Federal Aid: Is Hazard Pay Next?

Soon after the U.S. government provided some financial relief for physician practices, the Trump administration may also provide hazard pay for doctors on the front lines of the new coronavirus disease (COVID-19).


The most recent government stimulus bill provided $100 billion in direct financial support to physician practices, hospitals, and other healthcare providers under the Public Health and Social Services Emergency Fund, the AMA said in a press release.

“This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation,” AMA said.


The stimulus bill also provides Small Business Administration loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.


“Physician practices are being hard-hit by the pandemic, which is threatening the sustainability of practices and could reduce access to care,” said AMA Patrice Harris, MD, in the press release. “We are urging the Administration to expedite the creation of programs included in the stimulus legislation to enable the dissemination of financial support to meet the urgent need facing many physician practices.”

Meanwhile, the Trump administration is exploring the possibility of providing hazard pay for doctors, nurses, and other healthcare workers. In an interview with "Fox & Friends" on Fox News, President Donald Trump said he is "looking at" providing additional pay for health care workers, CBS News reported.

That financial aid could come in a separate relief package, according to Trump.

"We are looking at different ways of doing it, primarily through the hospitals," Trump said. "If anybody's entitled to it, they are.”

Many legislators are also urging hazard pay for healthcare workers.

“These nurses, these doctors, health care workers, they're risking their lives. I’m sure when they walk to work or take the subway to work, they're wondering, will I catch this virus? But they're like the firefighters and police officers and construction workers were heroes of 9/11; these are our heroes today. And they should get hazard pay,” Sen. Charles Schumer (D-NY) said, NPR reported.

“In the next coronavirus relief package that Congress passes, essential workers —first responders, hospital and medical workers, grocery store workers, farm workers, etc.—should receive hazard pay from their government or their company,” Rep. Joaquin Castro (D-TX) tweeted.


The Centers for Medicare & Medicaid Services also recently provided financial relief to physician practices. “Practicing medicine is harrowing and dangerous in the face of the pandemic, but less noticed is the fiscal peril that many practices face. The Centers for Medicare & Medicaid Services has recognized this, and its recent action to immediately send accelerated payments to physicians will help keep practices open to Medicare patients,” Harris said in a press release.

Other provisions of the stimulus bill that will help physician practices include:

• Suspension of the 2 percent Medicare sequester in May through December 2020.
• Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
• A temporary waiver of the face-to-face visit requirement with home dialysis patients.
• Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.

Secretary of HHS will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

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Five Medicare Services to Keep Your Patients and Practice Healthy During COVID-19

As the COVID-19 outbreak continues to spread, physicians are under immense pressure to maintain continuity in caring for their patients while promoting social distancing. In response to this, Medicare has urged providers to use telehealth for the provision of services to all beneficiaries.


The main narrative from Medicare has been focused on providing telehealth E/M visits. Although there is a need for such visits, there are other non-face-to-face Medicare services that can protect patient health, provide an opportunity to educate patients on the current crisis, and increase practice revenue to help balance out the drastic shortfall in outpatient visits.

To help keep your practice (and patients) healthy during the crisis, consider providing the following five Medicare services.

1. Annual Wellness Visit (AWV)

The AWV is included in the current telemedicine waiver, is relatively easy to provide via telehealth, and has been overlooked by many practices. Providers are allowed to reach out to patients to schedule and perform AWVs, making it a great opportunity to contact some of your most vulnerable patients to check up on their health and educate them on COVID-19 prevention and response.

Since the AWV can be performed under Medicare's "direct supervision" standard, it can be performed primarily by clinical staff, giving practices a solution for using staff who might otherwise be idle due to the reduced in-person patient volume. Further, many practices have been reporting difficulties collecting the copayments required for telehealth E/M visits, which are completely waived for the AWV. This can be a great incentive for patients not sold on the idea of telehealth to try the program.

During such a tumultuous time, patients may also want to discuss advance care planning (ACP) which can be billed as a separate service. ACP has its copay waived when provided with an AWV.

2. Preventive Services

The current telehealth waiver also covers many Medicare preventive services. These services can largely be billed together during the same televisit and in conjunction with an AWV. When grouped together, they can make a single telehealth call go further for patients and practices. Many of the preventive services, particularly those involving behavioral and mental health, are critical as patients are needing to manage more of their health concerns at home.

3. Remote Patient Monitoring (RPM)

Medicare has bolstered its reimbursement for "care management" services, such as RPM, over the past few years. These services are performed outside of an office visit, but are not considered telehealth services by Medicare and thus avoid telehealth restrictions.

RPM was expanded by Medicare in 2020 and is particularly well suited for the current crisis. Even the FDA has acknowledged the importance of RPM, having recently announced a temporary policy to allow device manufacturers expanded leeway to produce RPM devices to help meet demand.

