Baraga County Tells Whitmer: We’re Done
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

The sum of Baraga County government passed a resolution telling Gov. Gretchen Whitmer it will no longer be participating in any more shutdown orders designed to protect the population from COVID-19.

All five county commissioners signed a resolution Jan. 11 along with the county’s sheriff, prosecutor, clerk, and treasurer that “we have no intention of participating in the unconstitutional destruction of our citizen’s economic security and liberty.”

The county officials also said they will “take no action whatsoever in furtherance of this terribly misguided agenda.”

County Commission Chair Bill Rolof said the people in his county are beyond upset. Businesses are being shut down, likely to never reopen again. Meanwhile, they feel as if they have taken every safety precaution voluntarily.

“Enough is enough,” Rolof said. “The people up here are ready to move on.”

The roughly 8,500-person county has had 476 confirmed cases of COVID-19 since the pandemic began and 29 deaths. That’s roughly 5.6% of the population to test positive, putting it 18th among the state’s 83 counties in contraction rates.

Still, MIRS found other Upper Peninsula counties are in the same boat, tired of the Governor and her administration putting [Read More]

Employers Can Mandate Employees Have the COVID-19 Vaccine…With Restrictions

By SARA H. JODKA
On December 16, 2020, the Equal Opportunity Employment Commission’s (EEOC) issued “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws” (the Guidance). The Guidance does not even specially address the question as to whether employers can mandate employees have the vaccine, rather, the Guidance jumps right in assuming employers already knew they could have mandatory vaccine policies and goes into the limited restrictions as to when an employer may have to pause and engage the employee in interactive discussion regarding the employee’s medical, religious or other reasons for not wanting the vaccine.

Specially, Section K of the guidance discussion “Vaccinations” and provides a handful of helpful Q&As that succinctly guide employers. Here are some highlights:

How should an employer respond to an employee who indicates the employee is unable to receive the vaccine because of a disability?

The ADA allows employers to have a qualification standard that includes “a requirement that an individual shall not pose a direct threat to the health or safety of individuals in the workplace.” When dealing with a vaccine, which screens out or tends to screen out an individual with a disability, the employer [Read More]

By ELISABETH ROSENTHAL
I still remember exactly where I was sitting decades ago, during the short film shown in class: For a few painful minutes, we watched a woman talking mechanically, raspily through a hole in her throat, pausing occasionally to gasp for air.

The public service message: This is what can happen if you smoke.

I had nightmares about that ad, which today would most likely be tagged with a trigger warning or deemed unsuitable for children. But it was supremely effective: I never started smoking and doubt that few if any of my horrified classmates did either.

When the government required television and radio stations to give $75 million in free airtime for antismoking ads between 1967 and 1970 — many of them terrifyingly graphic — smoking rates plummeted. Since then, numerous smoking “scare” campaigns have proved successful. Some even featured celebrities, like Yul Brynner’s posthumous offering with a warning after he died from lung cancer: “Now that I’m gone, don’t smoke, whatever you do, just don’t smoke.”

As the United States faces out-of-control spikes from COVID-19, with people refusing to take recommended, often even mandated, precautions, our public health announcements from governments, medical groups and health care companies feel lame compared with the urgency of the moment. [Read More]

More than 10,000 people have died of COVID-19 in Michigan as of Dec. 8.

The 191 deaths added to the state’s toll brought Michigan to 10,138. Another 5,909 cases brought that number to 410,295. The current fatality rate to COVID-19 is 2.47 percent.

On a nationwide scale, Michigan ranks ninth among the states by total deaths, according to The New York Times, although The Times has Michigan at 10,415 deaths as of today. On a per-capita basis, Michigan is 11th at 104 deaths per 100,000 people.

As a result, Gov. Gretchen Whitmer ordered U.S. and Michigan flags within the Capitol Complex and upon all public buildings and grounds across Michigan to be lowered to half-staff for 10 days – representing one day per 1,000 deaths – through Dec. 18 to honor and mourn the more than 10,000 people who lost their lives due to COVID-19.

