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AMA’s ROLE IN COVID-19 PANDEMIC

The following is a message from American Medical Association EVP/CEO James L. Madara, MD. 

The COVID-19 pandemic represents an enormous threat to public health and an extreme challenge to physicians. Now, more than ever, physicians need a powerful ally in patient care. The AMA’s COVID-19 response strategy, attached, provides a road map for our initiatives in an unprecedented pandemic scenario. The strategy frames the AMA’s response in three key areas:

  • Providing clear, evidence-based guidance from trusted resources, including JAMA Network, the CDC, WHO, state and local agencies and AMA subject matter experts.
  • Building an interface with physicians on the front line, allowing them to share their experience with other physicians, the government and key health agencies.
  • Removing obstacles to diagnosis and treatment through our Advocacy, CPT, PS2 and other initiatives.

We are acquiring many ideas and we filter them through the above three strategic channels (keeping in mind the overarching view of what it is the AMA does well). Since early January, we have closely monitored the global outbreak of COVID-19 and compiled up-to-the-moment information for physicians. Here are some examples of what we’ve done recently viewed through the lens of our COVID-19 response strategy:

  • Building an interface with physicians on the front lines
    • Speaking directly to power on behalf of physicians
    • Conversations and updates with our Federation partners and AMA Ambassadors
    • Learning from and sharing first-hand accounts of physicians on the front lines. Listen to JAMA Editor Howard Bauchner, MD interview Maurizio Cecconi, MD in Italy and NIAID’s Anthony Fauci, MD;  read how the Permanente Medical Group developed new approaches to preserve PPE. 
    • Listening to and answering questions from physicians on twitter, leveraging ambassadors to engage and spread the word, and will be conducting Twitter chats to answer physician questions and share experiences. 
    • Called on the Administration for $100 billion dollars to support front line health care personnel and providers.
  • Removing obstacles to diagnosis and treatment
  • AMA Head: Lack of protective gear for health care workers is ‘unacceptable’
  • AMA Calls on Administration to Use Every Lever to Address Protective Equipment Needs, Lack of Tests in COVID-19 Fight
  • Mobilizing a dramatic increase in the nation’s telemedicine capacity through its advocacy and publication of the Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care.
  • Developed new CPT code for coronavirus.
  • Eased restrictions on the use of laboratory developed tests for COVID-19 testing to expand local access. 
  • Administration exercising flexibility in reducing regulatory burdens by allowing physicians to care for Medicare beneficiaries in States other than where they are licensed, waiving enrollment requirements and expediting enrollment, and waiving the requirement for Medicare patients for a 3-day hospitalization prior to covering skilled nursing facility care.  
  • Worked with HHS on the development of new recommendations for deferring non-urgent elective procedures that are consistent with recommendations of the American College of Surgeons. 

The AMA’s COVID-19 news and video coverage is promoted across the AMA website, email, Morning Rounds, all social platforms and Apple News. Since COVID-19 coverage began through March 18, nearly 390,000 users have consumed COVID-19 content from the AMA website, including nearly 17,000 clicks/referrals to JAMA and EdHub resources.

Resources

AMA Letters:

  • March 19  Letter to Congressional Leaders re: urgent steps to help preserve viability of physician practices due to the demands of COVID-19.
  • March 18  Letter to Seema Verma re: CPT code clarification in light of COVID-19 with remote physiologic monitoring and telephone evaluation and management.
  • March 16  Letter to Michael Pence re: Request for assistance with shortage of personal protective equipment for health care professionals.
  • March 13  Letter to Alex Azar re: Medicare assistance for solutions facing the nation with the COVID-19 outbreak.

Sign-On Letters:

Press releases to date:

March 20:

March 19:

March 18:

March 17:

March 13:

March 10:

March 5:AMA statement on Congress passing supplemental COVID-19 appropriations

COVID-19 Activity in Tarrant County – 3/21/20

Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Saturday, March 21, 2020 at 9:30 a.m. Find more COVID-19 information from TCPH here.

CITYCASESACTIVEDEATHSRECOVERED
TOTALS423912
Arlington11 1 
Benbrook1   
Colleyville2   
Euless2   
Forest Hill1   
Fort Worth11   
Grapevine1   
Lakeside2   
Keller1   
Mansfield3   
N Richland Hills2   
Southlake3   
Watauga1   
White Settlement1   

Practical Answers to COVID-19 Questions for Your Practice – Updated

By David Doolittle

Originally published on the Texas Medical Association website.

As the number of COVID-19 cases in Texas and around the country grows, what steps should your clinic take to ensure the safety of your staff and patients? 

The Texas Medical Association COVID-19 Task Force has updated its “Frequently Asked Questions” that answer many of the questions you might have about caring for people who have been exposed to the virus.

Among the questions answered:

  • How to minimize exposure to COVID-19 in your clinic; 
  • Types of infection prevention control measures to implement in your clinic;
  • How to best prepare staff;
  • Infection prevention and control precautions to take if a patient with possible COVID-19 requires evaluation at an emergency department (ED); and
  • Infection prevention and control recommendations to give to patients with suspected COVID-19 who are well enough to go home.

The FAQ is based on guidance from the Centers for Disease Control and Prevention (CDC), the Department of State Health Services (DSHS), and other health organizations.

