Ramona Midkiff

Sen. Tim Scott has joined a bipartisan group that’s urging the congressional leadership to to make permanent the expanded use of telehealth services for Medicare beneficiaries during the COVID-19 pandemic.

Scott was among 49 lawmakers to sign a letter to Senate Majority Leader Mitch McConnell of Kentucky,  Senate Minority Leader Chuck Schumer of New York,  House Republican Leader Kevin McCarthy of California,  and House Speaker Nancy Pelosi of California.

The letter says that telehealth visits have been a critical tool during the pandemic because telehealth ensures patients receive needed services while slowing the spread of the virus.

“We continue to hear from our constituents and health care providers that the uncertainty about the long-term future of Medicare telehealth coverage is a barrier to organizations investing fully in telehealth,” the letter continues. “Congress needs to act now to better serve patients and health care providers during the pandemic, and to ensure that telehealth remains an option after the pandemic is over.”

By Eric Wicklund

The Health and Human Services Secretary will allow healthcare providers to use telehealth across state lines to deliver “Covered Countermeasures” against the coronavirus.

December 04, 2020 – The federal government is expanding the telehealth platform for diagnostic tests and other devices that may be used to address the coronavirus pandemic.

The US Department of Health and Human Services has issued its fourth amendment to the Declaration under the Public Readiness and Emergency Preparedness (PREP) Act, adding connected health channels to increase access to countermeasures against COVID-19.

“During the pandemic, the Trump Administration has made broader use of the PREP Act to expand access to potentially life-saving countermeasures than we’ve ever done before in a public health emergency,” HHS Secretary Alex Azar said in a December 3 press release. “This new use of the PREP Act will help expand access to important services via telehealth, increase availability of authorized PPE, and make it easier to administer eventual COVID-19 vaccines.”
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More specifically, the order allows healthcare providers to use telehealth in any state to administer what are called Covered Countermeasures, such as diagnostic tests that have received Emergency Use Authorization (EUA) from the US Food and Drug Administration.

The order targets a significant barrier to telehealth expansion: state and federal rules that prohibit providers from using telehealth to treat patients in other states. The federal government and some states have enacted emergency measures during the ongoing public health emergency to facilitate license portability and interstate licensure, but the issue is still very murky.

The HHS order defines a “qualified person” as a healthcare provider using telehealth to order or administer Covered Countermeasures for patients in other states. This would include certain pharmacists, pharmacy interns and pharmacy technicians who order or administer certain COVID-19 tests or vaccines.

“When ordering and administering Covered Countermeasures through telehealth to patients in a state where the healthcare personnel are not already permitted to do so, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients through telehealth in the state where the healthcare personnel are licensed or otherwise permitted to practice,” the amendment reads. “Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures through telehealth is preempted. Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services.”

The PREP Act, enacted in December 2005, allows the HHS Secretary to issue a declaration that provides immunity from liability for certain claims during a public health emergency, including “claims of loss caused, arising out of, relating to, or resulting from administration or use of countermeasures to diseases, threats and conditions; determined by the secretary to constitute a present, or credible risk of a future public health emergency; and to entities and individuals involved in the development, manufacture, testing, distribution, administration, and use of such countermeasures.”

Previous declarations have been issued to deal with the Ebola virus, Zika virus, anthrax, smallpox, acute radiation syndrome, botulinum toxin, the influenza pandemic and nerve agents and insecticides.

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021.

The calendar year (CY) 2021 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

Background on the Physician Fee Schedule

Since 1992, Medicare has paid for the services of physicians and other billing professionals under the PFS. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. Payment under the PFS is also made to several types of suppliers for technical services, often in settings for which no institutional payment is made. For most services furnished in a physician’s office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ambulatory surgical center, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. For many diagnostic tests and a limited number of other services under the PFS, separate payment can be made for the professional and technical components of services. The technical component is frequently billed by suppliers like independent diagnostic testing facilities and radiation treatment centers, while the professional component is billed by the physician or practitioner.

Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.

PAYMENT PROVISIONS

CY 2021 PFS Ratesetting and Conversion Factor

CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the third year of the market-based supply and equipment pricing update, and standard rate-setting refinements to update premium data involving malpractice expense and geographic practice cost indices (GPCIs).

With the budget neutrality adjustment, as required by law, to account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from finalized policies.

Medicare Telehealth and Other Services Involving Communications Technology

For CY 2021, we are finalizing the addition of the following list of services to the Medicare telehealth list on a Category 1 basis. Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list:

• Group Psychotherapy (CPT code 90853)
• Psychological and Neuropsychological Testing (CPT code 96121)
• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335)
• Home Visits, Established Patient (CPT codes 99347-99348)
• Cognitive Assessment and Care Planning Services (CPT code 99483)
• Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)
• Prolonged Services (HCPCS code G2212)

Additionally, we are finalizing the creation of a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic (COVID-19 PHE) that will remain on the list through the calendar year in which the PHE ends.

We sought comment on services added on an interim basis to the Medicare telehealth list during the COVID-19 PHE that CMS did not propose to add to the Medicare telehealth list permanently or temporarily on a category 3 basis. Based on those comments we are finalizing the addition of a number of services to the Medicare telehealth list on a category 3 basis.

We are finalizing the addition of the following list of services to the Medicare telehealth list on a Category 3 basis:

• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337)

• Home Visits, Established Patient (CPT codes 99349-99350)
• Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
• Nursing facilities discharge day management (CPT codes 99315-99316)
• Psychological and Neuropsychological Testing (CPT codes 96130-96133; CPT codes 96136-96139)
• Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)
• Hospital discharge day management (CPT codes 99238-99239)
• Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476)
• Continuing Neonatal Intensive Care Services (CPT codes 99478-99480)
• Critical Care Services (CPT codes 99291-99292)
• End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962)
• Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226)

In response to stakeholders who have stated that the once every 30-day frequency limitation for subsequent nursing facility (NF) visits furnished via Medicare telehealth provides unnecessary burden and limits access to care for Medicare beneficiaries in this setting, we proposed to revise the frequency limitation from one visit every 30 days to one visit every 3 days. We also sought comment on whether it would enhance patient access to care if we were to remove frequency limitations altogether, and how best to ensure that patients would continue to receive necessary in-person care. Based on information from commenters about creating a disincentive for in-person care and after additional consideration of how patients in the NF setting, in general, tend to have longer lengths of stay when compared to patients in the inpatient setting, we reconsidered, including considering whether the frequency limitations for subsequent visits furnished via telehealth in the NF setting should be the same as in the inpatient setting.  We are therefore finalizing a frequency limitation for subsequent NF telehealth visits of one visit every 14 days.

We also clarified that licensed clinical social workers, clinical psychologists, physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) can furnish the brief online assessment and management services as well as virtual check-ins and remote evaluation services. In order to facilitate billing by these practitioners for the remote evaluation of patient-submitted video or images and virtual check-ins (HCPCS codes G2010 and G2012), we are establishing two new HCPCS G codes.

We have also received questions as to whether services should be reported as telehealth when the individual physician or practitioner furnishing the service is in the same location as the beneficiary; for example, if the physician or practitioner furnishing the service is in the same institutional setting but is utilizing telecommunications technology to furnish the service due to exposure risks. We are, therefore, reiterating in this final rule that telehealth rules do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service.

In the March 31, 2020 COVID-19 interim final rule with comment (IFC), we established separate payment for audio-only telephone (E/M) services. While we did not propose to continue to recognize these codes for payment under the PFS in the absence of the COVID-19 PHE, we noted that the need for audio-only interactions could remain as beneficiaries continue to try to avoid sources of potential infection, such as a doctor’s office. We sought comment on whether CMS should develop coding and payment for a service similar to the virtual check-in but for a longer unit of time and consequently with a higher value. We also sought input from the public on the duration of the services and the resources in both work and practice expense involved in furnishing this service. We sought comment on whether this should be a provisional policy to remain in effect until a year after the end of the COVID-19 PHE, or should be adopted as permanent PFS payment policy. Based on support from commenters we are establishing payment on an interim final basis for a new HCPCS G-code describing 11-20 minutes of medical discussion to determine the necessity of an in-person visit.

