Physicians can now preview their 2023 Merit-based Incentive Payment System (MIPS) performance information as it will appear later this year on the compare tool on Medicare.gov and in the Provider Data Catalog (PDC). Upon reviewing MIPS performance information and finding any errors, physicians may file a targeted review but must do so by June 25. Eligible physicians also now have the option to opt-out of having MIPS data publicly posted but only have until June 25 to inform the Centers for Medicare & Medicaid Services (CMS).

Publicly reported information includes MIPS and Qualified Clinical Data Registry quality measures, MIPS Promoting Interoperability measures and attestations, and MIPS improvement activities attestations. More information is available in this overview. Access to the secure preview is available on the QPP website through Wednesday, June 25, 2025, at 8 pm ET. For questions about how to access the preview or public reporting on the compare tool on Medicare.gov, contact the QPP Service Center by emailing QPP@cms.hhs.gov, submitting a QPP Service Center ticket, or calling 1-866-288-8292 (Monday–Friday, 8 am–8 pm ET).

November 5, 2021 
 
Expanding Populations Eligible to Receive the Pfizer-BioNTech COVID-19 Vaccine to Include Persons 5 Years Through 11 Years of Age

View Online
 
On October 29, 2021, the U.S. Food and Drug Administration (FDA) expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to include children 5 years through 11 years of age. 
 
For more information regarding the latest guidelines, please use the links below:

• FDA News Release
• Fact Sheet for Health Care Providers Administering Vaccine
• Fact Sheet for Recipients and Caregivers 

Florida COVID-19 Vaccine Ordering and Distribution Information
 
Health care providers may now place orders for Pfizer-BioNTech pediatric COVID-19 vaccines in Florida SHOTS. All enrolled COVID-19 vaccine providers who wish to order Pfizer-BioNTech pediatric COVID-19 vaccine may order in 300 dose increments; however, on November 9, 2021 pediatric COVID-19 vaccine may be ordered in 100 dose increments. According to the Centers for Disease Control and Prevention (CDC), doses ordered on or before November 9, 2021 are expected to arrive by November 12, 2021.

The Florida Department of Health’s Immunization Section placed pre-book orders for eleven county health departments (CHDs) to serve as regional hubs for vaccine storage and distribution. These CHDs were selected based on location, population size, storage capacity and capability to transfer vaccine to other health care providers. According to the CDC, vaccine shipments are expected to arrive between November 6-12, 2021.
  
Vaccine Adverse Event Reporting System (VAERS) Reporting
 
Health care providers should report the following adverse events to VAERS:
Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether it is or is not clear that a vaccine caused the adverse event,
Vaccine administration errors,
Vaccine manufacturers are required to report to VAERS all adverse events that come to their attention.
 
Health care providers are required to report the following adverse events to VAERS:
Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccinations,
An adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine.
 
Online reporting is strongly encouraged. Please report clinically important adverse events that occur after vaccination of children and adults, even if you are not sure whether the vaccine caused the adverse event. To make a report, please visit: https://vaers.hhs.gov/reportevent.html and notify the state health department of any severe reactions reported.  
 
 
Pre-book Ordering
 
Should you choose to obtain vaccines from the pre-book order from the CHDs, please use the following contact information:
 
Alachua County Health Department: Vicki Ennis, 352-334-8811
Broward County Health Department: Barbara Bateman, 954-847-8007
Clay County Health Department: Robin Thomas, 904-838-5424
Duval County Health Department: Tawanda Washington, 904-253-1055
Escambia County Health Department: Beate Bolton, 850-595-6500 Ext., 1200
Hillsborough County Health Department: Jylmarie Lewis, 813-559-4649
Indian River County Health Department: Maryjo Sullivan, 772-794-7478
Lee County Health Department: Marie George, 239-332-9505
Leon County Health Department: Eugene Buerkle, 850-404-6270
Marion County Health Department: Michael Smith, 352-644-2660
Miami-Dade County Health Department: Jean Toussaint, 305-575-3831
Okaloosa County Health Department: Suzanne Clemons, 850-344-0606
Orange County Health Department: Gissella Suarez, 407-723-4081 or 407-340-1910
Palm Beach County Health Department: Dana Marie Heinlein, 561-671-4052
Pinellas County Health Department: Norma Osgood, 727-820-4105
Polk County Health Department: Tammy Durden, 863-578-2113
Sarasota County Health Department: Donna Keith, 941-861-2914
St. Lucie County Health Department: Daniel Buchin, 772-873-4885
Volusia County Health Department: Patricia Boswell, 386-274-0799

Source: Florida Board of Medicine

In this declaration the Governor authorized each state agency to suspend the provisions of regulatory statutes, orders or rules of that agency if strict compliance would hinder or delay necessary action in coping with the emergency.

Many of these rules directly affected the practice of medicine.

Click here to read a full explanation from FMA General Counsel, Jeff Scott of the provisions and important changes resulting from the expiration of the order.

https://medone.informz.net/medone/data/images/ExecutiveOrder-ends.pdf

Source: Florida Medical Association (FMA)

As summarized below, the two Executive Orders do not impede upon the ability of businesses and individuals to continue to follow the safety precautions for employees and customers that were operationalized during the pandemic.   Nor do they impact the recommendations from the CDC and OSHA requirements for preventing the spread of COVID-19.   Business owners, customers, and the General Public are free to continue to follow those precautions that they feel are best given their circumstances, operations and other authoritative guidance.

Below is the summary of the two Executive Orders:

Executive Order 21-101, effective July 1, mandates that “any emergency order issued by a political subdivision due to the COVID-19 emergency which restricts the rights or liberties of individuals or their businesses is invalidated.”

Executive Order 21-102 suspended “all local COVID-19 restrictions and mandates on individuals and businesses” and went into effect immediately.

https://www.flgov.com/2021-executive-orders/

CDC Guidance for Workplaces and Businesses:

https://www.cdc.gov/coronavirus/2019-ncov/community/workplaces-businesses/index.html

US Department of Labor OSHA Guidance for Workplaces and Businesses:

https://www.osha.gov/coronavirus

Renewal of Determination That A Public Health Emergency Exists

https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx 

Source: Acevedo Consulting

Most Physicians Experienced Little Relief from Prior Authorization as COVID-19 Cases Soared
Insurers’ requirements for advanced approvals associated with treatment delays, care disruption, and patient harm


CHICAGO - As new cases of COVID-19 in the United States were peaking in late 2020, most physicians reported that health plans continued to impose bureaucratic prior authorization policies that delay access to necessary care and sometimes result in serious harm to patients, according to new survey results issued today by the American Medical Association (AMA).

“As the COVID-19 pandemic began in early 2020, some commercial health insurers temporarily relaxed prior authorization requirements to reduce administrative burdens and support rapid patient access to needed drugs, tests and treatments,” said AMA President Susan R. Bailey, M.D. “By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care.”

According to the AMA survey, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 reported that health insurers had either reverted to past prior authorizations policies or never relaxed these policies in the first place. More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care, and nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.

“Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency,” said Dr. Bailey. “This hard- learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification.”

Nearly one-third (30%) of physicians reported that prior authorization requirements have led to a serious adverse event for a patient in their care, according to the AMA survey. More specifically, prior authorization requirements led to the following repercussions for patients:

• Patient hospitalization – reported by 21% of physicians
• Life-threatening event or intervention to prevent permanent impairment or damage – reported by 18% of physicians
• Disability or permanent bodily damage, congenital anomaly, birth defect, or death – reported by 9% of physicians

While the health insurance industry says prior authorization criteria reflect evidence-based medicine, the physician experience casts doubt on the credibility of this claim. Only 15% of physicians reported that prior authorization criteria were often or always based on evidence-based medicine.

Other critical physician concerns highlighted in the AMA survey include:

• Nine in 10 physicians (90%) reported that prior authorizations programs have a negative impact on patient clinical outcomes.
• A significant majority of physicians (85%) said the burdens associated with prior authorization were high or extremely high.
• Medical practices complete an average of 40 prior authorizations per physician, per week, which consume the equivalent of two business days (16 hours) of physician and staff time.
• To keep up with the administrative burden, two out of five physicians (40 %) employ staff members who work exclusively on tasks associated with prior authorization.

The findings of the AMA survey illustrate a critical need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery. The AMA has taken a leading role in advocating for prior authorization reforms and convening key industry stakeholders to develop a roadmap for improving the prior authorization process.

In January 2018, the AMA and other national organizations representing pharmacists, medical groups, hospitals and health plans signed a consensus statementoutlining a shared commitment to improving five key areas associated with the prior authorization process. However, health plans have made little progress in the last three years toward implementing improvements in each of the five areas outlined in the consensus statement.

The AMA continues to work on every frontto streamline prior authorization. Through our research, collaborations, advocacy and leadership, the AMA is working to right-size prior authorization programs so that physicians can focus on patients rather than paperwork. Patients can share their own personal experiences with prior authorization at FixPriorAuth.org

Congress extended Medicare coverage for immunosuppressive drugs for the life of a transplant. This issue has been a legislative priority for RPA for two decades and is a massive step forward in the treatment of post-transplant kidney patients.

Additionally, the bill provides relief from scheduled reductions in Medicare Fee Schedule reimbursement due to a proposed 10% cut in the Medicare conversion factor (CF), while preserving substantial increases in valuation for the outpatient dialysis service code family as well as the outpatient evaluation and management (E&M) codes. Recall that except for CPT code 90954 (the four-visit code for pediatric patients ages 2-11), every code in the outpatient dialysis code family, from CPT codes 90951-90970 and including pediatric, adult, in-center, home, and daily codes, received substantial increases in value, from 13%-27%. RPA was the sole organization that provided detailed rationale to CMS on why revaluation of the outpatient dialysis codes was necessary and long overdue.

Congress provided this relief by appropriating an additional $3 billion in funding for the 2021 fee schedule, and by delaying the implementation of the G2211 E&M complexity modifier until January 1, 2024. While the delayed onset of the complexity modifier is unfortunate in that it could have been used in the care of chronic kidney disease (CKD), the combined impact of the additional Congressional appropriation and the savings from the delayed use of the modifier should reverse most if not all of the 10% CF cut. Given the fact that there was intense advocacy from procedural medicine to reverse the dialysis and E&M code revaluations and use those funds to pay for the CF cut, this is about as positive an outcome for internal medicine and primary care that could have occurred. RPA participated in coalition efforts organized by internal medicine to address the CF cut without adversely affecting the revaluation increases, and this is largely what occurred. CMS is likely to issue sub-regulatory guidance or a technical correction to the fee schedule in the coming weeks that will finalize the 2021 conversion factor. Nephrology was scheduled for a 6% payment increase across the specialty before the CF cut was reversed, therefore, it is likely that the 2021 gains for nephrology will be increased proportionately.

Further, the Advanced Alternate Payment Model (AAPM) thresholds have been frozen at current levels for two years, easing the path for physicians participating in those models to qualify for the 5% bonus (of the provider's entire Medicare spend) during that time period. These thresholds were projected to increase in 2021 and beyond, so the bar will be lower to qualify for the bonus in 2021 and 2022.

Finally, the bill provides $3 billion in additional grants for hospitals and health care providers including nephrologists to be reimbursed for health care related expenses or lost revenue directly attributable to the public health emergency (PHE) resulting from coronavirus. Congress provided direction to HHS to allocate not less than 85% of available funds in the Provider Relief Fund through an application-based portal to reimburse health care providers for financial losses incurred in 2020. RPA will be providing additional direction about how to access these funds as information becomes available.

The National Renal Administrators Association sent letters to CMS and the CDC urging the agencies to prioritize issuance of the COVID-19 vaccine to patients with end-stage renal disease and the dialysis clinic staff who provide their care.

“The high risk of virus exposure for ESRD patients and their caregivers at dialysis clinics combined with the underlying prevalence of multiple comorbidities and overall suppressed immunity have resulted in substantially higher rates of hospitalization and likely mortality from COVID-19 in the ESRD patient population compared to non-ESRD patients,” the National Renal Administrators Association (NRAA) wrote in letters to the two agencies. “It is therefore imperative that ESRD patients and the dialysis clinic staff who care for them have priority status in COVID-19 vaccine distribution.”

The association wrote in the letters that the heightened risk of COVID-19 exposure that patients with ESRD face “has led to Medicare beneficiaries with ESRD having a more than four times greater likelihood of contracting the virus than aged and disabled beneficiaries. ESRD beneficiaries who have contracted COVID-19 have had a hospitalization rate more than seven times higher (2,194 per 100,000 beneficiaries) than that of either aged (320 per 100,000) or disabled (268 per 100,000) beneficiaries.”

It remains unclear how many patients with ESRD receiving care in the United States have contracted COVID-19; last month, the National Kidney Foundation and the American Society of Nephrology sent a letter to CMS asking for access to national data on this.

Maria Regnier

“Comprehensively understanding the spread of COVID-19 among symptomatic, asymptomatic and pre-symptomatic dialysis patients has been challenging because CMS has not thus far made data on COVID-19 infection rates among in-center and home dialysis patients available to researchers, patients or practitioners,” the organization leaders wrote.

The NRAA wrote in the letters that the disproportionately high rates of hospitalization for Medicare beneficiaries with ESRD and COVID-19 follow data reported by the U.S. Renal Data System, “which strongly suggest a discernible and marked increase in mortality in the ESRD patient population from COVID-19.”

Reference:  https://www.nraa.org/covid-19

Source: https://www.healio.com/news/nephrology/20201202/administrators-patients-with-eskd-care-givers-should-be-priority-for-covid19-vaccine

Below are some resources that we have compiled on the plans for distribution on a State and Federal level.

