Updates from your ACE team
The first half of the year has been interesting to say the least. State governments have started lifting stay-at-home orders and we continue to navigate COVID-19 and how to best combat some of the hardest challenges the pandemic has brought and brings our nation and the healthcare industry together. Conversations and action plans of how to reopen the nation and different atmospheres - beaches, restaurants, hair and nail salons, gyms, to name a few - have started. However, just because these conversations have started and orders have been lifted, doesn't mean we're through the pandemic. Life won't be back to normal until there is at least 50 percent immunity. One day, COVID-19 will either be like the plague or small pox, both were once deadly diseases that are both curable and unheard of today or like the flu where there are seasonal flares and a vaccine.

This month we focus on how you can drive your revenue and achieve financial independence by implementing additional lines of service onto your existing services that patients greatly appreciate, such as providers being closer to their homes, telehealth and home delivery. This newsletter explains: how working with private practices can expand and drive your revenue while helping the struggling private practices keep their doors open and how together it's possible to provide medical care to a wider population, a new Health Resources and Services Administration (HRSA) grant for residency programs, new data from the Kaiser Family Foundation that shows an increase of COVID-19 cases and deaths in rural America, how to make Medicaid revenue work for you in these times and why you should take advantage of it and pharmacy home delivery programs that will drive your pharmaceutical revenue while keeping patients and your pharmacy staff safe by limiting both parties' number of interactions.
Where is the influx of insured and uninsured patients coming from and how are you treating them?
A few months ago, we mentioned some of the benefits of partnerships between FQHCs and private practices . Last month we talked about private primary care practices and rural hospitals possibly closing because of the pandemic. According to an article from Rev Cycle Intelligence published on April 22, 2020 , a new survey , that was conducted from April 10 to April 13, showed that the pandemic is going to deplete 20 percent of the nation's primary care practices of the necessary resources required to be open past May 20, 2020. According to the survey:
  • 34 percent clinicians said they have no capacity for COVID-19 testing while 32 percent reported having a limited capacity.
  • 53 percent reported a lack of personal protective equipment (PPE) while 58 percent reported they are utilizing either used or homemade versions.
Furthermore, the private "practices are hoping to receive external financing support to" be able to stay open and treat patients. About 1 / 5 of the survey respondents, stated that it is likely for them to apply for a Small Business Administration loan in the next four weeks.

What does this mean for your providers, facility and patients? This could mean:
  • Longer government-ordered stay-at-home and work-from-home orders through the pandemic.
  • An influx of insured and uninsured patients.

It sounds bad all the way around when it doesn't have to. Community health centers are in a unique position. Because large private and public hospital systems may not be contracting out or entertaining the idea of adding staff, community health centers can contract with or temporarily absorb the private practices threatening to close. If the hospital systems aren't willing to do it, why should community health centers? For starters, community health centers are structured differently and the influx of patients that will be coming through your door because they were laid off or furloughed (and may not have insurance) are both drivers to do it.

Are you recruiting a new provider? Were you planning an expansion via a provider but then the pandemic happened?

Either way - the pandemic might sweeten the deal for the private practices to join forces with you in this fight and be the key to getting through the pandemic.

While Medicare has lifted its restrictions related to virtual visits for the pandemic, it has not decided whether or not it will reimburse private practices for the services its providing to Medicare beneficiaries. 44 percent of the survey respondents are not sure if their practice will be reimbursed.
Are you following up on your self-pay now Medicaid later patients?
COVID-19 continues to add pressure to the government, the local and global economy, several industries and the health care system, especially community health centers. An interesting way you can work to increase revenue is through retro active Medicaid.

As more Americans lose their health insurance and file for unemployment, more patients will visit a community health center and qualify for Medicaid after their visit. It is now more important than ever to review this data to ensure your providers and facility are being reimbursed for the services provided.
Rural America sees an increase of COVID-19 cases
The Kaiser Family Foundation completed a two week analysis that ended on April 27, 2020. The analysis discovered that the growth rate of COVID-19 cases and deaths in rural America, where the population is older and the younger people that live there have high-risk health conditions, are increasing and is higher than big cities and major urban areas. These areas within the nation have fewer intensive-care beds than the metro counties.

Where are the majority of these rural cases located? Georgia, Oklahoma and Montana - areas where social-distancing measures are easing. Are you prepared?
Save lives with Rx home delivery
Are your patients still coming into the pharmacy to pick up their prescriptions?

By implementing a home delivery program and encouraging your patients to get their prescriptions delivered, you will be keeping your employees and patient base safe by limiting both parties' possible exposure. Your patient base will be able to save their time and money and the program will allow them to stay compliant with stay-at-home orders.

While the nation is starting to lift stay-at-home orders and allow things to reopen, some are concerned with the pace and style different venues - public pools, beaches, theme parks, gyms and restaurants - are opening. A home delivery program will allow patients that wish to limit their interactions with others to do so.
Telehealth saves lives
Last month we discussed the necessary advancements made by Centers for Medicare and Medicaid Services (CMS) for telehealth because of the pandemic and the need to keep patients home. CMS expanded telehealth advancements for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to achieve the objective of keeping patients and providers safe during the pandemic. Foley & Lardner LLP's blog post, COVID-19: CMS Issues Second Round of Groundbreaking Changes for Telehealth - What You Need to Know , from May 3, 2020 explores CMS' latest updates. CMS' latest updates include: an expanded list of eligible telehealth practitioners to include physical and occupational therapists and speech language pathologists and a few other specialists to bill Medicare for professional services, auto-only telehealth elevated, opioid treatment programs (OTPs) may furnish periodic assessments via phone, Medicare coverage of RHCs and FQHCs provided telehealth, hospital billing and facility fee reimbursement for outpatient and home settings, new telehealth code approval procedure, time-based level selection for E/M telehealth, loosened remote physiological monitoring (RPM) billing requirements, inclusion of telehealth and virtual care in ACO primary care services. CMS' additional telehealth allowances through the pandemic allows providers to now see their patients through telehealth for additional services , including annual wellness visits.

