Archive for Coronavirus

Statement in response to Ivey’s Safer at Home order

Statement in response to Ivey’s Safer at Home order

Statement applauding the decision to continue the Safer at Home Order and encouraging increased safety precautions from citizens

Alabama’s healthcare provider organizations were pleased to see the Safer at Home order extended this morning and to hear from local and state leaders about the importance of staying the course on the precautions being taken.

While all of us are suffering from quarantine and mask fatigue, now is not the time to let up. Over the past week, Alabama has added almost 6000 new COVID-19 cases, the highest 7-day total during the course of the pandemic. The number of hospitalizations are increasing, and the state has now had more than 900 deaths attributed to COVID-19. Things are not getting better. They are getting worse.

Physicians, hospitals, nursing homes and other providers have treated those with the virus while continuing to provide care to other non-COVID patients who need their help. They have worked long hours and remain dedicated to their mission of healing.

If you want to find a way to thank these selfless men and women, then do your part to stop the community spread of this disease. It’s as easy as these four steps:

· Stay at home as much as possible.

· Wear a mask when you leave your house.

· Wash your hands frequently.

· Keep at least six feet of distance between yourself and others, avoiding crowds at all costs.

We would also urge local governments in counties with rising numbers of cases to consider mask ordinances, and we thank those leaders who have already taken action to require masking.

Basically, as the Governor and others noted in the news conference this morning, it all boils down to using our common sense. The virus is real; it’s serious, and it will take all of us doing our part to control its spread.

Stated on behalf of the Alabama Hospital Association, the Medical Association of the State of Alabama and the Alabama Nursing Home Association

Posted in: Coronavirus, Official Statement

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Advocacy Efforts During COVID-19

Advocacy Efforts During COVID-19

The spread of COVID-19 has affected nearly all aspects of our daily lives. For the Medical Association’s efforts in protecting physicians and patients, this was also true. Nonetheless, between March 13 (when Gov. Ivey issued the COVID-19 state of emergency) and mid-May, our advocacy work continued in full-force.

Executive Actions & Proposals

  • Worked with various stakeholders and Governor Ivey to secure liability protections via an Executive Order for physicians, their staff and their practices against frivolous COVID-19 lawsuits (summary available here);
  • Successfully advocated against multiple dangerous scope of practice expansions proposed by both state and national organizations. Among other things, these proposals would have (1) eliminated physician supervision and destroyed the team-based care model; (2) granted CRNAs the ability to prescribe controlled substances; and (3) allowed pharmacists to switch a patient’s drugs without prescriber authorization and without any requirement to notify to the prescriber or the patient; and
  • Successfully advocated against a proposal to give out-of-state telehealth corporations special treatment that physicians currently living, working, and paying taxes in Alabama do not enjoy.

Telehealth Payment Parity

  • As one of our longstanding priorities (payment parity between in-person visits and telehealth services), we were proud to see reimbursement rates addressed and the policy of parity come to fruition.

Miss our 2020 Legislative Recap, What if No One was on Call? Click here for the annual rundown.

Posted in: Advocacy, Coronavirus, Liability, Members

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Provider Relief Fund Update

Provider Relief Fund Update

Last week, HHS launched an application portal to distribute $15 billion in CARES Act Provider Relief Fund payments to eligible Medicaid and CHIP physicians and organizations. The payment will be at least 2 percent of reported gross revenue from patient care, and the final amount will be determined based on submitted data, including the number of Medicaid patients served. Eligible physicians and organizations have until July 20, 2020, to submit their application and report other necessary information, such as annual patient revenue data.

HHS is hosting two webcasts at 2 pm EST on Tuesday, June 23 and Thursday, June 25 for physicians and other health care professionals who are interested in learning more about the application process. Registration is required.  

Please find answers to two relevant questions posted in the FAQs on June 12, 2020.

Q: Why is there a new Provider Relief Fund Payment Portal?

A:  Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund starting Wednesday, June 10, 2020. At this time, this portal will serve as the point of entry for providers who have received Medicaid and CHIP payments in 2017, 2018, 2019 or 2020 and who have not already received any payments from the $50 billion Provider Relief Fund General Distribution.

Q: What is the difference between the first Provider Relief Fund Payment Portal and the Enhanced Provider Relief Fund Payment Portal for the Medicaid Targeted Distribution?

