April 3, 2020
COVID-19 Financial Relief
The coronavirus pandemic is hitting physician practices acutely, in terms of both economic hardship and disruption to patient care. Since March 1, almost 100% (99.4%) of independent physician practices report a decrease in patient volume, resulting in millions of dollars in lost revenue. Our survey was shared with 5,000 physicians working in independent (non-networked) physician clinics in Washington state. Total responses equaled 384. After adjusting for multiple answers per practice site, the total response number was 311.
Overall, almost 18% of respondents said their practice revenue has decreased by more than $1,000,000 since March 1. Sixteen percent said their revenue has dropped $21,000-$50,000 during that time period, while another 16% said their revenue has dropped in the range of $101,000-$200,000.
Based on the reduction in patient volume since March 1, the majority of responding practices have furloughed staff:
- 63% are laying off or furloughing staff.
- 61% are changing office hours.
- 26% have closed temporarily.
- Two practices reported they have closed permanently.
When asked "Looking at the next three months, do you believe your patient volumes will increase or decrease?" 63% of all respondents said decrease. The loss in margin was widespread among all respondents:
- 19% said $100,000-$250,000.
- 19% said $500,000-$1,000,000.
- 17% said $250,000-$500,000.
- 14% said $1,000,000-$2,000,000.
For questions about the WSMA survey, contact wsma@wsma.org. The WSMA is using this data in our advocacy to try and ensure practices get the financial support they need to keep their doors open after the COVID-19 outbreak. Specific work in this regard includes:
CMS provides accelerated payments in Advance Payment Program
The WSMA has been advocating at both the national and state levels to not only ensure that you get necessary supplies and protection to care for your patients, but to ensure that your practice can be there for your community when the outbreak subsides. In very good news for physicians, the Centers for Medicare & Medicaid services has announced that it will pay physicians their 2020 Medicaid and Medicare payments in advance.
The federal agency is expanding its Advance Payment Program to allow more physicians to qualify and receive expedited payments, interest-free. CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment. The expansion of this program is only for the duration of the public health emergency. Details on the eligibility and the request process are outlined in this CMS fact sheet. While expansion of the APP is welcome, the WSMA continues to advocate to Washington's Congressional delegation and CMS to not subject practices to repayment or recoupment.
Paycheck Protection Program goes into effect today (Friday)
The federal stimulus package (aka CARES Act) is intended to provide financial relief to individuals and businesses through a number of programs. The Paycheck Protection Program is likely to be of most utility to physician practices, as it provides loans of up to $10 million to qualifying businesses of less than 500 employees that under some circumstances do not need to be repaid.
The loans do not require collateral and can cover up to two months of your average monthly payroll costs from the last year, plus an additional 25% of that amount (with payroll calculations capped at $100,000 per employee). Provided that the funds are used to primarily cover payroll costs, and that staff and payroll are maintained for the duration of the loan, the loan can be forgiven. Beyond payroll, up to 25% of the loan may be used for operational expenses such as rent, interest on mortgages, and utilities.
The Paycheck Protection Program launches on Friday, April 3. Given the projected demand for these loans, the WSMA strongly encourages physicians to act quickly. As a first step, consider reaching out to the bank your practice works with as all federally insured financial institutions are eligible lenders. The U.S. Treasury Department offers a fact sheet on the program, and the application form can be found here. Finally, the Association of Washington Business will be hosting a webinar on the program at 10 a.m. on Monday, April 6. Register here.
CMS covers phone visits at same rate as in-person visit
Another of WSMA's top line asks on behalf of our physician members during the pandemic was answered in the affirmative this week when CMS released an interim final rule temporarily expanding the list of covered telehealth services and providing regulatory waivers to help hospitals and physician practices respond to the coronavirus outbreak. The new services and waivers are intended to help facilitate telehealth visits with Medicare beneficiaries, including permitting physicians to provide certain services by telephone to new or established patients using CPT codes 98966-98968; 99441-99443.
For the duration of the public health emergency, telehealth services will be reimbursed at the same rate as a face-to-face visit. To implement this change, CMS instructs physicians to bill for Medicare telehealth services to report the POS code that would have been reported had the service been furnished in person and use modifier 95. These changes are effective retroactively, starting March 1, 2020. CMS will exercise its enforcement discretion on an interim basis and not conduct reviews to consider whether these services were furnished to established patients. For details, see this CMS fact sheet. For further telehealth guidance for your practice during COVID-19, visit the WSMA's Telehealth and Reimbursement page. For more detail or with questions, please reach out to policy@wsma.org.