Category: Access to Care

CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up our healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work towards limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. They should also urge patients to follow the President’s recently issued guidelines to help slow the spread of the virus.

The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. This will help providers to focus on addressing more urgent cases and preserve resources needed for the COVID-19 response. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.

The recommendations can be found here:  https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

These recommendations, and earlier CMS guidance and actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov for further information. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

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CMS Announces Actions to Address Spread of Coronavirus

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus

Today, the Centers for Medicare & Medicaid Services (CMS) is announcing several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals. Critically, this shift in approach, first announced yesterday by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19.

As the agency responsible for Medicare and Medicaid, CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs. CMS is also issuing three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations – to inspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals.

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CMS Rural Health Strategy

Approximately 60 million Americans or roughly 1 in 5 live in rural areas, with nearly every state having a rural county. CMS recognizes the significant obstacles faced by patients and providers in rural areas and places an unprecedented priority on improving the health of these Americans, including the introduction of the first Rural Health Strategy. In the last year, CMS took several steps to improve rural health:

  • Expanded access to telehealth and other virtual services across the Medicare program
  • Proposed to increase the wage index of rural and other low wage index hospitals through the Inpatient Prospective Payment System (IPPS) proposed rule: CMS is seeking input on several approaches for accomplishing this
  • Proposed to remove urban-to-rural hospital reclassifications from the calculation of the rural floor wage index value through the IPPS proposed rule
  • Announced the CMS Primary Care First Initiative, a new set of payment models for primary care practices and other providers: Seeking public comment on the Direct Contracting: Geographic Population-Based Payment model option
  • Developing a new innovative model for rural communities that will offer a pathway for stakeholder coalitions to invest collectively in increasing access and improving rural health care delivery

See the full text of this excerpted CMS Blog (issued May 8).

Breaking through the Access to Care Barriers

Dialysis facilities across the country treat patients from a variety of backgrounds and experiences. Patients who start dialysis have multiple health comorbidities, which may also be complicated by a history of mental health issues or socio economic problems. The Network works to assist facilities in successfully managing these patients by providing guidance, resources, and policy clarification especially if patients are at risk for an issue with access to care. From patients at risk for being involuntarily discharged, to patients being lost to follow up and discontinuing treatment, a patient’s access to care is becoming a more widespread issue with significant risks to our patient population.

The Network can provide guidance to facilities as they support patients through any one of these processes. Facilities can then take preventative measures to minimize the potential for patients to encounter access to care issues. Facilities should also closely review their own policies in working with these patients and some national resources like the Kidney Patient Advisory Council (KPAC) Grievance Toolkit found at esrdnetworks.org, as well as the CMS Conditions for Coverage.

Teleconferencing Can Help You Involve Your Patients in their Plans of Care

Part of the responsibility of the interdisciplinary team (IDT) is to include patients, and if requested, their care partners and family members in both developing/setting goals and reviewing the patient plan of care.

Is it acceptable to hold a plan of care meeting with the IDT and the patient, their care partner or family members (if requested) via telephone conference? As stated in the CMS Interpretive Guidance for the Conditions for Coverage for End-Stage Renal Disease Facilities, the answer is “yes.”

“A substitute mechanism for a team conference needs to facilitate discussion among team members about the information gathered from the comprehensive patient assessment and provide the opportunity for team coordination and development of an effective, individualized plan of care for the patient to ensure the desired outcomes are achieved. To facilitate full team participation in conferences, any member, including the patient, may participate through telecommunication.”

CMS Interpretive Guidelines (see page 205): http://esrd.ipro.org/wpcontent/uploads/2017/08/InterpretiveGuidelines.pdfÂ

For more information on the regulations on plans of care, see the CMS Conditions for Coverage for end-stage renal disease facilities. Subpart C – Patient Care: https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-sec494-90.xml

 

 

 

 

Addressing Patient Placement Challenges: 30 Day Trial Period

In 2016, the IPRO ESRD Network of New York introduced an innovative program to help facilities accept patients who had been previously involuntarily discharged from their dialysis facility.  As reported in the April 6, 2016 issue of Nephrology News and Issues, through the program prospective dialysis units are offered a 30-day trial period during which they may accept a patient for treatment as if he or she is a “transient” patient. The unit accepts the patient with the understanding that there is no commitment to continue treatment after 30 days; should the patient cause excessive disruption to the unit or exhibit threatening or violent outbursts. Participating units agree that if the patient refrains from these behaviors, the unit will accept the patient as permanent after the 30th day or the 12th treatment. In 2017 the program continues to help patients who have been involuntarily discharged from their dialysis facility, with five patients being accepted permanently in a new dialysis facility, to date.  This program helps those patients who have been involuntarily discharged from their unit receive a second chance.  Through this second chance, the patient and facility get to know one another and the patient has an opportunity to gain a sense of stability and reliable access  to the treatments needed to stay healthy and to survive.

Click here, to read the complete article, An innovative approach in addressing dialysis patient placement challenges.