Novel Coronavirus (COVID-19)
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May 5, 2020 by VoterVoice

Example from Kentucky Medical Association

 
KDPH Announces Arrival of Battelle CCDS
 

May 1, 2020

The Kentucky Department for Public Health (KDPH) has announced the arrival of a Battelle CCDS (Critical Care Decontamination System) in Louisville to assist with the shortage of personal protective equipment (PPE) in light of the COVID-19 pandemic across the state.

The Battelle CCDS will provide healthcare facilities a process to decontaminate N95 or N95-equivalent respirators for reuse up to 20 times without degrading the respirator's performance. The system can decontaminate up to 80,000 N95 respirators a day. Deployment includes a complete system, logistic planning, and an onsite Battelle CCDS team to operate the system.

For more information, and to register, please visit the website: Battelle CCDS

Healthcare facilities will be provided with a procedure to collect used masks, properly bag masks, and track masks in process. This process is available to hospitals, ambulatory surgery centers, physician offices, dental offices, and others. Additionally, physicians may use this for healthcare facilities in an operational unit, even if across state lines.

Battelle CCDS, through a federally awarded contract, will provide N95 respirator decontamination at no charge to healthcare providers. KDPH has asked that physicians and facilities maximize our use of this opportunity in Kentucky and enroll facilities immediately to begin using this service the week of May 4, 2020.

A letter regarding this opportunity from Commissioner Steven Stack, M.D. is available here, and a slide with more information is available here.

CMS Increases Payments for Medicare Audio-Only Telephone Visits

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that they will be increasing payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110, and the payments are retroactive to March 1, 2020.

The American Medical Association (AMA) sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma on April 29 which included the following requests:

  1. Increase Medicare payment rates for telephone-based evaluation and management (E/M) codes (99441-99443) to bring payments for these codes equal to Medicare's established in person visit codes (99212-99214) that will ensure that patients without advanced video-sharing capabilities are able to get care virtually, while helping to sustain physician practices.
  2. Immediately provide guidance to Medicare Administrative Contractors (MACs) to ensure that recent CMS guidance and rules are followed appropriately to enable the payment of telephone E/M claims.

Provide Members of Congress with a briefing on CMS efforts to address this issue by May 8, 2020.

The AMA letter is available here.
 

Kentucky Medical Association / www.kyma.org
 

 


 

 






KMA President Brent Wright, M.D. to Appear on KET's "CORONAVIRUS: A Kentucky Update"

April 30, 2020

KMA President Brent Wright, M.D. will appear on tomorrow evening's episode of the KET program "CORONAVIRUS: A Kentucky Update." The program, hosted by Kentucky Physicians Leadership Institute graduate Wayne Tuckson, M.D., will discuss the phased reopening of the healthcare system. Dr. Wright will appear with Dr. Mark Moats of the Kentucky Dental Association. It airs at 8:30/7:30 p.m. with additional air times and online viewing available here

Kentucky Medical Students Host Blood Drive Competition

Students from the University of Kentucky College of Medicine, University of Louisville School of Medicine and the University of Pikeville Kentucky College of Medicine have organized a statewide blood drive competition in support of COVID-19 efforts called "MedMadness." The event begins May 1 and runs through May 31 through the Kentucky Blood Center. Anyone is invited to participate in the competition and support the medical school of their choice. Donation tallies will be calculated and published every Monday of the competition, with the final tally being released on Monday, June 1st. All volunteer (non-paid) donations will be considered in the competition totals. For more information about the event, please visit the Facebook event page.
 

Kentucky Medical Association / www.kyma.org
 

 


 



Kentucky-Based Laboratories Available to Run COVID-19 Tests
 

April 29, 2020

Several Kentucky-based laboratories have the capacity to run COVID-19 tests and are eager to serve the medical community and assist with the reopening of healthcare services. Public Health Commissioner Steven Stack, M.D. has requested that contact information for these labs be shared with KMA physicians.
 
Bluewater Diagnostics
Mount Washington, KY (Louisville area)
Lori Millner, PhD - Laboratory Director
lori.millner@bluewaterdxlab.com
 
Solaris Diagnostics
Nicholasville, KY (Lexington area)
Preetpal Sidhu, PhD - CEO
psidhu@solarisdx.com

BIOTAP Medical
Louisville, KY
Kristen Reynolds, PhD - COO
kreynolds@biotapmedical.com

CMS Call with ASCs and Freestanding EDs Tomorrow, April 30

The Centers for Medicare and Medicaid Services (CMS) is hosting a call for Ambulatory Surgery Centers (ASCs) and Freestanding Emergency Departments (EDs) to provide targeted updates on the agency's latest COVID-19 guidance. Agency officials will be available to answer technical and operational questions from providers on this topic.  

CMS Call with ASCs and Freestanding EDs
Thursday, April 30th at 12:00 - 1:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 4366486
Audio Webcast Link:
https://protect2.fireeye.com/url?k=bce35157-e0b65887-bce36068-0cc47a6a52de-acbb85b5ac9dc0a2&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2081
 

Kentucky Medical Association / www.kyma.org


 






KDPH Releases New Guidance on Requesting PPE

April 29, 2020

The Kentucky Department for Public Health has released a new fact sheet, available here, in response to Gov. Beshear's "Healthy at Work" initiative for the reopening of healthcare services. At this time, only emergent PPE requests to support direct COVID-19 patient care will be considered. This guidance is specific to the following PPE:

  • N95 Masks
  • Isolation Gowns
  • Face Shields
  • Surgical (Droplet Masks)
  • Examination Gloves
  • Coveralls
For more information, visit kycovid19.ky.gov.


HHS Provider Relief Fund Updates

 
  • General Allocation Program

On April 24, the Department of Health and Human Services (HHS) released a new round of funding from the $100 billion that Congress allocated to hospitals, physicians, and other health care providers in the Public Health and Social Services Emergency Fund (Provider Relief Fund).

As a reminder, on April 10, an initial $30 billion was provided to clinicians and facilities based on their proportion of Medicare fee-for-service spending in 2019. HHS is now delivering an additional $20 billion to all physicians who received payments during the first round of funding. This subsequent payment, together with the initial payment received from the first tranche, is being allocated for general distribution and will be proportional to the physician's 2018 net patient revenue, which provides greater assistance to physicians with lower volumes of Medicare patients. Payments will be sent out weekly, on a rolling basis, as information is validated, with the first wave being delivered on April 24, 2020.

KMA has produced a one-page handout, available here, for physicians regarding details about the General Allocation Program and the allocation of these funds. The information is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your practice.
 

  • Uninsured Program

In addition to the $50 billion for the General Allocation Program, another portion of the $100 billion Provider Relief Fund, known as the Uninsured Program, will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured. Physicians are eligible for this funding. Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the Uninsured Program and will be reimbursed at Medicare rates, subject to available funding. Steps will involve enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit.

Providers can register for the Uninsured Program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.
 

Congress Replenishes Loan and Grant Programs


On April 23, Congress passed a bipartisan "Interim Economic Relief" agreement that contains $480 billion in new COVID-19 funding assistance. Specifically, the legislation includes an additional $320 billion for the popular Paycheck Protection Program (PPP), after the program exhausted the original $350 billion in funding within two weeks. The PPP provides forgivable loans to physician practices to cover payroll and other operating expenses. Given the high demand for such loans, physicians are encouraged to contact their banks/lenders as soon as possible to optimize their chance for the new funding.

On April 23, Congress passed a bipartisan "Interim Economic Relief" agreement that contains $480 billion in new COVID-19 funding assistance. Specifically, the legislation includes an additional $320 billion for the popular Paycheck Protection Program (PPP), after the program exhausted the original $350 billion in funding within two weeks. The PPP provides forgivable loans to physician practices to cover payroll and other operating expenses. Given the high demand for such loans, physicians are encouraged to contact their banks/lenders as soon as possible to optimize their chance for the new funding.

The bill also adds $50 billion for the Economic Injury Disaster Loan (EIDL) program as well as another $10 billion for the EIDL Advance Grants. EIDL and EIDL Advance Grants can be used to assist physician practices with payroll expenses, accounts payable, and other operating expenses that could have been met had the disaster not occurred.

Finally, Congress allocated an additional $75 billion to the existing $100 billion designated for the U.S. Department of Health and Human Services Public Health and Social Services Emergency Fund, also known as the Provider Relief Fund. This program is specifically designed for physicians and hospitals by providing lump sum payments for healthcare-related expenses or lost revenue attributable to the coronavirus. These are funds that, like PPP monies, do not have to be repaid. HHS guidance regarding how the $75 billion will be distributed is expected in the coming days.

For more information on these and other loan/grant programs for physician practices, please visit kyma.org/covid19
 

Kentucky Medical Association / www.kyma.org






KMA COVID-19 Physician Survey Results

April 28, 2020

Last week, KMA conducted an online survey of member physicians regarding the impact of the COVID-19 pandemic on their practice and patients. The survey covered the financial impact of the crisis, changes in patient loads, and the utilization of telehealth services.

More than 300 physicians completed the survey, with nearly every corner of the state participating and a wide variety of specialties represented. Results of particular note include the dramatic increase in appointments conducted via telehealth. Approximately 74% of physicians indicated using telehealth during the pandemic, despite only 10% having used the service on a regular basis before.

KMA plans to share this information to assist with the reopening of healthcare facilities as well as through public messaging and advocacy efforts. Full summary results of the survey are available here.

Gov. Beshear Modifies Executive Order Regarding Non-Urgent/Emergent Procedures

Following the announcement that the state will begin a phased reopening of certain medical services, Gov. Andy Beshear has modified the executive order originally issued on March 14 stating that all non-urgent/emergent in-person healthcare procedures cease by close of business on March 18.

As outlined during the Governor's press conference last night, the state began a phased approach to reopening certain services on April 27, including non-urgent/emergent healthcare services, diagnostic, radiology and lab services in outpatient hospital settings, healthcare clinics and medical offices, physical therapy settings and chiropractic offices, optometrists and dental offices.
 
The full revised order is available here. More information on the phased reopening guidelines are available here.
 