A: The first Provider Relief Fund Payment Portal was used for providers who received a General Distribution payment prior to Friday, April 24th. These providers were required to submit financial information in order to receive approximately 2% of gross revenues derived from patient care.

HHS has developed the new Enhanced Provider Relief Fund Payment Portal for providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care, and behavioral health providers.)

Posted in: Coronavirus, Management

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Lights, Camera, Action…No!

Lights, Camera, Action…No!

By: Kelli Carpenter Fleming, Esq.

The Office for Civil Rights (“OCR”), the entity responsible for HIPAA compliance and enforcement, has issued a series of guidance documents regarding the interplay of HIPAA and the COVID-19 pandemic. The most recent guidance serves as a reminder to health care providers to follow the requirements of HIPAA when speaking with the media or allowing filming within the office or facility. This has even greater importance due to the increased amount of media attention on healthcare providers and the facilities treating COVID-19 patients. 

The recent guidance reminds health care providers that the HIPAA Privacy Rule is not altered during the COVID-19 public health emergency. HIPAA does not permit a health care provider to give media and film crews access to facilities where patients’ protected health information (“PHI”) will be accessible without the patients’ prior authorization. Even during the current COVID-19 public health emergency, health care providers are still required to obtain a valid HIPAA authorization from each patient whose PHI will be accessible to the media. Consistent with past guidance, OCR reminds providers that masking or obscuring patients’ faces or identifying information before broadcasting a recording of a patient is not sufficient. According to the guidance, by way of an example, “a covered hospital may not allow media personnel access to the emergency department where patients are receiving treatment for COVID-19, without first obtaining each patient’s authorization for such filming.”

We have seen at least two (2) previous OCR investigations regarding inappropriate disclosure of PHI to film crews (in 2016 and 2018), both of which were resolved with corrective action plans and monetary settlements. I would not be surprised if we see additional future OCR enforcement actions in this regard in light of the increased media coverage surrounding COVID-19. 

The recent guidance may be found here.

Kelli Fleming is a partner at Burr & Forman, LLP practicing exclusively in the firm’s Health Care Industry Group.

Posted in: Coronavirus, Legal Watch, MVP

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Gov. Ivey Provides Physicians Liability Protections from COVID-19

Gov. Ivey Provides Physicians Liability Protections from COVID-19

Today, Gov. Ivey issued an executive order protecting physicians, their staff, and their practices from lawsuits related to COVID-19. The governor’s order, the eighth such supplemental emergency order issued by her administration since the pandemic began, provides a “safe harbor” for services affected by COVID-19 or Alabama’s response to the pandemic and from other COVID-19 related claims.

“As one of many Alabamians on the front lines of this pandemic, I thank Gov. Ivey for working with the Medical Association to provide this much-needed liability protection for these unprecedented circumstances affecting care provisions that are far beyond any of our control,” Medical Association President John Meigs, Jr., M.D., said.

The order provides immunity for treatment that resulted from, was negatively affected by or was done in response to the COVID-19 pandemic or the State’s response to the pandemic unless proven by clear and convincing evidence that a health professional acted with wanton, reckless, willful, or intentional misconduct – a standard significantly higher than simple negligence. Importantly, the liability protections in today’s order apply retroactively to March 13, 2020, and will remain in place until the COVID-19 public health emergency is terminated.

Protecting physicians, their staff, and medical practices from COVID-19 lawsuits has been a priority of the Medical Association since Alabama entered a state of emergency in mid-March. In addition to the governor’s office, the Association has worked with multiple other organizations on today’s order and appreciates the expertise of the Birmingham law firm of Starnes, Davis and Florie during those negotiations. Click the button below to view a summary of the proclamation.

Posted in: Advocacy, Coronavirus, Legal Watch

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Alabama Department of Public Health Advises Health Care Providers in Use of COVID-19 Tests not Approved by the United States Food and Drug Administration

Alabama Department of Public Health Advises Health Care Providers in Use of COVID-19 Tests not Approved by the United States Food and Drug Administration

The Alabama Department of Public Health (ADPH) supports health care workers’ efforts to care for Alabama citizens during this COVID-19 health crisis. As this public health emergency evolves, there is need for increased availability of SARS CoV-2 diagnostic testing. In response to this demand, the United States Food and Drug Administration (FDA) released policies to authorize emergency use of in vitro diagnostics to increase testing capacity and development to promote widespread testing for COVID-19. As a result, the availability of commercial testing devices proliferated, many with false claims by distributors. ADPH therefore advises health care providers to choose COVID-19 testing systems that are FDA approved when making decisions regarding their patients.

