Zotec Partners Anesthesiology Digest | July 2020

July 7, 2020

Anesthesiology Digest: News from July 2020.

HHS Officially Renews Public Health Emergency for COVID-19
By Rachel Cohrs | July 23, 2020
HHS Secretary Alex Azar on Thursday officially extended the COVID-19 public health emergency designation for another 90 days.

Significant funding and regulatory relief for hospitals and other healthcare providers are tied to the emergency, which was set to expire on July 25. Lobbyists and healthcare industry players were concerned that the bureaucratic decision could get caught up in political maneuvering and pressured the administration to continue the emergency. HHS officials had repeatedly signaled HHS’ intention to continue the emergency designation, and the agency previously renewed it in April.

“Today I signed a renewal of the COVID-19 national public health emergency declaration,” Azar tweeted. The formal declaration is listed on HHS’ website.

The renewal gives the healthcare industry certainty through the fall on several key policies to assist with the COVID-19 response. Some notable policies tied to the public health emergency are the 20% Medicare inpatient add-on payment for COVID-19 patients, increased federal Medicaid matching funds for states, a mandate that insurers cover medically necessary COVID-19 tests without cost-sharing, relaxed telehealth restrictions, and Section 1135 waivers that give providers additional flexibility to respond to COVID-19.
To read more, go to Modern Healthcare.

White House and Congress at Odds Over Pandemic Relief Package
By Kelsey Snell, Susan David, Deirdre Walsh | July 21, 2020
Washington is racing to complete a fifth round of legislation to address the ongoing, and still surging, coronavirus pandemic in the next three weeks. The two parties and the White House are at odds over what the major pillars of the legislation should include and how much it should cost.

Senate Majority Leader Mitch McConnell, R-Ky., wants to get a bill to President Trump by Aug. 7 when Congress is scheduled to adjourn for the rest of the summer — a time when lawmakers traditionally hit the campaign trail in an election year.

The aggressive timeline puts pressure on Republicans in Congress and the White House to agree on their demands so that bipartisan negotiations can begin in earnest.

Republicans have not released a detailed list of their demands, but McConnell has ruled out a large spending package such as the roughly $2.5 trillion CARES Act that passed in March. He is expected to unveil the Senate GOP proposal this week that is estimated to cost around $1 trillion.

“The legislation that I have begun to sketch out is neither another CARES Act to float the entire economy, nor a typical stimulus bill for a nation that’s ready to get back to normal,” McConnell said Tuesday on the Senate floor. “Our country is in a complex middle ground between those two things. We can’t go back to April, and we can’t snap our fingers and finish the vaccine overnight. We need to carve out a ‘new normal.’ “

McConnell has listed some components, including $105 billion for schools, some additional federal unemployment support, a second round of direct payments, and legal liability limitations to prevent lawsuits related to COVID-19.

Trump has publicly backed a different set of demands. White House press secretary Kayleigh McEnany told reporters that the president is pushing for a payroll tax cut to be part of the package. Congressional Republicans have repeatedly rejected that idea, but McEnany said a tax cut would go to the “hardest-working — middle-income and low-income workers,” but she said it was one of a number of items they are discussing, including another round of direct payments.
To read more, go to NPR.org.

7 Things to Consider with New Telehealth Legislation Proposed
By Mandy Roth | July 21, 2020
As calls for a permanent extension of emergency telehealth waivers echo in the nation’s Capital, last week members of the House Telehealth Caucus introduced the bipartisan Protecting Access to Post-COVID-19 Telehealth Act. The legislation “seeks to expand the use of telehealth beyond the current national health crisis, including permanently eliminating obsolete geographic originating site restrictions,” according to the American Telemedicine Association (ATA).

As this legislative initiative moves forward, what do health systems, hospitals, and providers need to consider? Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS); ATA; the Healthcare Information and Management Systems Society (HIMSS); and experts at other organizations are weighing in with insights and predictions.

  1. Is the proposed house legislation enough?
  2. Evaluating the clinical appropriateness of telehealth
  3. Will parity payment continue?
  4. Licensure across state lines
  5. The impact of fraud
  6. Incentives to invest in telehealth technology
  7. Legislation to expand broadband services
    To read more, go to Health Leaders Media.

