In response to the surge in positive COVID-19 cases and the increase in hospitalizations, leaders at the Alexandria, Va.-based trade association AMGA have called on Congress to provide additional support for healthcare providers.
With daily COVID-19 cases topping more than 181,000 in a single day, and hospitalizations reaching a record high of more than 69,000, AMGA members are preparing for an increase of patients by postponing or canceling procedures so that the staffing, personal protective equipment, and hospital space are available for patients with COVID-19, the association stated. More than 175,000 physicians practice in AMGA’s member organizations, delivering care to one in three Americans.
“Earlier this year, Congress recognized the need for an immediate response to support healthcare providers,” said AMGA President and CEO Jerry Penso, M.D. “Based on the current facts on the ground and this rapid increase in cases, additional financial support is now needed.”
AMGA recommends that Congress replenish the Public Health and Social Services Emergency Fund (Provider Relief Fund) and instruct federal regulators to restart Medicare’s Accelerated and Advance Payments (AAP) program. These two programs offer critical financial assistant to providers that are facing increased costs due to COVID and a disruption of their usual patterns of care, the association contends.
In addition, Congress also should permanently lift the geographic and originating site restrictions that normally limit the availability of telehealth. On this front, there are several bills that have been introduced that call for removing geographic restrictions, expanding originating sites where patients could be eligible for telehealth, as well as broadening the scope of which Medicare providers are eligible to provide telehealth and get reimbursed for it. While the federal government has removed many telehealth restrictions during the public health emergency (PHE), it’s still unclear which ones will go back into place once the PHE ends. Patients accustomed to such care will expect it to be available after COVID-19 subsides, AMGA said.
Additionally, AMGA recommends that Congress address several policies that will provide stability to the Medicare program, while ensuring that providers maintain their ability to deliver high-quality care during the crisis. These include “preventing significant reimbursement cuts that are pending in the Medicare Physician Fee Schedule, reaching consensus on surprise billing legislation that protects patients and does not set reimbursement rates, and ensuring providers have a meaningful opportunity to participate in value-based models of care.”
Specifically, AMGA’s letter brings up that CMS is considering substantial spending cuts in the Medicare Physician Fee Schedule through proposed changes to Evaluation and Management (E/M) codes, and if those proposals become finalized, “there will be excessively steep reductions in Medicare reimbursement for select specialties. Should CMS move forward with its proposal, some provider payments would be reduced by as much as 11 percent,” AMGA wrote.
What’s more, AMGA’s letter stated that Congress also has an opportunity to continue the transition to a value-based healthcare system by reforming the qualification thresholds for the advanced alternative payment model (APM) program. As currently implemented, 50 percent of providers’ revenue must be received through an Advanced APM; that threshold will increase to 75 percent in January. AMGA said they are “concerned that without revising the thresholds, the movement and support for value-based care will stall. Part of the issue is the dearth of access to commercial risk products and limited Medicare Advanced APM options. To correct this situation, Congress should reduce these thresholds to reflect actual market conditions, which would, in turn, result in increased Advanced APM participation,” the letter stated.