Many practices have patients with chronic conditions who come into the office periodically for what amount to vital checkups. With the crisis, these patients have largely been told they must remain at home. RPM allows providers to electronically collect and monitor health data, such as blood pressure, glucose, or weight, from their patients. As of 2020, RPM can be furnished under Medicare's "general supervision" standard, meaning it can be conducted by auxiliary staff. The devices themselves can be mailed to a patient for use in the program once the patient has provided verbal consent to participate in the program.

4. Chronic Care Management (CCM)

CCM is Medicare's original care management service. Medicare has expanded CCM steadily for years, including major improvements in 2020.

CCM reimburses practices for spending 20 or more minutes communicating with and managing patients with two or more chronic conditions. CCM is another general supervision service, so patient communication can be conducted by clinical staff.

Although enrolling a patient into CCM requires a bit more work than the other services on this list, ongoing support for patients with chronic conditions is critical during this pandemic. Risk for major complications from COVID-19 are much more likely in older patients with chronic conditions. Two-thirds of Medicare patients have two or more chronic conditions.

5. Virtual Check-ins

Finally, let's discuss a relatively new Medicare service that covers brief telephone or messaging communication with patients. The vast majority of Medicare telehealth services, even under the current waiver, require real-time video communication. Although the virtual check-in does not pay much, it has extremely low time requirements and can be furnished over the phone. This is especially helpful for less technologically adept patients.

The virtual check-in has a sister service called remote evaluation or "store and forward." This pays a provider to briefly evaluate an image or video sent by the patient.

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Proactive engagement improves medication management

Despite an increased national focus on medication management, coordinating and managing drugs for elderly patients and those with multiple chronic conditions presents numerous challenges for primary care physicians.

Patients 65 years of age and older metabolize medications differently than younger adults due to diminished kidney and liver functions. Additionally, elderly patients can be forgetful, and don’t always remember to take their medications in the right dose or at the right time. They may not remember the over-the-counter (OTC) medications they’re taking or fail to list medications prescribed to them from specialist providers, making it hard for the primary care physician to manage their holistic care and ward off any potential adverse drug interactions.

Similarly, patients being treated for multiple chronic conditions may see multiple providers, each lacking visibility into the full set of medications a patient is taking.

These issues can be amplified if a patient fills their prescriptions at more than one pharmacy. Additionally, their adult caregiver at home can miss important information about their medications or give them OTC medications for common ailments that end up interacting with their prescription drugs.

Since the impact of adverse drug events can be significant—resulting in 1.3 million emergency department visits each year—identifying an approach to more coordinated and informed care for older patients and those managing multiple chronic conditions, such as diabetes, high blood pressure, or asthma becomes an important part of the patient care conversation.

That said, the primary care physician should be the center of this coordinated care effort. The physician-patient interaction is the most important element in ensuring medications are managed appropriately, making it less likely that a patient has an adverse drug event.

In doing so, there are several tactics that can be used to make a difference.

Encouraging openness, honesty, and inquiries. It’s widely known that patients don’t always share fully truthful or complete information with their provider. While that’s not necessarily a deliberate act, when patients sense they can trust their provider with information that will be received without judgment, they’re more inclined to share details about their lifestyle and medication routines. That information that could turn out to be highly relevant to their treatment. Encouraging patients or caregivers to write down questions and bring in the paperwork they receive when filling a prescription is a good idea. When the patient has questions, following up to ensure they understand the answer can help clarify the concern has been addressed.

Knowing the patients’ full medication list. Ask the patient to bring in their prescription bottles with them. Ask them to describe how and when they take the medication to make sure they’re properly following directions and to clear up any confusion. It is important to clarify that they should list any and all OTC medications or herbal supplements they may be using regularly or even occasionally.

Repeating the process during each visit. Repeating the step above each time the patient visits can expose any new medications or side effects the patient is encountering. Additionally, asking patients to describe any challenges they have with their prescription is also important and may help in uncovering any social determinants of health that may be impacting the patients’ medication regime.

Spending the right amount of time for the patients’ needs. It’s important to gauge which patients may need more time to have their questions answered, review their medications, and discuss their treatment plans. Doing so provides a triple benefit: ensuring the patient is informed, strengthening the doctor-patient relationship, and improving satisfaction all around.

Suggesting the patient fill all of their prescriptions at a single pharmacy. In doing so, the pharmacist becomes a more active, involved member of the care team. They can use available patient and pharmacological information, history, and data to highlight potential concerns before they become issues.

Using available tools, such as medication profiling, to help provide insights that the patient otherwise can’t. Working with a medical laboratory that offers screening specifically for chronic care conditions, as well as blood tests or urine drug tests to detect the presence of medication can give physicians additional answers they need to intervene on the patient’s behalf. With objective laboratory drug testing, physicians can objectively reconcile polypharmacy medications prescribed to patients, monitor medication levels to improve dosing, reduce the likelihood of adverse drug reactions, and decrease the cost of medical expenses related to treating patients with chronic conditions.