Federal Operation Warp Speed Vaccine Distribution Plan:  https://www.hhs.gov/sites/default/files/strategy-for-distributing-covid-19-vaccine.pdf

Florida Department of Health Draft Vaccine Distribution Plan:  http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/vaccination-plan/vaccination_plan_latest.pdf

Governor’s latest comments on the State Distribution Plan:  https://www.winknews.com/2020/11/19/desantis-gives-update-on-covid-19-vaccine-distribution-plan/

Registration Link for Facilities and Physicians to sign up on Florida Shots to be able to deliver the vaccine to patients:  http://www.floridahealth.gov/programs-and-services/immunization/COVID-19VaccineInfo/index.html

Coverage Available at No Cost to Beneficiaries Across Variety of Settings in Health Care System

CMS announced that starting November 10, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat COVID-19 with no cost-sharing during the Public Health Emergency (PHE). CMS' coverage of monoclonal antibody infusions applies to bamlanivimab, which received an Emergency Use Authorization (EUA) from the FDA on November 9.

"Today, CMS is announcing a historic, first-of-its kind policy that drastically expands access to COVID-19 monoclonal antibodies to beneficiaries without cost sharing," said CMS Administrator Seema Verma. "Our timely approach means beneficiaries can receive these potentially life-saving therapies in a range of settings – such as in a doctor's office, nursing home, infusion centers, as long as safety precautions can be met. This aggressive action and innovative approach will undoubtedly save lives."

CMS anticipates that this monoclonal antibody product will initially be given to health care providers at no charge. Medicare will not pay for the monoclonal antibody products that providers receive for free but this action provides for reimbursement for the infusion of the product. When health care providers begin to purchase monoclonal antibody products, Medicare anticipates setting the payment rate in the same way it set the payment rates for COVID-19 vaccines, such as based on 95% of the average wholesale price for COVID-19 vaccines in many provider settings. CMS will issue billing and coding instructions for health care providers in the coming days.

CMS anticipates the announcement will allow for a broad range of providers and suppliers, including freestanding and hospital-based infusion centers, home health agencies, nursing homes, and entities with whom nursing homes contract, to administer this treatment in accordance with the EUA, and bill Medicare to administer these infusions.

Under section 6008 of the Families First Coronavirus Response Act (FFCRA), state and territorial Medicaid programs may receive a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP), through the end of the quarter in which the COVID-19 PHE ends. A condition for receipt of this enhanced federal match is that a state or territory must cover COVID-19 testing services and treatments, including vaccines and their administration, specialized equipment, and therapies for Medicaid enrollees without cost sharing. This means that this monoclonal antibody infusion is expected to be covered when furnished to Medicaid beneficiaries, in accordance with the EUA, during this period, with limited exceptions.

View the Monoclonal Antibody COVID-19 Infusion Program Instruction.

• Many Medicare-enrolled providers don’t have to take any action until a vaccine is available – make sure your provider-type enrollment is all set
• Some Medicare-enrolled providers must also separately enroll as a mass immunizer to administer and bill for COVID-19 vaccines when they’re available – find out if you must also enroll as a mass immunizer
• If you’re not a Medicare-enrolled provider, you must enroll as a mass immunizer or other Medicare provider type that can bill for administering vaccines

Enrolling over the phone a mass immunizer is easy and quick — call your MAC-specific enrollment hotline (PDF) and give your valid legal business name, national provider identifier, tax identification number, practice location, and state license, if applicable.

“Under President Trump’s leadership, we have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-19,” said CMS Administrator Seema Verma. “As Operation Warp Speed nears its goal of delivering the vaccine in record time, CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”

To ensure broad access to a vaccine for America’s seniors, CMS released an Interim Final Rule with Comment Period (IFC) that establishes that any vaccine that receives Food and Drug Administration (FDA) authorization, either through an Emergency Use Authorization (EUA) or licensed under a Biologics License Application (BLA), will be covered under Medicare as a preventive vaccine at no cost to beneficiaries. The IFC also implements provisions of the CARES Act that ensure swift coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in and out-of-network providers during the course of the public health emergency (PHE).

In anticipation of the availability of new COVID-19 treatments, the IFC also establishes additional Medicare hospital payment to support Medicare patients’ access to these potentially life-saving COVID-19 therapies.  In Medicare, hospitals are generally reimbursed a fixed payment amount for the services they provide during an inpatient stay, even if their costs exceed that amount. Under current rules, hospitals may qualify for additional “outlier payments,” but only when their costs for a particular patient exceed a certain threshold. Under this IFC, hospitals would qualify for additional payments when they treat patients with innovative new products approved or authorized to treat COVID-19 to mitigate any losses they may experience from making these therapies available, even if they do not reach the current outlier threshold. The IFC also makes changes to reimbursement for outpatient hospital services to ensure payment for certain innovative treatments for COVID-19 that occur outside of bundled arrangements and are paid separately. In addition, CMS released information to prepare hospitals to bill for the outpatient administration of a monoclonal antibody product in the event one is approved under an emergency use authorization (EUA).

This rule also allows states to employ a broad range of strategies - based on local needs - to appropriately manage their Medicaid program costs. The guidance and flexibility provided to states in the IFC will help them maintain Medicaid beneficiary enrollment while receiving the temporary increase in federal funding in the Families First Coronavirus Response Act (FFCRA).

CMS is also taking continued steps to ensure that price transparency extends to COVID-19 testing during the PHE. Provisions in the IFC require that any provider who performs a COVID-19 diagnostic test post their cash prices online. Providers that are non-compliant may face civil monetary penalties.

In addition to these provisions, the IFC:

• Provides an extension of Performance Year 5 for the Comprehensive Care for Joint Replacement (CJR) model; and
• Creates flexibilities in the public notice requirements and post-award public participation requirements for a State Innovation Waiver under Section 1332 of the Patient Protection and Affordable Care Act during the COVID-19 PHE.

Along with these regulatory changes, CMS is issuing three toolkits aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans. Together, these toolkits will help ensure the health care system is prepared to successfully administer a safe and effective vaccine by addressing issues related to access, billing and payment, and coverage.

Increasing Access to Vaccines for Medicare & Medicaid Beneficiaries

The toolkits issued today give health care providers not currently enrolled in Medicare the information needed to administer and bill vaccines to Medicare patients. CMS is working to increase the number of providers that will administer a COVID-19 vaccine to Medicare beneficiaries when it becomes available, to make it as convenient as possible for America’s seniors. New providers are now able to enroll as a “Medicare mass immunizers” through an expedited 24-hour process. The ability to easily enroll as a mass immunizer is important for some pharmacies, schools, and other entities that may be non-traditional providers or otherwise not eligible for Medicare enrollment. To further increase the number of providers who can administer the COVID -19 vaccine, CMS will continue to share approved Medicare provider information with states to assist with Medicaid provider enrollment efforts. CMS is also making it easier for newly enrolled Medicare providers to also enroll in state Medicaid programs to support state administration of vaccines for Medicaid recipients.