Remote Physiologic Monitoring Services

In recent years, CMS has finalized payment for seven remote physiologic monitoring (RPM) codes. In response to stakeholder questions about RPM, CMS clarified in the CY 2021 PFS final rule our payment policies related to the RPM services described by CPT codes 99453, 99454, 99091, 99457, and 99458. In addition, we finalized as permanent policy two modifications to RPM services that we finalized in response to the COVID-19 PHE.

• We clarified that after the COVID-19 PHE ends, there must be an established patient-physician relationship for RPM services to be furnished.
• We finalized that consent to receive RPM services may be obtained at the time that RPM services are furnished.
• We finalized that auxiliary personnel may provide services described by CPT codes 99453 and 99454 incident to the billing practitioner’s services and under their supervision. Auxiliary personnel may include contracted employees.
• We clarified that the medical device supplied to a patient as part of RPM services must be a medical device as defined by Section 201(h) of the Federal Food, Drug, and Cosmetic Act, that the device must be reliable and valid, and that the data must be electronically (i.e., automatically) collected and transmitted rather than self-reported.
• We clarified that after the COVID-19 PHE ends, 16 days of data each 30 days must be collected and transmitted to meet the requirements to bill CPT codes 99453 and 99454.
• We clarified that only physicians and NPPs who are eligible to furnish E/M services may bill RPM services.
• We clarified that RPM services may be medically necessary for patients with acute conditions as well as patients with chronic conditions.
• We clarified that for CPT codes 99457 and 99458, an “interactive communication” is a conversation that occurs in real-time and includes synchronous, two-way interactions that can be enhanced with video or other kinds of data as described by HCPCS code G2012.  We further clarified that the 20-minutes of time required to bill for the services of CPT codes 99457 and 99458 can include time for furnishing care management services as well as for the required interactive communication.

Immunization Services

In the CY 2021 PFS final rule we are maintaining payment rates for immunization administration services described by CPT codes 90460, 90461, 90471, 90472, 90473, and 90474, and HCPCS codes G0008, G0009, and G0010 at their CY 2019 payment levels in consideration of payment stability for stakeholders, public health concerns and the importance of these services for Medicare beneficiaries.

Direct Supervision by Interactive Telecommunications Technology

For the duration of the COVID-19 PHE, for purposes of limiting exposure to COVID-19, we adopted an interim final policy revising the definition of direct supervision to include virtual presence of the supervising physician or practitioner using interactive audio/video real-time communications technology (85 FR 19245). We recognized that in some cases, the physical proximity of the physician or practitioner might present additional infection exposure risk to the patient and/or practitioner.

In the CY 2021 PFS proposed rule, CMS proposed to allow direct supervision to be provided using real-time, interactive audio and video technology (excluding telephone that does not also include video) through the later of the end of the calendar year in which the PHE ends or December 31, 2021. We sought information from commenters as to whether there should be any guardrails in effect if we finalize this policy through the year in which the PHE ends or December 31, 2021, or if we were to consider it beyond the time specified and what risks this policy might introduce to beneficiaries as they receive care from practitioners that would supervise care virtually in this way. In addition to comments regarding patient safety/clinical appropriateness, we also sought comment on potential concerns around induced utilization and fraud, waste, and abuse and how those concerns might be addressed.

After consideration of public comment, we are finalizing that direct supervision may be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the PHE ends or December 31, 2021.

Payment for Office/Outpatient Evaluation and Management (E/M) and Analogous Visits

As finalized in the CY 2020 PFS final rule, in CY 2021 we will be largely aligning our E/M visit coding and documentation policies with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, beginning January 1, 2021. We are finalizing revisions to the times used for rate-setting for the office/outpatient E/M visit code set.

We are finalizing revaluation of the following code sets that include, rely upon or are analogous to office/outpatient E/M visits commensurate with the increases in values we finalized for office/outpatient E/M visits for CY 2021:

• End-Stage Renal Disease (ESRD) Monthly Capitation Payment (MCP) Services
• Transitional Care Management (TCM) Services
• Maternity Services
• Cognitive Impairment Assessment and Care Planning
• Initial Preventive Physical Examination (IPPE) and Initial and Subsequent Annual Wellness Visits (AWV)
• Emergency Department Visits
• Therapy Evaluations
• Psychiatric Diagnostic Evaluations and Psychotherapy Services

We are also clarifying the definition of HCPCS add-on code G2211(formerly referred to as GPC1X), previously finalized for office/outpatient E/M visit complexity, and refining our utilization assumptions for this code. In the proposed rule, we assumed that this code would be reported with 100% of office/outpatient E/M visits by specialties that rely on office/outpatient E/M visits to report the majority of their services.  Because we think it may take some time for practitioners to begin reporting HCPCS add-on code G2211, for CY 2021, we are assuming that it will be reported with 90% of office/outpatient E/M visits by specialties that rely on office/outpatient E/M visits to report the majority of their services.

We are also finalizing separate payment for a new HCPCS code, G2212, describing prolonged office/outpatient E/M visits to be used in place of CPT code 99417 (formerly referred to as CPT code 99XXX) to clarify the times for which prolonged office/outpatient E/M visits can be reported.

Policies Regarding Professional Scope of Practice and Related Issues

1. Supervision of Diagnostic tests by Certain Nonphysician Practitioners (NPPs)

CMS is finalizing our proposal to make permanent following the COVID-19 PHE, the same policy that was finalized under the May 1, 2020 COVID-19 IFC (85 FR 27550 through 27629) for the duration of the COVID-19 PHE to allow nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistants (PAs), and certified nurse-midwives (CNMs) to supervise the performance of diagnostic tests within their scope of practice and state law.  We are adding certified registered nurse anesthetists (CRNAs) to this list. These practitioners must maintain the required statutory relationships under Medicare with supervising or collaborating physicians.

2. Pharmacists Providing Services Incident to Physicians’ Services

CMS is reiterating the clarification provided in the May 1, 2020 COVID-19 IFC (85 FR 27550 through 27629), that pharmacists may fall within the regulatory definition of auxiliary personnel under our “incident to” regulations. As such, pharmacists may provide services incident to the services, and under the appropriate level of supervision, of the billing physician or NPP, if payment for the services is not made under the Medicare Part D benefit. This includes providing the services incident to the services of the billing physician or NPP and in accordance with the pharmacist’s state scope of practice and applicable state law.

3. Therapy Assistants Furnishing Maintenance Therapy

In the CY 2021 PFS final rule, CMS finalized the Part B policy for maintenance therapy services that was adopted on an interim basis for the PHE in the May 1, 2020 COVID-19 IFC (85 FR 27556).  This finalized policy allows physical therapists (PT) and occupational therapists (OT) to delegate the furnishing of maintenance therapy services, as clinically appropriate, to a physical therapy assistant (PTA) or an occupational therapy assistant (OTA). This Part B policy allows PTs/OTs to use the same discretion to delegate maintenance therapy services to PTAs/OTAs that they utilize for rehabilitative services.

4. Medical Record Documentation

In the CY 2020 PFS final rule, CMS finalized broad modifications to the medical record documentation requirements for physicians and certain NPPs. In this CY 2021 PFS final rule, we are clarifying that physicians and NPPs, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the PFS. We are also clarifying that therapy students, and students of other disciplines, working under a physician or practitioner who furnishes and bills directly for their professional services to the Medicare program, may document in the record so long as the documentation is reviewed and verified (signed and dated) by the billing physician, practitioner, or therapist.

