East Bay COVID-19 Update – April 16, 2020
HHS Clarifies Terms & Conditions, Paycheck Protection Funding Update and
City of Berkeley Announces Universal Masking Order

As of  April 16, there are 1,007 confirmed cases of COVID-19 in Alameda County and 39  deaths (including City of Berkeley information). As of  April 16, there are 631 confirmed cases of COVID-19 in Contra Costa County and 16 deaths. Please check  www.accma.org/COVID-19   for the latest updates.   
HHS Clarifies Terms and Conditions for $30 Billion Payments to Physicians

On April 10, 2020, the U.S. Department of Health and Human Services (HHS) began sending FFS Medicare-enrolled physicians direct deposit disbursements totaling $30 billion. The lump sum payments will go to each physician organization’s TIN that normally receives Medicare payments. The $30 billion is part of the $100 billion Public Health and Emergency Fund created by the Coronavirus Aid, Relief and Economic Security Act (CARES Act) to provide financial assistance to physician practices, hospitals and other providers negatively impacted by the COVID-19 pandemic.

Each physician organization receiving these grants will need to attest to certain HHS terms and conditions within 30 days of receiving the grant. Yesterday HHS clarified the terms and conditions in response to organized medicine’s concerns. In agreeing to the terms and conditions of the grants, physicians were being required to attest that they “diagnose, treat or test patients for COVID-19.” The American Medical Association (AMA), on behalf of organized medicine, argued that the language inappropriately narrowed physician use of the funding. In response, HHS has now modified some of the language to make its meaning more clear, stating that every patient is a possible case of COVID-19.

The website at hhs.gov/provider-relief now includes the following statement: “If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

Also, the second provision of the terms and conditions has been changed to no longer say providers attest to "currently" taking care of patients, just that they did so after January 31, 2020.

The CARES Act Provider Relief Fund Payment Attestation Portal exit disclaimer icon is now open. Providers who have been allocated a payment from the initial $30 billion general distribution must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment. Physicians must also attest that they will not balance bill patients “for all care for a possible or actual case of COVID-19.”

A second wave of payments from the CARES Act Public Health and Emergency Fund should be going out soon. HHS said it is working to disburse additional funding to providers with lower shares of Medicare reimbursement (such as pediatricians, allergists and OB-GYNs) and Medicaid providers, and for COVID-19 treatment for the uninsured.

HHS will have the new terms and conditions posted on its website by April 18, 2020.
Paycheck Protection Program Funding Update

As part of the Coronavirus Aid, Relief and Economic Security Act (CARES Act), Congress created the Small Business Association Paycheck Protection Program (PPP). This program allows small businesses of less than 500 employees to apply for forgivable, zero-fee loans of up to $10 million to cover approximately 8 weeks of payroll and other operating expenses. The PPP loans are forgivable if 75% of the loan is dedicated to payroll expenses.

Because of the widespread financial distress among small businesses across the country, private banks and lenders were overwhelmed with applications. Some even stopped taking applications within the first few days of the program. As of April 15, 2020, the program had already run out of money. 

Congress is working to increase funding for the program by another $250 billion and the Federal Reserve announced it would back another $250 billion in loans. The California Medical Association (CMA) recommends that interested physicians continue to pursue local lenders so they are in a good position when new funding is released. ACCMA will notify physicians when the additional funding is approved.
Universal Masking Order Establishing Requirements for Control of COVID-19
for Individuals Entering Certain Licensed Facilities and Other Agencies

Effective April 17, 2020, The Health Officer of the City of Berkeley has issued an Order to certain licensed facilities requiring masking, temperature monitoring, self-evaluation of symptoms, cancellation of group activities, notification of transport, among other requirements. Full details of the requirements and of the types of facilities affected can be found in the order .

This Health Officer Order is issued based on evidence of increasing occurrence of COVID-19 within the City and throughout the Bay Area and that COVID-19 can easily spread between people who are in close contact with one another. The Order is intended to reduce the risk of COVID-19 exposure in Covered Facilities in order to protect vulnerable populations residing at certain Covered Facilities.

To fulfill the Order’s requirements, all Licensed Facilities and Other Agencies must:
  • Implement temperature screenings for all staff, contractors and other essential visitors before allowing entrance or commencing services in the facility.
  • Ensure all individuals who enter or provide services to the facility self-evaluate for mild to moderate symptoms related to COVID-19. These include fever, sore throat, coughing, shortness of breath, chills, sneezing, gastrointestinal symptoms, or otherwise not feeling well.
  • Prohibit entry to anyone who has a temperature of 100.0° F or 37.8° C or greater, feels like they have a fever, or has symptoms identified through self-evaluation.
  • Implement masking among staff, residents and other essential visitors to cover their nose and mouth while in the facility and, for residents, outside their rooms. Appropriate and recommended Personal Protective Equipment must be worn by staff when available if there is a confirmed or suspected case of COVID-19 at the facility.
  • Cancel all group activities and communal dining. Staff and residents who must leave their rooms should practice physical distancing and remain 6 feet apart.
  • Notify acute care hospitals, Emergency Medical Services and transport agencies if a resident who is suspected or confirmed of having COVID-19 is being transferred to an acute care hospital. If the facility already has COVID-19 case(s), then they must notify EMS and the receiving hospital of potential COVID-19 exposure.