The week of Dec. 8, the state added 34 new school outbreaks tied to 98 COVID-19 cases. Overall, the state has 267 school outbreaks across the state with 7,518 associated cases. Both of those numbers are up from last week’s 260 outbreaks and 7,105 cases.

Of the 267 outbreaks listed that week, 96 are traceable to high schools, or 35 percent overall, with 889 associated [Read More]

By EWA MATUSZEWSKI
The move to virtual office visits has been swift and far-reaching. But are we perhaps going too far? I know of at least two physician practices that aimed to be completely virtual (with some exceptions) from the onset of the virus until January 2021. Why? As of this writing, the case count is far higher than it was when the initial switch to virtual visits occurred in April. Even with the promise of multiple vaccines, we are likely at least a year away from getting out of pandemic mode in terms of how we work, socialize, educate and entertain. We must commit to a new era of healthcare protocols that properly address COVID and other pandemics that may follow, but do not seek to eliminate or minimize the value of an in-person encounter.

The physician’s office may never fully return to pre-COVID days of mask-less patients in crowded waiting rooms, and walk-ins – and no one will lament the passing of that piece of healthcare history. Why was that even tolerated? But, when possible, isn’t a successful physician/provider-patient contact at least partially measured by an exchange of human touch? You can see a desperate parent and crying baby on a screen and ask questions [Read More]

By DUSTIN WACHLER
Effective November 22, 2020, the Centers for Medicare & Medicaid Services’ (CMS) final rule “Modernizing and Clarifying the Physician-Self Referral Regulations” aims to reduce the regulatory burdens of compliance with the federal self-referral prohibition most commonly known as the Stark law. The final rule eliminates unnecessary requirements within the Stark law that imposed undue regulatory burdens and increased administrative costs on healthcare providers. The final rule also eliminates regulatory barriers to value-based, coordinated healthcare delivery and payments systems at the foundation of integrated care models, alternative payment systems, and other arrangements that improve patient care while reducing costs to governmental healthcare programs. ,

The final rule reflects the shared policy achievements of CMS’ “Patients over Paperwork” initiative and the U.S. Department of Health & Human Services’ (HHS) “Regulatory Sprint to Coordinated Care’. “Patients of Paperwork” is a CMS-wide initiative started in 2017 to reduce unnecessary regulatory burdens on healthcare providers. HHS’ “Regulatory Sprint to Coordinated Care” focuses on identifying and eliminating regulatory requirements and other prohibitions that act as barriers to value-based, coordinated healthcare services and payments.

First enacted in 1989, Stark was intended to combat increased utilization within fee-for-service healthcare payment systems that rewarded volume-based care. Due to Stark’s draconian penalties and strict-liability [Read More]

Opinions expressed in the article below are those of the author and do not necessarily reflect those of Healthcare Michigan, its publisher or staff.

By ALLAN DOBZYNIAK, MD
The motives driving the battle to control healthcare are suspect. Many physicians—likely the majority—do not buy into the public deception that has been attributed to them. In fact, a small contingent of progressive, “woke” physicians amplify this deception.

Most doctors are too busy with their own lives, families and professions to get involved with politics and leftist, “politically correct” healthcare thinking. They have become disinterested in the deteriorating professional organizations charged with guiding them through healthcare’s questionable evolution.

Physicians who try to participate in hospital decision-making—with few exceptions—are, in a single word: “excluded.” Unfortunately, they have conceded turf to physicians who can take the time and to hospital management bureaucracies operating in self-preservation mode. Often those who can take the time are not necessarily the most talented people, but are those with a political agenda dedicated to changing traditional medical professional objectives.