5. PFS Payment for Services of Teaching Physicians and Resident “Moonlighting” Services

For residency training sites of a teaching setting that are outside of a metropolitan statistical area (MSA), the CY 2021 PFS final rule established a policy to allow teaching physicians to use  interactive, real-time audio/video  to interact with the resident through virtual means in order to meet the requirement that they be present for the key portion of the service, including when the teaching physician involves the resident in furnishing Medicare telehealth services. In addition, for residency training sites of a teaching setting that are outside of an MSA, the CY 2021 PFS final rule allows teaching physicians involving residents in providing care at primary care centers to provide the necessary direction, management and review for the resident’s services using interactive, real-time audio/video communications technology. For these sites, residents furnishing services at primary care centers may furnish an expanded set of services to beneficiaries, including communication technology-based services and inter-professional consults.

These flexibilities do not apply in the case of surgical, high risk, interventional, or other complex procedures, services performed through an endoscope, and anesthesia services. Further, in order to ensure that the teaching physician renders sufficient personal and identifiable physicians’ services to the patient to exercise full, personal control over the management of the portion of the case for which the payment is sought, in accordance with section 1842(b)(7)(A)(i)(I) of the Act, the medical record must clearly reflect how the teaching physician was present to the resident during the key portion of the service.  For example, the medical record could document the physical or virtual presence of the teaching physician during the key portion of the service.

Finally, the CY 2021 PFS final rule permanently expanded the settings in which residents may moonlight to include the services of residents that are not related to their approved GME programs and which are furnished to inpatients of a hospital in which they have their training program.  In order to prevent the potential duplication of payment with the Inpatient Prospective Payment System (IPPS) for GME, and regardless of whether the resident’s services are performed in the outpatient department, emergency department or inpatient setting of a hospital in which they have their training program, the medical record must show that the resident furnished identifiable physician services that meet the conditions of payment of physician services to beneficiaries in providers in § 415.102(a); that the resident is fully licensed to practice medicine, osteopathy, dentistry, or podiatry by the State in which the services are performed; and that the services are not performed as part of the approved GME program.
Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs (OTPs)

Section 2005 of the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act established a new Medicare Part B benefit category for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs) during an episode of care beginning on or after January 1, 2020. As part of CY 2020 PFS rulemaking, CMS implemented coverage requirements and established new coding and payment describing a bundled episode of care for treatment of OUD furnished by OTPs.

In the CY 2021 PFS final rule, CMS is finalizing the proposal to extend the definition of OUD treatment services to include opioid antagonist medications, specifically naloxone, that are approved by Food and Drug Administration under section 505 of the Federal Food, Drug, and Cosmetic Act for emergency treatment of opioid overdose, as well as overdose education. CMS is also finalizing the proposed creation of a new add-on code to cover the cost of providing patients with nasal naloxone and pricing this code based upon the methodology set forth in section 1847A of the Act, except that the payment amount shall be average sales price (ASP) + 0.  Since auto-injector naloxone is no longer available in the marketplace, CMS is instead finalizing a second new add-on code to cover the cost of providing patients with injectable naloxone and is contractor pricing this code for CY 2021. CMS is finalizing the proposal to apply a frequency limit on the codes describing naloxone, but allowing exceptions in the case where the beneficiary overdoses and uses the supply of naloxone given to them by the OTP, to the extent that the additional supply of naloxone is medically reasonable and necessary.  Additionally, CMS is finalizing our proposal to allow periodic assessments to be furnished via two-way interactive audio-video communication technology.

Section 2002 of the Support Act

Section 2002 of the SUPPORT Act required the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) to include screening for potential substance use disorders (SUDs) and a review of any current opioid prescriptions. CMS is implementing section 2002 of the SUPPORT Act requirements, which complements existing requirements of the IPPE and AWV. The review of medical history, and therefore, current medications, includes a review of any current opioid prescriptions. Clinicians in the course of conducting the AWV and IPPE may also determine that a referral for further evaluation and management is appropriate for patients who are identified as high risk for SUD. Referral to treatment is a critical component of getting patients who have a possible SUD the necessary care. The new IPPE and AWV elements required by the SUPPORT Act, working in tandem with our existing relevant requirements, will promote the early detection of high risk patients and help empower clinicians to offer appropriate referrals.

Section 2003 of the Support Act

Section 2003 of the SUPPORT Act requires that, effective January 1, 2021, the prescribing of a Schedule II, III, IV, or V controlled substance under Medicare Part D be done electronically in accordance with an electronic prescription drug program, subject to any exceptions, which HHS may specify. To help inform CMS’s implementation of section 2003, we issued a Request for Information entitled “Medicare Program: Electronic Prescribing for Controlled Substances; Request for Information,” as a separate document on July 30, available here. The RFI solicited stakeholder feedback on whether CMS should include exceptions to the electronic prescribing of controlled substances (EPCS) requirement and under what circumstances and whether CMS should impose penalties for noncompliance with the EPCS mandate. We will use this public feedback to draft separate rules to further implement this SUPPORT Act provision in future rulemaking.

To help ensure that section 2003 of the SUPPORT Act is implemented smoothly and with minimal burden to prescribers, in this CY 2021 PFS final rule we are finalizing that prescribers be required to use the National Council for Prescription Drug Programs, (NCPDP) SCRIPT 2017071 standard for EPCS prescription transmissions, the same standard which Part D plans are already required to support. We proposed implementation of the EPCS mandate effective January 1, 2022 but based on comments received, are finalizing the provision with an effective date of January 1, 2021 and a compliance date of January 1, 2022 to encourage prescribers to implement EPCS as soon as possible, while helping ensure that our compliance process is conducted thoughtfully.

Clinical Laboratory Fee Schedule: Revised Data Reporting Period and Phase-in of Payment Reductions

Section 1834A of the Social Security Act, as established by section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), required significant changes to how Medicare pays for clinical diagnostic laboratory tests (CDLTs) under the Clinical Laboratory Fee Schedule (CLFS). The CLFS final rule “Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule” (81 FR 41036) was published in the Federal Register on June 23, 2016 and implemented section 1834A of the Act at 42 CFR part 414, subpart G. Under the CLFS final rule, reporting entities must report to CMS certain private payor rate information (applicable information) for their component applicable laboratories. The second data collection period (the 6-month period during which applicable information is collected) for CDLTs that are not advanced diagnostic laboratory tests (ADLTs) occurred from January 1, 2019 through June 30, 2019.

Section 105(a) of the Further Consolidated Appropriations Act, 2020 (FCAA) (Pub. L. 116- 94, enacted December 20, 2019) and section 3718 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136, enacted March 27, 2020) made revisions to the CLFS requirements for the next data reporting period for CDLTs that are not ADLTs and the phase-in of payment reductions under the Medicare private payor rate-based CLFS.

In this CY 2021 PFS final rule, we are finalizing conforming changes to the data reporting and payment requirements at 42 C.F.R. part 414, subpart G, to reflect the revisions to the data reporting period and phase-in of payment reductions enacted in the FCAA and the CARES Act for the Medicare CLFS.

In summary, the revisions are as follows:

The next data reporting period of January 1, 2022 through March 31, 2022, for CDLTs that are not ADLTs will be based on the data collection period of January 1, 2019 through June 30, 2019.

• After the data reporting period in 2022, there is a three-year data reporting cycle for CDLTs that are not ADLTs (that is 2025, 2028, and so on).
• Additionally, the statutory phase-in of payment reductions resulting from private payor rate implementation is extended through CY 2024. There is a 0.0 percent payment reduction for CY 2021 as compared to the amount established for CY 2020, and for CYs 2022 through 2024, payment may not be reduced by more than 15 percent as compared to the amount established for the preceding year.