Georgia Enacts Favorable Surprise Medical Billing Legislation
July 17, 2020
On July 16, Georgia Gov. Brian Kemp (R) signed into law House Bill 888, legislation to resolve surprise medical bills. Supported by the Georgia Society of Anesthesiologists (GSA) and a broad medical coalition, this new law removes patients from the middle of billing disputes between health care professionals and insurers by prohibiting health care professionals from balance billing a patient for any amount beyond their in-network, cost-sharing obligations for emergency or non-emergency out-of-network services received without patients’ consent. Insurers will be required to pay the greater of: (1) the in-network amount for same or similar services paid by all eligible insurers (excluding Medicare and Medicaid rates), (2) the most recent in-network amount agreed to between the insurer and the health care professional for the same services, or (3) a higher amount determined by the insurer, given the complexity and circumstances of the services provided.

For disputes regarding the insurer’s payment amount, the measure establishes an arbitration process where the arbitrator must consider the circumstances of the case, the training and education of the health care professional, and evidence submitted by the parties when deciding between the insurer’s payment amount or the health care professional’s billed amount. The new law also creates an all-payer claims database for use in determining the in-network amount for same or similar services. Notably, this new law excludes Medicare and Medicaid rates from payment considerations.
To read more, go to ASA’s website.

Michigan Governor Protects Public, Rescinds Scope of Practice Waiver Order
July 14, 2020
On July 13, Michigan Gov. Gretchen Whitmer (D) rescinded Executive Order 2020-61 , which, among other things, waived physician supervision requirements for nurse anesthetists as part of the facilities response to the COVID-19 pandemic, provided that the services are appropriate to the nurse’s education, training, and background. The now rescinded supervision waiver also required consultation of the medical facility leadership.

With most states concluding stay-at-home orders and resuming essential surgeries, any state that temporarily waived physician supervision requirements to address the pandemic should reinstate the full range of critical safety standards that patients depend on, including the requirement for physician supervision of nurse anesthetists. Patients are best served when traditional care team models of practice are fully utilized, both during this public health crisis and upon the resumption of elective and non-emergent surgeries and other procedures. Governors and their staffs are encouraged to use the recommendations provided in the ASA Statement of the Use of Nurse Anesthetists During COVID.

The now rescinded order in Michigan mirrored orders in other states in that it included the appropriate patient safety guardrails necessary to ensure supervision waivers were limited to the treatment of COVID patients, were consistent with the recommendations of the physician leadership, and were aligned with the nurse’s education, training and experience. Executive
Order 2020-150
, which replaces 2020-61, temporarily suspends continuing education, BLS/ACLS certifications, fingerprinting, and cancelled exam requirements (for those cancelled) for health care professionals.

ASA commends Gov. Whitmer’s efforts to protect patient safety by reinstating physician supervision requirements.
To read more, go to ASA’s website.

Providers, Payers Hint They Will Sue CMS Over Proposed IPPS Rule
By Michael Brady | July 13, 2020
Hospitals and insurers are fuming over the Trump administration’s latest idea to lower healthcare costs by changing how CMS calculates Medicare severity DRG payments.

Under the proposed Inpatient Prospective Payment System rule, CMS would force hospitals to report for each MS-DRG the median payer-specific negotiated rates for all Medicare Advantage organizations and third-party payers beginning in 2021. Regulators say hospitals should be able to calculate the charges since they will have to pull together and publish most of the data under the disputed price transparency rule, which is making its way through the courts.

The agency is thinking about using the information to adjust inpatient prospective payments starting in 2024, speculating the change could help rein in healthcare spending.
But in comments on the proposed rule, providers and payers signaled they may sue the federal government if it moves forward with the changes, arguing that regulators don’t have the power to do either.

“CMS lacks any authority to adopt a ‘market-based’ MS-DRG weighting methodology because Congress has explicitly instructed CMS to weight MS-DRGs based on ‘relative hospital resources used with respect to discharges’ for each MS-DRG,” the Federation of American Hospitals wrote in a comment letter.

CMS multiplies a hospital’s payment rate per case by the relative weight of a DRG to determine how much to pay for a specific case. According to the agency, the weighting is currently based on “the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs.” Under the proposal, CMS would base it on payer-specific negotiated charges.

Hospitals and payers have fought nearly every price transparency effort by the Trump administration, arguing that Congress didn’t give regulators the power to make them disclose their rates. Doing so would be difficult and wouldn’t help consumers, they say. But a number of experts think price transparency could reduce healthcare costs in the long term by increasing competition among providers, even if there’s a short-term uptick.

Providers also took issue with CMS’ attempt to change and clarify policies related to so-called Medicare bad-debt claims, especially the agency’s desire to apply such changes retroactively. Most notably, CMS emphasized in the proposed rule that providers must put forth a similar effort to collect unpaid debts from non-indigent patients regardless of payer. The agency is worried that providers won’t try as hard to collect debts from non-indigent Medicare patients if they think the federal government will pay instead.
To read more, go to Modern Healthcare.

