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Ophthalmology’s response to COVID-19

Updates on the impact on the ophthalmic industry and practices, and the fight to overcome the pandemic.

Update April 29, 2020: Ophthalmic ASC reopening checklist 

To support the safe reopening of ophthalmic ASCs, the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Outpatient Ophthalmic Surgery Society, developed a reopening checklist. This checklist includes guidance on how to approach and manage some of the key decisions of reopening. For more information and guidance, visit the AAO's website.
 

Update April 28, 2020: CARES Provider Relief Fund payment portal open  

Providers who received funds from the CARES Act Provider Relief Fund may be eligible to receive additional funds by visiting the General Distribution Portal. Providers must attest to each payment associated with their billing Taxpayer Identification Number(s). In addition, providers who have already received payments will need to upload their most recent IRS tax filings as well as estimates of lost revenues for March and April 2020. This portal is only for organizations that have already received payments through the CARES Act Provider Relief Fund.

For help with this process, visit the CARES Act Provider Relief Fund Application Guide.
 

Update April 28, 2020: CMS suspends Advance Payment Program 

The Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending the program to Part B suppliers effective immediately. The agency paid more than $100 billion to health-care providers and suppliers through this program. For more information, see the CMS Accelerated and Advance Payments Program fact sheet
 

Update April 20, 2020: Joint statement roadmap for reopening ASCs 

The American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and American Hospital Association issued a joint statement regarding the resumption of elective surgery. Principles and considerations set forth in the statement include timing for reopening, personal protective equipment, case prioritization and scheduling, safety and risk mitigation and more. 

For details, read the joint statement roadmap here.  
 

Update April 7, 2020: Letter to Congress on emergency funding for physicians 

The American Medical Association and other physician organizations, including the AAO and ASCRS, are urging the U.S. Department of Health and Human Services to provide 1 month of revenue to physicians, nurse practitioners and physician assistants enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses.

According to the letter to Secretary Azar, "Many physicians who practice in offices and ambulatory surgical centers are not seeing patients for non-essential visits and procedures to preserve medical supplies for treating patients with COVID-19 and to slow the community spread of the virus. We are also concerned that small practices are particularly vulnerable to financial ruin as they have less ready access to capital and are already operating on razor thin margins. In addition, we have heard from many large physician practices and faculty practice plans that have over 500 employees and will not qualify for the small business assistance in the CARES Act."

The organizations recommend HHS use an individual’s average monthly payment amount from October-December 2019 as the basis for determining pre-pandemic monthly revenue. The organizations cite that since Medicare patients account for 35% of all patients in most specialties, HHS should extrapolate that figure and issue three times the October-December 2019 average. 


Update April 6, 2020: COVID-19 and health-care law 

In an Ophthalmology Management online exclusive, Gary W. Herschman, Anjana Patel and Denise Dadika provide key legal updates for ophthalmology groups. Click here 


Update March 30, 2020: Trump signs stimulus bill into law

On Friday, President Trump signed the $2 trillion coronavirus bill into law to address the growing pandemic. The Coronavirus Aid, Relief and Economic Security (CARES) Act is aimed at providing relief to state and local governments, individuals, small and large businesses and hospitals. 
 
The AAO provided information for ophthalmology practices on eligibility, the application process and more on its website (https://www.aao.org/practice-management/article/paycheck-protection-program-covid-19).

Update March 30, 2020: Accelerated and advance Medicare payments 

As a result of the COVID-19 pandemic, CMS announced an expansion of its accelerated and advance payment program for Medicare-participating providers and suppliers. CMS specifically highlighted the disruption to the health-care industry, including the delay of non-essential surgeries and procedures and the disruption to billing. 
 
Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is a disruption in claims submission and/or claims processing. Hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers can request the payments. 

For more information and to see if you qualify, visit https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.
 

Update March 30, 2020: Urgent and emergency procedure list

Last week, the AAO and CMS advised ophthalmologists to suspend non-essential surgeries and procedures until further notice. The AAO shared a list of commonly performed procedures that fall under the “urgent” or “emergent” categories. For the list, visit https://www.aao.org/headline/list-of-urgent-emergent-ophthalmic-procedures.
 

Update March 27, 2020: Senate passes stimulus legislation

The Senate passed H.R. 748, the “Coronavirus Aid, Relief, and Economic Security (CARES) Act,” Phase 3 stimulus legislation of the Coronavirus relief packages. Speaker Nancy Pelosi (D-Calif.) will bring the legislation to the House floor for a voice vote. If passed by the House, the bill will be sent to President Trump for his signature.

For key physician-related provisions, see the ASCRS/ASOA’s Phase III document: https://ascrs.org/-/media/ascrs-website/government-relations/pdfs/washington-watch-weekly/march-2020/covidphase3legislation.pdf.

Update March 26, 2020: Advocacy efforts

Ophthalmology groups have joined colleagues in efforts to secure relief for physicians and practices impacted by COVID-19.

First, in a letter to Congress (RE: Relief for Independent Physicians’ Offices) ASCRS and ASRS, in conjunction with the Alliance of Specialty Medicine, request that physician practices qualify for financial relief, including loans and relief from payroll taxes as part of the Small Business provisions. The organizations say that “Trauma care and telemedicine may create some revenue, but not enough to meet the obligations of the practice, such as lease payments, payroll, insurance, taxes and other costs. Our physicians and their hardworking nurses, assistants and other staff members want to ensure that their offices remain open for patients who need care.”

For the full letter, visit https://ascrs.org/-/media/ascrs-website/government-relations/pdfs/washington-watch-weekly/march-2020/asm-covid19-relief-letter.pdf .

Another letter sent by the AAO and ASCRS in conjunction with the Surgical Coalition, voices support for the Immediate Relief for Rural Facilities and Providers Act, which would provide an emergency, one-time grant for all providers and ASCs. The relief would be equal to practice total payroll from Jan. 1 to April 1, 2019, and authorize the Small Business Administration to provide low-interest loans to providers and ASCs at a 0.25% interest rate. The loans would not accrue until 2 years after the COVID-19 pandemic ends.

Addressed to Senators Michael Bennet (D-Colo.) and John Barrasso, MD (R-Wyo.), the coalition writes: “As the majority of elective cases are being canceled or rescheduled, case volumes will plummet. During this time, physicians are trying to keep their businesses afloat including paying their staff and office expenses. The Immediate Relief for Rural Facilities and Providers Act would alleviate this unexpected and extreme strain on physician practices.”

For the full letter, visit https://ascrs.org/-/media/ascrs-website/government-relations/pdfs/washington-watch-weekly/march-2020/scsupportletterbennetbarrassoimmediatereliefact.pdf .