Kentucky Medical Association / www.kyma.org

 









President's Message: The New Normal


April 27, 2020

This week we start anew as we pursue a fresh start in addressing the COVID-19 pandemic.  Like many of you during these last several weeks I have worked my way through various stages from disbelief and denial to anger and acceptance.  One of the most important things I have experienced during this time is the simple act of human kindness.  About a week ago, I found a note on top of my trash can as I was preparing to roll it back to our home.  The note said, "Doctor Wright, Thank you for all you do and to all the other Dr.'s: stay safe."

That simple note and act of caring helped to provide focus.  We did not cause this crisis, we are only required to respond and solve it.  In these efforts we find our true strength as physicians by utilizing our knowledge, caring, and resilience to serve humanity in the unique ways in which we are trained.  And as we serve humanity, we cannot forget how tightly linked we all are in the roles we fulfill and how we serve each other in countless ways that are often taken for granted until a moment when they may cease to exist.

Many challenges await us in the months ahead.  We will continue to utilize technology through telemedicine to protect some of the most vulnerable patients among us.  We will learn everything there is to know about this novel corona virus in an effort to keep our patients, communities, and fellow healthcare workers safe from its most devastating effect. And we will help to lead a healthcare system that needs to embrace health as a paramount defense to both present and future threats to our well-being.

While we work to explore and create this new normal, I encourage you to share your thoughts, ideas, and hopes with your KMA.  Over the coming weeks, KMA will be developing public service announcements that will help patients in returning to their doctor's offices just as we have helped physician offices in connecting to the resources they need in preparing for this next phase in care delivery.  I encourage you to avoid fear in the days ahead and become reinvigorated in the service that binds us together, caring for patients.

Administration Releases Additional Healthcare Reopening Guidelines

This afternoon, Public Health Commissioner Steven Stack, M.D. outlined more details on requirements for various phases of the reopening of healthcare services.

For all phases of reopening, providers and facilities must:

  • Use telemedicine/telework instead of in-person whenever possible
  • Fever and COVID-19 screening prior to entry into healthcare facility
  • Discontinue use of traditional waiting rooms/common areas
    • Use non-traditional options, e.g. wait in car, call ahead registration, etc.
    • Use modifications to ensure social distancing > 6 feet and/or physical barriers
    • Universal masking for all persons for all direct person-person contact
    • Enhanced sanitizing and disinfecting; hand sanitizer stations available
    • Providers must procure PPE through commercial routes
    • No visitors except end-of-life and assisting vulnerable populations
    • All phases subject to delay or rollback if COVID-19 surge requires

For Phase I reopening, which began today, April 27:
  • Resume non-emergent/non-urgent outpatient healthcare services, including diagnostic laboratory services
  • Includes:
    • 'High-touch' settings (e.g. physical therapy, chiropractic) with enhanced PPE including gloves and eye protection for direct patient manipulation
    • 'High-aerosol' settings (e.g. dentistry, oral surgery, anesthesia, pulmonary) with enhanced aerosol mitigation proposed by their professional associations
    • Non-emergent/non-urgent surgical and invasive procedures are not included in this phase

For Phase II reopening, which begins Wednesday, May 6:
  • Outpatient/ambulatory surgery and invasive procedures may resume
  • All patients must have COVID-19 pre-procedure testing per professional association and KDPH guidance
  • Each facility must maintain 14-day supply of all necessary PPE based on a projected 14-day burn rate for facility
  • Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
  • For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

For Phase III reopening, which begins Wednesday, May 13:
  • Non-emergent/non-urgent inpatient surgery and procedures may resume at 50% shutdown volume
  • All surgical/procedural patients must have COVID-19 pre-procedure testing per professional guidelines consistent with KDPH guidance
  • Each facility must maintain 14-day supply of all necessary PPE based on a projected 14-day burn rate for facility
  • Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
  • For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

For Phase IV reopening, which begins Wednesday, May 27:
  • Non-emergent/non-urgent inpatient surgery and procedures may resume at volume determined by each facility
  • All patients must have COVID-19 pre-procedure testing per professional guidelines consistent with KDPH guidance
  • Each facility must maintain 14-day supply of all necessary PPE based on a projected 14-day burn rate for facility
  • Type and timing of cases determined by facility-specific procedure prioritization and oversight committee
  • For acute care hospitals, maintain at least 30% bed capacity, per facility surge plan, in both ICU and total beds for COVID-19 patients

More information and the slide deck from today's press conference will be made available this evening at kycovid19.ky.gov.

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it 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.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the COVID-19 pandemic. Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund.
 

Additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

Kentucky Medical Association / www.kyma.org





Reminder: Guidelines for Reopening Healthcare Services; Services Can Begin Monday, April 27

April 24, 2020

Last evening, Kentucky Public Health Commissioner Steven Stack, M.D. outlined the administration's guidelines for reopening certain medical services and healthcare facilities. The first phase of reopening, which begins Monday, April 27, will include non-urgent/emergent healthcare services, diagnostic, radiology and lab services in outpatient hospital settings, healthcare clinics and medical offices, physical therapy settings and chiropractic offices, optometrists and dental offices (although with enhanced aerosol protections).

The phased, gradual reopening process may be adjusted should a COVID-19 surge occur. Dr. Stack also stressed that telehealth should continue to be utilized as much as possible. Additional requirements include:
 

  • No visitors, except when necessary for end-of-life, vulnerable populations, minors, etc., and then only to minimum essential extent.
  • Eliminate traditional waiting rooms/common areas and use non-traditional alternatives, such as a "parking lot lobby."
  • Maintain social distancing in all settings and install plexiglass barriers when possible.
  • Screen all healthcare workers, patients and others for temperature and COVID-19 symptoms upon arrival. Sick staff should be required to stay home.
  • Plan for enhanced workplace sanitizing.
  • Plan for and ensure enhanced hand hygiene compliance.
  • Provide easily accessible hand sanitizer throughout the office/building.
  • Each healthcare setting must be able to procure necessary PPE via normal supply chains.

Specific guidance was also outlined in regards to masks:
  • All healthcare providers and staff must wear surgical/procedural masks while in healthcare office/facility.
  • All patients and other persons in healthcare office/facility must:
    • Wear a surgical/procedural mask while in an acute care hospital or ambulatory surgical center.
    • Wear either a surgical/procedural mask or cloth mask/face covering in all other healthcare settings.

The slide deck utilized during the press conference is available here

No additional guidance was released during the press conference this evening.
 
Kentucky Medical Association / www.kyma.org

 




Reminder: KMA COVID-19 Physician Survey Closes Tonight 

April 24, 2020

 

“Please complete the KMA COVID-19 physician survey if you haven’t already. Survey closes tonight at 5pm ET: https://www.surveymonkey.com/r/KMACOVID
 

Kentucky Medical Association / www.kyma.org





Administration Releases Guidelines for Reopening Healthcare Services


April 23, 2020
 

This evening, Kentucky Public Health Commissioner Steven Stack, M.D. outlined the administration's guidelines for reopening certain medical services and healthcare facilities. The first phase of reopening, which begins Monday, April 27, will include non-urgent/emergent healthcare services, diagnostic, radiology and lab services in outpatient hospital settings, healthcare clinics and medical offices, physical therapy settings and chiropractic offices, optometrists and dental offices (although with enhanced aerosol protections).
 
The phased, gradual reopening process may be adjusted should a COVID-19 surge occur. Dr. Stack also stressed that telehealth should continue to be utilized as much as possible. Additional requirements include:

 
  • No visitors, except when necessary for end-of-life, vulnerable populations, minors, etc., and then only to minimum essential extent.
  • Eliminate traditional waiting rooms/common areas and use non-traditional alternatives, such as a "parking lot lobby."
  • Maintain social distancing in all settings and install plexiglass barriers when possible.
  • Screen all healthcare workers, patients and others for temperature and COVID-19 symptoms upon arrival. Sick staff should be required to stay home.
  • Plan for enhanced workplace sanitizing.
  • Plan for and ensure enhanced hand hygiene compliance.
  • Provide easily accessible hand sanitizer throughout the office/building.
  • Each healthcare setting must be able to procure necessary PPE via normal supply chains.


Specific guidance was also outlined in regards to masks:
 
  • All healthcare providers and staff must wear surgical/procedural masks while in healthcare office/facility.
  • All patients and other persons in healthcare office/facility must:
    • Wear a surgical/procedural mask while in an acute care hospital or ambulatory surgical center.
    • Wear either a surgical/procedural mask or cloth mask/face covering in all other healthcare settings.


The slide deck utilized during the press conference, as well as written guidance, will be made available this evening at kycovid19.ky.gov.
 

KMA Submits Recommendations to Administration for Physician Offices

 

This morning KMA submitted recommendations to Public Health Commissioner Steven Stack, M.D. regarding the reopening of physician offices, a number of which were included in the guidance released this afternoon for Phase I. Dr. Stack thanked KMA during the press conference for providing valuable feedback and input.
 
The recommendations emphasize the continuation of telehealth services and suggest that changes made to the service by insurers and CMS be continued. Preliminary results from KMA's physician survey have indicated that while 88% of respondents had not used telemedicine prior to the COVID-19 pandemic, 51% of physicians now say they will continue to use telemedicine, and that less than 6% of patients had an unfavorable opinion of it. The guidelines strongly suggest that for telemedicine to continue and become more widely accepted and improved, the recent regulatory and reimbursement changes should be made permanent.

 

Please Complete: COVID-19 Physician Survey

 

KMA has created a survey for physicians regarding several aspects of the COVID-19 pandemic and its impact on practices and patient care. The short, multiple choice survey can be completed anonymously if preferred and should take less than 5 minutes to finish. KMA will share the results of the survey with members.
 
If you have not already, please take a few minutes and complete the survey here. The survey will be available until Friday, April 24 at 5 p.m. ET.

 



SPECIAL ALERT - Gov. Beshear Announces Medical Offices, Some Healthcare Services to Reopen Monday

April 22, 2020

 

Gov. Beshear announced this evening the administration is finalizing plans to reopen certain healthcare services beginning Monday, April 27. The services allowed to reopen during the first phase of the plan include diagnostic, radiology, non-urgent, emergent, in-person, office and ambulatory visits, as well as pre-anesthesia testing services.

