Providers Say They Need More Financial Aid As COVID-19 Cases Rise

Providers belonging to the American Medical Group Association (AMGA) are citing rising COVID-19 cases as a reason why Congress should pass additional financial assistance.

In a letter sent to Congressional leaders earlier this week, AMGA president and CEO Jerry Penso urged Congress to immediately provide new funding for the Provider Relief Fund and restart Medicare’s Accelerated and Advance Payments (AAP) program once policymakers reconvene in January.

“The increase in the number of cases, the need to cancel care, influenza season, and the coming winter months create a confluence of conditions that will strain our healthcare system’s ability to respond to this national crisis,” wrote Penso, MD, MBA.

Medical groups and health systems have already started to postpone or cancel elective procedures to ensure they have the resources they need for anticipated increases in COVID-19 patients, AMGA noted.

Missouri-based BJC Healthcare is one of the latest health systems to announce the suspension of elective services.

“As of November 16, we are suspending some elective surgery and other procedures that can be postponed safely. We must take this drastic measure both to increase our hospital capacity and ensure we have the staff available to continue providing exceptional care for our patients. An available room means nothing if there is not a nurse at the bedside,” health system leaders explained in a letter to the community.

But providers across the country have been rolling back elective services for the past couple of weeks, including the Mayo Clinic, St. Luke’s Health System, and Ballad Health.

The decisions could be a sign of hard times to come. When providers shut down elective services at the start of the COVID-19 pandemic, the loss of revenue, particularly on the fee-for-service side of business, resulted in significant financial losses and even practice closures for some providers.

Congress allocated hundreds of billions of dollars to healthcare providers as part of several COVID-19 stimulus packages. But another bill, which provider groups have been pushing for, does not seem to be on the horizon.

Legislative action, like replenishing the Provider Relief Fund and accepting new loan applications under the AAP program, would help providers maintain financial viability as they face another round of revenue losses.

The group is also calling on Congress to make other policy adjustments, such as extending the moratorium on Medicare sequester cuts through the duration of the public health emergency and promoting the use of telehealth services.

“CMS expanded the number of services that qualify for telehealth, while also increasing payments for telehealth so reimbursement is the same as for in-person services,” Penso explained in the letter. “CMS also recognized the need for patients without smartphones or computers to access care while staying at home by creating a set of audio-only codes for select services. Congress should now recognize the important role that telehealth has in a modern healthcare system and permanently lift the geographic and originating site restrictions that normally limit the availability of telehealth.”

Additionally, AMGA called for Congress to address other key healthcare issues, including proposed Medicare payment cuts for certain specialists paid under the Medicare Physician Fee Schedule, provider qualification for value-based care models, and surprise billing.

Congressional action, such as revisions to the Advanced Alternative Payment Model (APM) thresholds or a bill that prevents Medicare payment cuts, “will provide stability to the Medicare program and ensure providers maintain their ability to deliver high-quality care to their patients during the pandemic,” according to the medical group.

President-elect Joe Biden has said he would support another COVID-19 stimulus package and has encouraged the lame duck Congress to agree on legislation to support the economy. However, Democrats and Republicans have failed to pass major COVID-19 legislation related to the virus since the Paycheck Protection Program and Health Care Enhancement Act in April.

Efforts to pass a large stimulus package may also be a challenge in January if Republicans maintain hold of the Senate.