IRS: For-profit Providers Have to Pay Taxes on COVID-19 Relief Grants
By Rachel Cohrs | July 13, 2020
The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.

The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.

“Physicians or hospitals will be asked to give back on average 21 cents of a dollar of relief, while large tax-exempt hospitals will get 100 cents on the dollar when everybody is experiencing the same losses,” said Federation of American Hospitals CEO Chip Kahn. “It’s unfair and will lead to an unlevel playing field.”

Some for-profit providers had hoped that the grants could be classified as a qualified disaster relief payment, but the IRS said the grants have to be included in gross income. Tax-exempt providers won’t be taxed on the grants unless they reimburse the provider for lost revenue for an unrelated trade or business.

“In the beginning there was denial that this could be taxable because it did not seem like it was in line with the spirit of the legislation to create liquidity to help hospitals and medical providers,” said Jennifer Breen, a partner at Morgan, Lewis & Bockius.

The Federation of American Hospitals, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, and U.S. Chamber of Commerce asked congressional leaders on June 25 to change the policy so that for-profit providers don’t have to pay taxes on the grants.
To read more, go to Modern Healthcare.

Anesthesiologist Compensation in 2020: 5 Things to Know
By Angie Stewart | July 13, 2020
Anesthesiologists earn $398,000 a year, on average, according to Medscape’s “Anesthesiologist Compensation Report 2020.” Medscape collected data from more than 17,000 physician respondents in over 30 specialties.
Five things to know:

  1. Anesthesiologists’ average annual income was up slightly from 2019, when the average was $392,000.
  2. In 2020, the average annual bonus for anesthesiologists represented 14 percent of the average total salary for their specialty.
  3. Nearly 3 in 4 anesthesiologists achieved more than three-fourths of their potential annual incentive bonus.
  4. The average anesthesiologist achieved 78 percent of his or her potential incentive bonus.
  5. The average male anesthesiologist earned $410,000 annually, whereas women in the field made $354,000 a year, on average.
    To read more, go to Becker’s’ ASC Review.

Some Hospitals Choose to Continue Providing Elective Procedures
By Shelby Livingston | July 10, 2020
Many hospitals and other providers are continuing to perform non-emergency procedures despite the fact that most states are once again seeing an increasing number of COVID-19 cases.
Hospitals say they don’t need to delay care like they did in the initial months of the crisis. With four months of the pandemic under their belts, providers better understand how to control the spread of COVID-19. They have better protocols in place to conserve and reuse personal protective equipment and other resources needed to care for patients. And they have more access to coronavirus testing, they say.

There is also a financial need to resume elective procedures and keep them going. Hospitals and physician practices want to reschedule deferred care to fill the holes in their bottom lines sustained when procedures had to be delayed and patients canceled routine appointments for fear of becoming infected.

But more importantly, providers say continuing to put off non-urgent procedures—which often aren’t things that can be postponed indefinitely—are causing harm to patients. “We stopped operating on patients during the first increase (in cases) because we knew so little, and because we were nervous about ‘was it possible to give these infections to other people?'” said Dr. Catherine O’Neal, Chief medical officer and an infectious disease specialist at not-for-profit healthcare ministry Our Lady of the Lake in Baton Rouge, LA.

“And because at that time we were also very, very nervous about our PPE supply. We are trying not to do that again because we saw that that harmed a lot of people. Putting off things is definitely harmful while people are waiting for very needed surgeries,” O’Neal said.

When the COVID-19 crisis first took shape in the United States, hospitals deferred non-urgent procedures, largely to conserve bed capacity, personal protective equipment and other resources.

The CMS in March urged hospitals to delay elective or non-essential medical and surgical procedures until the COVID-19 pandemic ended. Later in April, the agency unveiled guidance to help providers in areas that had already experienced a peak in COVID-19 cases resume elective procedures. It said hospitals shouldn’t start that process until their regions had experienced a decrease in COVID-19 cases for at least 14 days. Guidance from the American Hospital Association and other groups also included that 14-day rule.

Healthcare providers soon began to reschedule procedures that had been postponed after the initial outbreak of COVID-19 cases had subsided and states began lifting stay-at-home orders and social distancing restrictions. But coronavirus cases are again rising in most states, according to a database maintained by Johns Hopkins University. Confirmed U.S. cases have now blown past 3 million while deaths have reached 128,000, Johns Hopkins data shows.
To read more, go to Modern Healthcare.

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