Gov. Beshear indicated that the second phase would include outpatient and ambulatory procedures, which he hopes could restart in the next few weeks. He also cautioned that some elements of appointments would need to be adjusted to adhere to social distancing guidelines, such as patient waiting rooms.

KMA will provide more details to members as they become available.
 


 

Healthy at Work: Submit Proposals for Reopening Businesses

 

April 22, 2020

Gov. Beshear on Tuesday announced the Healthy at Work initiative, which is a phased approach to reopening Kentucky's economy.

Healthy at Work is based on criteria set by public health experts and advice from industry experts. Phase 1 is a state-readiness evaluation. Phase 2 is an individual business-readiness evaluation.

During Phase 2 of Healthy at Work, the Department for Public Health will evaluate individual businesses' ability to safely reopen. Businesses closed due to COVID-19 may begin submitting reopen proposals via the online reopen application. The Department for Public Health will evaluate these proposals based on White House guidelines and other government benchmarks.

For questions and additional information, please email HealthyAtWork@ky.gov.
 

Reminder: COVID-19 and Healthcare Providers: Relief, Business and Employment Concerns Online Enduring CME Activity


An online CME opportunity is now available from KMA and McBrayer, PLLC for physicians that provides a comprehensive explanation of the provisions of the CARES Act and the Families First Coronavirus Response Act. The activity details how these two new laws and guidance from the Centers for Medicare and Medicaid Services and the Department of Labor affect healthcare organizations as businesses, employers, and providers of healthcare and emergency response.

For more information and to complete the activity, click here.

 

Please Complete: COVID-19 Physician Survey


KMA has created a survey for physicians regarding a number of aspects of the COVID-19 pandemic and its impact on practices and patient care. The short, multiple choice survey can be completed anonymously if preferred and should take less than 5 minutes to finish. KMA will share the results of the survey with members.

If you have not already, please take a few minutes and complete the survey here

 


 

KDPH Clinician Webinar
 

April 21, 2020
 

The Kentucky Department for Public Health (KDPH) will be offering an update for healthcare providers on the COVID-19 situation in Kentucky via webinar on Thursday, April 23 at 11:30 a.m. ET.  The update will cover topics such as:

  • Current situation in Kentucky and nationally
  • Healthcare issues for both hospitals and long-term care facilities
  • Return-to-work policies for healthcare workers
  • Resources for facilities experiencing outbreaks
  • Testing issues, including rapid tests and serologic assay issues
  • Mental health support resources for patients and healthcare staff in crisis situations
  • Additional relevant topics
 

Registration is available here:https://attendee.gotowebinar.com/register/1799639257295780364
After registering, you will receive a confirmation email containing information about joining the webinar.

All registrants will receive a video archive of the webinar along with a copy of any slides. A question and answer session will be covered at the end of the presentation.
 

Please Complete: COVID-19 Physician Survey


KMA has created a survey for physicians regarding a number of aspects of the COVID-19 pandemic and its impact on practices and patient care. The short, multiple choice survey can be completed anonymously if preferred and should take less than 5 minutes to finish. KMA will share the results of the survey with members.

If you have not already, please take a few minutes and complete the survey here.
 

COVID-19 Telehealth Program


The Federal Communications Commission (FCC) COVID-19 Telehealth Program will provide immediate support to eligible health care providers by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services until the program's funds have been expended or the COVID-19 pandemic has ended.

The COVID-19 Telehealth Program order, released by the FCC on April 2, is available here. An overview of the program and the application is available here.

 



Please Complete: COVID-19 Physician Survey

 

April 20, 2020
 

KMA has created a survey for physicians regarding a number of aspects of the COVID-19 pandemic and its impact on practices and patient care. The short, multiple choice survey can be completed anonymously if preferred and should take less than 5 minutes to finish. KMA will share the results of the survey with members.

Please take a few minutes and complete the survey here.
 

In Your Own Words: Leslie Schwindel, M.D.


KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.

I have a general orthopedic practice, so I see everything from kids with broken arms to elderly with hip fractures and elective surgeries like joint replacements and carpal tunnel surgeries. Right now, we're not doing any elective procedures. Our clinic is probably a third of our regular volume. We're just seeing people with acute injuries, fractures, and people in severe pain──things that really can't wait. Anything elective is being pushed out at least a month or two.

It's really impacted the patients more than me. I've been lucky enough that I can still come to work every day, even if it's reduced hours. I can still get out of the house and do something every day, which has been a blessing.

 


We diagnosed the first COVID-19 case in Kentucky. I think maybe the first seven or so were from our county. Since then, it's really kind of calmed down here. Our hospital was probably a week or two ahead of most in the state as far as shutting things down and taking precautions.


We also have a cough clinic. I don't know if anywhere else in the state is doing that. Every day from about 1 or 2 p.m. until 8 p.m., we have a special clinic where people can walk in if they have symptoms they're concerned about and want to be screened. That way they can determine is it allergies, is it a cold, is it strep, or do we really need to be testing for COVID? They have a special entrance away from the hospital where they can come in. There's a special staff there. Everything's isolated so they're not exposed to the general population.

It's been nice to keep some of those people out of the ER or away from other people who are healthy and maybe they're not very symptomatic yet, but they can be screened. If they need to be admitted or sent to the ER, then they can.

I've been very impressed with how we've handled things. Our CEO is a former nurse. She's not just an administrator. She really gets the patient care side and the medical side. She's been very proactive. The day after this happened, we started spreading out all the chairs in the waiting room six feet apart, no visitors are allowed in the hospital and anybody who comes in gets their temperature screened. We've been taking our temperatures every day for three or four weeks now.

 

It concerns me that our population in Kentucky is not always the healthiest. I worry that if people aren't really cognizant of social distancing, how bad it could get here. With our hospital administrators and our governor, we've had really excellent guidance──probably one of the best responses in the country on keeping everybody healthy and socially distant. I've been really proud on how our state's handled that.

I know people want to open the state back up soon, and I think there may be a role for that, but if we're not careful about how we do it, things could get worse and that worries me a little bit.
 


Coronavirus Economic Stabilization Act's Main Street Lending Program

 

April 17, 2020
 

The Coronavirus Aid, Relief, and Economic Security (CARES) Act established or expanded several programs to assist businesses, including physician practices, that have been severely impacted by the COVID-19 emergency. A subpart of the CARES Act is the Coronavirus Economic Stabilization Act (CESA), which is designed to provide $454 billion in financing to banks and other lenders to make direct loans to businesses.By using a portion of the funds provided by CESA, the U.S. Department of the Treasury and Federal Reserve Board have created the Main Street New Lending Facility (MSNLF), which provides new loans for eligible small to midsize businesses.
 

KMA has created a guide to the program, available here, as an informational resource for members. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. Physicians should consult with their tax professional to determine if these benefits or others apply to their practice.
 

Gov. Beshear Outlines Guidelines for Reopening Economy


In close step with guidelines issued by the White House yesterday, Gov. Beshear today outlined the benchmarks Kentucky is adopting toward reopening the state's economy. The prerequisites include:

  • A 14-day downward trend in the rate of new COVID-19 cases
  • Increased testing and contact tracing capacity
  • Availability of personal protective equipment (PPE)
  • Ability to protect at-risk populations
  • Ability to social distance and follow Centers for Disease Control (CDC) guidelines on large gatherings
  • Preparedness for a possible future spike in cases
  • Status of a vaccine or effective treatment
 

Gov. Beshear indicated that he hoped some health care services could resume as early as late April or early May, but did not give a specific date.

The guidelines issued by the White House are available here.

 

"CORONAVIRUS: A Kentucky Update"


KMA begins sponsorship of the KET program "CORONAVIRUS: A Kentucky Update" beginning tonight at 7:30/8:30 p.m. The program, hosted by Kentucky Physicians Leadership Institute graduate Wayne Tuckson, M.D., will air each Friday through May 8, and also includes a town-hall style forum that airs April 20. The Association will receive two 15 second spots at the beginning and end of each program.
 

Submit Your Story for KMA's "In Your Own Words"


KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic through its Member News Alerts, on social media, and at kyma.org/covid19. KMA is currently calling for additional submissions. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.



Employee Retention Credit

 

April 16, 2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act established or expanded several programs to assist small businesses, including physician practices, that have been severely impacted by the COVID-19 emergency. The Employee Retention Credit is designed to encourage employers to keep employees on their payroll, despite experiencing economic hardship related to COVID-19.

KMA has created a one-page guide to this program, available here, as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. Physicians should consult with their tax professional to determine if these benefits or others apply to their practice.

 

KMA Releases New Telehealth Radio PSA


KMA has released a new 30 second public service announcement (PSA) that promotes the benefits of telehealth services during the COVID-19 pandemic. The PSA explains that many insurers have relaxed policies on telehealth and encourages patients to talk to their insurer and physicians about utilizing these services. The ad is currently being distributed to radio stations around the state and is currently running in Murray, Cadiz, Owensboro and Bowling Green, with more pickup expected. The ad can be heard here.
 

KMA to Sponsor KET's "CORONAVIRUS: A Kentucky Update"


KMA will sponsor the KET program "CORONAVIRUS: A Kentucky Update" on four Fridays beginning tomorrow, April 17 through May 8. The program begins at 8:30/7:30 p.m. and is hosted by Kentucky Physicians Leadership Institute graduate Wayne Tuckson, M.D. KMA will also sponsor a KET town-hall style forum that airs April 20.The Association will receive two 15 second spots at the beginning and end of each program, which will also be shown in re-airings a total of 33 times.




Economic Injury Disaster Loan & Emergency Advance

 

April 15, 2020


The Coronavirus Aid, Relief, and Economic Security (CARES) Act established or expanded several loan programs to assist small businesses, including physician practices, that have been severely impacted by the COVID-19 emergency. The Economic Injury Disaster Loan (EIDL) and the corresponding EIDL Emergency Advance can be used to assist practices with payroll expenses, accounts payable, and other operating expenses that could have been met had the disaster not occurred.
 
KMA has created a one-page guide, available here, on this program as a resource for physicians. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice.

 

Telehealth and Other Virtual Care Documentation Reminders During COVID-19


Medicare, Medicaid, and commercial insurers continue to announce new flexibilities and expand telehealth coverage in response to the COVID-19 emergency. While telehealth services have expanded rapidly, the documentation requirements for any form of virtual care (telehealth service or non-telehealth digital online service) remain the same as those for documenting in-person care.
 
