
  • Prohibit prior authorization for testing and all services related to testing.
  • Ensure coverage for testing and related services regardless of the provider's network status of the provider.

Access to Care

  • Suspend any prior authorization requirements that apply to treatment and care related to COVID-19.
  • Ensure coverage for the cost of care related to confirmed or potential COVID-19 cases without regard to the network status of provider.

Telehealth

  • Ensure broad coverage and payment for all telehealth services by all plans and payors.
  • Temporarily allow coverage and payment for all telehealth modalities.
  • Suspend requirements that an existing patient-physician relationship must be established prior to the provision of telehealth services.

Expanding Medicaid C overage 

  • Expand Medicaid eligibility temporarily to any uninsured state resident with COVID-19 related diagnoses or symptoms.

Enforcement of Existing Responsibilities/Laws

  • Verify that networks can handle the increase in need for health care services, including offering access to out-of-network services where appropriate and at the in-network cost-sharing level.
  • Prohibit prior authorization for emergency care, regardless of whether the care is in- or out-of-network.

Workers' Compensation 

  • Deem volunteer physicians not otherwise covered by the workers’ compensation laws of the state employees of the state for purposes of making a claim under the state’s workers’ compensation system.

Liability

  • Provide immunity from civil liability for any harm caused by volunteer physicians acting in good faith in response to COVID-19.

Many of the items on the list are subject to administrative actions by governors, Fellows can find contact information for their state governor on the National Governors Association website.

It is important to note that many state legislatures have adjourned. Find t he status of individual state legislatures.

Fellows can access contact information for their individual state legislators via SurgeonsVoice.

Lastly, a list of state health departments and state health officials can be found on the CDC website and the ASTHO website.

Florida Hospital Association Supports ACS Guidance on Non-Emergent Operations

Posted March 24, 2020

The Florida Hospital Association Board of Trustees recently voted to stand in support of postponing elective surgeries and procedures to ensure that necessary resources remain available to protect health care professionals. The Board also expressed support for the American College of Surgeons’ COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures to appropriately triage clinical decision making for elective surgeries and procedures.

U.S. Congress Temporarily Waive Telehealth Restrictions

Posted March 20, 2020

The president March 6 signed into law the first of three spending bills intended to fund the federal government’s response to the Coronavirus Disease 2019 (COVID-19). The legislation includes provisions that grant the Secretary of the U.S. Department of Health and Human Services (HHS) with the authority to temporarily ease restrictions around telehealth services for Medicare beneficiaries, including: lifting the rural and geographic requirements to provide and receive telehealth services, waiving federal requirements that physicians and health professionals be licensed in the state in which they are providing services if they have an equivalent license in another state, and loosening restrictions on the use of telephones to deliver care.

The Secretary of HHS has temporarily activated the provisions regarding telehealth to increase access by Medicare beneficiaries, but only while the COVID-19 public health emergency is in place. For more information regarding telehealth or health information technology, contact Amelia Suermann, American College of Surgeons Congressional Lobbyist, at asuermann@facs.org.

COVID Response Brings Attention to Good Samaritan Laws

Posted March 20, 2020

Reps. Raul Ruiz, MD (D-CA), and Larry Bucshon, MD (R-IN), last week introduced the House companion to The Good Samaritan Health Professionals Act. Federal and state Good Samaritan laws provide some civil liability protections for volunteer health care providers, but only if they are licensed in the state where the services are provided. This will leave many health care professional volunteers who provide care in other states without Good Samaritan protections. Without federal intervention, these states cannot address the gaps in Good Samaritan laws to protect providers from out of state. The Good Samaritan Health Professionals Act (S.1350/H.R. 6283) provides certainty by extending federal Good Samaritan civil liability protections (equivalent to the protections found in the federal Volunteer Protection Act of 1997 and many state laws) to interstate volunteers who are licensed in their home state.

The American College of Surgeons (ACS), along with various provider groups, are advocating for the inclusion of this legislation as part of the response to the Coronavirus Disease 2019 pandemic to ensure providers can assist where the need is the greatest.

Read the ACS letter of support. For more information or question on medical liability reform efforts, contact Hannah Chargin, Congressional Lobbyist, hchargin@facs.org

States Respond to COVID-19

Posted March 20, 2020

State and local officials have been working overtime to address the Coronavirus Disease 2019 (COVID-19) crisis. From governors, to public health departments, to state legislatures and local municipalities, all legislators and policymakers are responding and making the tough decisions. Surgeons who are interested in what may be happening at the state and local level regarding medical licensure/telemedicine, emergency declarations, legislative actions, and state health department initiatives should consider the following online resources:

New Billing Processes Established for COVID-19 Testing

Posted March 20, 2020

The Centers for Medicare & Medicaid Services (CMS) issued two new Healthcare Common Procedure Coding System (HCPCS) codes to help track testing related to Coronavirus Disease (COVID-19) and standardize reporting and reimbursement for such tests offered by hospitals, health systems and laboratories across the country. Beginning April 1, providers can bill Medicare and other payors for the administration of tests developed by the Centers for Disease Control and Prevention (CDC) for dates of service on or after February 4 using HCPCS code U0001. Providers performing non-CDC laboratory rests for COVID-19 can bill for them using HCPCS code U0002.

To further streamline billing processes and ensure proper payment for COVID-19 testing, the Current Procedural Terminology (CPT) Editorial Panel issued CPT code 87635 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique), which may be submitted on claims for services furnished on or after March 13. Providers are encouraged to contact payors to determine their guidelines regarding applicability for retroactive billing and payment for this code.

HCPCS and CPT codes should not both be reported on the same claim, and the appropriate code to be reported is dependent upon the billing requirements of the payor to which the claim is being submitted. More information about each code can be found on the CMS and CPT Editorial Panel websites. Contact Lauren Foe, Senior Regulatory Associate, at lfoe@facs.org with questions.

ACS Sends Letters to Congress on COVID-19

Posted March 19, 2020

The American College of Surgeons (ACS) organized a letter March 19 to Congress along with 21 surgical coalition members. The letter asks for a number of items to be included in the COVID package that is Congress is negotiating. In addition to the surgical coalition letter, the ACS sent another letter to Congress yesterday on the same topic.