Coverage

As a condition of receiving free COVID-19 vaccines from the federal government, providers will be prohibited from charging consumers for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans would not be responsible for reimbursing providers to administer the vaccine during this time. Medicare Advantage beneficiaries also pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicaid: State Medicaid and CHIP agencies must provide vaccine administration with no cost sharing for most beneficiaries during the public health emergency. Following the public health emergency, depending on the population, states may have to evaluate cost sharing policies and may have to submit state plan amendments if updates are needed.

Private Plans: CMS, along with the Departments of Labor and the Treasury, is requiring that most private health plans and issuers cover a recommended COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing. The rule also provides that out-of-network rates cannot be unreasonably low, and references CMS’s reimbursement rates as a potential guideline for insurance companies.

Uninsured: For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

Billing and Payment

The toolkits also address issues related to billing and payment. After the FDA either approves or authorizes a vaccine for COVID-19, CMS will identify the specific vaccine codes, by dose if necessary, and specific vaccine administration codes for each dose for Medicare payment. CMS and the American Medical Association (AMA) are working collaboratively on finalizing a new approach to report use of COVID-19 vaccines, which include separate vaccine-specific codes. Providers and insurance companies will be able to use these to bill for and track vaccinations for the different vaccines that are provided to their enrollees.

Medicare Payment

CMS also released new Medicare payment rates for COVID-19 vaccine administration. The Medicare payment rates will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series. These rates will be geographically adjusted and recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine. Medicare beneficiaries, those in Original Medicare or enrolled in Medicare Advantage, will be able to get the vaccine at no cost.

CMS is encouraging state policymakers and other private insurance agencies to utilize the information on the Medicare reimbursement strategy to develop their vaccine administration payment plan in the Medicaid program, CHIP, the Basic Health Program (BHP), and private plans. Using the Medicare strategy as a model would allow states to match federal efforts in successfully administering the full vaccine to the most vulnerable populations.

The IFC (CMS-9912-IFC) is scheduled to display at the Federal Register as soon as possible with an immediate effective date and a 30-day comment period.

For More Information:

• Fact Sheet
• COVID-19 vaccine resources for providers, health plans and State Medicaid programs
• FAQs on billing for therapeutics

But state numbers show that insurers have refused to pay nearly half of the workers’ compensation insurance claims filed by first responders, health care professionals and other workers.

Data collected by Chief Financial Officer Jimmy Patronis’ office show nearly 12,000 workers’ compensation claims had been filed as of July 31, but more than 43 percent of “indemnity” claims were denied by insurers.

The numbers show that most of the denials, or about 62 percent, were made by private insurers that provide coverage to Florida's employers.

The denials have come during a period where COVID-19 has shattered the state’s economy, and led to about 3.8 million people seeking unemployment benefits. While the economy largely shut down this spring, “essential” services such as hospitals, health care clinics and grocery and home-improvement stores remained open.

Not surprisingly, first responders and health care workers have filed the most workers’ compensation indemnity claims related to COVID-19. Combined, the professions accounted for more than 65 percent of the claims as of July 31. That included 4,345 protective service workers filing claims, along with 3,432 health care workers.

Another 2,897 claims were filed by people classified as service workers, a category that includes a wide variety of jobs such as working at restaurants, hotels, grocery stores and other retailers.

The state also tracks claims by type of insurer: private insurance companies, which typically write policies for a variety of businesses; private self-insured trust funds, which large private employers can use to insure their risks; and government self-insured trust funds, which insure risks of government agencies.

Of the 11,872 indemnity claims filed as of July 31, 5,527 were filed with private insurance companies.Those insurers denied, or partially denied, about 55 percent of the claims. Meanwhile private self-insured funds and government self-insured funds denied or partially denied 30 percent and 31 percent of claims,respectively.

In all, 5,144 claims had been completely denied as of July 31, while 32 claims had been partially denied, according to the report.

“No one should be shocked by this data,” said Bill Herrle, executive director of the National Federation of Independent Business in Florida.

Herrle said NFIB believes that private businesses should be held to a different standard when it comes to workers’ compensation benefits than public agencies that employ many of the first responders.

“We think there is a very ripe policy question on the responsibilities of the private sector versus the public sector, who clearly bears a higher responsibility for the front-line workers,” said Herrle, whose organization represents small businesses.

Business organizations have been clamoring for action by the Legislature or Gov. Ron DeSantis on liability issues related to the pandemic, but Republican legislative leaders have rejected calls for a special session and DeSantis has refused to act on requests for liability waivers.

Workers' compensation is a no-fault system meant to protect workers and employers. It is supposed to provide workers who are injured on the job access to medical benefits they need to be made whole.

The report put out by the state doesn’t include information on what are known as medical-only claims. Instead, it focuses on indemnity claims, which involve workers who are injured for at least eight days and who also are eligible to recoup lost wages. 

In exchange for providing those benefits, employers generally cannot be sued in court for causing injuries. While the system is supposed to be self-executing, injured workers hire attorneys when there are disputes over the amounts of benefits they should receive. 

Miami-Dade County leads the state in the number of COVID-19 infections and in workers’ compensation claims. It accounted for 34 percent of the indemnity claims filed as of July 31.

In addition to having claims information, the report also contains data on indemnity claims paid. 

Insurance companies, private self-insurance trust funds and government self-insured funds had paid $4.1 million on the 6,670 claims that had been closed, a total that includes claims that were denied.

Payments of nearly $9 million had been made by insurance carriers on the 5,202 claims that remained open, according to the data, which is from information sent to the state Division of Workers’ Compensation that includes codes for causes of injury and nature of injuries and allows for descriptions of workplace accidents.

Workers’ compensation indemnity claims had been filed in every county, with the exception of DeSoto County, according to the data. Also, 837 claims were filed with no county indicated.

News Service Florida: 

https://newsserviceflorida.com/app/post.cfm?postID=37975

Click here to read the AMA's letter to the FDA. 

Source: American Medical Association

“I think it’s bizarre,” said Daniel Larremore, a mathematician and infectious diseases modeler at the University of Colorado Boulder. “Any move right now to reduce levels of testing by changing guidelines is a step in the wrong direction.”

Prior iterations of the C.D.C.’s testing guidelines struck a markedly different tone, explicitly stating that “testing is recommended for all close contacts” of people infected with the coronavirus, regardless of symptoms. The agency also specifically emphasized “the potential for asymptomatic and pre-symptomatic transmission” as an important factor in the spread of the virus.

The newest version, which was posted on Monday, amended the agency’s guidance to say that people who have been in close contact with an infected individual — typically defined as being within six feet of a person with the coronavirus and for at least 15 minutes — “do not necessarily need a test” if they do not have symptoms. Exceptions, the agency noted, might be made for “vulnerable” individuals, or if health care providers or state or local public health officials recommend testing.

“Wow, that is a walk-back,” Dr. Butler-Wu said. “We’re in the middle of a pandemic, and that’s a really big change.”

Dr. Butler-Wu said she was concerned that the guidelines would be misinterpreted as implying that people without symptoms were unable to pass the coronavirus on to others — a falsehood that experts had been trying for months to dispel. “If people are getting exposed, and they’re not getting tested, and they’re not isolating, that’s a huge problem,” Dr. Kuppalli said.