However, all is not lost if our clinicians understand the stakes and begin to redirect the profession back to patient care in ways that underscore trust and confidence in physicians and reinvigorate physician morale. Taxpayers, parents, donors, communities—all who are [Read More]

By KIMBERLY RUPPEL
New and modified safe harbors to the Stark Law and Anti-Kickback statue allow healthcare providers and entities more flexibility to create and expand telehealth platforms in compliant fashion.

On Nov. 20, 2020, the Centers for Medicare & Medicaid Services and the Office of the Inspector General (OIG) finalized the rules modifying the safe harbors under the Anti-Kickback Statute and exceptions under the Stark Law, creating seven new safe harbors for value-based arrangements, modifying four already in place and codifying one new exception.

These changes offer opportunities for healthcare providers and entities to make better use of telehealth options in a “value-based enterprise” as opposed to the former regulatory framework which was tailored to a fee-for service environment. Providers will benefit from a reduced burden of regulatory compliance. Patients will benefit from improved outcomes and reduced cost of care.

By way of background, the Stark Law, otherwise known as the physician self-referral law, prohibits referrals by a physician to another provider if the physician or his immediate family has a financial relationship with the provider (with certain exceptions). The Anti-Kickback Statute (AKS), meanwhile, bars the exchange of remuneration – which according to this law is anything of value – for referrals that are payable by a [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Nesbitt Calls On Gordon To Resign
Senate President Pro Tem Aric Nesbitt (R-Lawton) called on Department of Health and Human Services Director Robert Gordon to resign after extending by 12 days the three-week shutdown of restaurants, entertainment venues, in-person high school instruction, and youth sports.

Just as former Unemployment Insurance Agency director Steve Gray “recently resigned in shame,” Nesbitt said Gordon has overseen a state department that’s experiencing “bureaucratic disasters . . . directly linked to poor leadership.”

Nesbitt flagged Gordon for putting seniors at risk for contracting COVID by putting positive patients in nursing homes with a vulnerable population. That policy has changed. Nesbitt also said Gordon oversaw the initial contact-tracing contract, which went to a firm with Democratic ties. It was quickly revoked and re-awarded to another company.

The Senator’s biggest gripe is that the partial shutdown is being continued through a “one-size-fits-all-approach” that “lacks collaboration, thoughtfulness, and empathy.”

“The time for Director Gordon to resign is way past due, and the governor should replace him with an independent leader who will bring much-needed organization and a spirit of partnership to this administration,” said Nesbitt, who also is the co-chair of the joint [Read More]

By VICTORIA KNIGHT & JULIE APPLEBY
In the waning days of the campaign, President Donald Trump complained repeatedly about how the United States tracks the number of people who have died from COVID-19, claiming, “This country and its reporting systems are just not doing it right.”

He went on to blame those reporting systems for inflating the number of deaths, pointing a finger at medical professionals, who he said benefit financially.

All that feeds into the swirling political doubts that surround the pandemic, and raises questions about how deaths are reported and tallied.

We asked experts to explain how it’s done and to discuss whether the current figure — an estimated 231,000 deaths since the pandemic began — is in the ballpark.

xxxDismissing Conspiracy Theories, Profit Motives
Trump’s recent assertions have fueled conspiracy theories on Facebook and elsewhere that doctors and hospitals are fudging numbers to get paid more. They’ve also triggered anger from the medical community.

“The suggestion that doctors — in the midst of a public health crisis — are over-counting COVID-19 patients or lying to line their pockets is a malicious, outrageous, and completely misguided charge,” Dr. Susan R. Bailey, American Medical Association president, said in a press release.

Hospitals are paid for COVID treatment the same as for any [Read More]

This story courtesy of MIRS, a Lansing-based news and information service.

The state’s chief medical executive said Oct. 19 attacking COVID-19 via the herd immunity strategy without the aid of a vaccine “would be inhumane, irresponsible, and scientifically negligent.”

Dr. Joneigh Khaldun was before the Legislature’s Joint Select Committee on the COVID-19 Pandemic today and addressed the concept of herd immunity in her opening remarks.