KMA has created a reference handout, available here, with reminders and resources for physicians when billing for telehealth.

In addition, KMA's COVID-19 website contains information on the new telehealth guidance by payor, as well as the various financial resources available to physicians through the grant and loan programs established or expanded by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Coronavirus Economic Stabilization Act (CESA).

 

In Your Own Words: Monalisa Tailor, M.D.


KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.

The weekend of March 15th, 2020, I will not forget it. Maybe it was the conversation on the Facebook Louisville Lady Doc group or maybe it was the realization of what was happening in Italy hitting all at once. The world had changed. Things would not be the same.

That following week was a roller coaster as an outpatient physician. No more handshakes and having routine conversations about physicals, preventative care, and hypertension. On Wednesday, March 18th, I saw a lady for "sore throat, chills, lethargy." She said her symptoms started 3 days ago. She was having chills at night and coughing. My patient is typically very well dressed with jewelry to match her beautiful clothes. The part of her story that struck me: "I got winded getting dressed for today's appointment. I had to sit down and collect myself before I came to see you." That did not fit. This was not a typical sinus infection. This was not bronchitis. This was something different. My voice quivered, "I think you have it."

I spent the next 15 minutes shaking while putting together a plan for my patient and instructions for isolation. The worst feeling of helplessness for an internist is being unable to offer a definitive treatment for a patient. That's how I felt. I was throwing things at her and hoping something would stick. I went back to talk to her about a plan and answered her questions. Her final question to me, "Am I your first?" My eyes gave me away, "Yes ma'am." I knew she would not be my last. I went home that day and cried. I just hoped I could do the best for her to manage at home so she would not have to go to the hospital. I continue to carry that same hope for my patients who are suffering from COVID-19.


 

Small Business Administration Paycheck Protection Program


April 14, 2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $350 billion to help small businesses, including physician practices, keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program (PPP), this Small Business Administration (SBA) initiative provides 100% federally guaranteed and forgivable loans to small businesses.

KMA has produced a guide to this program as a resource for physicians, available here. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice.

For additional information regarding the PPP loan, please visit the Small Business Administration and the U.S. Treasury Department.

KMA is providing members with resources related to physician financial health during the COVID-19 pandemic. To view and download these guides, please visit kyma.org/covid19.

 

CMS Announces Expanded Coverage for Essential Diagnostic Services


The Centers for Medicare & Medicaid Services (CMS), together with the Departments of Labor and the Treasury, has issued additional guidance on coverage of COVID-19. Diagnostic testing and certain other related services, including antibody testing, will be covered at no cost. This guidance implements the recently enacted Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which requires that private health issuers and employer group health plans cover COVID-19 testing and certain related items and services furnished during the COVID-19 pandemic, with no out-of-pocket expenses.

For additional information and to read the full release from CMS, click here.

 


 

Public Health and Social Services Emergency Fund


April 13, 2020
 

The CARES Act includes relief to health care providers, including physician practices, who are suffering financial loss due to COVID-19 by designating $100 billion funding for the Department of Health and Human Services (HHS) Public Health and Social Services Emergency Fund. 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.
 

KMA has produced a one-page handout, available here, for physicians regarding details about the allocation of these funds. The information is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice.
 

CGS Webinar on Accelerated/Advance Payment Program


CGS Administrators, LLC (CGS), which provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in a number of states, including Kentucky, will host a webinar on the Accelerated/Advance Medicare Payment Program tomorrow, April 14 at 1:00 p.m. (ET). CMS has expanded the current Accelerated and Advance Payment Program during the COVID-19 public health emergency to extend financial hardship relief to impacted Medicare Part A Providers, and Part B Providers/Suppliers. CGS staff will provide an overview of this expansion, provide step by step instructions and address questions. Registration is available online at https://register.gotowebinar.com/register/7098879583080721932.

Last week, KMA released an informational resource, available here, regarding what physicians need to know about the Accelerated and Advance Payment Program process.

 

In Your Own Words: Mark Brockman Jr., M.D. and Molly Maggard Brockman, M.D.


KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.

As a physician couple, my wife Molly and I have been through some uncertain and stressful times together. We met nine years ago in medical school and survived the stressors on our relationship that only fellow physicians would understand: surviving Step One (and two and three), couple's matching, the crazy schedules, the stress of residencies, and passing boards. But we got through it all, together, and our marriage emerged stronger than ever.

We were looking forward to settling into our lives as community physicians in the Louisville area and finally doing things that normal couples get to do. But now we're faced with the most uncertain and trying time of our career: our first (and hopefully last) pandemic as a pediatrician and med/peds physician.
 
These past few months have left me wondering where we will be when the smoke clears. We all see the news of front-line workers helping our communities, sometimes at the sacrifice of their own personal protection. Currently, we're on the hospitalist reserve list for potentially being pulled to those front lines, but for now, in the outpatient world, our view is very different.

Honestly, I still had influenza and RSV on my mind when we started talking about COVID-19 coming to Kentucky. As the days went on, I began to receive texts and calls from friends and family and countless patient questions about my opinion on the matter. It's frustrating when you studied so hard in your career to obtain knowledge about various diseases and feel so clueless about such a societal dismantling virus. Our community and patients look to us to offer knowledge and guidance. I find myself saying, "I don't know" when asked how long this will last or how the virus impacts child safety. Learning how to direct a discussion about COVID-19 to certain age groups has been challenging. We've both added time to our visits for extra conversation.

Although the CDC and NIH provide good information, the talks with my wife at the dinner table are perhaps the most helpful. We exchange articles we've read about the epidemiology, the ever-evolving knowledge of the pathophysiology, and possible treatments. Our texts used to consist of funny memes but now are an exchange of medical articles that offer more insight.
 
Right now, I can't image not having a partner that knows exactly how exhausting it is for a primary care doctor right now; adapting to the ever-changing policies and CDC updates, fielding calls from family and friends, trying to comfort anxious patients while simultaneously wondering if things really are going to be okay. I'll never forget the 7-year-old girl in my office, clinching a handful of masks to take back home to "protect her family." Now, our protective gear is stashed away, only to be used judiciously.

We've both been impressed with how quickly our practices have adapted schedules and implemented new policies. As with most primary care offices, we've seen a decline in patient numbers. This brings up so many questions: Are people staying home with things they normally need to come in for? Are kids not spreading germs with the new social restrictions in place? Are the decreased office visits hurting patients in the long run? What's happening to routine vaccine schedules, antibiotic stewardship, and patients with uncontrolled chronic illness during this time? Will we eventually see a primary care surge after COVID-19 dies down to catch up on what has been put off during this quarantine time? Will we see a surge of COVID patients?

One thing is for sure, offices have changed rapidly. To save PPE, physicians have been triaging and obtaining vitals and labs on all sick patients. Molly, also being an internist, has had many patients hospitalized and a death due to COVID-19. We have been chart-checking more from home as the amount of inbox messages have increased. This brings up a new challenge of triaging potentially sick patients through messages and phone calls because they do not want to come into the office. We've also implemented telemedicine at the office and, possibly soon, telemedicine from home. Hopefully, the patients won't mind my hound dogs howling at the barn cats in the background

As each day brings new changes and new challenges, Molly and I, like the rest of the world, will continue to adapt. Thankfully, our residency training perfects that "sink or swim" mentality, which is coming in handy now. We'll continue to provide the best care we can for our patients and come home at the end of the day to care of each other, just as we have since medical school. I have no doubt this experience will have an ever-lasting impact on our careers, and we will be better physicians because of it.


 

Requesting Personal Protective Equipment (PPE) Through the State Emergency Operations Center

April 10, 2020
 

The Kentucky Department for Public Health has distributed a fact sheet that provides guidance on how to request Personal Protective Equipment (PPE) through the State Emergency Operations Center (SEOC) in support of health and medical operations during the response to COVID-19. This guidance is specific to the following PPE:

  • N95 Masks

  • Isolation Gowns

  • Face Shields

  • Surgical (Droplet Masks)

  • Examination Gloves

  • Coveralls

 

The guidance includes the reporting requirements and request process and stipulations related to the review, approval allocation and distribution of PPE. The fact sheet is available here.
 

CARES Act Emergency Fund Disbursements
 

This morning the Department of Health and Human Services (HHS) announced the immediate disbursement of the first $30 billion out of the $100 billion that Congress allocated to hospitals, physicians and other health care providers in the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act.
 
This initial $30 billion is being directed to all hospitals and physician practices that billed Medicare fee-for-service (FFS) in 2019, and disbursements will be in direct proportion to the health care provider's share of total Medicare FFS reimbursements for that year. Priority for the first $30 billion will be given to providers that care for a large share of Medicare patients. A second disbursement is expected soon that will target providers that do not have high-volumes of Medicare patients as well as providers in COVID-19 hotspots.
 
These are grants, not loans, and do not have to be repaid. An application is not required to receive the funding. Note that the funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description. The funds may be used either for health care related expenses or for lost revenues that are attributable to coronavirus.
 
Additional details about the allocation are available at: https://www.hhs.gov/provider-relief/index.html
 
This website also includes a link to Terms and Conditions for receipt of the funds that each organization receiving the grants will need to attest to within 30 days of receiving the grant. As a part of the Terms and Conditions, physicians must attest that they will not give any surprise medical bills to COVID-19 patients.


 

Physician Resource: Accelerated and Advance Payment Program for Medicare Providers

 

April 9, 2020

In response to the COVID-19 pandemic, The Centers for Medicare and Medicaid Services (CMS) will provide accelerated payments to requesting providers and advance payments to requesting suppliers, including physicians and non-physician practitioners, who submit a request to the appropriate Medicare Administrative Contractor (MAC).
 
KMA has compiled an informational resource, available here, regarding what physicians need to know about this process. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice.

 

Medical Student Volunteers to Deploy as Part of COVID-19 Relief Efforts

 

A team of four third-year medical students who registered to serve as volunteers for COVID-19 efforts are being deployed to Kentucky Dam Village in Gilbertsville today.
 
The volunteers will be housed at the state park and will be helping to treat COVID-19 patients in the surrounding community.
 