By the C.D.C.’s own estimates, roughly 40 percent of people infected with the coronavirus may never go on to develop symptoms, remaining asymptomatic for the duration of their tenure with the virus. These numbers are tentative — and ironically can’t be confirmed without more testing of people who appear entirely healthy.

Although researchers remain unsure how often asymptomatic people unwittingly transmit the coronavirus, studies have shown that the silently infected can carry the virus in high amounts. The evidence is more clear-cut for pre-symptomatic people, in whom virus levels tend to peak just before illness sets in — a period when these individuals might be mingling with their peers, seeding superspreader events. Notably, experts can’t distinguish asymptomatic people from those who are pre-symptomatic until symptoms do or don’t appear.

“It seems backward to just ignore pre-symptomatic patients,” Dr. Butler-Wu said.

David Piegaro, who lives in Trenton, N.J., had sought out several tests for the coronavirus in recent months, after events like funerals and those that require travel because of his post in the National Guard. He never experienced symptoms, and his tests have all been negative, bringing him peace of mind, especially because he lives with his parents and grandfather. “I viewed testing as a good thing to do,” he said. “Asymptomatic people could be spreading the virus, so widespread testing seems valuable.”

Tracking asymptomatic cases is also important from the perspective of the infected, Dr. Kuppalli said. Less than a year into this pandemic, experts still don’t know the full extent of the long-term consequences of contracting the coronavirus, even if the initial encounter seems benign.

The reasons behind the surprise shift in testing recommendations are unclear. In response to an inquiry from The New York Times, a representative for the C.D.C. directed the questions to the U.S. Department of Health and Human Services. An H.H.S. spokesperson said that asymptomatic testing could still be warranted “when directed by public health leaders or health care providers,” and noted that testing decisions should be “based on individual circumstances and the status of community spread.”

On Twitter, some people speculated that the Trump administration made the change to try to address continuing supply shortages, which have stymied testing efforts in many parts of the country, stretching turnaround times for results to weeks or more. Many institutions and companies performing testing have prioritized people with symptoms in their lineup as a way to expedite the return of results for those most at risk for falling severely ill.

When asked about this, the H.H.S. spokesperson said that the modification was not a response to sputtering supply chains. “Testing capacity has massively expanded, and we are not utilizing the full capacity that we have developed,” the spokesperson said. “We revised the guidance to reflect current evidence and the best public health interventions.”

Poorly timed testing, if conducted infrequently, could lead to false positives or false negatives, mistaking healthy people as infected or vice versa. That’s a potential risk if someone gets tested too soon after being exposed to the coronavirus, Dr. Butler-Wu pointed out.

Even so, anyone with a known exposure should quarantine and consider seeking a test, Dr. Kuppalli said, adding, “We still need to be careful.”

Source: New York Times

More specifically, the trials will assess the presence of COVID-19 antibodies in these patients and determine the role genetics may play in disease severity, according to a press release. 

"Our researchers are seeking to contribute to understanding COVID-19’s impact on a patient population that has increased risk due to underlying medical conditions,” Amy Young, vice president of DaVita Clinical Research, said in the release. “These studies are particularly important to better forecast future COVID-19 outbreaks, minimize infections and, ultimately, save lives.”

The release elaborated on the studies, noting the first will monitor participants for 4 months in the fall and winter to investigate how the presence of COVID-19 antibodies may influence future virus infection and potential immunity. The second seeks to determine the associations between genetic markers and the severity of COVID-19 symptoms, focusing on the genetic differences between patients that may result in varying responses to the infection.

According to the release, the results of both studies are expected to be submitted for publication in early 2021.

“As a novel virus, there is still so much the medical community does not know about COVID-19,” Jeff Giullian, MD, chief medical officer for DaVita, added. “By using our resources to conduct this research, we hope to contribute meaningful data to a worldwide effort. We are eager to share our findings about how the virus behaves in a medically vulnerable population with the intent that they will spur greater innovation.”

Source: Healio

But it doesn’t have to be that way—nor should it be. That’s what team-based care experts said in a recent panel discussion hosted by AMA Chief Experience Officer Todd Unger. The AMA is providing COVID-19 video updates featuring interviews with a wide range of physicians and experts from the AMA and elsewhere who provide real-time insight on the challenge of the pandemic. 

Although physician practices that used team-based care for years initially reverted back to a physician-does-it-all system when they first started using telemedicine, they have since found ways to incorporate team-based care into virtually-based care. 

And physicians, staff and patients are better for it. 

“The first obstacle to overcome is just the recognition that it is possible to do it. And then to remind ourselves that the doctor-does-it-all model isn’t safe. It is not efficient, but it is also less safe. When we can give our undivided attention to the patient, our care is better,” internist Christine A. Sinsky, MD, the AMA’s vice president of professional satisfaction, said during the discussion.  

The AMA’s Telehealth Implementation Playbook walks physicians through a 12-step process to implement real-time audio and visual visits between a clinician and a patient. It is a powerful resource for practices now and as they continue to implement telehealth beyond the pandemic. 

And the CARES Act: AMA COVID-19 pandemic telehealth fact sheet helps physicians understand new policies designed to help them and hospitals during the pandemic, including Medicare covering an expanded array of telehealth services and audio-only telephone visits. 

Improving everyone’s experience 

Green Bay, Wisconsin, family physician James Jerzak, MD, has for years been heavily engaged in making team-based care a reality in his physician practice. But when COVID-19 hit and his practice switched to telehealth this spring, he found himself alone in a room and back to doing all the electronic health record (EHR) work himself. Under the team-based care model, he was accustomed to having staff in the room who helped with the documentation and order entry. 

Now his practice, which is part of Bellin Health, has figured out new workflows for the telehealth visits that allow other team members to be in the room to help him as they did with the team-based approach in a traditional office setting. 

“It has made a dramatic impact on my time,” Dr. Jerzak said. “When I’m done with my part of the visit, I will hand the phone or the iPad back to the person helping me and she can complete the visit and it has really allowed me to be much more efficient in the office.” 

Transitioning to team-based care 

Olmsted Township, Ohio, family physician Kevin Hopkins, MD, said his Cleveland Clinic practice saw tangible benefits when it transitioned to team-based care more than a decade ago. Those benefits included improved access for patients, increased productivity for the health system, better performances on quality measures, improved performance on patient satisfaction surveys and better caregiver engagement and satisfaction. 

Even amid stressful circumstances of the pandemic and the shift to telehealth, Dr. Hopkins advised practices to just pick somewhere to begin the transition to team-based care. 

“Start with certain patient types, certain visit types, certain chronic or acute conditions and evaluate and interact with those patients via the virtual platform and continue to think about roles and responsibilities of everyone in the practice,” he said. 

Source: AMA

This is their way of preserving masks and other personal protective equipment as they treat COVID-19 patients in the Rio Grande Valley, where infections are spiking. While Martinez and her colleagues sweat in full gear outside, the staffers and other patients inside the clinic aren't exposed and don't need as much PPE.

