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Internists Recommend Additional Steps to CMS to Support Physicians during COVID-19

Washington, DC (April 15, 2020) — In a letter sent to the Centers for Medicare and Medicaid Services (CMS) today the American College of Physicians (ACP) acknowledged the changes the agency has made to help support physicians and their practices during the COVID-19 national emergency and made recommendations for additional actions to help physicians treat patients during this time.

“ACP recommends additional emergency actions that CMS should take as soon as possible,” wrote Robert McLean, MD, MACP, president of ACP in the letter. “We believe these actions will complement those taken to date by the Agency and will further enable physicians to provide necessary care to those suffering from COVID-19, as well as their broader patient populations.”

The letter suggested changes to the Medicare Accelerated and Advance Payment programs to decrease the processing time and to extend the loan repayment timeframe.  The letter continued by recommending changes that should be made to improve coverage and payment for telehealth and telephone services by providing pay parity to make telephone services equal to in-office visits and ensuring that the agency cover telehealth Medicare wellness visits. 

“We are concerned that many patients are unable to connect via telehealth with their physicians, as they do not have compatible devices,” continued Dr. McLean. “We have heard from our physicians that during this crisis, they have been able to conduct successful audio-only telephone visits with patients, in lieu of in-person or telehealth visits, obtaining about 90 percent of the information they would collect using audio and video capable equipment.”

The letter recommended measures that could help to reduce some of barriers to providing care to patients while under the strain of the COVID-19 emergency, including waiving all prior authorization requirements.  The letter also acknowledged the changes that have been made to relax the in-person supervision requirement for residents and fellows, instead allowing communication by other means; however, ACP calls for additional changes to the direct supervision requirements.

“Residents and fellows are highly trained in medicine and have the skills to care for critical patients during emergency situations in which the healthcare workforce is severely strained,” Dr. McLean stated. “We recognize that these measures are unprecedented, but we must take unprecedented actions necessary to ensure that we are able to manage treatment of this virus.”

The letter went on to suggest several different changes that should be made to the Quality Payment Program (QPP) to help physicians meet the requirements of the program while dealing with the issues created by the COVID-19 pandemic.  These include further extending reporting deadlines for the Merit-Based Incentive Payment System (MIPS), making automatic exceptions that would hold physicians harmless from payment cuts, and extending deadlines and providing up-front funding for Alternative Payment Models (APMs).

The letter ended by bringing up two additional payment issues.  It called attention to the need for pay parity for Medicaid, so that payments for primary care and subspecialty services under the program are at least equal to Medicare rates.  In light of the loss of insurance facing many Americans due to the loss of employer-based coverage, the letter also recommended that CMS reimburse physicians and hospitals for care for the uninsured for COVID-related expenses.

“ACP is appreciative and encouraged by the actions taken by CMS to date that will be enormously beneficial to physicians and their teams in both caring for patients impacted by this pandemic and for patients at-large,” concluded Dr. McLean. “At the same time, we continue to strongly recommend that CMS take additional emergency actions to assist physicians and other clinicians with the resources and burden reduction they need to be successful in treating this pandemic.”

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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

Contact: Jackie Blaser, (202) 261-4572, jblaser@acponline.org