Principal Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

In the CY 2020 PFS final rule, separate payment was established for Principal Care Management (PCM) services paid under the PFS. For PCM services furnished on or after January 1, 2020, CMS established two new HCPCS codes, G2064 and G2065,that describe comprehensive care management services of a single high-risk disease. We are finalizing the revision of  42 CFR 405.2464 to reflect the current payment methodology that was finalized in the CY 2020 PFS final rule and add the 2 new HCPCS codes, G2064 and G2065, to the general care management HCPCS code, G0511, for PCM services furnished in RHCs and FQHCs beginning January 1, 2021.

RHCs and FQHCs that furnish PCM services will bill HCPCS code G0511, either alone or with other payable services on an RHC or FQHC claim. The current payment rate for HCPCS code G0511 is the average of the national non-facility PFS payment rate for the RHC/FQHC care management and general behavioral health codes (CPT codes 99484, 99487, 99490, and

99491). HCPCS G2064 and G2065 will be added to G0511 to calculate a new average for the national non-facility PFS payment rate. The payment rate for HCPCS code G0511 will be updated annually based on the PFS amounts for these codes.

Rebase and Revise the FQHC Market Basket

We are finalizing rebasing and revising the FQHC market basket to reflect a 2017 base year. The 2017-based FQHC market basket update for CY 2021 is 2.4 percent. The multifactor productivity adjustment for CY 2021 is 0.7 percent. The final CY 2021 FQHC payment update is 1.7 percent.

Medicare Shared Savings Program

CMS is finalizing changes to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021 to align with Meaningful Measures, reduce reporting burden and focus on patient outcomes. For performance year 2020, CMS is finalizing to provide automatic full credit for CAHPS® patient experience of care surveys. For more information, please see the Quality Payment Program fact sheet.

In response to new telehealth code policies finalized in this rule and to update the definition of primary care services used for beneficiary assignment to reflect the codes for assessment and care planning services for patients with cognitive impairment and chronic care management services, CMS is finalizing the inclusion of new evaluation and management and care management CPT and HCPCS codes in the methodology used to assign beneficiaries to ACOs. In addition, CMS is finalizing our proposals to exclude certain services furnished in skilled nursing facilities from the assignment methodology when provided by clinicians billing through FQHCs and RHCs, and to modify the definition of primary care services to exclude advance care planning CPT code 99497 and the add-on code 99498 when billed for services furnished in an inpatient care setting. CMS is also codifying our policy of adjusting an ACO’s historical benchmark to reflect any regulatory changes to the beneficiary assignment methodology in the regulations governing the benchmarking methodology.

CMS is finalizing several policies that will further reduce burden associated with repayment mechanisms.  Beginning with the application cycle for an agreement period starting on January 1, 2022 and annually thereafter, renewing ACOs and re-entering ACOs that are the same legal entities as ACOs that previously participated in the program, that wish to continue use of their existing repayment mechanism in a new agreement period may decrease their repayment mechanism amount if a higher amount is not needed for their new agreement period.  The final rule includes a revised methodology for calculation of repayment mechanism amounts beginning with the application cycle for an agreement period starting on January 1, 2022, and annually thereafter.  The final rule also offers a one-time opportunity for eligible ACOs that renewed their agreement periods beginning on July 1, 2019, or January 1, 2020, to elect to decrease the amount of their repayment mechanisms if the ACO’s recalculated repayment mechanism amount for performance year 2021 is less than their existing repayment mechanism amount.

The interim final rule with comment period (IFC) issued by CMS on March 31, 2020, and the IFC issued by CMS on May 8, 2020, included provisions modifying or clarifying Shared Savings Program policies to address the impact of the PHE for COVID-19 on ACOs. In the CY 2021 PFS final rule, in response to public comments received, CMS is finalizing the Shared Savings Program provisions in these IFCs, with several modifications. CMS is revising the regulations specifying the adjustment to program calculations for episodes of care for treatment of COVID-19 to ensure greater consistency in the policies used to identify inpatient services provided by inpatient prospective payment system (IPPS) and non-IPPS providers that trigger an episode of care for treatment of COVID-19. CMS is finalizing the regulation specifying the expanded definition of primary care services for purposes of determining beneficiary assignment with modifications for greater consistency with the existing beneficiary assignment methodology. Specifically, CMS is are finalizing that the expanded definition, which includes telehealth codes for virtual check-ins, e-visits, and telephonic communication, will apply when the assignment window for a benchmark or performance year includes any months during the PHE for COVID-19 as defined in § 400.200.  CMS is adding a provision specifying that the additional primary care service codes will be applied to all months of the assignment window (as defined in § 425.20), when the assignment window includes any month(s) of the COVID-19 PHE.

Part B Drug Payment for Drugs Approved under Section 505(b)(2) of the Food, Drug, and Cosmetic Act

Some drugs approved under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act share similar labeling and uses with generic drugs that are assigned to multiple source drug codes. CMS proposed to continue assigning certain section 505(b)(2) drug products to existing multiple source drug codes when such drug products meet the definition of multiple source drug set forth at section 1847A(c)(6)(C) of the Act. This approach would apply to section 505(b)(2) drug products where a billing code descriptor for an existing multiple source code describes the product and other factors, such as the product’s labeling and uses, are similar to products that are already assigned to the code.

The proposed approach is consistent with the concept of paying similar amounts for similar services and with efforts to curb drug prices. The proposal also would encourage competition among products that are described by one billing code and share similar labeling.

In response to comments asking for more detail about our proposed approach and requests to delay finalizing a decision, CMS is not finalizing the proposal or the corresponding regulation text for CY 2021.

Removal of Outdated National Coverage Determinations (NCDs)

We are finalizing removal of six outdated or obsolete National Coverage Determinations (NCDs). Removing outdated NCDs means Medicare Administrative Contractors no longer are required to follow those outdated coverage policies when it comes to covering services for beneficiaries. The result will allow flexibility for these contractors to determine coverage for beneficiaries in their geographic areas based on more recent evidence and information.

For more information: https://www.federalregister.gov/public-inspection/2020-26815/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part

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As a reproductive psychiatrist with the Medical University of South Carolina, she knew the stats were dire.

“From 1999 to 2014,” she would later note in a medical study, “the number of pregnant women with opioid use disorder (OUD) in the United States more than quadrupled, increasing  from 1.5 to 6.5 cases per 1,000 hospital births.”

Worse was the fact that only a fraction — fewer than one in four women with the disorder — ever received treatment. It wasn’t hard to imagine where many lived: far-flung rural communities where addiction is compounded with both long-term unemployment and little access to health care.

How to bridge the gap? For Guille, the solution was readily apparent. Since MUSC already had video technology, why not use it to connect doctors with remote patients?

Naturally, there were questions that often greet the use of telehealth, namely whether a doctor could communicate as effectively on video as in person. Guille undertook a year-long academic study, which followed the cases of 98 pregnant women under treatment for opioid addiction. The results, published earlier this year, showed little difference between telehealth and in-person treatment.

Use of telehealth is exploding

Today, telehealth is booming at MUSC and hospitals around the state – largely because of the onslaught of COVID-19.

Through MUSC’s Center for Telehealth, medical professionals come together to reach patients and doctors throughout the Palmetto State

“It’s really an integrated care team,” Guille said. “Obstetricians, nurses, psychiatrists and addiction specialists are all kind of working together to take care of these women.”

MUSC partners in telehealth with Epic, the software firm which maintains the electronic health records for most of the country (some 250 million people) and just over half of South Carolina. The use of video, such as with Epic’s popular MyChart app, has exploded since earlier this year.

“Back in January, we were seeing about 10,000 video visits across our entire Epic community,” said Epic software programmer Taylor Seale in an interview with Statehouse Report. “In April, we saw 2.5 million. Folks got introduced  to telehealth as a means of providing care during COVID, but now that we’re seeing what the tool can do, we’re looking at what it can do in the future.”