You can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

TexMed 2020 Update: Going Virtual

TexMed 2020 will not take place in Fort Worth on May 1-2, Texas Medical Association President David C. Fleeger, MD, announced Tuesday. The TMA House of Delegates, however, will convene in a virtual format on those same dates, using a focused agenda to address the key issues before the house.

“After careful consideration of the evolving COVID-19 situation in Texas, with input from local and state health officials and TMA’s Coronavirus Task Force, the TMA Board of Trustees has determined that TexMed 2020 will not take place in Fort Worth on May 1-2,” Dr. Fleeger said. “The health and safety of our members is paramount as you are on the front lines of the fight to control the spread of the virus and treat infected patients.”

Dr. Fleeger asked House of Delegates members to keep May 1 and May 2 open on their calendars and told them to expect additional information on the virtual house meeting over the coming weeks.

“While we regret that our members will not gather in Fort Worth, TMA leadership and staff are working to keep the association moving forward, and to provide alternate solutions where possible,” he said. These include:

  • Chairs of TMA boards, councils, committees, and sections will determine if and when those bodies will convene virtually. Members of TMA’s boards, councils, committees, and sections can expect additional communications from TMA staff.
  • Where possible, the CME education planned for TexMed 2020 will be made available to members via TMA’s online Education Center.
  • Information from exhibitors at the TexMed 2020 Expo Hall will be hosted online through the end of the year for members to explore the latest practice solutions and services.
  • The TMA Foundation Gala will transition to a different format. Ticketholders will receive additional information in the coming weeks.

Hotel reservations will automatically be cancelled for anyone who booked a TexMed 2020 room through the TMA website. Those who made a reservation outside the TMA room block or used points to book their room should contact the hotel directly to cancel their stay. For more information, visit the TexMed Housing and Travel page.

For information about the novel coronavirus and COVID-19, please visit TMA’s COVID-19 Resource Center

HHS Office of Civil Rights Enforcement will not Impose Telehealth Penalties

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).

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

CMS Outlines New Flexibilities Available to People with Medicare

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

The Trump Administration previously expanded telehealth benefits. Over the last two years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.

“These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus.”

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.  

President Trump’s announcement comes at a critical time as these flexibilities will help healthcare institutions across the nation offer some medical services to patients remotely, so that healthcare facilities like emergency departments and doctor’s offices are available to deal with the most urgent cases and reduce the risk of additional infections. For example, a Medicare beneficiary can visit with a doctor about their diabetes management or refilling a prescription using telehealth without having to travel to the doctor’s office. As a result, the doctor’s office is available to treat more people who need to be seen in-person and it mitigates the spread of the virus.

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect.

Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

This guidance follows on President Trump’s call for all insurance companies to expand and clarify their policies around telehealth.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

TMA Task Force Convenes to Prepare Physicians for COVID-19 Threat

COVID-19 Update from TMA – Physician Leaders Also Host Statewide Briefing for Doctors

The Texas MedicalAssociation (TMA) has assembled the TMA COVID-19 Task Force to help Texas physicians prepare their practices to protect and treat their patients in the event of a community outbreak of the 2019 novel coronavirus. As a first step, the TMA Board of Trustees and the task force convened a statewide tele-town hall phone meeting Tuesday evening to update thousands of primary care doctors from across the state.

The call, hosted by TMA Board of Trustees Chair E. Linda Villarreal, MD, and TMA President David C. Fleeger, MD, featured situational reports from Texas Department of State Health Services (DSHS) Commissioner of Health John Hellerstedt, MD, and DSHS Infectious Disease Medical Officer Jennifer Shuford, MD. They highlighted epidemiological updates and evidence-based criteria to evaluate suspected COVID-19 patients, advising doctors how to set up their clinics for a possible community outbreak.

Dr. Villarreal said the call was a good first step to inform Texas physicians on how to protect their patients and the community. “Our goal is to help you be as prepared as possible for this serious public health threat,” Dr. Villarreal said.

The TMA COVID-19 Task Force is chaired by Wendy Chung, MD, chief epidemiologist at Dallas County Health and Human Services and chair of the TMA Council on Science and Public Health. Dr. Chung will lead the team of 12 front-line infectious disease and primary care physician experts who will stay informed of the latest epidemiological information regarding COVID-19 and advise fellow physicians across the state about developments. The idea is for this TMA blue-ribbon group to empower front-line physicians to have their practices ready to answer the call and help their community’s patients if cases develop in their hometown.

Dr. Fleeger said the task force will play a critical role in safeguarding the health of Texans.

We as physicians have an ethical obligation to provide urgent medical care during emergencies such as this. Though it puts us at risk, there are precautions and measures we can take to protect ourselves and still take care of our patients effectively,” Dr. Fleeger said. “The ethical obligation also includes neither stigmatizing nor ostracizing anyone from receiving needed medical care – no matter their race, ethnicity, culture, or infection status.”

TMA also has established and continuously updates an online Coronavirus Resource Center for physicians.

TMA is the largest state medical society in the nation, representing more than 53,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

TMA Contacts:  

Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear@texmed.org

Marcus Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper@texmed.org 

Connect with TMA on Twitter, Facebook, and Instagram.

Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.