Kentucky Public Health Commissioner Steven Stack, M.D. made the announcement during yesterday's address from Gov. Beshear. KMA assisted Dr. Stack with the solicitation of medical student volunteers late last month. More than half of the state's 600 medical students registered to serve as volunteers during the outbreak.

 



KMA Signs on to Letter Urging Relief for Physicians Through CARES Act

 

April 8, 2020
 

KMA, the American Medical Association (AMA) and other healthcare organizations have signed on to a letter to Department of Health and Human Services (HHS) Secretary Alex Azar urging HHS to provide one month of revenue to each physician (MD or DO), nurse practitioner, and physician assistant enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses as reimbursement for losses experienced during the COVID-19 pandemic.
 
The Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act requires HHS to interpret eligibility for the funding. The letter outlines a number of hardships physician practices are experiencing during this time and asks that HHS use an individual's average monthly payment amount from October-December 2019 as the basis for determining pre-pandemic monthly revenue.
 
The full letter is available here.

 

In Your Own Words: Neal Moser, M.D.

 

KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/COVID-19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.

As with others across the state, we have ramped up preparations for increasing numbers of patients with respiratory failure. The hospital system has been very supportive, creating COVID-19 treatment wards and intensive care units. As patients enter the system with suspected COVID-19 infection they are cohorted in negative pressure rooms located on designated floors. One hospital of four in our system has been converted with negative pressure isolation rooms to handle the load. Our ICU admissions and ventilator use is increasing daily with several deaths due to ARDS associated COVID-19 infection.  We have doubled our ventilator capacity by including operating room equipment and advanced bilevel devices via ett for non-COVID-19 patients. 
 
Our group of 11 pulmonary critical care physicians and four nurse practitioners have created a schedule to redeploy wherever there is a need. We have purposely built in off time to allow decompression. All of the outpatient work via video or telephone protocols. Our hope is that the influx of new patients will be spread out and plateaued so our system can handle the volume. Our paramount concern is having staff exposed, quarantined, or infected. Several physicians and dozens or staff are now off work thus reducing the systems total capacity.
 
The interaction with colleagues several weeks ahead of us in Italy, New York, Detroit, and Seattle has been invaluable. The AMA resources have been up to the minute whether it be medical or practice management.  We have active almost hourly exchanges amongst our group with the latest data, updates, tips and tricks. Communication and support is key to weathering this pandemic over the next few months. We are now having 1-2x/week Webex meeting amongst 150+ colleagues in the greater Cincinnati area. I am truly impressed by the regional organization and response to this medical emergency.

 



Kentucky Department for Public Health COVID-19 Resources

 

April 7, 2020
 

As of April 6, the Kentucky Department for Public Health (KDPH) has confirmed 1,008 positive cases of COVID-19 and has tested 19,955 Kentuckians. The official KDPH COVID-19 webpage, available here, includes these updated totals as of 5pm ET each day. The site also contains a map of confirmed cases by county, as well as information on telehealth and donating personal protective equipment (PPE).
 

In Your Own Words: Mark Schroer, M.D.

 

KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.
 
KMA spoke to Mark Schroer, M.D., Internal Medicine Specialist, Newport, regarding his experience.

As I walk to the office each morning it feels like the beginning of a bad detective novel.  "The streets were quiet. Too quiet. I could tell something bad was about to happen." Only this time a shot doesn't "ring out" and the silence is real. Reality is often blunt and harsh and, in some ways, boring. The quiet in my town is all of that. The silence is unsettling. I don't like it. I feel like the silence is urging me to do something. Or is the silence trying to teach me something. I don't know. The media is calling health care workers heroes. Rightfully so. Shouldn't I be doing something heroic? So what do I do? I wait and prepare.
 
COVID-19 hasn't hit my community like others. The hospital census is low and everyone is staying inside. I've only treated one patient with COVID-19 and that was in a nursing home. Every morning I read the latest medical journal on MERS, SARS and SARS-COV-2. I even got out my old pharmacology textbook and studied the anti-viral drugs for AIDS. I'm not busy at the moment. I essentially closed my office for the first week of March. I saw maybe one or two acute patients a day. I thought the sooner we all stay home the sooner this will all be over. Then I noticed something. The office phone rang and rang and rang again. I opened the office back up. Because I discovered COVID-19 or no COVID-19 life goes on and people still need help. A man gashed his foot, gangrene settled in, and needed an amputation. A woman had the agonizing pain of cervical disc disease. Another had a wound dehiscence from a recent surgery. All the rest have "anxiety disorder." Worry - that is the disease of the day. "Will I get sick?" "Will I have a job?" "Can I visit my parents?" They want to share what they are worried about. I feel humbled that my patients feel they can share that with me, their doctor. Some need their wounds bound but most just need comfort. It's not much different from what I did in the "pre-epidemic era." Listening. Reassuring. Comforting.
 
So I am not doing anything heroic. I'm not managing a vent or deciding on a dose of chloroquine. I'm continuing my work-a-day activities. I am still waiting and preparing for the onslaught I hope never comes. And as the silence urges me to do better, I realize that doing the best job I can as a doctor is heroic enough. That's the great lesson from the silence I'll take during the Great COVID-19 Epidemic.

 

Reminder: Online CME Activity Available on CARES Act and Families First Coronavirus Response Act

 

An online CME opportunity is now available from KMA and McBrayer, PLLC for physicians that provides a comprehensive explanation of the provisions of the CARES Act and the Families First Coronavirus Response Act. The activity details how these two new laws and guidance from the Centers for Medicare and Medicaid Services and the Department of Labor affect healthcare organizations as businesses, employers, and providers of healthcare and emergency response.

For more information and to complete the activity, click
here.
 


 

COVID-19 and Healthcare Providers: Relief, Business and Employment Concerns Online Enduring CME Activity

 

April 6, 2020
 

An online CME opportunity is now available from KMA and McBrayer, PLLC for physicians that provides a comprehensive explanation of the provisions of the CARES Act and the Families First Coronavirus Response Act. The activity details how these two new laws and guidance from the Centers for Medicare and Medicaid Services and the Department of Labor affect healthcare organizations as businesses, employers, and providers of healthcare and emergency response.
 
For more information and to complete the activity, click here
.
 

In Your Own Words: Emily Miller, M.D.
 

KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.
 
I mentally prepare for my first hospital shift since the pandemic started. My hands skip over the neatly hung professional clothes and quickly pull scrubs from a pile. I tie my hair back into a ponytail. This feels so foreign. I try to calm the anxiety as I kiss everyone goodbye. I drink my coffee quickly; I don't want to risk taking it into the hospital. I mute WFPL's morning report - I feel like the weight of it will break me this morning. I recall the last few week's events in silence.
 
As a Neonatal Medicine fellow just three months from graduation, my family of six was gearing up for big life changes - new job, new city, new house - when my husband and I suddenly found ourselves homeschooling our older two children and our income cut in half due to my husband's abrupt furlough. With daycare also closed, I found myself hoarding moments with my children, time that had been precisely rationed for sports practices, Girl Scout meetings, and birthday parties. But now the moments are abundant - early morning coffee on the back porch with my rosy-cheeked eleven-month-old; a front-yard bouquet of flowers from my rambunctious three-year-old; watching my anxious six-year-old ride her bike without training wheels for the first time.
 
I take one last, deep breath. I won't take my mask off for the next twenty-eight hours as I rush premature infants away from their intubated mothers. Some families will be separated for weeks due to quarantine restrictions. I pray there will be no deaths. Tomorrow I will be exhausted, but content. I am unspeakably grateful to be part of this battle. I am terrified for the day I lose a colleague in the fight. I am overwhelmed with the magnitude of it all. And I am ready and willing pull out another pair of scrubs and do it all again the next day.

 

CARES Act: Programs and Resources for Physicians
 

The recently enacted "Coronavirus Aid, Relief, and Economic Security (CARES) Act" includes several significant programs and resources that benefit physicians and physician practices. The American Medical Association has provided information and links to resources about programs that are or will soon be available through the Small Business Administration (SBA) and Department of Treasury, as well as some additional tax provisions intended to assist physicians immediately. More information on how to apply for a small business loan is available on the SBA's Coronavirus (COVID-19): Small Business Guidance & Loan Resources website and at the U.S. Department of Treasury’s website.
 
The CARES Act established or expanded several loan programs intended to provide liquidity to businesses, including physician practices: (1) the Paycheck Protection Program (PPP) for small businesses; (2) the Coronavirus Economic Stabilization Act (CESA), which authorizes the Secretary of the Treasury to make loans, loan guarantees, other investments, and subsidies to provide liquidity for mid-size businesses between 500 and 10,000 employees for losses incurred as a result of coronavirus; (3) Emergency Economic Injury Disaster Loans (EIDL); and (4) the Small Business Debt Relief Program.
More information, as well as applications for these programs, is available here.

 

New Video Available from CMS on Medicare Coverage and Payment of Virtual Services

 

The Centers for Medicare and Medicaid Services (CMS) has released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
 
Click here to view the video.

 

MagMutual Offers New Benefits to Support Policyholders Amid COVID-19

 

Healthcare providers across the country are facing unprecedented challenges during the coronavirus outbreak. To help them during this critical time, MagMutual is offering medical professional liability policyholders two new benefits: the option to defer their premium payment for nine months and reimbursement for hotel stays. Additional support is available on the MagMutual COVID-19 Resource Center. To learn more, contact Scott Atkins at 470-631-0812 or email satkins@magmutual.com.
 


 

Revisions: Medicare Telehealth Services During COVID-19

 

April 3, 2020
 

Medicare continues to announce new flexibilities and expand telehealth coverage in response to the COVID-19 emergency. On March 17, Medicare announced it would allow providers to bill Medicare fee-for-service for patient care in all areas of the country and in all settings, including the beneficiary's home. Additional changes and clarifications made by the Centers for Medicare and Medicaid Services (CMS) include:

  • Medicare is further expanding access to allow for more than 80 additional services to be provided via telehealth.

  • Medicare also is permitting physicians and other clinicians to provide certain services by telephone.

