Archive for Coronavirus

Physicians Perspective: Dr. Chris Adams Talks Telemedicine

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Physicians Perspective: Dr. Chris Adams Talks Telemedicine

Adversity and necessity mandate invention. 

During the COVID-19 pandemic, telemedicine has been transformed almost overnight into a necessary medical tool for remaining connected to our patients.  Without warning, physicians suddenly found themselves in the position of adding communication technologies, learning regulatory requirements, and adapting to an entirely new way of interacting with patients, sometimes reinventing their standard clinic procedures.  Similarly, government and private health care had to modify longstanding obstacles and prohibitions by allowing interstate practice and revising reimbursement policies.

I doubt there is a physician in our state who believes they could have managed their patients through this pandemic without the benefit of telemedicine.  Having said that, telemedicine is not a panacea. 

Practicing in a rural environment, we have discovered that bandwidth challenges are a huge issue.  Older patients also have vision and hearing challenges that make telemedicine less effective than face-to-face visits.  There is still an enormous amount of paperwork involved in conducting a telemedicine visit, it is not simply a matter of “picking up the phone and chatting.”  That is one reason why it is so important to have parity for video and telephone encounters. 

Despite these challenges, most clinicians would like to maintain the availability of this tool as we continue our social and medical confrontation with coronavirus.  At the same time, we also recognize inherent limitations that telemedicine imposes (I just cannot do a good knee exam over the telephone).  The challenge we now face is to define and refine best practices for employing telemedicine.  Part of this effort will require continued advocacy and encouragement of health delivery systems to support telemedicine.  Some of this will also necessitate new legal safe guards for practitioners employing this tool.

As you reflect on how this pandemic has changed your practice, please consider how you can support and contribute to the future of medicine in our state by advocating for your patients and your practice.  It is up to us as clinicians to help mold the future of healthcare delivery.

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Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

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Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

By:          John S. Meigs, Jr., MD, President Medical Association of the State of Alabama

In a span of just a few months, the coronavirus pandemic has changed the way we function as a society and has fundamentally altered our healthcare delivery system. It has exacerbated weaknesses in the infrastructure of health care and exposed limitations in current policies at a time when costs are rising and access to care is dwindling.

In an effort to understand these changes and their effects, the Medical Association of the State of Alabama released a survey summary detailing the impact of the novel coronavirus (COVID-19) on medical practices and care delivery.  The survey identified several key findings:

  • Public Health Concerns: Survey data shows that patient volume is down considerably and there are concerns that Alabamians are not going to their physician for routine care, including childhood and adult vaccinations, which will have long term public health consequences.
  • Financial Impact: More than 70% of respondents said COVID-19 has had a severe impact on practice finances, causing layoffs and furloughs and limiting access to care
  • Patient Volume: Nearly 60% said patient volume reductions cut revenues by at least 50%, underscoring the extent to which patients are delaying or skipping necessary care
  • Telemedicine Increase: More than 71% said they’re likely to continue providing telemedicine so long as insurers continue covering the services for patients
  • Liability Concerns: More than 71% are concerned about the potential liability from lack of PPE and patients canceling or delaying procedures and other medical care

In addition, a similar study[1] found that Alabama is ranked sixth in the country in the number of patients that are delaying care. While COVID-19 may change how you receive care, it’s still important to look after yourself by getting the time-sensitive medical care you need to stay healthy.

In light of the findings of the survey, the Medical Association recommends several public policy proposals to combat COVID-19’s effects on physician practices and care delivery:

  1. Allocate state stimulus funds to reimburse practices for COVID-19 related expenses
  2. Expansion of testing, PPE, and cleaning supply availability
  3. Continued coverage of telemedicine by insurers at existing rates
  4. Enactment of “safe harbor” legislation to provide liability protections to health care providers

This pandemic has made telehealth more important than ever, enabling access to care to patients whose needs can be met remotely. Telemedicine has saved lives, helped reduce the spread of the virus, and enabled physicians to care for patients in a time when they might have otherwise been unable to. However, it is not a “silver bullet” and should not be viewed as a total replacement for in-person care.

Whether in a hospital, surgery center, or in a clinic, COVID-19 has drastically changed the care we as physicians provide for our patients. We cannot allow this virus to decimate our already strained healthcare system. Supporting those who care for us is needed now more than ever.

View the Survey Report

View the complete survey summary by clicking the button above or by using this link: https://masa.informz.net/masa/data/images/2020-Survey-Graphic_Summary-FINAL.pdf

John S. Meigs, Jr., MD, President Medical Association of the State of Alabama

[1] Bean, M., 2020. States Ranked By Percentage Of Americans Delaying Care: Nationwide, 40 Percent Of Americans Are Still Delaying Care, According To A Survey From The U.S. Census Bureau.. [online] Beckershospitalreview.com. Available at: <https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-percentage-of-americans-delaying-care.html> [Accessed 26 August 2020].

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Statement from the Medical Association on Statewide Mask Requirement

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Statement from the Medical Association on Statewide Mask Requirement

The number of COVID-19 cases and deaths throughout the state have been increasing at a dangerous rate. We now have over 58,225 cases and approximately 1,183 deaths from COVID-19 in our state. With physicians on the front lines of the Coronavirus pandemic, the Medical Association of Alabama, the state’s largest professional organization of physicians, announced their support of Governor Kay Ivey’s new amended ‘Safer at Home’ order.