Tests not approved by the FDA can produce false results and lead to unintended consequences for the patient and broader community. A false negative result from a non-approved kit may lead someone who has COVID-19 to think they are not infected and cannot spread the illness. Patients need accurate information about their health, and health care providers and officials need accurate information to provide appropriate medical care and make public health decisions.

Currently, the most accurate FDA-approved testing available is polymerase chain reaction (PCR) assays. PCR tests can detect small amounts of the virus collected in samples from the patient’s nose or throat. Public health, commercial, and some clinical laboratories use PCR technology to diagnose COVID-19 infections. Many of these tests have FDA approval through emergency use authorization (EUA).

Serology testing is gaining momentum in the marketplace as collection of blood samples is easy and many platforms are point of care with results in minutes.  Serological tests detect if an individual’s body is developing antibodies against COVID-19. While these tests can be used to track disease, they are not reliable as or recommended for diagnostics and is even stated on most package inserts. At this time, there are only three serological tests that are EUA approved (https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd).

If your facility is considering a serology-based test that is not EUA approved by FDA, understand that:

  • Currently no Centers for Disease Control and Prevention guidance exists as to how to interpret or take public health action in response to a positive or negative COVID-19 serology result.
  • These tests have not had performance reviews by FDA.
  • Negative serology results do not rule out COVID-19 in a patient.
  • Serological testing should not be the sole basis to diagnose or exclude infection, or to inform infection status. 
  • The immune response to SARS-CoV-2 infection is poorly understood at this time.
  • Cross reactivity is likely. Positive results could reflect past or present infection with non-SARS-CoV-2 strains.
  • False negative results could occur when the immune response is too low to be detected.
  • If serology-based test results are submitted to ADPH, they will not be included in the COVID-19 counts at this time due to lack of guidance regarding interpretation.

ADPH fully supports health care providers on the front lines of this pandemic and trust they will use this advisory to make informed decisions regarding their patient’s health. It is important to be aware of distributors’ false claims. Thank you for your commitment and dedication in service for the citizens of Alabama. If you have questions regarding this information, contact Burnestine Taylor, M.D., at burnestine.taylor@adph.state.al.us.

Posted in: Coronavirus, Members

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Chronic Care Management in the Coronavirus Pandemic

Chronic Care Management in the Coronavirus Pandemic

Article contributed by: Tammie Lunceford, CMPE CPC with Warren Averett

Chronic Care Management Expands Care

Several years ago, the Center for Medicare and Medicaid Services released Chronic Care Management to assist in improving patient outcomes, extend care, and improve quality in chronic illness.  The initial chronic care code, 99490 allowed for 20 minutes of non-face to face phone communication with clinical staff per month which reimbursed forty-two dollars per month.  The patient had to agree to be enrolled in the program and agree to an $8 co-pay.  Only one physician can enroll a patient and the patient must have at least two complex chronic conditions lasting more than twelve months.  Most physicians did not adopt chronic care management due to the low reimbursement, the physician had to treat all chronic conditions which excluded most specialists from participating.

Some large practices outsource chronic care management and share the reimbursement.  Whether the practice uses internal staff or outsourced staff, CCM services provide additional care and coordination to the most chronically ill.  The patients receiving this service feel more connected to their provider and a change in their status is identified quickly.  If the practice also has telemedicine, a non-face to face service can quickly become a face to face visit to address concerns. Due to the recent COVID-19 pandemic, these interactions could provide the care needed to protect the chronically ill from being exposed to the deadly virus. 

The 2020 Final Medicare Physician Fee Schedule added some provisions to Chronic Care Management services.  The addition of Principle Chronic Management allows a patient with a single high-risk chronic condition lasting more than 12 months to qualify for the program. PCM should increase the use of chronic care management with specialists, such as cardiologist and pulmonologists.  Also approved for 2020, is G2058 which is an add-on code to allow an additional 20 minutes of time spent in continuous communication with the patient.  The add-on code reimburses $37.89 and can be billed concurrently to 99490, two times monthly, per beneficiary.  The total possible reimbursement for 60 minutes of non-complex CCM is $118.01. 