Guille said video care hasn’t hindered communication.

“People connect no matter what, right? The more you start talking to someone and the more you know them and the more you engage, the screen just kind of falls away.”

Equally important, telehealth can provide women in remote areas with powerful stabilizing medications like methadone and buprenorphine, which according to Guille increases functioning and makes the patient less likely use opioids or become involved in criminal activity.

Telehealth broadens treatment options in S.C.

Unfortunately for some women in the state, doctors are leery about prescribing these medications to pregnant women.

“I think there are a lot of people, especially in the front line of obstetric practices, that don’t have a lot of training in addiction, and so a lot of these cases are going missed,” Guille said. “The word that needs to get out is that these problems are really common – you should be looking for them in pregnant and postpartum women, and that treatment is accessible and we should be getting people linked to that care.”

There is more to be done in other ways, she said, such as re-examining state and federal laws about prescribing controlled substances via telemedicine or regulations that require a doctor to see a patient first before prescribing medications.

“There were times where we were required to see these women in person first and it delayed care,” she said. “We even had an overdose with a pregnant woman who was trying to access our care but couldn’t get to an in-person appointment. So, we really need to use more of our access capability of being able to connect immediately and being able to get people on treatment when they’re ready.”

New technology will help rural areas, senator says

For lawmakers representing rural South Carolina, the benefits of the new technology are clear.

“Telehealth is going to be the mechanism by which a lot of people receive important facets of their health care,” said Orangeburg Democratic Sen. Brad Hutto, who has already seen two hospitals close in his district.

“In the late 1960s, the heyday of health care in the state was when every little town had a doctor or two, and every county had a hospital,” he said. “Now, small towns are lucky if they have a nurse practitioner or a physician’s assistant. Many small counties don’t have hospitals or won’t have hospitals as we go forward.”

Challenges ahead

Telehealth still has some bugs to work out. Doctors have long had telehealth reimbursement issues with insurance companies, with video visits not quite counting as a real office visit. With COVID, that seems to have changed, as the necessity for more care has meant accepting telehealth for at least the time being.

But the jury is still out.

“The idea of permanently expanding telehealth services covered under Medicare has garnered widespread support,” according to a recent article in MedCity News, “but how private insurers will react is less clear.”

“The way that those changes in reimbursement were framed is that they would be reevaluated or ended at the conclusion of the state of emergency,” said programmer Seale, “which is a little bit of a gray area. We don’t exactly know when that is going to end.”

For Guille, telehealth, has become an effective means of getting help for women in need  — and it’s here to stay.

“If we learned anything from COVID, [it’s that we must have telehealth],” she said. “Otherwise, we would have had no connection in the past seven months. Connection can happen in so many different ways.”

Rodney Welch is a freelance reporter who lives in Elgin.

It’s not breaking news that communicating with the public is vital for the success of your schools. And you know all too well that your relationship with local media can affect the way your community perceives you—and how often your story gets told.

We get it. Sometimes it’s hard to trust that the media has the purest intentions. News is a business, after all, and the most positive things happening on your campuses won’t always strike a reporter as newsworthy material.

As you know, no matter the story, your obligation is to the public. The media’s biggest concern is holding you to that. This can often make it seem like the press is an opposing force to your schools, only wanting to sell stories or get a good scoop. But this is a huge misconception, and it could be keeping you from sharing the most impactful stories coming out of your district.

“Don’t overthink it,” advises Alia Malik, an education reporter for the San Antonio Express-News. “Don’t think of it as one journalist or one media outlet. When you talk to the media, you’re talking to the public. Treat us with the same respect you would treat them.”

We know you can’t control every piece of news that’s out there about your schools—and that can be scary. What you can control is how you approach and work with the media. By building strong, trusting relationships with local education reporters, you can keep the most accurate stories about your schools in the news cycle and ensure you’re being heard in times of celebration or distress.

Establishing Media Partnerships

Beginning a media strategy can seem daunting. However, education reporters are actually looking for stories to print on schools, and they need credible sources to make their stories stronger. So what can you do to make sure they’re contacting your district?

Jenny LaCoste-Caputo knows a thing or two about building partnerships with the media. Before becoming the Chief of Public Affairs and Communications for Round Rock ISD in Texas, she was an education reporter herself. LaCoste-Caputo’s experience in journalism has helped her build a thriving partnership between her district and local media in the Austin area.

“When I was a reporter, I would often get frustrated with communications folks. I would say, They just don’t understand what we need,” she tells SchoolCEO. “You have to understand, frankly, that journalists are not your PR agency; that’s not their job. Their job is to report the news, to be a watchdog for the public.”
No matter how tempting it may seem, funneling inspiring stories to the media probably won’t get your schools the coverage you’re seeking. They may appreciate a celebratory story here and there, but touting your district’s strengths just isn’t their job—and this false expectation could lead to frustration for everyone.

Instead, make it your goal to build goodwill with local education reporters. When they’re on a deadline, you want them calling your district to ask for quotes and clarification—not asking a neighboring district or publishing a story without your knowledge. If the media knows you’re a good source to work with, you can start reaping the rewards of those partnerships. Once you’ve had a few conversations with your local media outlet, you’ll start to pick up on their needs—which puts you in a perfect position to supply information.

Make the initial connection.

To foster a good relationship with local media, connect with them before there’s a big story—when you don’t need anything at all. Get to know who’s reporting on your schools: not just who they are, but how they work, how they communicate, and what they expect from you and your team.

(Click here to read the full story.)  

Making that initial connection with a reporter doesn’t have to be scary, either. Remember that it not only benefits your schools, but also helps journalists who may be looking for education stories to cover down the line. The reporters we talked to said they appreciated school communications personnel reaching out to them directly—through email, phone call, or even text message.

“You’re almost always better off if you make a personal connection with someone,” says Charles Lussier. He’s been reporting on education for The Advocate in Baton Rouge, Louisiana, for 19 years. “If the goal is to actually get coverage, there needs to be a meeting of the minds. It’s harder and harder because there are fewer and fewer folks like me, and there are more and more schools seeking attention.”

He recommends reaching out to reporters with a simple email introduction. “Sometimes that could just be, Hey, do you have a minute to chat about what may work for you and what won’t?” he advises. “I get a lot of cold call emails where there is no connection made at all. Anybody who covers your schools on a daily or weekly basis is someone you’ll want to get to know.”

According to LaCoste-Caputo, establishing these personal connections should be a priority. “The very first thing you do is start to establish those relationships, calling reporters, telling them a little about yourself,” she says. “Try to set up coffee or lunch with them. Meetings are great—phone calls are fine too. But if you can start building a relationship, that’s always going to be helpful. Someone’s far more likely to pick up the phone or respond to your email if they recognize your name when they see it come across the screen.”

Let them know your “why.”

Even though the media is never going to be your PR agency, articulating your vision for the district can help them tell the complete story of your schools. If a journalist understands your mission, they’ll better understand your choices; they’ll get to know you. Eventually, they might even pick up on some of the words you are using in your marketing and branding—and help tell your district’s story.

For Dr. Shawn Foster, new superintendent of Orangeburg County School District in South Carolina, making a thoughtful connection with local media has allowed him to share his mindset as a school and community leader. “I think it’s important, first of all, that you sit down and explain your philosophy,” he tells us. “As superintendents, we have to make sure people see the big picture in regards to communication, because education is no longer about just reading, writing, and arithmetic. Education is a foundational economic driver for communities. We determine if someone’s going to come live here, if businesses are going to come in—we determine all of those things. So the message about your schools that the media puts out impacts everyone that lives in that community, including that media entity.”