Avoid, as much as possible, staffing scenarios that use employees who have worked at another Licensed Facility or Other Agency in the past 14 days while maintaining adequate staffing at the facility. Facilities must keep a daily log of employees present, identifying any other facilities the employees have worked at in the previous 14 days, and that log must be produced immediately if requested by any staff member of City of Berkeley County Public Health.
CMA Publishes COVID-19 Toolkit for Physician Employers

As the COVID-19 pandemic continues to have a profound economic impact nationwide, many physicians are facing important questions related to their practices and their roles as small business employers. In recent weeks, new laws have been quickly enacted at the federal, state, county and city level that have expanded unemployment benefits, sick leave provisions, and family medical leave laws to help both employers and employees affected by this public health crisis.

To help physicians understand the rapidly evolving personnel and other employment-related issues during the COVID-19 public health emergency, the California Medical Association has published the CMA COVID-19 Toolkit for Physician Employers . This resource is free to all and available on CMA’s COVID-19 resource page, cmadocs.org/covid-19 .

Alameda & Contra Costa County Recruiting Physicians for COVID-19

East Bay physicians can support COVID-19 response efforts through paid and/or voluntary service opportunities through the Alameda County, Contra Costa County, or the State of California. Please visit accma.org/COVID-19 and scroll to "COVID-19 Volunteer Opportunities" for application instructions.
PPE and Supplies - County Request Forms

The following is information about placing orders for PPE and other medical support through County resource allocation processes:

  • Contra Costa County: All Resource Requests should be submitted using the attachedCCCHS Request Form. If requesting PPE, must also complete attached “Medical/Health Items Provider Questionnaire" (found on the first page of the CCCHS Request Form). These forms should be submitted directly to the CCHS DOC Logistics Section at doc.logistics@cchealth.org. Per CCHS, you should first work within your vendors and systems first before sending requests to the DOC.
Complimentary Peer Discussion Groups
RechargedMD  is offering ACCMA members  complimentary online peer discussion and coaching specifically for physicians. With the guidance of a certified physician coach, physicians can receive and offer support, as well as learn from one another. Small groups will meet beginning on April 25 for 45 minutes per week for three facilitated sessions. Go to  rechargedmd.com/covid19support
Tips for Physicians to Protect Themselves and Their Families During the COVID-19 Pandemic
Click here for tips on what to do before going to work, at work, and after work/coming home to protect yourself and your family. Tips include how to create a hot zone (contaminated area) near your home entrance and how to take care of your skin. Courtesy of the TPMG Diablo Health and Wellness Team.    
ACCMA Resources Toolkit
The ACCMA has put together a free toolkit of resources that address the day-to-day needs of East Bay physicians of all career stages and in all modes of practice, from food and grocery delivery services to exercises that can be done at home. Click here to access and download the toolkit.  
Upcoming Webinars
Friday, April 17, 2020 | 12:30 PM - 1:30 PM | FREE

Telemedicine is the new normal for patient care through the COVID-19 Emergency. This webinar will focus on using telemedicine to enhance patient-centered care, including exploring new and upcoming technology solutions that will help support physicians in providing optimal person-centered care to patients. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Michael Harbour, MD
Monday, April 20, 2020 | 12:30 PM - 1:30 PM | FREE

With the COVID-19 Emergency requiring physicians to adopt telehealth and position more of their staff to work from home, important patient privacy and security risks emerge. This webinar will address those along with practical tips for compliance. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

David Ginsberg, co-founder and president of PrivaPlan Associates, Inc. 
Allen Briskin, Senior Counsel, Pillbury Winthrop Saw Pittman LLP 
Wednesday, April 22, 2020 | 6:00 - 7:00 PM | FREE

This one-hour webinar led by Linda Hawes Clever, MD, MACP, will offer practical, creative, and effective remedies to deal with the crush on personal and professional lives during the COVID-19 pandemic. It will start with some strategies, resources, and suggestions and then quickly evolve to questions and answers, as we listen and see the ingenuity, guts, and devotion with which we are addressing the harrowing challenges we all face as a profession, community, and nation. Participants will discover how to r educe personal stress and learn healthy ways to contend with the impact of COVID-19.

You are encouraged to submit questions in advance to help her address the range of clinician concerns and responses to the crisis. And you can also briefly share any personal tips and practices that are helping you during this difficult time. Please send your questions and comments to ccaufield.renew@gmail.com.
Thursday, April 24, 2020 | 12:30 PM - 1:30 PM | FREE

Join a panel discussion with three physicians who successfully transitioned to using Telemedicine in their practices. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Marc Dean, MD 
Uli K. Chettipally, MD 
Richard Thorp, MD

Please contact ACCMA at 510-654-5383 or accma@accma.org with any questions or concerns you have. Although we may not currently have an immediate answer to all questions, we want to know the information and resources that you need to continue to provide care for our community during this difficult time.  
This information will also be posted online at www.accma.org/COVID-19 and will be updated frequently. Please check the ACCMA website regularly for updates.