The new opportunities to provide chronic care management and principle care management will allow specialists managing hundreds of patients with chronic conditions, such as, COPD or diabetes to improve the overall health of the patient, improve patient engagement, improve quality and receive reimbursement worthy of the effort.

Practices are currently working to provide many modes of communication to serve patients without seeing them in the office.  Patient portals have failed in the past because many portals were not user friendly or practices failed to make them valuable by offering valid information through the portal.  In times of crisis, such as COVID-19, it is quite possible for the phone lines to be full but utilizing the patient portal and offering CCM and PCM allows a practice to fulfill many patient’s needs without a physician or mid-level providing the interaction.

We are in crisis as COVID-19 cases increase across the nation, but we have seen monumental change through the emergency expansion of telemedicine.  As administrators and physician leaders review the options to expand communication through technology and ongoing medical management, we will be better prepared for crisis situations in the future.

Posted in: Coronavirus, Management, Members

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The Privacy Vulnerabilities of Zoom Software and Potential Alternatives

The Privacy Vulnerabilities of Zoom Software and Potential Alternatives

Over the past month, as more nationwide “Shelter at Home” orders have been issued and more companies have transitioned to telework, the need for online meetings and webinars has skyrocketed. To accommodate this new way of doing business, many have turned to a platform called Zoom. The problem? No one bothered to read the fine print.

For those in the healthcare field, privacy is paramount. Yet, by using Zoom, users are seceding any and all content displayed or vocalized to the company. In Zoom’s own privacy statement, some of the “Customer Content” it collects includes “information you or others upload, provide, or create while using Zoom.”[i]  Additionally, Zoom also collects personal information like your name, physical address, email address, phone number, job title, employer.[ii]  And, even if you don’t make an account with Zoom, it will collect and keep data on what type of device you are using, and your IP address.[iii]

Now, while Zoom has recently updated its privacy policy and is taking steps to make the platform more secure, there are issues beyond the data mining mentioned above. On Monday, for instance, the Boston office of the Federal Bureau of Investigation issued a warning[iv]  saying that it had received multiple reports from Massachusetts schools about trolls hijacking Zoom meetings with displays of pornography, white supremacist imagery and threatening language — malicious attacks known as “zoombombing.”[v]

So, what’s the solution? Below are a few good alternative platforms to use instead Zoom:

  • Apple FaceTime (only available on iPhone and Macs)
  • Skype (available on all devices) (recommended)
  • Google Hangouts (available on all devices)
  • GoToMeeting (available on all devices)
  • Jitsi (available on all devices)
  • RemoteHQ (available on all devices)

[i] https://zoom.us/privacy

[ii] Id; see also https://protonmail.com/blog/zoom-privacy-issues/

[iii] Id.

[iv] https://www.fbi.gov/contact-us/field-offices/boston/news/press-releases/fbi-warns-of-teleconferencing-and-online-classroom-hijacking-during-covid-19-pandemi; see also https://www.nytimes.com/2020/04/02/technology/zoom-linkedin-data.html?partner=IFTTT

[v] https://www.adl.org/blog/what-is-zoombombing-and-who-is-behind-it; see also https://www.nytimes.com/2020/04/02/technology/zoom-linkedin-data.html?partner=IFTTT

Posted in: Coronavirus, HIPAA, Legal Watch, Management, Scam

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Stanford Researchers Address COVID-19 Face Mask Shortages

Stanford Researchers  Address COVID-19 Face Mask Shortages

For those healthcare workers facing a shortage of N95 masks, Stanford researchers have published guidance stating that such masks can be sterilized and reused with virtually no loss of filtration efficiency by leaving in oven for 30 mins at 70C / 158F. Don’t throw your masks away!

KEY TAKEAWAYS

  • Frontline health care workers across the United States report shortages of PPE ranging from gloves, protective gowns, eyewear and face masks.
  • It is unknown how wearing the same mask multiple times effects the fit of N95 masks [NIOSH]
  • NIOSH states “there is no way of determining the maximum possible number of safe reuses for an N95 respirator as a generic number to be applied in all cases” and advise to “discard N95 respirators following use during aerosol-generating procedures.”
  • Some methods of N95 mask disinfection can maintain filtration efficiency. Their effect on mask fit is unknown, and these methods are not approved by NIOSH.

Download the full report by clicking the button below

Posted in: Coronavirus

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