Updates from your ACE team
As we begin the last quarter of the year, and get ready to ramp up business to close the year strong; it’s important to focus on what happened and what didn’t and not blame the pandemic for what could have been. The pandemic reminded everyone of the importance of one's own health. And the value of health care workers everywhere.

Employers across the board either laid off, furloughed or sent their employees home in the wake of the pandemic. Health care workers from all over stepped up to the plate to assist however and wherever they could. Cuban physicians traveled to Italy to help Italy with its overflow of COVID-19 cases, the Italian hospital systems redistributed its staff that became infected with COVID-19 to treat the very ill patients that were unfortunately going to pass from COVID-19 because all other efforts had failed. All in all, COVID-19 has made the race for one vaccine seem almost impossible.

The pandemic is not over yet and may not be for a while. Johnson & Johnson paused trials of its vaccine after a study participant fell ill with an unexplained illness. The company paused the vaccination trials to investigate the illness and if the participant received the vaccine or the placebo. This isn’t the first company to pause the vaccination trial; AstraZeneca was halted after a study participant developed a neurological illness. Since that incident, AstraZeneca has resumed its testing, though it is still not testing its vaccine in the United States.
This newsletter focuses on financial independence and expansion opportunities, RCM tips and tricks to maximize collections while minimizing profitable write offs and new developments on the ongoing challenge between pharmaceutical companies and Health Resources and Services Administration’s (HRSA) 2010 guidance for the 340B Program and what that means for covered entities (think quality measures) and patients.

While the government distributed a lot of money through stimulus packages to several different industries and health centers worked to meet the influx of patients; waiting for stimulus and government funding is not sustainable. 20 million people depend on community health centers.
Happy Thanksgiving!
As we approach the holiday season, we’d like to wish you and your loved ones a very happy Thanksgiving and remind you to practice social distancing and wear your mask, even as you spend time with your friends and immediate and extended family this Thanksgiving (unless it’s over video conferencing software, like Zoom). Our office will be closed Thursday, November 26, 2020 and Friday, November 27, 2020 for the Thanksgiving holiday. 
Meet your patients where they are
In a recent story concerning opioid abuse and the nation’s current issues and government efforts to combat the crisis, a certain group that already has a lot to overcome is having a harder time receiving the treatment needed to kick the habit: pregnant women and new moms. One of treatments for those that abuse opioids is to give them opioids at a lower dosage that eventually wans them from using the drug altogether. “According to a study out of Vanderbilt University, pregnant women are 20 percent less likely than non-pregnant women to be accepted for medication assisted therapy. In 2016, [Wright Center, a FQHC in Pennsylvania], launched a comprehensive opioid treatment program to address the growing crisis in their community. [After realizing] that a [large] number of [their] patients were pregnant – and had specific needs – ‘The Healthy MOMS program was [created. The program] is [for] mothers who are [either] expecting or have recently had a child, up until the age of 2. The program provides behavioral health services, housing assistance and educational support. [Since the pandemic, Wright Center’s] providers have taken it a step further by delivering groceries [to those in the program].
FQHCs work to bring services that better the community in which they operate, whatever that service may be. While the opioid crisis is a nationwide issue, some states have a higher issue than others. According to the (Centers for Disease Control and Prevention) CDC, the states with the largest amount of opioid-involved death rates in 2018 were: West Virginia, Maryland, New Hampshire, Ohio, Massachusetts, Connecticut, Washington D.C., Rhode Island, Kentucky, Main, Vermont, Michigan, Tennessee and Missouri. Other issues that Americans are dealing with include alcoholism. New data from the CDC shows that mortality related to alcohol in adults 25 and older has increased from 2000 to 2018. Alcohol sales have increased in 2020 since the pandemic “started.” 

Not sure how to expand your practice? Check out our practice expansion fact sheet.
How much money are you accidentally leaving on the table by writing it off too soon?
Patients that come in and are self-pay patients may become eligible for Medicaid after their visit, up to 5 years after their visit. While it may seem daunting to keep multiple self-pay patients on the A/R for 5 years, facilities are able to bill Medicaid for that patient visit. So why is this something that almost never happens? Because most RCM departments don’t have the resources to continuously analyze the patient base to see who, if anyone, became eligible for Medicaid. We do!
The chess match between HRSA and pharmaceutical manufacturers continues
The past two newsletters have mentioned the current challenge pharmaceutical companies have brought against HRSA’s 2010 guidance. The guidance concerns allowing covered entities to provide 340B medications to their patient base through contract pharmacies. Since our last newsletter, the article Hospitals urge HHS to step in on 340B fight with drug manufacturers has been updated. As of September 11, 2020, “another group of hospitals sent a letter to the United States Department of Health and Human Services (HHS) Secretary Alex Azar asking him to take action against the [pharmaceutical companies that are trying to limit] 340B drug distribution. ‘If the administration permits pharmaceutical companies to continue these practices, 340B hospitals will face increased difficulties serving high volumes of patients living with low incomes in rural and urban communities,’ more than 1,100 hospitals in 340B Health group wrote. The American Hospital Association released a report finding 340B hospitals provided $64.3 billion in benefits to their surrounding communities in 2017, according to tax form data; an increase from $56.1 billion in 2016.” The AHA has also slammed Big Pharma over their efforts to limit access to 340B drugs to the patients that need them. “In separate letters to the companies” requesting additional information, “AHA said that it ‘is an outrage that this action is being taken at a time when hospitals are in the midst of their response to the COVID-19 public health emergency, which has further demonstrated the fractured, inadequate state of the prescription drug supply chain,’ and that the pharmaceutical companies’ actions are ‘attempting to compel hospitals to divert critical resources away from the pandemic.’”