She echoed what other medical experts have said in that to achieve herd immunity without the aid of a vaccine, 6 million more people in Michigan would need to be infected and roughly 30,000 more people would die as a result, which she called “unacceptable.”

“Let me also be very clear: natural herd immunity is not a scientifically sound or humane strategy to address COVID-19. Herd immunity, by any way outside of broad distribution of a vaccine, would be inhumane, irresponsible, and scientifically negligent,” she said.

Under questioning from Sen. Curtis Hertel Jr. (D-East Lansing) later in the hearing, Khaldun also said adopting a herd immunity strategy would be a “disaster” for Michigan’s case rate and death rate.

She said there’s a study out there that roughly 9 percent of Michiganders have antibodies for COVID-19, and had said that scientists have estimated that 80 percent [Read More]

By EWA MATUSZEWSKI
A giant in Michigan’s healthcare community, an advocate for primary care physicians and physician organizations, and someone who has come to be a dear friend and mentor, is retiring—and I cannot let this milestone pass without lavishing praise. Dr. Tom Simmer, until Dec. 31, the Chief Medical Officer of Blue Cross Blue Shield of Michigan, will not like this attention—but he certainly deserves it.

Tom advanced the goals and efforts of primary care in a brilliantly simple way: understand the role that physician organizations play in optimizing patient outcomes in primary care, then tap into their reach for population health for a greater patient impact. As population health became the mantra for identifying and advancing primary care initiatives that could tackle tough to manage chronic conditions such as asthma, depression, hypertension, heart disease, and diabetes – and the co-morbidities they frequently spawn – Tom knew that a targeted approach was the best option for incorporating population health into the primary care vernacular. He also knew that reaching primary care physicians (he started his career as an internist) was best accomplished by accessing their physician organizations.

Until his tenure as Chief Medical Officer, BCBSM had never partnered with PO’s, preferring to work directly with physicians – [Read More]

By JESSE MARKOS, ESQ
Wachler & Associates, PC

In today’s highly regulated health care environment, a criminal conviction of any kind (whether a felony or misdemeanor) can create significant problems for licensed health care providers. Criminal convictions always have the potential to have a serious impact on the lives of those convicted. However, a criminal conviction of any kind can have a disproportionately adverse impact on licensed health care providers.

Pursuant to the self-reporting requirements found in the Michigan Public Health Code, providers are required to report a criminal conviction to the Michigan Department of Licensing and Regulatory Affairs (“LARA”) within 30 days of the conviction. The Public Health Code makes no distinction between criminal offenses (misdemeanors and felonies) when it comes to the self-reporting requirement and, as such, any criminal conviction must be reported. However, there is no indication that non-criminal violations such as state or municipal civil infractions are included in the self-reporting requirement. Moreover, only the convicted offense must be reported, not the original offense charged or any other offenses which were subsequently dropped as part of a plea agreement.

When reporting the conviction, the provider will be required to explain the facts and circumstances underlying the conviction. Furthermore, LARA may request and receive information [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Trump Promises Vaccine Is Weeks Away During Waterford Rally
President Donald Trump promised to deliver a safe vaccine for the coronavirus “in just a number of weeks, a couple of weeks” during a rally at the Oakland County International Airport in Waterford Township Oct. 30.

He told the crowd of thousands the speed of creating the vaccine is the result of his “historic campaign to slash red tape and mobilize industry.”

Seniors will get the vaccine first, he said, then health care workers. But even without the vaccine, he contended the country is “still rounding the corner.”

“We have it, but without it we round the corner. And it will be available free. We are doing the vaccine free and the reason is, this wasn’t your fault. This wasn’t anyone’s fault. This was China’s fault. Just remember it. Our vaccine will eradicate the virus much more quickly and end the pandemic quickly, quickly, quickly because we want to have our life restored just to normal. That’s all we want, is normal,” Trump said.

He took a few opportunities to take swipes at Gov. Gretchen Whitmer, despite not mentioning her by name.