  • When billing for traditional Medicare telehealth services and non-traditional Medicare telehealth services (i.e., one of newly allowed telehealth codes) with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with the Place of Service (POS) equal to what would have been used if the service had been furnished in-person, along with modifier 95, indicating that the service rendered was actually performed via telehealth.

  • Providers can provide virtual check-in services to both new and established patients.

 

Additional Medicare Telehealth Resources:



KMA has updated its Medicare telehealth guidance for physicians with this information. It is available to download here.


 

Volunteers Requested for COVID-19 Relief Efforts

 

April 2, 2020
 

The Kentucky Department for Public Health is recruiting volunteer healthcare professionals, including physicians, for a number of potential scenarios related to COVID-19. These include helping at field hospitals, isolation facilities and testing sites.
 
A letter from Public Health Commissioner Steven Stack, M.D., available here, further outlines the request. A letter from Gov. Beshear is also available that describes workers compensation and liability coverage for volunteers.
 
Volunteers can identify themselves using this link:
https://ky.readyop.com/contact/register/71
 

CMS Webinar: Lessons from The Front Lines: COVID-19
 

The Centers for Medicare and Medicaid Services (CMS) is hosting the next conference call in its series for physicians called "Lessons from The Front Lines: COVID-19." The call will take place tomorrow, Friday, April 3rd from 12:30 - 2 PM EST and the topic of discussion is: COVID-19 Flexibilities. Physicians are invited to share your ideas, strategies, and insights.
 
Conference lines are limited, so physicians are invited to join via audio webcast, either via computer or smartphone web browser.
 
Participant Dial-In : (877) 251-0301
 
Access Code: 2674453
 
Webcast Streaming: https://protect2.fireeye.com/url?k=4be5adfc-17b0a42c-4be59cc3-0cc47a6a52de-f8b939daf2762cc0&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1794  

 

In Your Own Words: Suzanne E. McGee, M.D.


KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org.
 
Finding the "Bright Spots" in Pandemic Times
 
Several months ago, on a red-eye flight home, I was reading The Tattooist of Auschwitz, a heart-wrenching and illuminating book about Lale Sokolov, a courageous young Jewish man who was a prisoner in the Auschwitz concentration camp. His job was to mark all prisoners as they entered Auschwitz, an unimaginable task. Despite the unthinkable human suffering that Lale witnessed and endured, he had the uncanny ability to recognize the "bright spots" from his experiences. His resilience in an unconscionable situation really moved and stuck with me.
 
As I face this COVID-19 pandemic, I often think of Lale's reactions to adversity. From him, I learned that it is perfectly acceptable to be angry, fearful, and anxious about a bad situation, but that it is also vital to maintain a positive attitude and seek out the bright spots. One of the odd realities about this virus and pandemic is that it is full of juxtapositions, just as Lale's journey was. Even the name of the virus is alluring, derived from the Latin word corona, meaning "crown." But, how could something that sounds so majestic be so dreadful?

This pandemic has many Kentucky physicians feeling as if we are about to be swallowed by a massive wave; after all, we have seen the damage that COVID-19 has done in other states and countries. Personally, I dislike the uncertainty of this pandemic and worry about the physical and mental health of my colleagues, patients, loved ones, and frankly, all of humanity. However, despite the fear, anxiety, and uncertainty, I see an amazing resolve among healthcare workers to kick this virus in the derrière and keep staff and patients safe. I see a simplicity in day to day life that, amidst the ugliness of this pandemic, is refreshing. I have undeniably watched the goodness of humanity emerge as people recognize their kinship with one another-a recognition that we are in this together. As a physician, I choose to fight this virus, and I will continue to recognize bright spots as I do it. I hope you will consider doing the same.


 

DEA Removes Barrier for Treating Opioid Use Disorder During COVID-19

 

April 1, 2020
 

The U.S. Drug Enforcement Administration (DEA) has issued guidance to DEA-registered physicians providing new flexibility for physicians managing patients with opioid use disorder. The new guidance permits physicians and other health professionals with a waiver allowing them to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31 for the duration of the COVID-19 emergency.

The full guidance is available at: https://www.samhsa.gov/sites/default/files/dea-samhsa-buprenorphine-telemedicine.pdf
.
 

Telehealth Usage Increases Amid COVID-19; KMA Advocates for Additional Coverage from Insurers
 

The benefits of telehealth have become more apparent since the beginning of the COVID-19 pandemic. In the Louisville Courier-Journal, KMA Executive Vice President Pat Padgett pressures insurance companies to cover telehealth services provided via telephone, in order to serve a greater number of patients who may lack access to video and audio technologies. That op-ed is available here.

The Courier-Journal also contains a piece by Deborah Yetter on the efforts providers have made to quickly ramp up their telehealth efforts in the face of the outbreak. The article features an interview with Kentucky Physicians Leadership Institute (KPLI) graduate Monalisa Tailor, M.D. It is available here.

KMA encourages physicians to visit its COVID-19 webpage, kyma.org/COVID19, for resources on utilizing telehealth within their practices. KMA has provided one-page handouts on the updated telehealth policies of various payors, including Medicaid, Medicare, Anthem, Aetna, Humana, Cigna and UnitedHealthcare, as well as guidance from CMS, HHS and SAMHSA.


 

CMS Announces New Temporary Telehealth Waivers, Flexible Rules in Response to COVID-19

 

March 31, 2020

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued several temporary regulatory waivers and new rules to assist with flexibility in response to the COVID-19 pandemic. The waivers include Medicare coverage for telephone services, significant additions to the list of covered telehealth services such as emergency visits, and greater clarity on the use of remote patient monitoring for acute conditions like COVID-19.
 
More information on the waivers can be found in a fact sheet and press release from CMS.

 

In Your Own Words: William Thornbury, M.D.

 

KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org
 
KMA spoke to William Thornbury, M.D., of Glasgow specifically regarding his experience with telehealth.
 
Telehealth is working very well. About half the cases we're seeing right now are telehealth cases. I would attribute a lot of that in Kentucky to the foresight of the legislature in moving us through the telemedicine legislation in 2018.
 
That legislation put us in the forefront of telemedicine legislation in the country so now we're ahead of the game instead of behind the game. I think what's most likely going to happen after the crisis is a lot of the states will begin to see that they likely may need legislation very similar to ours so that their telemedicine markets can flourish.
 
This is allowing us to finally move from the horse and buggy to the automobile. We have a new delivery model that needs to be in place for a number of reasons. Healthcare has been woefully behind the rest of the economy in this delivery model. Crises like this bring out the best of what we can offer the public.
 
Half the people we're seeing are using it, but the other half need face-to-face visits. There's a very important caveat I learned the hard way over ten years−and this is something I didn't study when I did my work in telemedicine−when you take a few people out of your clinic, say three to five, that opens that space up.
 
If I'm seeing 40 patients a day, and I can see 20 of them online, then I can see the 20 I need to see in the office and give them some extra time or bring in people that want to call in the same day. In the past, we've not been able to do that. This makes our health system much more efficient instead of pushing people to the urgent clinics, or to the ERs.
 
We want to work together for the sustainability of our health economy, particularly in these times of crisis, as KMA members, we want to be the leaders in this, and we want to help our colleagues.

 

Anthem COVID-19 Telehealth Webinar

 

Anthem is hosting a free webinar for providers to address questions and highlight resources related to telehealth. The information applies to commercial, Medicare Advantage and Medicaid programs in Kentucky.
 
Attendees can sign up for one of several sessions:
 
April 2, 2020 - 12:30 p.m. to 1:30 p.m. Eastern time
 
April 3, 2020 (two sessions) - 10 a.m. to 11 a.m. and 1 p.m. to 2 p.m. Eastern time
 
Registration is limited and is available here: 
https://www.eventbrite.com/e/anthem-blue-cross-blue-shield-kentucky-covid-19-telehealth-webinar-tickets-101113994680
 

Additional COVID-19 Resources

 

HHS Office for Civil Rights FAQs on Telehealth and HIPAA during COVID-19
 

Substance Abuse and Mental Health Services Administration (SAMHSA) 42 CFR Part 2 Guidance


 

Doctor's Day 2020: A Moment to Honor & Reflect
 

March 30, 2020
 

A message from KMA President Brent Wright, M.D.

"...I will prevent disease whenever I can, for prevention is preferable to cure."
Hippocratic Oath - Modern Version
 
As we commemorate Doctor's Day 2020, we find ourselves in a battle with an unseen enemy.  The COVID-19 pandemic has taken the lives of thousands of people, many of whom have been brothers and sisters of our profession.  We watch the countless requests for greater testing, more protective equipment, and greater insight into the treatment of a disease that has moved with a speed and fury that many can neither comprehend nor prepare.
 
Our challenge will not end with the current threat as humanity dissects the aftermath of what we have witnessed.  Our knowledge and insight will be needed to drive society forward in a way that is both responsible and caring.  As a physician, you are blessed with a gift that very few will ever know and for your dedication I am thankful.
 
Join me on this Doctor's Day as we honor our profession, those who trained us, those who serve with us, those who are learning the art, and those whose efforts are remembered most nobly.
 
R. Brent Wright, MD
KMA President, 2019-2020

 

In Your Own Words: Lee Dossett, M.D.

 

KMA is sharing the first-person accounts of physicians from across the state as they prepare for and battle the COVID-19 pandemic. These stories will also be published at kyma.org/covid19. If you are interested in submitting an account, please email Emily Schott, schott@kyma.org. 
 
For the last 2 weeks I have gotten an up-close look at how hospitals are dealing with the COVID-19 pandemic.  As a member of the hospitalist leadership team at Baptist Health Lexington, I have been intimately involved in the daily preparations and execution of virus management plans. It has become evident that for these action plans to work, flexibility has to be a core value amongst providers.  Coronavirus was on our radar in February, but by early March it became clear it would be something no hospital would escape.
 
Together with my partners in the ED, ICU, and infectious disease we developed screening and treatment protocols.  We have used a variety of testing methods, public and private, with varying turnaround times.  Ultimately, our goal is to have rapid in-house testing.  When that occurs, it will help us create better guidance for patients regarding self-quarantine and help preserve PPE and resources in the hospital.
 
