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This newsletter outlines key federal regulatory developments and highlights PAI’s advocacy on matters that impact physicians and patients. During the COVID-19 pandemic, these efforts have focused on securing adequate financial supports and regulatory flexibilities to allow physicians to continue to safely care for their patients and remain financially viable. As the COVID-19 Public Health Emergency (PHE) continues to evolve, PAI is working to share feedback with members of Congress and federal regulators on issues that physicians and patients are facing. Please visit PAI's COVID-19 Resources page and the Healthsperien COVID-19 Resource Updates page for up-to-date information.

Physicians Weigh In On Impact Of Pandemic

Physician practices across the nation have struggled to remain viable during the coronavirus pandemic, notwithstanding various flexibilities and financial supports that have been extended by the federal government. A recent Physicians Foundation survey revealed the extent of physicians’ concerns about the impact of the COVID-19 pandemic, including the belief of 72 percent of physicians who indicate that COVID-19 will have serious consequences for their patients’ health because of delays in seeking and receiving care. 

In July, McKinsey & Company released a new report outlining their findings from a study on physician employment, including the financial pressures physicians have encountered as a result of COVID-19, and the path forward post PHE. The study found that more than half of respondent physicians re­ported that they were worried about their practices closing, so physicians were open to considering partnerships with large health systems to ensure financial stability. In a trend that PAI’s own research has documented, this survey found that small independent physicians now see the benefits of working for a larger practice, and a significant portion of all independent physicians are now considering selling their practice or working with a large health system. Read the full summary here.

Provider Relief Fund Updates

On July 31, HHS extended the application deadline for certain Medicare providers to apply for additional Provider Relief Fund payments. HHS also extended the application deadline for eligible Medicaid, Medicaid managed care, CHIP and dental providers. The deadline for both groups is now August 28. The announcement also specified that certain providers who experienced a change in ownership, and were therefore ineligible for Phase 1 funding, will also be given an opportunity to apply for financial relief under the extended deadline.
 
As of August 10, HHS is allowing eligible Medicare providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution to request additional relief funds.

CMS Begins Repayment of Medicare Accelerated and Advance Payment Program 

Physicians who received payments under the Medicare Accelerated and Advance Payment Program (APP) earlier this spring may begin seeing repayment of the funds under this program beginning in August. As a reminder, while physicians will have 210 days from the payment date to repay the total funds received under the APP, repayment of these funds begins 120 days after the payment date. If funds are not repaid within the 210-day period, the remaining balance will be subject to a 10.25 percent interest rate. PAI is advocating for a delay and/or lower interest rates for repayment of loans secured through the AAP program.  

CMS Releases CY 2021 Proposed Rules for the Medicare Physician Fee Schedule and Quality Payment Program

On August 3, CMS published the CY 2021 Medicare Physician Fee Schedule (MPFS) proposed rule (fact sheet can be found here) and the 2021 Quality Payment Program (QPP) proposed rule (fact sheet can be found here). For an extensive summary of both proposed rules, please review Healthsperien’ s complete summary here. Key proposed changes include the following:
 

PAI is currently developing a response to both proposed rules. All comments are due on October 5, 2020.

PAI Urges National Governors Association (NGA) to Support Policies to Help Physicians and Patients During Pandemic

On July 23, PAI sent a letter to the National Governors Association (NGA) outlining key COVID-19-related policy recommendations. In summary, PAI urged policymakers to consider the following priorities:

  • Continue financial support in the form of additional relief funds for all physician practices and adjust the distribution methodology to ensure equitable payments to all physician practices, including those with high Medicare Advantage and dual-eligible patient mixes as well as Medicaid-focused practices (e.g., pediatrics/pediatricians and some OBGYNs).
  • Address the Provider Relief Fund distribution formula that resulted in inequitable relief funding, with highest payments made to hospitals with the highest share of private health insurance revenue, further exacerbating the existing inequities and undermining barriers to care for the nation’s most vulnerable patients.
  • Amend federal law to clarify that financial assistance through the Provider Relief Fund is not taxable, and that entities receiving funds can maintain tax deductions attributable to these funds.
  • Continue current flexibilities for telehealth, remote patient monitoring (RPM), and communication technology-based services (CTBS), as well as continue increased reimbursement for telehealth services (including audio-only telehealth services) in Medicare, to ensure continued access to necessary physician services.
  • Expand funding opportunities that enable physicians to improve telehealth/virtual platforms, operational capacities, and data and interoperability capacities.
  • Continue and improve financial supports through the Paycheck Protection Program (PPP) and through necessary business insurance protections to cover salaries and overhead expenses as pandemic-related losses continue and are expected to continue post-PHE.
  • Establish a multi-stakeholder task force to develop a National Roadmap to inform health care policies for this and future public health emergency.

Summary of Recent Presidential Executive Orders

Since July, President Trump has issued four executive orders (EOs) addressing various health care policies, including three EOs (with one additional EO still pending authorization by the President) addressing prescription drug prices, and one EO on Rural Health and Telehealth Access. For information on the President’s EOs addressing prescription drug prices, please review Healthsperien’s summary and analysis memorandum here. Additionally, key provisions of the most recent EO on Rural Health and Telehealth Access are summarized below:

  • Directs HHS to launch a new CMMI payment model for rural healthcare providers. This model must provide flexibilities from existing Medicare rules, establish predictable financial payments, and encourage movement into high-quality, value-based care.
  • Directs HHS, alongside other Departments and agencies, to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure.”
  • Directs HHS to submit a report on existing and upcoming policy initiatives that aim to improve rural access to health care by eliminating regulatory burdens; prevent disease and mortality by developing rural-specific efforts to drive outcomes; reduce mortality and morbidity; and improve mental health in rural communities.
  • Directs HHS to review and potentially extend flexibilities currently in place during the PHE for telehealth and other administrative/supervision requirements. This was subsequently addressed within the 2021 MPFS proposed rules, as previously described.

CMS Introduces New Rural Health CMMI Model

On August 11, pursuant to the first directive of the Rural Health EO, CMS announced a new model, The Community Health Access and Rural Transformation (CHART) Model. This Model establishes two separate value-based payment tracks—a Community Transformation Track and an ACO Transformation Track—to address health care disparities and transform care delivery systems for Americans living in rural communities. While there is still limited information on the details of this model, CMS anticipates that the Notice of Funding Opportunity (NOFO) for the Community Transformation Track will be available in September 2020, and the Request for Applications (RFAs) for the ACO Transformation Track will be available in early 2021. For additional information, please see CMMI’s CHART Model Fact Sheet.

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