Six months into the coronavirus pandemic, some schools are reopening. Dentists and family doctors are seeing patients again. More businesses are getting back to work.

And they're all confronting a familiar problem: N95 respirator masks and other personal protective equipment can still be hard to come by.

Just like in March, when coronavirus cases spiked for the first time, some workers and employers across the country continue to face PPE shortages. Respirator masks, gloves, gowns, thermometers and other equipment are scarce. Demand has remained high, and prices have, too.

Churches, schools, businesses compete for same small supply

Now it's not just hospitals, states and federal officials vying for the same PPE. Smaller operations without a lot of buying power — from cash-strapped school districts to independent medical practices — are entering the market.

"The dramatically increased demand is not going away anytime soon," says Dr. Susan Bailey, president of the American Medical Association. "Churches, schools, businesses, everyone that's trying to reopen needs PPE, and we're all competing for the same small supply."

The AMA has called repeatedly for a comprehensive federal response on the level of the Manhattan Project, the massive research project that developed the first nuclear weapons during World War II. The medical association says such a response should include a federal database to track where there are shortages and suppliers that can meet the demand.

The Trump administration has not done that. Instead, back in the spring, the administration launched Project Airbridge, which airlifted PPE from overseas; it wound down in June. The administration also ordered some domestic manufacturers to ramp up production.

The administration insists that continued complaints about shortages are exaggerated. White House senior adviser Jared Kushner, in an interview with CNBC this week, called reports about doctors on the front lines not being able to get masks "hysterical."

"We created Project Airbridge. We were able to bring in from Asia ... hundreds of millions of masks," Kushner said. "We started domestic production by using the Defense Production Act."

"So the federal government has done a lot to stimulate the supply," he said. 

Deep pockets amass stockpiles of PPE as small buyers struggle

The supply crunch has eased for some buyers. For instance, big hospital chains with deep pockets have been able to amass stockpiles of PPE. But smaller buyers say they're still struggling to get what they need.

"Many manufacturers are asking that you buy 50,000 or 100,000 units of masks or gowns or gloves. A little clinic doesn't need that many units, and they can't afford it," said Dr. Megan Ranney, an emergency physician who teaches at Brown University. "So it really puts PPE out of the reach of the providers that are working in the hardest hit areas."

Ranney co-founded GetUsPPE, a nonprofit created in March to supply donated PPE to health care workers who still need it, including smaller assisted living facilities and community health centers.

"The PPE shortage, unfortunately, is not going away, and the PPE that is available remains far too expensive for many communities," Ranney said.

Some schools that are opening their doors to in-person education this fall are also struggling to find enough PPE.

'The federal government should be coordinating this'

Robin Cogan, who writes The Relentless School Nurse blog, said her school district in Camden, N.J., is having trouble sourcing protective gear for teachers and staff. She said she has heard from fellow school nurses in other cash-strapped districts who have been told to provide their own PPE when classes resume.

"We should not be asking our first responders, who are the school nurses, to get their own equipment. To me, that's unconscionable," Cogan said.

Cogan said she's shocked that the PPE shortage has lasted as long as it has. And she's not the only one.

"It is unbelievable that we're having to fight to get PPE," said Dr. Sandra Fryhofer, a primary care physician with a small office in Atlanta.

Fryhofer said she was able to buy some N95 respirator masks through a bulk order organized by the AMA and others. Since then, she has been conserving masks by hanging them in paper bags from a clothesline in the back of her office and then reusing them.

"The federal government should be coordinating this. Access to PPE should not be a problem during a pandemic," Fryhofer said.

"The small practices have been totally left out and it didn't have to be that way. All it would take is a national coordinated effort to make and distribute PPE," she said, "to make sure we have enough not just for today, but also for tomorrow."

Source: Health News Florida

That was on July 2. More than a month later, Brim is still far from fine.

Prior to the pandemic, the 28-year-old from Caldwell, Idaho, juggled homeschooling her two kids with her work as a makeup artist—she was supposed to open her own salon in July. Now, she suffers daily from shortness of breath, exhaustion, excruciating headaches, brain fog, neuropathy, high blood pressure and loss of taste and smell. She feels like “a little old lady,” completely knocked out by simple tasks like making lunch for her children. She’s working just enough to help pay the bills and the lease on her empty salon, but she has no idea when she’ll be able to work full-time again, and no idea how she and her husband will manage financially if she can’t. “Half of my day is spent trying to sleep, and the other half of it is trying to pretend like I’m okay—and I don’t know when I’ll be okay,” Brim says.

This is “long-haul” COVID-19. Even young, healthy people can become long-haulers (as many call themselves), left unable to work, lead a normal life or, some days, get out of bed. The consequences for each individual can be devastating—and at scale, they’re staggering. Over time, long-haul coronavirus may force hundreds of thousands of people out of work and into doctor’s offices, shouldering the double burden of lost wages and hefty medical bills for the indeterminate future. To treat them, the health care system may have to stretch already-thin resources to the breaking point.

It’s going to be “an impending tsunami of patients…on top of all the [usual] chronic care that we do,” says Dr. Zijian Chen, medical director of the Center for Post-COVID Care at New York City’s Mount Sinai Health System, one of the country’s only clinics devoted to caring for patients in the aftermath of coronavirus infection. “At some point it becomes very unsustainable—meaning, the system will collapse.”

When most people think of COVID-19, they imagine two possibilities: a flu-like illness that clears on its own, or a life-threatening condition that requires ventilation and a hospital stay. It’s not hard to see how the latter scenario leads to long-term damage. Mechanical ventilation is incredibly hard on the lungs, and days or weeks spent sedated in a hospital bed can sap physical and mental strength. In a small study published in 2011, nearly all the participants who needed intensive treatment for a severe lung injury reported decreased physical ability and quality of life five years after leaving the hospital. Some took years to return to work. Hospitalized coronavirus patients may face a similar fate.

But with COVID-19, it’s not just the sickest who face a long road back. A July 24 report from the U.S. Centers for Disease Control and Prevention (CDC) found that, out of about 300 non-hospitalized but symptomatic COVID-19 patients, 35% were still experiencing symptoms like coughing, shortness of breath and fatigue up to three weeks after diagnosis. (By contrast, more than 90% of non-hospitalized influenza patients fully recover within two weeks.) Recovery from COVID-19 can be a drawn-out process for patients of all ages, genders and prior levels of health, “potentially leading to prolonged absence from work, studies, or other activities,” the report noted.

The CDC’s surveyors only checked up on people a few weeks after they tested positive for coronavirus, but emerging evidence suggests a large subset of patients are sick for months, not just weeks, on end. Dr. Michael Peluso, who is studying long-term COVID-19 outcomes at the University of California, San Francisco, says about 20% of his research participants are still sick between one and four months after diagnosis.

Kayla Brim with her family, outside their home in Caldwell, Idaho, on Aug. 11. Brim has been sick with COVID-19 since early July.

 

Angie Smith for TIME

The implications of that problem are enormous. If even 10% of the more than 5 million (and counting) confirmed COVID-19 patients in the U.S. suffer symptoms that last this long, half a million people are already or could soon become chronically ill for the foreseeable future.

