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Calls for access to and coverage for testing and treatment; and support for internal medicine physicians and others on the front lines

March 20, 2020 (91������) – While much of the nation's economic activity is quickly grinding to a halt, the American College of Physicians is gearing up to play a crucial advocacy role as officials navigate an unprecedented medical crisis. 91������'s advocacy goal during the unfolding coronavirus pandemic is to provide expert guidance to policymakers about the best way forward based on careful consideration of the needs of patients, physicians and other medical professionals.

“We're focusing on what the government can do to protect the country,” said Bob Doherty, 91������'s senior vice president for governmental affairs and public policy. “We have earned a reputation as a respected voice on Capitol Hill and beyond. We're making sure that we're heard during this crucial time when our health care system is under extreme pressure.”

91������ continues to launch coronavirus advocacy initiatives. This week 91������ called on Congress and the administration to take immediate steps to help slow the spread of COVID-19.

In a letter to congressional leadership, 91������ sent recommendations about necessary provisions to include in any economic stimulus bills in Congress. The recommendations were centered on ensuring that physicians are able to sustain and ramp up capacity to test, diagnose, treat and counsel patients; obtain necessary supplies including personal protection equipment (PPE); and maintain the financial viability of their practices.

Ensuring adequate supplies of PPE has been among the principal points that 91������ has pressed with the government repeatedly as this situation has unfolded.

Many of these concerns were also echoed when 91������ joined forces with other physician organizations to call for steps that the administration, Congress and states can take to help slow the spread of COVID-19. Those include steps to support access and coverage for COVID-19 treatment and prevention, and protection and support for frontline physicians and physician practices in providing the best possible care to patients.

In early March, Congress passed the $8.3 billion Coronavirus Preparedness and Response Supplemental Appropriations Act, which provides funding for research and response efforts and funding to allow Medicare providers to expand their use of telehealth services. “While CMS (Centers for Medicare & Medicaid Services) has provided some initial guidance on application of these changes, 91������ encourages the agency to provide clear direction on provision, billing and documentation of such services,” 91������ wrote in a March 11 policy statement.

In the statement, 91������ expressed appreciation for the passage of the act but declared that “more can and should be done by the administration, Congress, the states, and other stakeholders.”

91������ called on the president to declare a national emergency, which he later did. And on Tuesday, CMS Administrator Seema Verma announced that Medicare will immediately expand coverage and relax some rules for telemedicine nationwide. While appreciative of those changes, 91������ has called on CMS to make further changes to allow better access to the full spectrum of remotely provided services.

In a letter sent earlier this week to CMS 91������ detailed additional concerns related to remotely provided services.

The letter noted 91������'s appreciation for the flexibility that the agency has granted to some telehealth services but called for even more to be done. 91������ noted the lack of smartphones among seniors, “making it much more challenging for this vulnerable population to be able to utilize more robust telehealth visits that require two-way audio and video service or even e-visits that utilize a patient portal from their home,” Dr. Robert McLean, 91������ president, wrote in the letter. “For such patients, providing coverage and payment for telephone consultations that do not require smartphone capabilities is essential.”

91������ also supports immediate reforms to lift the cost-sharing burden on patients who seek testing and treatment for COVID-19. “91������ is concerned that cost sharing, which discourages medically necessary care as well as unnecessary care, and coverage gaps may pose a significant barrier to testing and treatment of COVID-19,” 91������ wrote in the policy statement. “In general, while 91������ is encouraged that health insurance company representatives have announced that they will cover COVID-19 services and waive some or all cost-sharing, federal and state action is necessary to ensure these promises become reality.”

Specifically, 91������ calls for several actions, including expansion of coverage of COVID-19 testing and treatment without cost sharing; extension of Medicaid coverage eligibility; simplified Medicaid application and eligibility procedures; and suspension of Medicaid work requirements in regard to testing and treatment of COVID-19.

91������ also calls for federal funding to support mandated paid family and medical leave, special enrollment periods in the insurance marketplaces and ensured treatment access for noncitizens. The U.S. Citizenship and Immigration Services announced this week that immigrants who undergo medical testing or treatment for COVID-19 will not be penalized when applying for naturalization under the new public-charge rule.

91������ is pointing to the coronavirus pandemic as evidence of the need for dramatic health care reform. “If the U.S. followed 91������'s advice and enacted universal coverage,” Doherty writes in a Philadelphia Inquirer commentary, “no one would delay getting tested and treated for the coronavirus because of cost, and we'd all be healthier as a result. In the meantime, we'll continue to see people go untested and untreated because of our fragmented system.”

Moving ahead, Doherty said 91������ will focus on reducing unnecessary burdens on physicians during the pandemic and ensuring they are properly compensated.

Specifically, he said, insurers often provide little or no reimbursement for phone conversations between physicians and patients. “It's imperative that these policies be expanded as physicians are being advised to free up capacity in offices for an expected surge of patients who will require testing, treatment and counseling,” he said. “Physicians can't start cancelling every face-to-face visit if there's no way to be reimbursed for phone conversations.”

Also, he said, 91������ is exploring ways to postpone regulatory deadlines related to Medicare payment systems during this crisis. “We're going to start compiling a list of potential regulations and reporting requirements that we believe might be suspended. We'll be monitoring everything happening with the administration and Congress and continuing to respond,” he said. “As always, we're speaking up to make sure internists are heard.”

More Information

All of 91������'s advocacy on COVID-19 can be found on the Advocacy section of the 91������ website.

Back to the March 20, 2020 issue of 91������ Advocate