Dr. Foster also stresses that a strong relationship with the media is beneficial in making sure who they’re writing about and reporting on is never forgotten. “We have to tell a story about children,” he says. “That’s the one thing people have to remember when you’re talking about communication in the school aspect—you’re talking about kids. No matter where they go when they leave us, if someone hears something negative about the area they come from, people oftentimes unfairly associate what they heard with those kids. And that’s not fair to them. So it’s extremely important, because a child may have to bear the burden of what we put out into this small world.”

Building and Maintaining Credibility

Let’s say you’ve put in the work: you’ve reached out to local media, had coffee chats and Zoom calls, exchanged emails and phone numbers. You trust that when a story comes their way, you’ll be the first to know. But how do you maintain that level of credibility when things get chaotic or unpredictable? How can you ensure that you’re still trusted to be a reliable source, no matter the news?

Maintaining your credibility is an essential part of your relationship with the media and the public. “If you’re working with the same school comms directors for any length of time, you have a sense of who’s responsive and who’s capable of getting your questions answered,” Malik tells us. “If you don’t return calls and you’re not interested, that doesn’t let you off the hook. When the school district is not releasing or providing that information, then that becomes part of the story.”

Credibility can also go a long way with the media in times of crisis. We know it can be difficult to be responsive when your priority is the safety and health of your students and staff, so that foundation of trust can go a long way with a journalist. If you know a reporter and they know you, the communication between you will be more timely, efficient, and accurate. The relationship you’ve already built with them saves you drama and stress when your schools need you most.

There are three main tenets to maintaining credibility: be responsive, be prepared, and be transparent.

Be responsive.

Remember that reporters are busy, and they’re often working on a deadline. You don’t have to respond perfectly, but make sure that you respond as soon as possible.

(Click here to read the full story.)

“Reporters are really busy just like we’re all really busy,” LaCoste-Caputo tells us. “So being specific and brief is really important. If you take the time to build those relationships, here’s what’s awesome—on slow news days when they’re looking for something, they’re going to call you up, because they trust your judgment and know you’ll hustle to churn something out quickly.”

Be prepared.

One thing you don’t want slowing you down when dealing with the press is not knowing about state or local laws, especially concerning media relations with the district. “I think comms directors need to have some basic knowledge about public records and open meetings laws in their states,” says Malik. “They shouldn’t have to go to their district’s lawyers every single time there’s a media request.”

This is another reason it’s especially important for a school leader and their communications director to work closely together. “I think the comms person and the super need to have a symbiotic relationship themselves,” Lussier tells us. “The comms directors who are more plugged in are the ones I seek out. Reporters always prefer to talk to people who are in the know.”

(Click here to read the full story.)

Be transparent.

Transparency is the foundation of your credibility, and the experts we spoke with emphasized it repeatedly. “If the media feels like you’re going to hide things from them or answer in a misleading way, they will not trust what you’re sharing with them,” says Kelly Avants, APR, former President of NSPRA and current Chief Communications Officer for California’s Clovis Unified School District. “It’s a huge one—be transparent and be willing to rip off your own Band-Aid.”

In San Antonio, Malik covers education in an area with 17 public school districts and more than 30 private and charter schools. Needless to say, she knows a few things about keeping up healthy relationships with school districts. “Good comms directors tell the truth and are open and transparent,” she says. “I understand they have lots of demands on their time, but I think they should prioritize talking to the media because they view it as talking with the public.”

Being honest and forthright regarding your district is not just a way to build credibility and strengthen your brand—it’s your obligation to the public. “You want to make sure to have an organization that’s doing things the right way,” LaCoste-Caputo says. “But then also share the challenges. People need to understand them. It’s two-fold. You’re building trust for being honest. But primarily, you’re demonstrating your needs so that when there’s a call to action, people feel compelled to answer.”

Pitching Stories

We don’t have to tell you that newsworthy things are happening on your campuses every single day. But without a strategic and thoughtful plan for collecting and sharing these stories, you could be missing out on countless chances to connect with your community and highlight your schools through media coverage.

The media won’t always know what’s going on in your schools unless you tell them. So you also need a plan for taking stories you’ve collected from your schools and pitching them to local education reporters. With an internal story pitching strategy and a plan for pitching to the media, you can be sure the best things happening in your schools don’t go unnoticed.

Create an internal system for pitching stories.

Nobody knows your schools better than the teachers and administrators in your classrooms everyday. But if a class starts a successful fundraiser for a local food bank, would their teacher know how to share that story with the district or media? Does the principal know who to talk to? Should they go to your communications team or directly to the media?

“Our district has some pretty strict protocols in place, and I think for a leader who is learning or rethinking their media strategy, there’s a lot of value in that,” says Avants. At Clovis Unified, she assigns a communications liaison to each one of the district’s more than 50 school sites. This person serves as the district’s eyes and ears on the ground. “They’re tasked with sending information to us,” she explains. “They’re bringing that content to us, and we’re figuring out how to use it—maybe putting out a press release, creating a media event, or simply posting a video on Instagram. We consider ourselves our own newsroom in a sense. We certainly work with the media to tell our story, but it is incumbent on us to tell our own story as well.”

Many journalists don’t like the idea of checking in through the communications office before talking with sources in schools, but Avants says there are good reasons to do this as a district. “I often remind the media that we are sometimes dealing with contentious custodial issues with families who have restraining orders, one parent against the other, etc.,” she says. “We want to be confident that our systems are not going to put a vulnerable child in the line of a camera or a reporter that would be jeopardizing them while they are under our care.”

So as you align your district’s media communications, make sure your stakeholders know that there are always extenuating circumstances and events that are beyond anyone’s control. Make sure they know your system is meant to help them communicate their stories, not silence them. “There’s some time lost in unnecessary middleman stuff if there’s restrictions on teachers reaching out to the press,” says Malik. “What I’m concerned about is that people feel like they are able to talk to the press no matter where they fall in the school system—especially students and their families.”

In Orangeburg County, students and families always come first when it comes to communication with the media. For Merry Glenne Piccolino—Orangeburg’s Assistant Superintendent for Communications, Business, and Community Partnerships—that means having a solid system in place that helps find the most impactful stories to share. “Alignment is important to me,” she tells us. “I think about a teacher being an example of a strategic vision for the school district. When you can actually have a human interest story that relates and contributes to the vision and the goals of the school district and shows its employees fulfilling that vision, it’s such a win.”

Learn how to pitch to the media.

So you’ve got your plan in place for gathering story pitches from your schools, but how do you take those ideas and share them with the media? Unfortunately, you can’t just send them anything that comes across your desk—you need to learn more about their needs and what they like to cover. What are they looking for in terms of stories?

(Click here to read the full story.)

Cameron Bell, Executive Director of Media Relations and Public Information for Jeffco Public Schools in Colorado, does research into her district’s local media to learn as much as she can about them. “Get to know publications and outlets,” she advises. “Watch them, read them, follow them on social media—and follow reporters on their own channels as well. Look at what they’re doing so you can also get to know them. That way, you know their voices and what they tend to report on most often. You know what kind of stories they like to tell and seem passionate about.”

Bell also says to be aware that some journalists you work with may not know exactly what they’re looking for. “A lot of reporters who normally cover politics or sports are having to cover things like education because of shortages,” Bell tells us. “A lot of them will say to me, I don’t even know what this means. Can you help me?” If you’re prepared with newsworthy stories and pitches, you can make a reporter’s job a lot easier—and that buys you goodwill and helps you build a stronger connection.

However, the media is always looking for a few common things. “People need to think in terms of what is new, what is a little different,” says Lussier. “They also need to think about the medium. I work at a newspaper. Newspapers aren’t just print entities anymore; we’re news sites. So we’re also trying videos now. The more complete the package on a story you can deliver to someone like me, the more it’s sellable. Especially if it’s visual.”