When Mount Sinai opened its Post-COVID Center in May, the hospital advertised it as the first in the country; since then, a handful of others have opened in states including Colorado, Indiana and Illinois. Mount Sinai’s clinic was modeled after the practice the hospital opened to treat survivors of the 9/11 terrorist attacks. “It’s very similar. It’s a new group, and they need special care,” Chen says. The biggest difference, he says, is the size of the group. Significantly more people have survived COVID-19 than were directly affected by 9/11. Mount Sinai has only scratched the surface of that demand, treating about 300 people so far. The wait time for new patients extends into October.

The challenge for doctors like Chen is that nobody really knows why long-haul COVID-19 happens, let alone how to treat it. Other viral diseases with long-term symptoms, such as HIV/AIDS, offer some clues, but every day in the clinic is essentially uncharted territory. One hypothesis is that the virus persists in the body in some form, causing continuing problems. Another is that coronavirus pushes the immune system into overdrive, and it stays revving even after the acute infection passes. But at this point, it’s not clear which theory, if either, is right, or why certain patients recover in days and others suffer for months, Peluso says.

Plus, just as there’s huge variation in acute COVID-19 symptoms, not all long-term patients have the same issues. A researcher from the Indiana University School of Medicine in July surveyed 1,500 long-haulers from Survivor Corps, an online COVID-19 support group. They reported almost 100 distinct symptoms, from anxiety and fatigue to muscle cramps and breathing problems. A JAMA Cardiology study published in July suggested many recently recovered patients had lingering heart abnormalities, with inflammation the most common.

Some long-term COVID-19 patients have abnormal test results or damage to a specific organ, giving doctors clues as to how they should be treated. But for others, there’s no obvious reason for their suffering, making treatment an educated guessing game. “We don’t know why they [still] have symptoms. We don’t know if our techniques are working,” Chen says. “We don’t know if they’re going to get back to 100%, or 90%, or 80%.”

With little evidence, some doctors turn coronavirus long-haulers away or try to convince them their symptoms are psychological. Marcus Tomoff, a 28-year-old in Tampa, Fla. who is in his second month of debilitating fatigue, back and chest pain, nausea and anxiety after a bout of coronavirus, says he hasn’t been taken seriously by friends or even his doctors. “Several times I’ve cried in front of my doctors and they say, ‘You need to deal with this, you’re young,’” he says.

The haphazard testing system in the U.S. has further complicated patients’ searches for care. Mount Sinai’s Post-COVID Center, for example, only accepts patients who tested positive for COVID-19 or its antibodies, and Chen fears potential patients who couldn’t get tested or got false-negative results may be falling through the cracks. The best he can do right now is refer them to specialists and hope they find a doctor who can help.

For 46-year-old Andrea Ceresa, getting better is a full-time job—minus the paycheck. Ceresa had to stop working as a New Jersey dental office manager after she got sick in mid-April with what she and her doctors believe was COVID-19. (She tested negative for the virus and its antibodies, but her doctors think they were false negatives.) More than 100 days later, she’s in regular contact with her primary care physician, an integrative care doctor and a rotating cast of specialists who she hopes can treat her lingering gastrointestinal problems, hearing and vision issues, weight and hair loss, heart palpitations, migraines, brain fog, neuropathy, fatigue, nausea and anxiety. She finally got an appointment at a post-COVID program after weeks of waiting, but she’s mostly been left to cobble together her own care team.

Ceresa has paid for her own health insurance through the federal COBRA program since she stopped working, which has put her in a precarious financial state. “I have a stack of bills and I just am starting to open them now,” she says. “I’m definitely, at this point, going to be in the hole thousands of dollars. I’m collecting unemployment. I know I’m going to have to go on disability.” Even then, she says, it may not be enough to pay her bills.

There may soon be a lot of patients like Ceresa, says Dr. Bhakti Patel, a pulmonologist at University of Chicago Medicine who studies the long-term effects of critical care. Patel says patients with long-term issues after surviving coronavirus may face a number of obstacles. Patients who remain too sick to return to work (or who are unemployed due to the economic climate) may lose employer-sponsored health insurance at the moment they need it most. Younger patients who do not qualify for Medicare but need public insurance will likely be funneled toward Medicaid, which Patel says is “already over-stretched.” The services long-haul coronavirus patients may need—like physical therapy and mental health care—can be difficult to access, especially via public insurance networks like Medicaid, Patel says. That bottleneck will only get worse if more people need public aid.

As patients with an emerging disease, long-haulers also need “an intensity of outpatient care and expertise,” that goes beyond what the average primary care physician can offer, Peluso says. Very few doctors are experienced in treating long-haul symptoms—and even among those who are, “experienced” is a relative term. “This wasn’t a specialty three months ago,” says Chen.

People who can’t get into a dedicated post-COVID program may need to try a slew of specialists before they find one who can help, an expensive and tiring game of trial-and-error. (That’s assuming patients can get appointments with specialists like pulmonologists and neurologists, who are often few and far between outside of densely populated areas.) The sickest long-haul patients may also require pricey and difficult-to-access rehab or in-home care, on top of other medical costs. If a family member has to give up work to become a caregiver, that can also have serious economic consequences.

Some long-haulers will likely have to file for disability benefits, a byzantine system of its own that’s at risk of becoming overwhelmed. From 2008 to 2017, only about a third of people who applied for disabled-worker benefits in the U.S. were initially approved, according to Social Security Administration (SSA) data. It can be especially difficult for patients without a clear diagnosis or cause of illness, since SSA requires claimants to provide “objective medical evidence” of an impairment.

With few other resources available, thousands of long-haulers have sought help from virtual support groups like Survivor Corps and Body Politic, where members talk about their symptoms and celebrate signs of recovery. Programs like COVID Bootcamp 101, an online rehab series run by the nonprofit Pulmonary Wellness Foundation, are also trying to fill gaps in care. The scientific community is doing its best to catch up, but Chen says the government may need to help develop long-term solutions that address the economic consequences of long-term coronavirus symptoms, like a medical safety net program (as it has done for HIV/AIDS patients) or financial assistance for COVID-19 patients (as it did for 9/11 survivors).

Without clear answers about what happens next, all doctors can offer the public is yet another plea to take coronavirus seriously—because right now, the only surefire way not to become a long-hauler is to not get COVID-19 at all.

That doesn’t help people like Ceresa, though. After more than 100 days of feeling sick, Cersa says she’s still “baffled” this happened to her, an active and healthy woman who’s been a vegan for decades. She stayed home all April except for a couple trips to the grocery store and still had her life destroyed by the virus. She can’t work, sing in her band or plan her wedding after getting engaged a few weeks before the pandemic hit. She tries to comfort herself by thinking about ways it could be worse—it could be cancer—but the truth is, things are bad. “You try to be hopeful and think somehow, miraculously, you’re going to be better, and it doesn’t happen,” she says. “I can’t imagine living like this for another day, let alone the rest of my life.”