“We’ve got to get our [Read More]

By CHRISTOPHER RYAN
Some areas of the law are black and white. In those cases, contractual provisions can often be easily labeled as permissible or impermissible, allowed or not allowed, reasonable or unreasonable. The enforceability of a provision prohibiting an employer from working in a competing business following their employment (a noncompetition provision) is not one of those areas of the law. The enforceability of noncompetition agreements between and employer and employee lives in the “gray” zone, and courts analyze the provision on a case by case basis. An enforceable noncompetition provision in one situation may not necessarily be enforceable in another. Unfortunately, the answer to whether a noncompetition agreement is enforceable is almost always: it depends. This article will describe some of the factors that courts in Michigan consider when deciding whether a noncompete agreement is enforceable.

Example Provision
Throughout this article, the following example of a noncompetition clause in an employment contract will be referenced: “Employee agrees that, for a period of 1 year following termination of employment with Employer, Employee will not practice vascular surgery within a 35 mile radius from any location where Employee provided services while employed by Employer.”

General Rule
The Michigan Antitrust Reform Act permits an employer to obtain an agreement that [Read More]

This story presented in cooperation with MIRS, a Lansing-based news and information service.

The Michigan Department of Health and Human Services largely reinstated aspects of Gov. Gretchen Whitmer’s COVID-19 emergency orders Oct. 5, including mask requirements, gathering size limitations, and bar restrictions.

With the Michigan Supreme Court majority invalidating Whitmer’s previous orders that rested on a law the court deemed unconstitutional, DHHS Director Robert Gordon said the order relies on a different law that wasn’t at issue in the case from Friday.

He said under MCL 333.2253, if the DHHS director determines that controlling an epidemic is necessary to protect the public health, he or she can prohibit public gatherings, among other actions geared toward protecting public health.

Gordon, who said he once was a law clerk for the U.S. Supreme Court, said the MSC decision from Friday used what he called the “non-delegation doctrine,” which Gordon said had not been used to invalidate a Michigan law until now.

He said when he clerked for SCOTUS, the nation’s high court turned away a non-delegation challenge in an 8-1 vote in an opinion authored by the late GOP-nominated Justice Antonin Scalia.

But, Gordon said, that doctrine “has become popular on the anti-government right” and the MSC majority used it to invalidate [Read More]

By JONEL ALECCIA & LIZ SZABO
As trust in the Food and Drug Administration wavers, several states, including Michigan, have vowed to conduct independent reviews of any COVID-19 vaccine the federal agency authorizes.

But top health experts say such vetting may be misguided, even if it reflects a well-founded lack of confidence in the Trump administration — especially now that the FDA has held firm with rules that make a risky preelection vaccine release highly unlikely.

At least six states and the District of Columbia have indicated they intend to review the scientific data for any vaccine approved to fight COVID-19, with some citing concern over political interference by President Donald Trump and his appointees. Officials in New York and California said they are convening expert panels expressly for that purpose.

“Frankly, I’m not going to trust the federal government’s opinion and I wouldn’t recommend [vaccines] to New Yorkers based on the federal government’s opinion,” New York Gov. Andrew Cuomo said last month.

“We want to make sure — despite the urge and interest in having a useful vaccine — that we do it with the utmost safety of Californians in mind,” Dr. Mark Ghaly, California’s health and human services secretary, said at a recent news conference.

The District of Columbia, [Read More]

By EWA MATUSZEWSKI
Be afraid. Be very afraid. That’s one option for independent primary care physicians—but not one I would advocate if my livelihood were at stake. And make no mistake, community physicians are in danger of becoming extinct in the next decade.