Education is rife with confusing and complicated rhetoric, so it’s also important to keep that in mind when you’re pitching a story. “The more complex a story, the more human you’ve got to make it,” Lussier advises. “If readers see someone grappling with something in real time and in real circumstances, it’s going to mean more, and it’s going to come alive.”

Knowing what your local media is looking for in terms of education stories will make things a lot less stressful for you, your communications team, and the media. And if everyone’s on the same page, the right stories get told.

Don’t be afraid to nudge reporters.

Depending on your location, you may or may not be dealing with a great number of other schools that want to tell their stories, too. Keeping up your end of the communication bargain may sometimes mean being consistent and assertive in pitching to the media to make sure you’re being heard.

In Jeffco, Bell sends out a weekly newsletter to local media that includes a list of story pitches from schools around the district. “Once I send them out, I post each one on our media relations webpage,” she says. “We give information, but we also pitch fun stories, give construction updates, and things like that.” When directly pitching to a reporter, Bell may use “a blurb-like pitch” or even develop an idea into a story that a reporter can then expand on.

It also never hurts to follow up with a reporter or reach out when something is important or timely. “Definitely nudge me,” Lussier says. “If you really think something is a story, you may have to grab me by the lapel and shake me a little bit and go, This is something and here’s why. Don’t assume that I’m just going to jump to it. If I’ve been doing five other things, it wasn’t even on my radar.”

In terms of how you should nudge or reach out to a reporter, Lussier offers some sound advice. “It’s usually an escalation. If it’s something happening now, give me a call. If it’s something happening tomorrow or the next day, you can start with an email or maybe send a text.” Also remember that reaching out to a reporter who may be too busy for your story isn’t a fruitless endeavor. “If I can’t do it, but I know it’s something big enough, I may be able to find someone else, or we can think about a plan B and circle back,” he says.

When Bad News Strikes

Your schools should be prepared to respond to any kind of story that comes across a reporter’s desk. Sometimes, as you well know, it isn’t good news. So first it’s important to acknowledge and accept that you can’t keep news from reaching your community, no matter what it’s about. Because you serve the public, much like the media, you already know that being transparent and responsive is a top priority. This, in turn, will help you build strong relationships with local education reporters so that when negative things do happen, they call you first.

React thoughtfully and honestly.

As simple as it may seem, being thoughtful goes a long way, and being as honest as possible with the media and public should always be your priority. If there’s a story involving your schools, you want local media to know they can trust you to give them the answers. Bad things happen every day, and you certainly don’t want your reaction to the media to become part of the story.

“Realize that anytime someone has an issue, they’re going to call me,” Lussier tells us. “But if I have a good relationship with a district, I’m not going to pop off with the first tip of the day. I’m going to call them and go, Look, I heard about this. What’s going on here? I’m willing to have a conversation with them on anything people come to me with.”

To react to negative stories in a thoughtful, transparent way, be as open as you can be with the media and public about whatever is going on. If there’s been an incident on one of your campuses, or a mistake has been made, your district should be as upfront as possible. “There are going to be negative things that happen,” Piccolino says. “The media needs to know that when we’ve done something wrong, I’m going to own it. I’m not going to sugarcoat it or try to spin the story or anything like that. If a child is hurt or something else has happened that is the fault of an employee, process, or system, I’m going to own it, apologize, and identify how we’re going to do things differently to prevent it from ever happening again.”

Build a bank of good stories.

You can’t keep bad things from happening, but you should always remember that good things are happening, too. Having a system in your schools for gathering those inspiring stories means you’ll be ready to share them when you need to most.

“We’re always trying to build that bank of really good stories,” Piccolino says. “We’re one of the largest employers in the community, and people make mistakes—kids, adults, everybody. Sometimes when things aren’t going so well, we pull a story out of our pocket that is going to change hearts and minds. Those living examples help refocus the community’s mindset on what’s positive and on the intentions of our work. It recenters public interest and attention on something that is positive so that stakeholders can put a small error in perspective while remembering the larger and overwhelmingly positive impact our school system makes.”

(Click here to read the full story.)

By being prepared to share your very best stories, you can ensure that no matter what happens, your schools are being seen, heard, and understood. As the saying goes, If you don’t tell your story, someone else will. After all, it’s the media’s job. But nobody ever said you couldn’t help them along the way.

SchoolCEO is free for K-12 school leaders. Subscribe below to have a digital copy of the most recent edition of SchoolCEO sent to your inbox.

COVID-19 brought telehealth into the forefront, and consequently, funding is increasing, restrictions are loosening, and the public’s interest is waxing.

Telehealth was already building acceptance when the pandemic catapulted it into the national spotlight. Now that Pandora’s Box has opened, telehealth is here to stay. And it’s going to evolve. There would be no Netflix without Blockbuster — no iPhone without the first mainframe. All technological innovation triumphs begin with the forerunner. And in that context, telehealth is performing quite well. Imagine what’s in store — more than convenience, telehealth purports to be a crucial part of the 360o customized health care solution.

A short time ago, telehealth was an infrequently used option to traditional health care, a system burdened with fluctuating rules and regulations affecting reimbursement and the variegated, non-eligible costs and services imposed by state and federal laws. Any hope for the swift advancement of telehealth as a practicable alternative to traditional health care was floundering in a hotbed of red tape.

Related: Embracing telehealth benefits in the workplace

However, the onset of COVID-19 brought telehealth into the forefront of health care, and consequently, funding is increasing, restrictions are loosening, and the public’s interest is waxing. This year alone, investor dollars have raised 9.4 billion for digital health, smashing the 2018 record of 8.2 billion, and mega deals are going through the roof. Medicare has also waived many of its restrictions, which prior to the pandemic included physicians receiving either lower reimbursements than in-person visits or no compensation whatsoever. And just this past April, the FCC initiated the COVID-19 Telehealth Program, which gives $200 million in funds to ensure that health care providers have the necessary services and equipment to serve their patients remotely.

Many formerly in-person activities are being re-imagined remotely. Obviously, business meetings and school education, but also music lessons and birthday parties. Surprisingly, people have found that there are distinct and unexpected benefits to distanced activities. Telehealth is similar with 51% of people planning to continue to use telehealth after the pandemic, not just for the convenience of the appointment, but for many little treasures like faster appointment setting, streamlined communications and timely follow-up.

It’s difficult to discount those who suggest the pandemic is responsible for thrusting telehealth into its current predominance. Some experts say that invoking telehealth services into mainstream health care options is long overdue, while others believe that telehealth is untenable, artificially inflated by COVID-19, and its popularity will fade as soon as the pandemic recedes. If nothing else, the pandemic has legitimized this budding service so it can be recognized for what it is — a cutting edge treatment option promising as yet unrealized bonuses.

While COVID-19 may have forced many into using telehealth, by no means was telehealth born out of the pandemic. Case in point: the 12-month period between January 2019-2020 shows telehealth claims increased 43%, and the February 2019-2020 period shows a 121% increase, demonstrating that before the pandemic, telehealth services were already on the rise.

While telehealth is the safer choice amid the pandemic, its pre-COVID rise is due to some of telehealth’s most primary and obvious advantages, including provider support, reassurance, communication and education regarding treatment and medications that is equal to traditional in-office visits. Now, add to these the savings in time, travel, parking, childcare and scheduling conflicts all while receiving care in the comfort and confidential space of one’s home or office. Telehealth saves providers time, too, and allows them to cut costs, meet outcomes and serve patients in remote and rural areas.

Yet, telehealth faces criticism — it is not perfect. It does not allow providers to perform physical exams, which means less information with which to diagnose and medicate, and there are social and technical inequities, e.g., patients who do not have access to computers or reliable Internet. Patients may also not have access to a private area in which to meet; older patients may not have access to the necessary technology or know how to operate it. And truly, some providers and patients adamantly prefer face-to-face appointments.