The order states that a face covering must be worn in public. More specifically, it stipulates masks must be worn when within 6 feet of a person from another household. The order will go into effect Thursday, July 16 and will remain in effect until July 31.

“For a contagious respiratory infection for which we have no treatment, masking, isolation and social distancing are our only effective means to slow down the spread of this disease and save lives,” said Dr. Meigs. “Governor Ivey and State Health Officer, Dr. Scott Harris, are to be commended for having the courage to make this difficult decision and to do what is right, what was needed, in the face of the political pressure against these measures.”

“We want the economy open. We want businesses open. We want schools open. The best way to do this is to wash your hands, socially distance, and wear a mask/face covering over the mouth and nose to lower the spread of droplets that contain the virus,” said Dr. Arora. “The evidence is clear – masks and face coverings significantly reduce the spread of SARS-CoV-2, the virus that causes COVID-19 and we believe that we should take care of ourselves as a responsible community.”

Until we have a vaccine and effective treatments for COVID-19, our only option is to wear a mask, exercise safe social distancing, and wash your hands/use hand sanitizer regularly. We all have a role to play in stopping the spread of COVID-19. We all have the power to protect ourselves, our fellow Alabamians, and the most vulnerable among us. Be informed, stay healthy, and please wear your mask.

John S. Meigs, MD

Medical Association President

Centreville, Alabama

Aruna Arora, MD

Medical Association President-Elect

Huntsville, Alabama

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Small Business COVID-19 Grant Program Available

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Small Business COVID-19 Grant Program Available

This week, Governor Ivey announced the Revive Alabama grant program to support small businesses, including some physician practices, in Alabama that have been impacted by COVID-19. The program will reimburse practices for expenses they have incurred due to interruptions in business activity caused by the pandemic. 

Practices that qualify as small businesses may receive up to $15,000 to reimburse expenses as a result of the pandemic. However, there are several factors that will determine the eligibility of a practice. Consequently, physicians are encouraged to click the following link to view the eligibility requirements for further clarification.

 Note, there are limitations if your practice received or is expecting to receive federal assistance such as a Paycheck Protection Program (PPP) Loan, Economic Injury Disaster Loan, or Pandemic Unemployment Assistance (PUA).

Practices may access the grant application by visiting the Revive Alabama page on the Alabama Department of Revenue website. Application Period: Noon on July 16,2020 – Midnight on July 25, 2020. 

What Business Are Eligible to Apply?

  • Must be a resident of the state with a permanent place of business located in the state.  A resident includes an individual, partnership, corporation or other business entity.  For businesses, “resident” means based or headquartered in AL.
  • Was in business and fully operational as of March 1, 2020 and continues to be operational as of the date of application.
  • Had no more than 19 full-time equivalent employees as of March 1, 2020.
  • Is not a subsidiary of or owned by a business with more than 50 FTEs, or part of a larger business enterprise with more than 50 FTES.
  • Filed AL Income Tax returns for both 2017 and 2018 tax years as of March 1, 2020 (if entity was in existence).
  • Businesses that existed during 2019 must also verify that they will timely file and pay 2019 income taxes in accordance with the due date for the return, including applicable extensions.
  • Businesses that existed during 2019 must have had gross revenues for the year that do not exceed $5,000,000.
  • Business that existed prior to 2019 must have had less than an average of $5,000,000 in gross revenues in each of the past two tax years.
  • Eligible small businesses formed in 2020, must verify that they will timely file and pay income taxes for the 2020 tax year.
  • Be in good standing with the ALDOR as of March 1, 2020.
  • Incurred eligible expenses due to the interruption of business, such as mortgage interest, rent, payroll and utilities, up to the grant amount requested. Additional practice expenses such as PPE, cleaning supplies, telehealth hardware and software costs, may also qualify.
  • Has not received a federal Paycheck Protection Program (PPP) Loan, Economic Injury Disaster Loan or Pandemic Unemployment Assistance (PUA)
    • Or, if received or expected to receive, incurred eligible business interruption expenses up to the amount requested that were not covered with these funds.

 Funds cannot be use for the following:

  • As reimbursement for cost or damages covered by insurance
  • For expenses that have been or will be reimbursed under any federal program, including the PPP, Economic Injury Disaster Loan Program, or PUA
  • For reimbursement to donors for donated items or services
  • For workforce bonuses other than hazard pay or overtime
  • For severance pay
  • For legal settlements

Please note: All practices must first establish a secure My Alabama Taxes (MAT) account before submitting an application. Click here to create an MAT account. Practices may want to go ahead and create a MAT account prior to the application process opening.

The Medical Association will provide more information regarding the grant as it becomes available and is continuing to work with the Governor’s office on additional stimulus funds for physician practices that don’t qualify under this program.

 We are also working with our Corporate Partner Warren Averett to provide up to date information on the grant program. For specific practice advice please contact Maddox Casey, CPA at Maddox.casey@warrenaverett.com.

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Statement in response to Ivey’s Safer at Home order

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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

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Advocacy Efforts During COVID-19

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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.

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Provider Relief Fund Update

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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.)

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Lights, Camera, Action…No!

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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.

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Gov. Ivey Provides Physicians Liability Protections from COVID-19

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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.

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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

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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

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.

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