At this point, no one knows if she’ll have to.

Source: TIME

• In-person doctor visits plummeted during the start of the COVID-19 crisis in the United States, but have rebounded to a rate somewhat below pre-pandemic levels, according to a new analysis issued by The Commonwealth Fund and conducted by researchers from Harvard Medical School, Harvard University and the life sciences firm Phreesia.
• According to data compiled through Aug. 1, all physician visits were down 9% from pre-pandemic levels. That's significantly improved compared to data from late March, when visits were down 58%. Although the rebound got major traction beginning in late April, it began plateauing in early June, when all visits were 13% lower than normal. As of early August, in-person visits were down 16% compared to pre-COVID levels. States that are currently coronavirus hot spots are seeing bigger declines than states where the case levels are lower.
• Meanwhile, telemedicine encounters have settled in at rates much higher than pre-pandemic levels. However, they still make up just a fraction of patient-provider encounters for care. As of the start of this month, they comprised 7.8% of all such encounters. That's compared to a peak of 13.8% in the latter part of April. Prior to COVID-19, they were only 0.1% of all visits.

Dive Insight:

COVID-19 has widely disrupted healthcare delivery in the United States. However, it is becoming clear that as the pandemic has become a part of everyday life for the time being, how patients visit their medical providers has also settled into a pattern.

According to Harvard researchers using data from Phreesia's more than 50,000 provider clients, the plunge in patients seeing their physicians has rebounded from its nearly 60% dive in early spring. However, with all patient-physician encounters still consistently down from pre-COVID levels, the study's authors warn that "the cumulative number of lost visits since mid-March remains substantial and continues to grow."

Meanwhile, COVID-19 hotspots in the South and Southwest are depressing patient-provider encounters for the time being. Encounters were down as of late July by 15% in Arizona, Florida and Texas, compared to 12% in the Northeast and 8% in all other states.

Among medical specialties, only dermatology has seen a rebound beyond pre-COVID levels, with encounters up about 8% overall. But primary care visits are down 2%; surgery encounters, 9%; orthopedics, 18%; and pediatrics are in a 26% decline.

That the encounters between patients, doctors and other providers remains lower than normal has sparked some concerns about practices and other medical enterprises moving forward. HHS just earmarked $1.4 billion for nearly 80 children's hospitals across the United States to try to shore them up financially.

The private sector has also undertaken an initiative to encourage patients to return to their providers. Insurer Humana, along with the Providence and Baylor Scott & White healthcare systems, launched an advertising campaign last month to encourage patients to seek out healthcare needs, even during the historic pandemic.

Source: HealthcareDive

Content provided by: American Medical Association

But she lives at least an hour away and it was the middle of her workday. It was also the middle of a pandemic. Enter telemedicine.

The 34-year-old Leominster, Massachusetts, resident arranged a quick video visit through the app Zoom in May with her doctor in Boston. He reassured her that he was confident in their treatment plan, and the chances of her breast cancer returning were low.

“It was really great to be able to talk to him about what I was feeling,” she said. She felt comforted afterward “knowing that I wasn’t alone.”

This is how doctors and health care researchers envision telemedicine evolving after the COVID-19 pandemic fades. They see the practice — which has grown explosively this year — sticking around to replace many in-person visits and become a greater part of routine care.

Imagine more contact with doctors or nurses but fewer trips to the office. Patients might use telemedicine more for check-ins like Shell did or to talk to a doctor after a procedure or get a second opinion. There’s also secure messaging for quick questions and more remote monitoring of chronic health problems like diabetes.

“Your care is going to get better,” said Dr. Thomas Lee, a Harvard professor and care delivery expert with the health care consultant Press Ganey.

But to keep some of telemedicine’s growth, thorny questions about insurance coverage and doctor reimbursement need to be resolved.

Plus, patients and doctors who were forced to try virtual care during the pandemic need to keep using it.

Doctors scrambled to shift to telemedicine when the coronavirus hit the U.S earlier this year. Care providers like the Cleveland Clinic went from averaging 5,000 telemedicine visits a month before the pandemic to 200,000 visits just in April.

Many insurers waived fees to encourage its use. The federal government relaxed restrictions on telemedicine’s use in Medicare, the federal coverage program for people age 65 and over. The government also started temporarily allowing visits over apps that didn’t meet patient privacy standards.

That helped Dr. Jay Meizlish connect with his mostly older heart patients. At first, they struggled. He often had to hold cards up to his camera, telling patients to unmute their microphone or turn up their volume.

Then he found what worked — he switched to the more familiar and easier to use FaceTime.

“That’s how they talk to their grandchildren,” the Yale New Haven Hospital doctor said.

“We have learned the power of this, but whether it continues is not in our hands,” he said.

Experts expect some telemedicine restrictions will return, including fees that are now waived. And some doctor practices will be reluctant to work telemedicine permanently into their practices until they know exactly how they get paid, noted John League, a senior consultant with Advisory Board, which researches health care strategy.

“They have no appetite for uncertainty,” he said.

Insurers ultimately will cover more remote care because it can help keep people out of expensive hospitals and emergency rooms, said Arielle Trzcinski, a senior analyst with Forrester, which does research for insurers and hospitals, among other clients.

The insurer Oscar recently announced that it will offer free primary care visits through telemedicine in coverage that starts next year. Leaders in Washington also are interested in expanding telemedicine’s use in Medicare.

Trzcinski also thinks doctor groups will provide more virtual care because patients who tried it during the pandemic may go elsewhere if they don’t. With travel and time in the waiting room, an office visit can carve more than an hour and a half out of someone’s day on average, she said.

“People value time,” she said.

She estimates that virtual care could eventually replace up to 40% of in-person doctor visits that don’t involve hospital stays.

Shell, the cancer patient, said she never would have been able to visit her doctor in person that day. She teaches veterinary science at a vocational high school. That makes it hard to break away for an in-person doctor’s appointment.

She wound up using telemedicine a few times because of the pandemic. She hopes the practice continues.

“I feel strongly that increased safety, convenience, and accessibility are all reasons to continue,” she said.

Researchers don’t expect telemedicine to replace all in-person care. Millions of people don’t have access to the technology or a reliable internet connection. Some people may still be reluctant to use it.

And not all ailments can be treated remotely.

Alexandra Thomas tried it last spring when she woke up with vertigo that made her so dizzy she could barely walk. The nurse practitioner handling her virtual visit wanted Thomas to see someone in person. That meant the 24-year-old Charlottesville, Virginia, resident had to spend another $30 on a copayment and wait three more hours at a clinic before finally getting treated.

Telemedicine, Thomas said, is “a good idea in theory, but maybe not so much in practice.”

Doctors see it playing a larger role for people with chronic conditions. More patients with diabetes may get their blood sugar monitored at home, go to a lab for blood draws and then visit their doctor once a year instead of every three to six months.

Lee, the Harvard professor, said doctors are shifting to caring for patients as efficiently as possible. The pandemic accelerated this push.

“I just think there’s no going back,” he said.