Ob/Gyns, Peds, Other PCPs Seeking COVID-19 Financial Relief From Feds

Alicia Ault

April 30, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

A handful of specialties — including family medicine, obstetrics/gynecology, pediatrics, and other primary care specialties — are calling for targeted and urgent relief payments from the federal government, saying that they have been left out of distributions aimed at alleviating the financial fallout associated with the novel coronavirus.

The federal government has already distributed something like $150 billion — through direct payments and advances on reimbursement ― to clinicians, but, to date, the money has only been given to providers who bill Medicare, and not even all of those individuals have received payments.

"It is critical that frontline physicians who may not participate in Medicare fee-for-service, in whole or in part, including obstetrician-gynecologists, pediatricians, and family physicians, have the resources they need to continue providing essential health care to patients amid the pandemic and in the months to come," said the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG) in a letter to Health and Human Services (HHS) Secretary Alex Azar.

In particular, the organizations are concerned that no money has been distributed or earmarked for clinicians who serve Medicaid recipients.

"The organizations that signed that letter are the primary providers of care to the Medicaid population," Shawn Martin, senior VP for the AAFP, told Medscape Medical News. That's true even for family physicians, he said.

"Typically, in an average family medicine practice, their Medicaid panel size is equal to if not greater than the Medicare panel size," he said.

On April 23, Azar said HHS was working on a distribution plan for providers who only take Medicaid, as well as for dentists and skilled nursing facilities. An HHS spokesperson confirmed to Medscape Medical News that the agency still intends to provide money to those groups of providers and that the agency is committed to distributing funds quickly and with transparency.

Azar had also announced that the government would soon start distributing $20 billion in payments to Medicare providers, on top of the $30 billion that had already been handed out to clinicians on April 10 and 17.

That $50 billion came from the COVID-19-related $100 billion Provider Relief Fund, which was part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27.

Additionally, the Centers for Medicare & Medicaid Services had distributed some $100 billion to providers who participated in Medicare Part A or B through the Medicare Advance Payment program, which is a deferred loan. The agency brought that program to a halt on April 27, as reported by Medscape Medical News.

An additional $75 billion will now be available through the Public Health and Social Services Emergency Fund (PHSSEF) as part of the third congressional COVID relief package, signed into law on April 24.

Martin said AAFP and other physician organizations have been talking with HHS about how to distribute money from that new pool of funds. "There's been a lot of progress, but there hasn't been any action," he said, adding that the purpose of the joint letter to HHS "is to say it's time for action."

COVID-19 Damage

AAFP, AAP, and ACOG noted in the letter the damage that's being inflicted by COVID-19. They cited data that show a 50% decline in measles, mumps, and rubella shots, a 42% drop in diphtheria and whooping cough vaccinations, and a 73% decline in human papillomavirus shots. The groups also noted a rise in child abuse injuries that are being seen in emergency departments and the potential for a worsening of the maternal mortality crisis in the United States.

Primary care physicians are also the go-to doctors for upper respiratory infections, noted the groups in the letter.

"Put simply, our physician members need to be able to keep their doors open and continue treating patients," said the groups.

A study by Harvard University and Phreesia, a healthcare technology company, found that ambulatory practice visits had declined by at least half since early February, with a 71% drop in visits by 7- to 17-year-olds and a 59% decline in visits by neonates, infants, and toddlers (up to age 6). Overall, pediatric practices experienced a 62% drop-off in visits.

Research conducted by the Physicians Foundation and Merritt Hawkins shows that 21% of 842 physicians who responded to an early April survey said they'd been furloughed or been given a pay cut. That number rose to 30% among doctors who are not treating COVID-19 patients.

Although the majority in the survey (66%) said they planned to keep practicing in the same manner during the pandemic, 32% said they planned to change practices, opt out of patient care roles, close their practices temporarily, or retire. The survey has a margin of error of ±3.5%.

Internists Seek Consideration, Too

The American College of Physicians (ACP) also has urged HHS to give special consideration to its members. The group wrote to Azar on April 28, recommending that payments from the new $75 billion PHSSEF be prioritized for primary care, as well as for smaller practices, those that provide care in underserved areas, and internal medicine subspecialty practices.

"Internal medicine specialists and other primary care physicians have an essential role in delivering primary, preventive, and comprehensive care not only to patients with symptoms or diagnoses of COVID-19, but also to patients with other underlying medical conditions, including conditions like heart disease and diabetes that put them at greater risk of mortality from COVID-19," wrote ACP President Jacqueline Fincher, MD, MACP.

ACP said the government could pay physicians on the basis of the amount of additional expenses incurred that were related to COVID-19, such as extra staffing or temporary relocation of their place of residence to prevent exposing family members to the virus. Pay should also be based on the percentage of revenue losses from all payers, including Medicare, Medicaid, and commercial insurers, Fincher said in the letter.

AAFP, AAP, and ACOG also had a suggestion for distributing payments to non-Medicare providers. "Given that most women's health, pediatric, and family practices have received less financial relief to date, we recommend that HHS provide these practices with a larger proportion of funds relative to their reported revenue than is provided on average across specialties," they wrote.

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