Also calls for further action to protect non-American international medical graduates
April 3, 2020 (ACP) – Though the $2.2 trillion coronavirus aid package recently passed by Congress and signed by the president brings some welcome relief to people across the country, the American College of Physicians continues to push for added measures to protect primary care physicians and their patients.
“We are hearing from many smaller primary care practices in particular that they soon may not be able to make payroll without more direct support and could even be forced to close their doors,” wrote Dr. Robert M. McLean, president of ACP, in a March 26 letter to congressional leaders, adding “additional steps must be taken to support and sustain practices.”
The U.S. Senate and House of Representatives approved the Coronavirus Aid, Relief and Economic Security (CARES) Act in late March, and the President promptly signed it on March 27.
ACP has been insistent about both the need for the relief plan and the need for further important steps. In the March 26 letter to top federal officials, ACP highlighted its support for several aspects of the relief plan while pointing to areas that need to be implemented in ways that support physicians and patients. ACP supports the following parts of the CARES Act:
- $100 billion in funding for the Public Health and Social Service Emergency Fund. This funding will help sustain physician practices through grants for health care-related expenses or lost revenues that are attributable to COVID-19. “We ask that Congress do everything possible to ensure that the administration implements this provision in a way that ensures rapid disbursement of funds to financially distressed practices, preferably prospectively or concurrently, in a way that makes it feasible for small practices to apply and receive funding,” McLean wrote in the letter.
- Payroll tax relief. Provisions to provide payroll tax relief, loans and other programs will help smaller businesses such as physician practices. However, ACP urged Congress to provide oversight “to ensure that such assistance is implemented in a way that provides physician practices, especially small and medium-size practices, with access to the relief as rapidly as possible to make a difference.”
In an interview, Bob Doherty, ACP senior vice president for governmental affairs and public policy, explained the struggles that physician practices – especially smaller ones – are facing. “They have little or no revenue coming in,” he said. “If the support funding isn't disbursed for five to six weeks, that may be five to six weeks too late for practices that are trying to make payroll.”
- Paycheck Protection Loan Program and loan forgiveness. “Businesses with fewer than 500 employees would be able to cover payroll costs with up to a $10 million fully guaranteed loan at four percent in order to help keep workers paid and employed,” McLean wrote. “Businesses that maintained their payroll may also be allowed to receive loan forgiveness on a paycheck protection loan over an eight-week period in order to rehire workers who were laid off. Like other provisions in the legislation, this will need to be implemented as quickly as possible.”
- Advance tax credits for expanded paid sick and family leave. ACP believes these credits will be helpful to many physician practices.
- $16 billion in funding for the Strategic National Stockpile. This funding will help to procure personal protective equipment, ventilators and other medical supplies for federal and state response efforts. “We need to see that equipment is actually going to achieve the goal,” Doherty said, “which is that every physician, nurse or other health care worker has adequate personal protection equipment as they take care of COVID-19 patients on the front lines.”
- Suspension of the Medicare sequester throughout the rest of 2020. “This will provide appropriate relief to physicians and hospitals from scheduled cuts,” McLean wrote.
- Reauthorization of funding for critical health programs. These programs include Community Health Centers, the National Health Service Corps, the Teaching Health Center Graduate Medical Education program, Title VII health professions (including Primary Care Training and Enhancement) and Medicare quality measure endorsement.
- Protection of patients from some out-of-pocket expenses associated with COVID-19 testing and treatment. “Additional steps should be taken to ensure coverage for vulnerable patients, including expanding Medicaid coverage fully funded by the federal government,” McLean wrote.
Still more needs to be done to support physicians.
To that end, this week ACP enacted new policy supporting physicians using their own personal protective equipment (PPE) to protect themselves and others when those items are in short supply in their health systems. The policy also states that physicians should be able to speak out about conditions related to the care of COVID-19 patients without retribution.
“Lack of PPE puts physicians, health care workers, and patients at greater risk during COVID-19 and could severely hinder the response to this pandemic, and physicians should be allowed to bring their own PPE if they don't have access to it,” said McLean about the new policy. “Additionally, ACP is concerned by reports that some physicians who have spoken out about a lack of PPE have been dismissed from employment or otherwise disciplined. Physicians who have concerns about conditions and practices related to care of COVID-19 patients should have the right to speak up within their workplaces and more broadly without fear of retaliation to achieve needed change for the health and safety of physicians and patients.”
ACP is also calling for the following additional steps to be taken by Congress:
- The Centers for Medicare & Medicaid Services announced this week that they would begin to pay for audio-only telephone consultations between physicians and their patients. ACP would like to see Congress require such payments from all payers.
- Ensure Medicaid parity throughout the duration of the COVID-19 national emergency. “We strongly support the renewal of applying the Medicare payment rate floor to primary care services furnished under Medicaid and are very disappointed that this did not make it into the final bill,” McLean wrote. “This will ensure that primary care physicians and internal medicine and pediatric subspecialists are paid no less than they would be paid under Medicare for the duration of the COVID-19 public health emergency.”
- Enact a grant program expressly to support and sustain physician practices. “We strongly supported the Immediate Relief for Rural Facilities and Providers Act of 2020,” McLean wrote. “We are disappointed that this amendment, which would have provided direct grants and low-interest loans to physicians during this crisis, was not included in the bill. Accordingly, we strongly recommend this grant program be included in subsequent COVID-19 legislation.”
- Require that the administration pay physicians and hospitals 110% of the Medicare rates for providing COVID-19-related treatment for uninsured persons and increase Medicare physician fee schedule payments to physicians for the duration of the public health emergency or retroactively to the date of the national emergency declaration.
It's not clear when Congress will next be in session. In the meantime, ACP hopes the nation's leaders make further legislative action a priority in order to better protect the nation's patients and physicians. “Congress needs to listen to our input as to what else needs to be done and start crafting a bill that would provide additional help,” Doherty said. “We'll be working with congressional staff on that.”
On another front, ACP is lobbying the Trump administration to take immediate action to protect non-American international medical graduates who are either in the United States or plan to come here. “Our country can't afford to delay processing of visas for medical residents and physicians during this critical time,” wrote McLean in a separate March 26 letter to Secretary of State Mike Pompeo and Kenneth Cuccinelli, acting director of U.S. Citizenship and Immigration Services.
ACP is urging the State Department and U.S. Citizenship and Immigration Services to “expedite entrance of international medical graduates who are citizens of other nations (non-U.S. IMGs) into the country and to ensure that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic,” McLean wrote in the letter.
In the March 26 letter, he noted that more than 4,200 non-U.S. IMGs were just placed via the National Resident Matching Program into training positions that start on July 1.
ACP made the following recommendations:
- Open visa processing at embassies and consulates worldwide for medical residents and physicians.
- Continue and prioritize H-1B premium processing for medical residents and physicians.
- Expedite processing of applications for extensions and changes of status for lawfully present medical residents and physicians to either begin a U.S. residency program or assume a position in an underserved area of the United States.
- Temporarily extend visas and other protected status for medical residents and physicians so that their status is not negatively impacted by the COVID-19 pandemic.
- Permit medical residents and physicians on J-1 and H-1B visas to be redeployed as needed to respond to the COVID-19 pandemic.