Instead of considering telehealth as a replacement for in-person care, most would agree that telehealth and its technology integrations are a welcome complement in the frame of total health care — a vision of minimal but timely intervention, quality monitoring, customized human care, delivered in unison by holistic instead of fragmented disciplines. Telehealth will evolve to meet the growing and complex needs of the future of total care.

In the famous analogy, NASA doesn’t launch its shuttles on a perfect trajectory from the launch pad to the final destination. Rather, it launches a shuttle past the earth’s atmosphere and then adjusts coordinates in flight. Well, telehealth is launched. Now its course will be altered by the millions of patients and providers who have begun to overcome its shortcomings. The pandemic has fueled telehealth’s rise into the stratosphere and revealed its power as a viable alternative, one that has been overshadowed by healthcare’s traditional complacencies. So what does the future of telehealth look like? As we move through this pandemic and into a post-pandemic world, it is likely that telehealth will evolve into something very different than it is today.

Telehealth developed from technological possibilities and, as of late, has been nurtured by necessity — a required, inconceivable, essential circumstance. So, as we’ve required telehealth services to meet our needs through most of 2020, we’ve learned that it will continue to be indispensable, making telehealth an essential service beyond today’s needs and into preventive care; expedient care for triaging new symptoms; mental health management; and close monitoring of chronic conditions. However, the future of telehealth has the potential to also look like this: a 360o care that includes tele-assessment, tele-diagnosis, tele-interactions and tele-monitoring through artificial intelligence that connects a patient’s many providers to a shared knowledge base to ensure better, faster, less-expensive mainstreamed care.

Loraine Daugherty is Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group where she provides analytical decision-making, strategic planning and executive leadership. As CEO, she is focused on developing best practices for organizational processes, performance measurement systems and building IMCS’s infrastructure to maximize the company’s growth. With more than 30 years of industry experience in workers’ compensation, Ms. Daugherty also has professional expertise in Medicaid, Medicare Part B, third-party contracting, administration, client services and operations. 

Read more: 

• Infographic: Telehealth growth amid the COVID pandemic
• Insurers pull the plug on telehealth cost-sharing waivers
• The future of telehealth is hybrid

BlueCross BlueShield of South Carolina announced in a release Monday that they have awarded $11.6 millionin grants to Diabetes Free S.C.

Several healthcare providers in the state have been grant recipients of Diabetes Free S.C., a multi-million dollar project to improve diabetes healthcare.

The grant money will be split between Prisma Health, the Medical University of South Carolina (MUSC), the Alliance for a Healthier Generation and FoodShareSC.

“It’s connecting different health systems across the state to collaborate and provide consistent, standardized care to improve outcomes,” said Hannah White, a Registered Dietitian and Certified Diabetes Educator at Prisma.

According to the American Diabetes Association (ADA), 35% of adults in South Carolina are pre-diabetic and 500,000 South Carolinians are diagnosed with diabetes.

The main objectives for the grant are improving pregnancy outcomes for women with diabetes, reducing diabetes risks in children and diabetes prevention for adults.

At Prisma Health in the Upstate, a group of doctors and experts wrote their grant to focus on improving pregnancy outcomes.

Dr. Megan Shellinger, Maternal Fetal Medicine Specialist and Medical Director of the OB Center for Prisma Health Upstate, helped write the grant at the beginning of the coronavirus pandemic. Her team was awarded $1.5 million of the BlueCross BlueShield grant.

“The benefit of this grant is that they will have all of their care partners in the same clinic,” said Shellinger. “And we’re able to reach patients who haven’t necessarily had access to all of the latest technology and all of the specialists that they need, so this really gives us the opportunity for a holistic care model for these patients.”

Additionally, the cost of care for diabetics in South Carolina can be a barrier for many. In 2017, the ADA reported that the annual cost of care for diabetics in the state was $5.89 billion.

“For some of our patients, insulin is one of the things that they need to survive, so this grant is going to be able to provide that to those patients in need as well as making their lives easier with access to diabetes technology, such as continuous glucose monitors, insulin pumps and those sorts of therapies,” said White.

Part of their diabetes prevention will even include supplying food to patients with food insecurity or without access to healthy options that are essential to preventing and treating Type- 2 diabetes through the FoodShareSC program.

Additionally, Prisma will offer telehealth and virtual medicine to patients with transportation issues and in order to reach more counties, according to Shellinger.

“It will just be such a blessing to our patients because this is what they truly need,” said Shellinger. “They get access to the medications they need the specialists they need, as well as the latest technology, and it will be equal across the state of South Carolina.”

By Kat Jercich

Healthcare lawyer Andrew Selesnick said one key will be to establish a stable, user-friendly platform that can make documentation seamless.

The future potential of telehealth hinges on how it’s reimbursed. Virtual care may be popular among patients, but if providers can’t get paid for their services, it’s unlikely they’ll be able to continue to provide them.

The government has signaled its support for reimbursing some telehealth services, at least in the short term. The Centers for Medicare and Medicaid Services announced earlier this month, for example, that it would add 11 virtual services to its reimbursement list during the COVID-19 public health emergency – following in the footsteps of its earlier flexibilities for virtual care.

This could act as a signal for other payers to do the same, said Andrew Selesnick, a shareholder in Buchalter’s Los Angeles office, in a Healthcare IT News interview. “The government can play a very positive role in telehealth by establishing clear standards and clear reimbursement guidelines,” said Selesnick. If the government, for example, requires documentation for certain services and certain rules around telehealth, “then the payers will be hard pressed to ignore them for a lengthy period of time.”

“If Medicare says you have to cover something – that’s going to be harder” for private payers not to cover it, Selesnick said.

Indeed, private payers have slowly begun to reinstate out-of-pocket costs for telemedicine. UnitedHealth Group and Anthem are saying that some members will be responsible for copays, coinsurance and deductibles for non-COVID-19 virtual visits.

The COVID-19 pandemic has “been a time of tremendous change” with regard to virtual care, said Selesnick.

Given the dozens of changes to policy at the federal level, including allowing providers to practice across state lines and to regard a patient’s home as an originating site, “we’ve probably had more regulatory reform in the last six months than we’ve had in the last six years when it comes to telehealth,” he said. “Many of my clients who weren’t even telehealth providers before have jumped into the fray.”

The providers most focused on the future of reimbursement and telehealth tend to be primary care clinicians, Selesnick said, as well as a “goodly number” of emergency physicians.

“They can do a lot of things, and they’re used to dealing with limited information and making decisions with people they don’t know,” said Selesnick, making them particularly nimble when it comes to virtual care.

“Hospitals and health systems were very active as well, because they had such a huge drop in volume at the early stage of the pandemic,” Selesnick continued, with many of them pivoting to ramp up existing telehealth technology and accommodate patients. “A lot of places saw drops of 30 to 50% in volume, and they have fixed costs – and people still need care.”

When it comes to the future of reimbursement, Selesnick predicted a continuously changing outlook over the next one to two years. “We’re going to see a lot of activity over the next 12 to 24 months, where the landscape shakes out and people have a good understanding of where they stand,” he said. “It’s going to be a struggle.”

So, given that uncertainty, how can providers best prepare?

One way, he said, is having a “stable, user-friendly platform.”

“And I don’t just mean user-friendly for the consumer; I mean for providers as well,” said Selesnick. He described clinicians who can’t easily get into their electronic health records from telehealth platforms and then just not billing for services, rather than jumping through technological hoops.

For providers, he continued, “it’s about clear guidelines” about what telehealth reimbursement requires in terms of documentation and visit length. “You put a lot of hurdles in, you’re going to have diminished use.”

Ultimately, “telehealth is here to stay,” he said. “I think there will be a scale-back in telehealth in terms of what they’re going to pay for, but it’s definitely going to stay.”

Video visits as a form of family visits in the hospital are slated to continue, some experts assert, as a key method for driving patient satisfaction.