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Internists Say Relief Funding Must be Prioritized to Primary Care and Other Frontline Physician Practices to Ensure Continued Care

Washington, DC (April 29, 2020) In a letter sent this morning to the Department of Health and Human Services (HHS), the American College of Physicians (ACP) said that primary care physicians and their practices need to be prioritized for relief funding in order to ensure they are able to continue operating while dealing with the impact of the COVID-19 pandemic. The letter to Secretary Azar also recommended other categories of physician practices should be prioritized for funding out of the Public Health and Social Services Emergency Fund (PHSSEF), including smaller practices, those providing care in underserved areas, and internal medicine subspecialty practices. The letter noted that while the funds that have been sent to physicians and practices to date, while helpful and appreciated, will not be sufficient to keep practices open and laid out a series of recommendations about how additional funding should be disbursed.

“Internal medicine specialists and other primary care physicians have an essential role in delivering primary, preventive, and comprehensive care not only to patients with symptoms or diagnoses of COVID-19, but also to patients with other underlying medical conditions, including conditions like heart disease and diabetes that put them at greater risk of mortality from COVID-19,” wrote Jacqueline Fincher, MD, MACP, president, ACP in the letter. “Many studies have shown that the availability of primary care in a community is associated with reduced preventable mortality and lower costs of care, yet recent surveys suggest that many will soon close without additional support.”

ACP specifically called for HHS to disburse the remaining dollars in the PHSSEF to physicians based on attestation of revenue lost from all payers and increased costs associated with COVID-19.  

For primary care practices, ACP recommended that HHS set aside a dedicated portion of the PHSSEF to make them whole for lost revenue, using a prospective per patient, per month payment.  Noting problems that fee-for-service payments have posed for practices when they have been trying to operate during the COVID-19 national emergency, ACP called attention to existing Medicare programs operating under the Center for Medicare and Medicaid Innovation that already use this type of payment for primary care physicians.

“COVID-19 has illustrated the flaws of paying primary care physicians predominantly on a fee-for-service basis, because as they have moved away from in-person visits, they no longer are getting the “fee” associated with the office visit service, while the “fees” for telehealth and audio-only phone calls have not been sufficient to offset the loss of revenue from in-person visits,” continued Dr. Fincher. “Distributing funds to primary care physicians and their practices through a per patient, per month methodology would provide them with the revenue and support needed to keep their practices open at this difficult time, without having to depend on a flawed fee-for-service system that is unlikely to provide them the support needed and make them whole for lost revenue.”

The letter concluded by expressing concern about the decision by the Centers for Medicare and Medicaid Services (CMS) to suspend the Medicare Advance Payment program earlier this week. This program had allowed physician practices to apply to for a short-term loan equal to a portion of the Medicare payments they would expect to earn in the near future.

“This program, combined with other sources of potential revenue from the PSSPF disbursements, has been a lifeline to many practices. ACP has previously recommended that HHS and CMS extend the repayment period, and lower the interest rate to zero, for the Advance Payment Program,” concluded Dr. Fincher. “It is inexplicable that CMS has decided instead to suspend it, and the rationale offered does not support suspending it. ACP strongly urges HHS and CMS to reinstate the Advance Payment Program and implement the changes that ACP has previously recommended to improve it.”

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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