For right now we have designated specific floors that are completely negative pressure for rule out patients with a consistent group of nurses, staff, and physicians providing care.  We have plans in place should volume increase.  One of our biggest concerns is the preservation of PPE.  Currently the hospital is well supplied, however we have enacted preservation strategies in preparation for any surge which may develop.  This includes using telehealth options when clinically appropriate on admitted patients and a robust de-escalation of isolation as negative results come back.
 
From a clinical standpoint we have seen a wide range of ages, symptoms, and severity.  Those who present to the emergency room with mild symptoms can be swabbed and discharged home with instructions for self-quarantine.  Those who are sick enough to be in the hospital but hemodynamically stable can be admitted to a telemetry floor for close monitoring.  If they show respiratory compromise they are watched in the ICU with the plan of early intubation in a controlled setting when necessary.
 
With delayed testing, we have found chest CTs to be very helpful with risk stratification.  The pathognomonic changes of COVID-19 can develop rapidly, as seen by dramatic changes in one patient within 4 days.  While the virus is most dangerous in the older population with co-morbidities, we have seen young and otherwise healthy individuals severely affected.  We have also seen deaths unfortunately.  It is extremely important to continue to stress social distancing and good hand hygiene to "flatten the curve" so that COVID does not overrun local and national hospital capacity.

 

State Legislature Responds to COVID-19 Pandemic

 

On Thursday, March 26, lawmakers returned to Frankfort after a week at home and resumed legislative work for one day only. The day's activities were punctuated by the legislature enacting Senate Bill (SB) 150.
 
This legislation, initially a surprise billing measure introduced by Senator Ralph Alvarado, was stripped of the original language and revised to become an emergency COVID-19 relief bill that will provide Kentuckians, including the state's health care providers, financial and regulatory assistance surrounding the novel coronavirus pandemic. SB150, a summary of which is available here, awaits the Governor's signature.
 
Going forward, lawmakers will work a legislative day on Wednesday, April 1, before adjourning for a 10-day veto recess. Lawmakers will return for two days on April 14-15 to consider any veto overrides and finish other business.

 

U.S. Congress Passes COVID-19 Stimulus Package

 

On Friday, President Trump signed a $2 trillion stimulus and COVID-19 relief package into law. The final version, known as the CARES Act, contains billions of dollars in relief to health care providers. Provisions of interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.

  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.

  • Suspension of the 2% Medicare sequester in May through December 2020.

  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.

  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.

  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
     

Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.
 

A comprehensive summary of the CARES Act that was produced by the American Medical Association and is available here.
 

CMS Announces Expansion of Accelerated and Advance Payment Program

 

Centers for Medicare & Medicaid Services (CMS) announced an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat COVID-19. The program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act, provides emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.
 
To qualify for accelerated or advance payments, the provider or supplier must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider's/ supplier's request form,

  • Not be in bankruptcy,

  • Not be under active medical review or program integrity investigation, and

  • Not have any outstanding delinquent Medicare overpayments.

 

An informational fact sheet on the accelerated/advance payment process and how to submit a request can be found here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.
 

UnitedHealthcare Expanding Telehealth to Audio-Only Services
 

UnitedHealthcare (UHC) is expanding telehealth services through June 18, 2020, for their Medicare Advantage, Medicaid, and commercial plans to make it easier for patients to connect with their health care provider during the COVID-19 emergency. UHC will reimburse both participating and non-participating providers who submit appropriate telehealth claims.
 
KMA has prepared a one-page guide to using telehealth with UnitedHealthcare for members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined apply to UnitedHealthcare plans only.
 
The UnitedHealthcare telehealth guide is available here.


 

Cigna to Allow Providers to Bill Standard Face-to-Face Visit for Telehealth, Including Telephone-Only

 

March 27, 2020
 

Cigna is making an exception during the COVID-19 emergency to allow providers to bill a standard face-to-face visit for all virtual care, i.e., telehealth services, including those provided by telephone-only. This policy applies to new and established patients (Cigna has released separate interim telehealth guidance for behavioral health services).
 
KMA has produced a one-page guide for physicians, available here, for utilizing telehealth with Cigna patients. This document is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to Anthem plans only.

 

American Board of Medical Specialties (ABMS) Releases Statement Regarding Continuing Certification During COVID-19

 

The American Board of Medical Specialties (ABMS) has released a statement regarding continuing certification in light of the COVID-19 outbreak. The statement includes the Board's commitment to flexibility during this time, including "enhanced activities and heightened education in partnership with specialty societies focused on COVID-19, to deferment of activities or requirements and/or the extension of cycle deadlines, depending on the timing of activities in the Boards' continuing certification programs in 2020."
 
"We understand that the pandemic will have a highly variable impact on physicians based on the unique needs of their specialty. Individual Boards will respond in ways that best meet the needs of physicians in their particular specialty."
 
The full statement is available here
.
 

Directives from Kentucky Board of Pharmacy Special Board Meeting

 

The Kentucky Board of Pharmacy met March 25 to discuss concerns regarding prescriptions and licensing during the COVID-19 pandemic. Directives from that meeting are available here.

 

CMS Conference Call: Lessons from The Front Lines: COVID-19

 

The Centers for Medicare and Medicaid Services (CMS) is inviting physicians to participate in a conference call tomorrow, Saturday, March 28th from 12:00 PM - 2:00 PM EST. The topic of discussion is "COVID-19 Therapeutics." Physicians are invited to join to share ideas, strategies, and insights with one another. 

Please see dial-in details below. Conference lines are limited, so attendees are highly encouraged to join via audio webcast, either via computer or smartphone web browser.
 
Participant Dial In: 877-251-0301
Conference ID: 9409959
Audio Webcast
https://protect2.fireeye.com/url?k=0d59a9bc-510ca0af-0d599883-0cc47adb5650-9ac2bdf1f2555d1a&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1738

 

Reminder to Members: KMA COVID-19 Webpage Resources

 

KMA's dedicated COVID-19 webpage, kyma.org/covid19, provides a number of resources of interest to Kentucky physicians during the COVID-19 pandemic.
 
The page includes sections on telehealth, directives and waivers, coding reminders, archives of previous KMA Member Alerts, and links to public service announcements produced by KMA and the Foundation for a Healthy Kentucky.
 
Members are also encouraged to sign up for KMA's text alert service for the latest updates by texting "KMA" to 50457 and to follow KMA on Twitter, @KYMedAssoc.



Humana Encouraging Use of Telehealth; Temporarily Updates Policy to Include Phone Service

March 26, 2020
 

Humana is encouraging the use of telehealth services to ease the systemic burdens from COVID-19. Therefore, effective March 23, 2020, Humana is temporarily updating its telehealth policy during the emergency period to allow for telephone-only services in addition to telehealth services via video + audio.

KMA has produced a one-page guide for physicians, available here, for utilizing telehealth with Humana patients. This document is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to Humana plans only.

 

CALL TO ACTION: Contact Congressman Massie and Encourage Support for the CARES Act

 

Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. The final version, known as the CARES Act, contains over $100 Billion in relief to health care providers. Provisions of interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.

  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.

  • Suspension of the 2% Medicare sequester in May through December 2020.

  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.

  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.

  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.

  • Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.
     

This legislation is crucial for the survival of many physician and other health care provider practices and MUST PASS the House. However, Congressman Thomas Massie (KY-4) has indicated he will NOT VOTE in favor of the bill when the measure goes before the U.S. House for a vote. Even more concerning, Congressman Massie is considering a procedural move that could delay passage of the bill to Saturday or Sunday.

Please contact Representative Massie IMMEDIATELY to encourage him to VOTE YES for the CARES Act and provide much needed assistance to physician practices during these unprecedented times.

Northern Kentucky Office 
Phone: (859) 426-0080
Fax: (859) 426-0061

Washington, DC Office
Phone: (202) 225-3465

 

Additional Telehealth Guides by Insurer


As telehealth policies are changed or relaxed in light of the COVID-19 pandemic, KMA has provided resource guides to telehealth services for physicians. Additional telehealth information is available at kyma.org/covid19.

Medicare Rules for Telehealth Services

Medicaid Rules for Telehealth Services

Anthem Expands Coverage to Include Telephone-only Services for 90-Days

Aetna Expands Telehealth Coverage for 90 Days

Humana Telehealth Temporarily Includes Phone Service

For the latest COVID-19 developments and resources, please visit kyma.org/covid19 or follow KMA on Twitter, @KYMedAssoc. Physicians are also encouraged to sign up for text alerts by texting "KMA" to 50457.

 


 

KMA, Foundation for Healthy Kentucky Release COVID-19 PSAs

 

March 25, 2020
 

KMA and the Foundation for a Healthy Kentucky partnered to release three thirty-second public service announcements today designed to reinforce critical public health messages that will help prevent the spread of the COVID-19 virus.
 
"Prepare, protect and disinfect" is the theme of the messages, which also encourage Kentuckians to follow prevention guidelines, to take steps to manage mental health and anxiety, and to be prepared for changes within the health care system during this time.
 
The PSAs are being distributed statewide for radio and television and are also available for viewing and download here:   https://www.healthy-ky.org/research/category/2/videos/article/123/covid-19-psa-videos?order_by=latest.
 
Aetna Expands Telehealth Coverage for 90 Days
 
Aetna is temporarily expanding telehealth coverage during the COVID-19 emergency to allow for limited telephone-only services in addition to telehealth services via video and audio.

KMA has produced a one-page guide for physicians, available here, for utilizing telehealth with Aetna patients. This document is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to Aetna plans only.


 

Anthem Expands Coverage to Include Telephone-only Services for 90-Days

 

March 24, 2020

Anthem is temporarily expanding telehealth coverage during the COVID-19 emergency to allow for telephone-only services in addition to telehealth services via video and audio. This includes covered visits for medical and behavioral health services from in-network providers for Anthem fully insured employer plans, individual plans, Medicare plans, and Medicaid plans.
 
KMA has produced a one-page guide for physicians, available
here
, for utilizing telehealth with Anthem patients. This document is available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to Anthem plans only.
 

Reporting Positive COVID-19 Cases

 
The KBML has distributed directions on reporting positive COVID-19 cases. As with all reportable diseases, the Department for Public Health must be notified for both contact tracking and reporting to the CDC. That information is available
here.
 