Berg Insights recently published a white paper on April 30, 2020 that dives into how to implement telehealth and why it's important to do so. Telehealth provides providers with the ability to treat patients from their home. Telehealth took off over the past 10 years and has recently become a necessity instead of a luxury because of the pandemic and the need to keep patients home to protect that patient, other patients and all hospital staff.

The Federal Communications Commission (FCC) has a goal to improve lines of communication. To achieve this goal, FCC has about "$200 million to help healthcare providers launch or expand telehealth programs during the pandemic and another $100 million to expand connected health programs to rural areas over the next three years." In an effort to increase telehealth capabilities in response to the pandemic, the U.S. Department of Health and Human Services (HHS), through HRSA, awarded $15 million to 159 organizations across five health care programs on May 13, 2020 . HRSA made the awards based on the organizations' capacity to implement COVID-19 telehealth activities that train high-demand professions - such as students, physicians, nurses, physician assistants, allied health, etc. - across the health care team.

Because providers have started treating patients with telehealth because of the pandemic, Congress has a new bill, The Improving Telehealth for Underserved Communities Act (HR 6792) , to review. The bill addresses reimbursing FQHCs and RHCs for telehealth and also looks at reducing the amount of paperwork associated with telehealth visits.

Do you have telehealth solutions? If not, what do you need to implement them?
Media watch and other useful info
HHS has been a little busy. On April 22, 2020, CMS and the Assistant Secretary of Preparedness (ASPR) released the COVID-19 Workforce Virtual Toolkit . The toolkit is to assist state and local healthcare decision makers with maximizing their workforce flexibilities when treating COVID-19 in their communities. The toolkit helps rural providers understand the scope of practice expansions, licensure, EMS resources, volunteer workforce needs and more.

Community health centers have been hard at work throughout the pandemic. According to a HRSA press release , "health centers are providing more than 100,000 COVID-19 tests to their communities on a weekly basis." On April 27, 2020, "HHS, through HRSA, launched a new COVID-19 Uninsured Program Portal ." The portal allows providers to be reimbursed, generally at the Medicare rates, for the COVID-19 uninsured patients they either conducted testing for or provided treatment to on or after February 4, 2020. Providers will be able to submit claims electronically beginning on May 6, 2020 and receive reimbursement starting in the middle of May. Click HERE to access the portal to submit claims for reimbursement.

On May 7, 2020 , "HHS through HRSA, awarded nearly $583 million to 1,385 HRSA-funded health centers." COVID-19 claims that are be to reimbursed by HRSA can only be submitted once. If the claims are denied, the center is left to write off the bill.

As this pandemic continues around the world,  Modern Healthcare  has put together a tracker list that is regularly updated with the regulatory status of tests in the US, European and Asian markets.

CMS released a CMS News Alert that was distributed on May 6, 2020. CMS released an Interim Final Rule with Comment Period (IFC) building the agency's efforts to give the American healthcare system maximum flexibility to respond to the COVID-19 pandemic.

CMS also granted RHCs and FQHCs flexibilities to fight the pandemic. All of these efforts have the goal to:
  • "Expand the healthcare system workforce by removing barriers for physicians, nurses and other clinicians to be readily hired from the community or other states
  • Ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites, or CMS Hospital Without Walls
  • Increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home
  • Expand in-place testing to allow for more testing at home or in community based settings
  • Put Patients Over Paperwork to give temporary relief from paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage and Part D plans and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19."

CMS is hosting Stakeholder Engagement Calls with healthcare industry professionals to share information related to the agency's response to COVID-19. These calls are intended to provide updates, share best practices among peers and offer attendees an opportunity to ask CMS and other subject matter experts questions.

The federal funding is set to expire this month! Community health centers' work on the front lines of the pandemic is far from done. The funding we are seeing being released is for the pandemic, not for when it will be a conversation of yesterday.

The National Association of Community Health Centers (NACHC) is seeking  your  stories to strengthen its efforts to extend the funding past May 22, 2020.
Call 301-347-1550 and follow the prompts to share your experiences.

NACHC is following COVID-19. Stay updated with their COVID-19 information for community health centers here .

What does your residency program look like? HRSA released a new grant that has a $750,000.00 ceiling for 11 community health centers in rural areas. The RRPD Program was created to "support the development of new, sustainable rural residency programs accredited by the Accreditation Council on Graduate Medical Education (ACGME)."

HRSA's RRPD Program "is a multi-year initiative [with a goal to expand] the physician workforce and [increase] the [number of] opportunities available to residents to train in rural communities across" the nation.

HRSA posted some new notices on the Office of Pharmacy Affairs website . Check to ensure your pharmacy is compliant.

Stay updated with HRSA's latest information about COVID-19 here .