It was recently announced that Village MD will be setting up primary care clinics in Walgreens. Around the same time, Aurora Health announced its intent to take good care of Beaumont physicians—in part by recommending they become employees of the health system. This is not new—but it’s an accelerating trend. These mega health organizations (and private equity groups who see dollar signs but not patients) are courting suitors quickly—as if to get a bargain on a Tiffany ring—while the world reels from a global pandemic. Their typical method of operation historically is to marry into the community full of promises to be good corporate citizens and stewards of care; then, after taking over a health system, spread their web to self-employed physicians, offering them solar systems as yet undiscovered. If you ever want to see an unhappy physician, speak with one who sold their practice to a health system long before they were ready to retire.

While this is a national trend, Michigan physicians are [Read More]

By STEPHEN SHAVER
This summer, President Donald Trump issued four orders targeting prescription drug prices. Three issued on July 24, 2020 with a fourth being signed, but not issued at that time. The fourth order appeared Sept. 13, 2020. All of the orders seek to lower prescription drug prices by directing the Department of Health and Human to exercise its regulatory authority. However, as each order requires significant legwork by HHS, it is unclear when, if ever, the effects of the orders will be seen.

The most recent order, issued Sept. 13, 2020 and titled “Executive Order on Lowering Drug Prices by Putting Americans First,” outlines a policy that Medicare should not pay more for Part B or Part D prescription drugs than the “most-favored-nation price.” The order defines the “most-favored-nation price” as the lowest price, adjusting for volume and differences in GDP, for a drug that the manufacturer sells to an Organization for Economic Co-operation and Development (OECD) member country with a comparable GDP per capita. For reference, Norway, Austria, and the Netherlands are all OECD member countries with GDPs per capita similar to the United States.

The order directs HHS to “immediately” implement a test payment model. The test model would apply the new policy [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

DHHS Issues More COVID Orders; Mac Center Questions Validity
The Michigan Department of Health and Human Services issued more emergency orders Oct. 6 in reaction to the Supreme Court ruling Oct. 2 that struck the law on which the governor had issued similar executive orders.

DHHS Director Robert Gordon signed one order that maintains protections for people in residential and congregate care as well as juvenile justice facilities. Another one requires K-12 schools to provide public notice about probable and confirmed cases of COVID-19 within 24 hours.

The order on residential care continues restrictions on visitation to residential care facilities, which include nursing homes, homes for the aged, adult foster care, assisted living, and independent living, according to the state.

Outdoor visits are permitted with precautions, such as allowing for at least six feet separation between all people, and communal dining is permitted under the order at all facilities consistent with the Center for Medicare and Medicaid Services and DHHS guidance.

The order also covers notification requirements involving COVID-19 cases for these facilities.

There are different visitation rules for child caring facilities and juvenile justice facilities. In those cases, the facilities may allow visitors as long as [Read More]

By ROSE WILLIS
Healthcare providers have additional regulatory restrictions related to the structure of their practice entities (Practice Entities), which are not applicable to those operating in other industries. Such restrictions include but are not limited to ownership and control by licensed professionals and limitations on the number of Practice Entities that a licensed professional may own or become employed by. The purpose of this article is to summarize certain regulatory restrictions placed on Practice Entities, which, if violated, could result in significant monetary penalties.

Many state laws prohibit the ownership or control of a Practice Entity by non-licensed individuals. This rule is referred to as the “Corporate Practice of Medicine” rule (CPOM Rule). Michigan law requires that for-profit Practice Entities form as “professional” entities, such as a professional corporations or professional limited liability companies. Michigan law prohibits the ownership of such a Practice Entity by anyone other than someone licensed in the service provided by the Practice Entity. This applies to physicians, physical therapists, chiropractors, dentists, among others.

Additionally, the CPOM Rule prohibits a non-licensed person from “controlling” the Practice Entity. For example, if the Practice Entity enters into a management services arrangement with a third party who is unlicensed, such an arrangement would need to [Read More]

Community colleges would be allowed to offer four-year bachelors of science nursing degrees, under legislation a Senate committee began taking testimony Sept. 15.

Sen. Aric Nesbitt’s (R-Lawton) SB 1055 would re-open legislation passed in 2012 that first allowed limited baccalaureate offerings by community colleges.

