EPtalk by Dr. Jayne 7/9/20

CMS never misses an opportunity to make its incentive programs more complicated, so they recently posted guidance on how telehealth encounters will fit in for Eligible Professional and Eligible Clinician electronic Clinical Quality Measures for the 2020 and 2021 performance periods. This includes the Quality Payment Program with its Merit-based Incentive Payment System and Advanced Alternative Payment Models (APMs); Comprehensive Primary Care Plus; Primary Care First; and Medicaid Promoting Interoperability Program for Eligible Professionals. Honestly, at this point I’m not sure many of us care any more. My brain is too fatigued at this point to even try to understand this:

There are 42 telehealth-eligible eCQMs for the 2020 performance period. When reviewing this list of eCQMs, please note there may be instances where the quality action cannot be completed during the telehealth encounter by eligible professionals and eligible clinicians. Specifically, telehealth-eligible CPT and HCPCS codes may be included in value sets where the required quality action in the numerator cannot be completed via telehealth. Therefore, it is the eligible professionals’ and eligible clinicians’ responsibility to make sure they can meet all other aspects of the quality action within the measure specification, including other quality actions that cannot be completed by telehealth.

I’m personally going to blame my foggy-headedness on having to wear a mask all the time, since my patients have been telling me they trap carbon dioxide and need work notes so they don’t have to wear masks. As someone who grew up watching M*A*S*H and idolizing Hawkeye Pierce, masks are cool, and I’m not about to make you miss out on the pleasure of wearing one. In all seriousness, there are a couple of good health-related reasons why people shouldn’t wear masks, but I have yet to have a patient request a note for one of those reasons.

I’ve been down on conferences lately, especially after being burned by the HIMSS hotel debacl, the non-event that was HIMSS Digital, the American Telemedicine Association’s sad attempt at a virtual conference. With that in mind, I want to give props to people who are doing it right. The Telehealth Innovation Forum’s initial communications caught my eye, so I signed up. They provided plenty of lead time to allow people to block their schedules for July 21-22, and have been transparent about the sessions.

They sent out an attendee update last week, and I have to say they’re about as close to pulling off the feel of a real conference in a virtual format as I imagine you can get. First, they’re mailing some kind of swag kit to those who request it. Second, they’ve got a volunteer activity with the World Telehealth Initiative. Participants will receive materials to decorate backpacks that will be filled with school supplies and donated to children in need. I’m eagerly awaiting my backpack and have some bedazzling supplies at the ready. I always enjoyed the vendors who had similar activities at HIMSS. Last, they’re offering a virtual “lunch together” with digital GrubHub gift cards sponsored by NTT Data for use on July 21. Kudos to the team at InTouch Health (now part of Teladoc Health) for getting the plan right.

One of our physician assistants called me today to vent about life in the patient care trenches. I feel for her, because she’s early in her career and hasn’t been through a truly terrible flu season yet. As such, she hasn’t learned how to “embrace the suck” or figure out how to arrange her own personal psychology to make it through the crazy practice environment we’re currently in.

Apparently patients were lined up in lawn chairs outside the office today before the clinical team even arrived, and everyone was expecting to be tested. While another provider focused on handling the in-person visits, she had the unenviable task of calling patients whose lab results have finally returned after 10 days (thank you, Quest Diagnostics!) and most of them have already ended their quarantines based on CDC’s time-based strategy. It’s absolutely surreal that professional athletes are getting daily COVID tests and the average person in our city may have to wait more than a week to get results back.

The big hospitals are adding to the problem because they are refusing to test patients unless they are referred to the testing sites by physicians who are on their medical staff. Funny, they were happy to run lab orders and profit on radiology studies from independent physicians previously.

Since Quest Diagnostics and LabCorp understandably won’t perform COVID swabs in the patient service centers, the patients have descended on the urgent cares, where the lab backlogs are crippling. It’s not like we could all work together and serve the community – I guess it’s much better for them to protect their fiefdoms.

For those of you in the trenches, you’ll recognize the four Abbott ID NOW machines in the photo above. We have more than 100 of them at our sites, but we can’t use them because we can’t get supplies. Apparently you don’t get testing supplies unless you’re a hot spot, even though the only way to avoid being a hot spot is to have testing supplies so you can give solid advice to patients other than “everyone just stay home,” which isn’t happening.

I was able to talk my colleague to a semi-happy place, but it’s a shame that providers have been put in this position by ineffective and uncoordinated response over the last four months. It’s bad across the country, not just here. One friend of mine in California told me about how bad things are at local hospitals and having dubious honor of being tied for the most saturated ICU.

Another friend of mine in the Midwest who was furloughed for two months  — unpaid and without the option to use PTO or vacation time because he’s part time and doesn’t have those benefits — learned through a news story that his clinic received more than $5 million in Paycheck Protection Program funds. It’s not like they only furloughed the docs since nearly 50% of their workforce was off without pay. He’s wondering what happened to those funds and why they weren’t used to protect paychecks as intended. Unfortunately, in the current environment with physicians being downsized across the country, he’s reluctant to speak up about it.

Did your organization get PPP funds and how did it use them? Leave a comment or email me.

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