Ultimately, being proactive with each patient goes a long way to ensure they understand their medications, how and when to take them, and how to avoid potential complications. An increased focus on care coordination can help providers understand what patients are taking and how they’re working for the patient, which can ultimately help to reduce adverse drug events and associated costs, especially for elderly populations and those with multiple chronic conditions.

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Medical practices have a love-hate relationship with the fax machine

The administrator for the Centers for Medicare & Medicaid Services has issued a challenge to make physicians’ offices fax-free by 2020. But old habits die hard, especially when it comes to physicians and their patients.


Despite the fact that 86% of physician practices have an electronic health record (EHR) system,[1] many doctors still take notes by hand and utilize fax machines to send and receive data. Although advances have been made in technology, three-quarters of medical communication in the United States occurs by fax, which includes physical or legacy fax machines as well as more advanced faxing technologies such as cloud fax.[2]

Digital cloud fax technology represents next-generation communication capabilities, as documents flow seamlessly through secure email or electronic health information exchange (HIE) and can become part of an electronic patient record.

The demise of the physical fax machine has been predicted for decades, yet it remains a healthcare workhorse. By breaking the habit of paper-based fax and adopting more modern communications channels such as digital cloud fax technology, physician practices can save money, adopt more efficient workflow practices and reduce the chances for a data breach.

Status quo tough to change

The federal government offered more than $35 billion in incentives to encourage eligible professionals or eligible physician practices to adopt EHRs. While the adoption rate is high, the government didn’t mandate interoperability between systems, so disparate systems simply don’t talk to one another. Patient information such as a lab reports arrive via fax. Likewise, orders needing a physician signature, such as a care plan or a home health referral, remain mainly fax-based.

CMS Administrator Seema Verma addresses physical faxes and other forms of non-electronic communication when during a 2018 speech she says, “(H)ealth care providers are in a 1990’s time warp…where doctors are faxing patient records, medical staff are manually entering results into EHRs, and hospitals are handing out data on a CD-ROM while the rest of the economy is functioning on fully digitized, integrated data that informs decision-making instantaneously.”[3]


The problem with all these technology systems is that interoperability among each remains poor. While strides are being made on that front, large gaps remain in a truly integrated patient record. Technology is one hurdle, but the possibility of competition cannot be overlooked.

EHR vendors don’t have much incentive to make their systems compatible with others for fear of losing market share. Health systems and providers, too, can be reluctant to transfer patient information electronically to another hospital or physician to slow patient leakage from their facilities, so they may not be keen to promote interoperability.

Despite the march of technological progress in the exam room, many physicians still rely on handwritten notes and refer to paper copies of records. The fax remains a reliable way to communicate, where records are returned in a familiar format. The comfort level with existing practices cannot be overlooked, nor can the lack of incentives and availability of improved options for document distribution to replace physical faxing.

Strong arguments to make a change

The healthcare industry wastes more than $9 billion annually by continuing to use manual processes instead of electronic ones, according to the Council for Affordable Quality Healthcare. A manual process costs, on average, $6 more than an electronic one, but the difference can be as high as $11 more. Besides monetary savings, providers could save a minimum of 1.1 million labor hours per week by employing electronic transactions. Each fax or phone call requires an average of eight minutes to handle and as much as 30 minutes.[4]

Multiply each manual process, each phone call, each sent or received fax, and the costs add up quickly.

Industry consolidation has brought a new level of interoperability that is breaking down some of these communication barriers.

But the biggest reason change needs to occur may be the lack of security for a paper fax. HIPAA regulations mandate a tight chain of custody at all times, but it’s difficult to imagine a tight chain of custody for a fax machine in the copy room. Multifunction scanners also can expose PHI.

With the cost of a healthcare data breach topping $8 million, health systems and providers must take all necessary precautions to ensure that patient data in all forms remains safe and secure.

Bringing the fax into the digital age

Digital cloud faxing solves the problems and potential breaches associated with physical faxing. First, there is no more fax machine. Communications are sent by secure email, a fully HIPAA compliant solution. Documents are encrypted while in transmission and at rest, arriving directly in the in-box of the recipient, who logs in to view messages. Communications also can be sent through an HIE, another secure document exchange medium.

When deployed across an organization, faxes can be sent from any connected device: computer, tablet or smartphone through a secure mobile app. If communications need a higher level of security, documents can be stored in a secure server with 256-bit encryption.

If a breach occurs, companies that use HIPAA-compliant cloud faxing would be covered by the “safe harbor” provision of the Breach Notification Rule because the encrypted data had been rendered unusable, unreadable, or indecipherable to unauthorized individuals. “If protected health information is encrypted pursuant to this guidance, then no breach notification is required following an impermissible use or disclosure of the information.”[5]

The days of the physical fax machine are numbered – and physician practices would be smart to cut those ties sooner rather than later. Digital cloud faxing combines the utility of faxing with the security protocols that HIPAA regulations and commonsense demand while presenting information in a way that physicians and staff are accustomed to.

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