“This was a policy that I was supportive of before I even came to the House,” Nesbitt said. “A simple change to the statute that will have far-reaching impact across our state. Adding the BSN to community colleges will increase the geographic access to this degree.”

Nesbitt said that the original legislation expanding baccalaureate offerings was introduced by then-Rep. John Walsh. That legislation, which covered some technical fields including maritime and cement management among others, had originally included the offering of BSN degrees by two-year community colleges.

“The House passed it fairly solidly on a bipartisan vote,” Nesbitt said. “In the Senate, the BSN was stripped out of it. What was signed into law was the compromise.”

The legislation brought out support from community colleges, particularly rural community colleges, as well as rural health care facilities. Opposing the expansion were the state’s public universities and independent universities.

Dr. Trevor Kubatzke, president of Lake Michigan College, testified that his community is rural enough that he cannot get a [Read More]

By SUSAN ADELMAN, MD
Physicians are used to seeking practical answers to definable problems. We do this in our clinical work and in our research. Perhaps this physician might suggest a useful approach in a time of worldwide demonstrations over racism. Normally in medicine, we try to break down a larger problem into its component parts, which need to be definable issues that can be addressed effectively to create real change.

Just as occurred in Detroit after the 1967 riots, we need civic leaders to join with leaders of affected neighborhoods, identify the issues that would be the most productive to work on, seek the people who need to come together for each project and prioritize the efforts. Working groups need to figure out what possible solutions would be realistic and would solve more problems than they will create. Then they need to coordinate with the political establishment and with sources of funding, in order to move forward.

The enthusiasm is here. The timing is now. We need to turn all of this turmoil into real change, change that will help. We understand that there are police who need more discipline. Then we need to work on this, not blow up the whole police force, which would have [Read More]

By EWA MATUSZEWSKI
Today I revisit a topic I have written about many times: The Patient-Centered Medical Home Neighborhood (PCMH-N). Yet now I address it with a fresh perspective in the context of the pandemic.

The PCMH-N, with its connectivity to the broader healthcare community, encompasses primary care, health systems, nursing homes and rehabilitation centers, pharmacies, human service agencies and other organizations that seek to promote health, wellness, and healing within a community. Never before have the benefits of the PCMH been as clear as they have become during the pandemic. Starting with the immediate and wide-scale need for personal protective equipment (PPE) for those caring for community members, to the gathering of resources such as food, clothing and shelter, to sharing best practices to re-opening, the PCMH neighborhood was ready to respond as it was designed to do.

I am not saying it was designed specifically for a pandemic, but when the pandemic hit, it certainly seemed like it was. Such collaboration! Such teamwork! To have a network of resources at the ready—even if we may not have considered ourselves to be so networked previously—was a light in a very dark and scary place. We are not over this, but despite the remaining uncertainty, I’d like to [Read More]

By KAITLIN A. NUCCI, ESQ.
Wachler & Associates, P.C

Regardless of the fact that the United States is still in the midst of a public health emergency battling the spread of COVID-19, the Center for Program Integrity encouraged the Centers for Medicare and Medicaid Services to resume both Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits. For now, these audits will focus on claims submitted prior to March 1, 2020. CMS has not yet stated when they will be auditing claims submitted after March 1, 2020 and through the duration of the current public health crisis, but professionals in the field expect these audits to begin in the coming months. Providers are encouraged by CMS to discuss any COVID-19 related hardships that may affect audit response times.

While it is not clear when audits for claims submitted after March 1, 2020 will begin, providers should be prepared for post-payment reviews, particularly with regards to COVID-19 claim submissions. In fact, CMS has announced a new requirement to obtain reimbursement for COVID-19 patients. Beginning Sept. 1, 2020, a provider will receive a 20 percent Medicare reimbursement add-on payment for a COVID-19 patient only if the provider documents a positive test in the patient’s chart. This new guidance [Read More]