Cabinet for Health and Family Services COVID-19 Clinician Webinar
 
The Kentucky Department for Public Health will provide an update on the rapidly moving 2019 Novel Coronavirus (COVID-19) situation in Kentucky via webinar on Thursday, March 26 at 11:30 a.m. ET.
 
The Cabinet encourages listeners to conserve lines and view thewebinar together as much as possible so that as many clinicians as possible can attend.
 
Registration is available at:

https://attendee.gotowebinar.com/register/4477565796822338571.
 
After registering, you will receive a confirmation email containing information about joining the webinar. A video archive of the webinar will be sent to all registered participants along with a copy of any slides.
 
For the latest COVID-19 developments and resources, please visit
kyma.org/covid19 or follow KMA on Twitter, @KYMedAssoc. Physicians are also encouraged to sign up for text alerts by texting "KMA" to 50457.


 

KMA Signs on to Letter Requesting Congressional Support for Physicians

 

March 23, 2020
 

KMA has signed on to a letter to Congressional leadership from the American Medical Association (AMA) regarding inclusion of support for physician practices in any economic stimulus package. The letter, which can be viewed here, also calls for Congress take all possible actions to ensure that every physician and health care worker has access to critically needed PPE. It also includes signatures from the American Academy of Family Physicians, American College of Physicians, American College of Surgeons, and Medical Group Management Association.
 

Prescribing Controlled Substances
 
The Kentucky Board of Medical Licensure (KBML) reminded licensees who are prescribing controlled medications (whether Schedule IIs, IIIs, IVs or Vs) of KRS 311.597(4), which calls upon licensees to conform with acceptable and prevailing medical practices and the provisions of 201 KAR 9:260 Section 2(2), which states:
 
If a physician is unable to conform to professional standards for prescribing or dispensing controlled substances due to circumstances beyond the physician's control, or the physician makes a professional determination that it is not appropriate to comply with a specific standard, based upon the individual facts applicable to a specific patient's diagnosis and treatment, the physician shall document those circumstances in the patient's record and only prescribe or dispense a controlled substance to the patient if the patient record appropriately justifies the prescribing or dispensing of a controlled substance under the circumstances.
 
The notice encourages physicians to responsibly exercise their best clinical judgment on a case-by-case and patient-by patient basis. The full advisory is available
 here.
 

Elective Procedures Mandate

 
The Cabinet for Health and Family Services issued revised directives to assist in the exercise of judgement regarding elective procedures. This differs from the directive issued last week. The new directive is available
here.
 


Medical Students Volunteer for COVID-19 Relief

 
In this afternoon's address, Gov. Beshear and Public Health Commissioner Steven Stack, M.D. praised the more than 263 medical students who had signed up to volunteer their services as part of the COVID-19 response efforts. Dr. Stack's letter to medical students last week was distributed by KMA and is available
here.
 
For the latest COVID-19 developments and resources, please visit kyma.org/covid19 or follow KMA on Twitter, @KYMedAssoc. Physicians are also encouraged to sign up for text alerts by texting "KMA" to 50457.


 

Medicaid Rules for Telehealth Services

 

March 20, 2020
 

The Kentucky telehealth law requires Medicaid and managed care organizations (MCOs) to cover medical services provided via telehealth to the same extent they cover medical services provided in-person. Medicaid recipients in all areas of the state and in all settings, including the recipient's home, may receive telehealth treatment. This includes new and established patients.
 
In response to the COVID-19 emergency, Medicaid is relaxing its rules on telecommunications and is encouraging the use of telehealth for delivery of all appropriate types of health care services as outlined in 907 KAR 3:170.
 
KMA is providing the document below to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to Medicaid and managed care organizations (MCOs) only.

 
Download Medicaid Rules for Telehealth During COVID-19 here.
 

For the latest updates regarding the COVID-19 outbreak, sign up for KMA text alerts. Text "KMA" to 50457.

 


 


New Medicare Rules for Telehealth Services


March 20, 2020


For the duration of the COVID-19 emergency, Medicare is expanding telehealth coverage. KMA has created an informational resource guide for members. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The guidance outlined applies to traditional Medicare only.
 
Download the Medicare Rules for Telehealth Services guide
here.
 
For the latest updates regarding the COVID-19 outbreak, sign up for KMA text alerts. Text "KMA" to 50457.


 


Physician Responses to Practice Changes Amid COVID-19 Outbreak


March 19, 2020
 

KMA asked members what they are doing in their practices during the coronavirus emergency. This document contains some of the information provided by members in a one-page, easy to read format. We are making this document available to members as an informational resource. KMA expresses no opinion as to the feasibility, applicability, or impact to your particular practice. The American Academy of Family Physicians put out information, as have other specialty societies, for those in a practice setting. 
 
Receive COVID-19 alerts from KMA via text message. Text "KMA" to 50457.


 

Order Regarding Office Visits/Outpatient Procedures; Telehealth & HIPAA

 

March 18, 2020

On Saturday, Governor Andy Beshear requested that all hospitals cease performing elective procedures by the close of business today, March 18. Today, the Cabinet for Health and Family Services issued an order that all health care providers "cancel all procedures that in the opinion of a physician the delay will not cause harm to the patient or negatively affect the patient's life expectancy." Following discussions with the Cabinet for Health and Family Services, the Kentucky Board of Medical Licensure issued a notice to physicians this afternoon:
 
"It is our understanding this directive applies to all procedures no matter the location or setting, which includes a physician's in-office setting or outpatient surgery center.
 
Please note the directive does give a physician the discretion whether a delay will not cause harm to the patient or negatively affect the patient's life expectancy."
 
The
directive from the Cabinet states that all elective procedures, encompassing all levels of care be cancelled as of midnight tonight, March 18.
 


Telehealth & HIPAA

 
The COVID-19 outbreak has led to the Department for Health and Human Services Office of Civil Rights to announce yesterday that they will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA).
 
The announcement goes on to detail that physicians may utilize popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, as well as traditional telephone or cell phone calls, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services.
 
Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn't confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.

 

Physician Resources:

 
Kentucky Department for Public Health Emergency Department (ED) Flow Chart for COVID-19 Testing
Providers guidance for determining whether a patient should receive the COVID-19 test
 
AMA Quick Guide to Telemedicine in Practice
Providers guidelines and resources to help physicians expedite the implementation of telemedicine

 


 


URGENT: HHS Office for Civil Rights Will Not Impose Penalties on Physicians Using Telehealth in Event of Noncompliance Under HIPAA


From the American Medical Association, March 17, 2020:

 
"In light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA).
 
Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules. 
 
However, today's announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
 
For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician's or patient's phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions. 

Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn't confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.
 
Additional information can be found
 at this notice from Department of Health and Human Services (HHS)."


 

A Message from KMA President Brent Wright, M.D.

 

March 17, 2020


There is no question that the last several weeks have been challenging for physicians and all of our colleagues in healthcare. This situation is likely to become even more complex in the coming days.
 
Unfortunately, the paradox of this issue is that the best way to fight COVID-19 is to distance ourselves from many aspects of direct patient care in non-urgent settings as social distancing has been recommended from the CDC; however, that is a real challenge we are faced with as caring directly for our patients is what makes us physicians.
 
The KMA is requesting communication from our members, so we are asking you to help us. Please tell us what you are doing as a physician and within your practice to help mitigate the spread of the virus. Your responses can help others determine best practices and protocols that can keep our patients, our staff and ourselves safe until such protocols may be published by others. Every moment we save allows us to spend more time on the challenge before us.
 
Please send these to Lindy Lady at KMA,
lady@kyma.org or call 502-553-0684.
 
As mentioned in previous communications, we still want your suggestions, questions and concerns on COVID-19 so that they can be shared with the Cabinet for Health and Family Services and Public Health Commissioner Steven Stack, M.D.
 
Thank you for your service to this organization, but more importantly, to the patients of the Commonwealth.

 


MEMBER ALERT: March 16 COVID-19 Update for Physicians

 

March 16, 2020

The Kentucky Medical Association (KMA) has streamlined its member and public communications to address ONLY COVID-19 issues and is keeping physicians updated with the latest information, which continues to be updated daily and, sometimes, by the hour.
 
This release to our members addresses issues with medical practices preparing for COVID-19, as well as complying with the Governor's request to stop all elective surgical procedures by close of business on Wednesday. Despite the disruption to normal medical practice, the KMA supports this action, which has been taken by other states and countries to try to slow the spread of COVID-19 and prepare health care system resources for its effects.
 
On March 14, Governor Beshear announced that he is requesting that all hospitals "cease elective procedures by close of business on Wednesday" in order to ensure capacity for the expected COVID-19/coronavirus cases. KMA has been in close contact with the Beshear Administration and the Kentucky Hospital Association (KHA), which today released guidance regarding the definition of an "elective procedure."
 
KHA's statement is available
here, but in summary, outlines that an elective procedure be considered one in which "if delayed, in the physician's judgment will not cause harm to the patient, delay diagnosis, or negatively impact the patient's life expectancy. Examples include: cataract surgeries, cosmetic surgeries, and some orthopedic cases. Hospitals will continue to provide needed procedures as it is safe to do so, prioritizing care that if delayed could negatively affect the patient's health outcome, harm the patient, or lead to disability or death."
 
KHA also provided
Stanford Guidelines for determining the necessity of a scheduled surgery, and stated that KHA and its Chief Medical Officers supported the use of these during the response to the COVID-19 outbreak. These definitions and guidelines may be useful to physicians, but how they are implemented within each medical system, hospital or practice may vary.
 

Additional Resources to Review


American Academy of Family Physicians Checklist to Prepare Physician Offices
This is a very useful checklist for practices that Includes information for staff and office preparedness

Centers for Disease Control Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19)
How to prepare and communicate with staff and patients, links to additional resources

Centers for Disease Control Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings
Addresses recommendations for infection prevention and control practices when performed outside a healthcare setting

Letter from Public Health Commissioner Steven Stack, M.D. to Physicians and Healthcare Providers
March 9 letter regarding state laboratory testing for COVID-19

Kentucky Department for Public Health Guidance for Healthcare Providers and Laboratory Services
Links to COVID-19 case reporting forms, guidance for providers and labs

American Medical Association: COVID-19 Frequently Asked Questions
Answers to common questions regarding COVID-19 for physicians

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