Magdi Awad, MSA, Pharm. D., RPh from AxessPointe Community Health Centers wrote a Letter to the Editor concerning the problems this pharmaceutical block would bring to patients everywhere, especially those that are underserved and uninsured. The letter highlights some of the most concerning issues: access to medication, especially medication through the 340B Program. Prescriptions are a part of practicing preventative health care, which leads a hand in quality measures (and how facilities and providers are reimbursed for their services). Distribution of medication works to prevent emergency room (ER) visits and hospitalizations. Those that receive medication(s) through the 340B Program are mostly underserved and uninsured patients – patients that cannot afford to be hospitalized on several different factors.

If you are interested in having an in-house 340B Pharmacy, there is no better time to join the program. HRSA is allowing covered entities to enroll in the program on a weekly basis.
From the Hill and other useful info
The White House coronavirus task force’s Dr. Birx is concerned with COVID-19 cases being spread by those that are infected with COVID-19 and are not showing symptoms. As we approach the cooler months and some states start putting the heat on, she would like to encourage Americans to not gather inside warmer venues without their mask and to continue to practice social distancing. Secretary Alex Azar extended the public health emergency, effective October 23, 2020. 

Georgia finalized new telemedicine practice rules
"The Georgia Composite Medical Board recently finalized a new amendment, [effective September 28, 2020] to its telemedicine practice standards. The [Board's change identifies] three scenarios in which either a Georgia-licensed physician, physician assistant or advanced practice registered nurse, may provide services via telemedicine without conducting a prior in-person exam. Under the revised rule, a Georgia-licensed practitioner can offer treatment and/or consultation recommendations via telemedicine if the practitioner is 'able to examine the patient using technology or peripherals that are equal or superior to an examination done personally by a provider within that provider's standard of care.'"

Upcoming funding opportunities
“The National Institutes of Health (NIH) will support research projects from public and private higher learning institutions, nonprofit organizations, Indian/Native American tribal governments and state and local governments. Research will explore innovative health services for disparity populations that include racial/ethnic minorities, socioeconomically disadvantaged populations and underserved rural populations.”
“The federal government is clarifying how it regulates remote patient monitoring, with changes that could significantly affect – and potentially restrict – how care providers use telehealth and mHealth to care for patients at home.” CMS’ changes that were distributed on August 3, 2020 were somewhat lost in the other news that expanded telehealth coverage.

Why is this a big deal? When remote patient monitoring was rolled out during the pandemic, it was to allow providers, patients and other health care staff to stay safe by keeping those that could be home, home, especially if they were sick. This allowed providers to see patients that needed to be seen and to stay healthy through the screen. This clarification doesn’t specify – yet – if this will allow new patients to be seen through telehealth post pandemic. It will allow established patients to continue to be seen through telehealth and remote patient monitoring.

“The relevant Medicare codes are CPT codes 99091, 99453, 99454, 99457 and 99458.”

October 15, 2020 was a big day for primary care. “HHS and HRSA announced nearly $500 million in awards to support, recruit and retain qualified health professionals and students through its National Health Service Corps (NHSC), Nurse Corps and other workforce development loan repayment and scholarship programs. ‘National Health Service and Nurse Corps clinicians have been heroic frontline providers in high-need rural, urban and tribal communities for decades, and their service has proven only more essential during the COVID-19 pandemic,’ said HHS Secretary Alex Azar. ‘This year’s nearly half a billion dollars in awards will help Corps clinicians continue their work as part of HHS’ efforts to address health disparities, tackle substance abuse and expand access to care for vulnerable Americans.’”

Read the full press release here
Pharmacy Access Office Hours are a monthly activity that allow FQHC and Primary Care Association (PCA) staff to ask questions and share information about 340B Pharmacy. They are held the third Thursday of each month.