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CARES Act provider relief payments disproportionately went to medically underserved areas, helping providers in already struggling areas to keep their doors open during the peak of lockdowns.

January 05, 2021 – At the start of the COVID-19 pandemic, the healthcare industry was confused, scrambling, and scared. Patients did not know when and where it was safe to seek care and providers were overwhelmed with patients needing care for a disease they did not know how to treat. Hospitals quickly hit capacity as ICU beds filled with patients needing ventilators while small physician practices had to close because no patients were coming in for care.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided economic stimulus and relief throughout the country amidst the COVID-19 pandemic and gave specific funding directly to providers and care delivery organizations. In total, this Provider Relief Fund allocated over $50 billion to Medicare fee-for-service providers for healthcare-related expenses or lost revenue as a result of COVID-19.

As telehealth quickly emerged as a catch-all solution to providers many challenges, Provider Relief Funding could support providers implementing these solutions without seeing a drop in revenue. Supportive policies from CMS and other payers relaxed restrictions previously limiting telehealth’s use and funded telehealth-based care.

Primary care visits delivered via telehealth grew by nearly fifty percent. But providers still needed support to rollout telehealth solutions and other technologies that improved patient access to care and kept safety at the forefront of care delivery. Providers needed to innovate if they were to keep their doors open and adjust practice to meet the demands of the time.

Funding from the CARES Act gave providers a needed economic boost when patient volume was at an all-time low and provide support to rolling out solutions that would keep facilities operating. An additional $18 billion was set aside for Medicaid and CHIP providers, including assisted living facilities. A final $20 billion was allocated for financial losses and changes in operating expenses to providers including, behavioral health providers.

A portion of the Provider Relief Fund was distributed based on the provider’s 2018 Medicare fee-for-service revenue. Additional funding was granted based on provider application, so those providers who were leveraging value-based payments were also eligible for funding.

New York, California, and Texas received the highest total number of payments across all states, according to the Department of Health and Human Services (HHS). Allocation strategy indicated that the areas hit the hardest by the COVID-19 pandemic would receive priority payment.

Over 40,000 payments were given to California providers alone, as this state has the highest number total cases across the county at over 1.5 million, according to data from the Centers for Disease Control and Prevention.

Payments ranged from $1 to $1,196,544,217 but averaged $265,759 for all recipients. HHS appeared to live up to its call as those areas hit the hardest by the COVID-19 pandemic received some of the highest payments.

But medically underserved areas also appear to have received higher total payments and average payments from the Provider Relief Fund than their counterparts in resource-rich areas, revealed an analysis from Xtelligent Healthcare Media.

Medically underserved areas are defined by the Health Resource and Services Administration (HRSA) as geographic areas that lack access to primary care services. Four elements contribute to an area being designated as a medically underserved area:

• Rate of primary care providers
• Percent of population at the federal poverty level
• Percent of population over age 65
• Infant mortality rate

A low rate of primary care providers for an area means patients have difficulty accessing care where and when they need it.

As primary care is central to care delivery and often the spoke behind care coordination, limited access to these services and results in poor care delivery and uncoordinated care. Previous research has shown that populations with a high proportion of primary care providers see lower mortality rates and improved life expectancy.

Poverty rates have also long been tied to health outcomes. Social determinants of health such as income and economic opportunity can correspond to a slew of health-related factors from accessibility of care to access to safe housing, all of which impact health outcomes.

Population over the age of 65 is likely also considered an element in the medically underserved designation as older patient populations typically have higher rates of comorbidities and chronic conditions.

These conditions, including diabetes and heart disease, require more and more frequent health services. A higher population over the age of 65 would suggest a stressed healthcare system or at least a healthcare system needing more resources to care for a sicker population.

Similarly, high infant mortality rate suggests poorer health status of mothers and thinned healthcare resources.

So medically underserved areas have the perfect storm of overextended care – fewer providers to care for a greater and more in-need patient population. These areas are in greater need of assistance to meet these needs of their complex patient population.

It is, therefore, reassuring that analysis from Xtelligent Healthcare Media found 240,461 more Provider Relief Fund payments made to providers in medically underserved communities.

Data on provider payments from HHS was paired with the HRSA’s indication of medically underserved populations to understand the relationship between relief payments and county-level resources.

The average payment for providers in medically underserved areas was over $20,000 higher than those in resource-rich environments. Not only does this data indicate that those areas in the greatest need received more payments, but they also received higher valued payments.

The difference in total payments to medically underserved areas compared to non-medically underserved areas was over $66 billion.

While reassuring that providers the most in need of additional resources were receiving aid, this data does not reflect the total impact of Provider Relief Funding in these communities because the data is only based on the payments accepted by providers at the time of analysis. Pending payments were not a part of analysis and reports from July show that nearly $100 billion had yet to be dispensed. Hopefully, this pending aid will continue supporting providers who are already stretched thin because of resource limitations in their communities and the impact of COVID-19 on their practice.

While priority was given to areas hit the hardest by COVID-19, the current wave of infections is sweeping the country irrespective of state and county lines. How HHS dispenses the remaining funds will be critical to support providers in areas with the most need.

It is a positive indication that medically underserved counties received over $66 billion more in aid than non-medically underserved populations, but is this enough?

For providers in areas where broadband is limited, HHS funding may not be enough to support equal access to telehealth services for their entire patient population. Or cancer care clinics whose patients are at the highest risk for developing severe COVID-19 may not have enough funding to provide safe and effective home care. Continued support to these areas will be critical moving forward as the pandemic continues to sweep the country.

Media Contact:

Joseph Calascione, (202) 418-2085

[email protected]

For Immediate Release 

Carr Welcomes Launch of Round 2 of FCC’s COVID-19 Telehealth Program

FCC Seeking Comment on Additional $250 Million for Successful Telehealth Initiative

WASHINGTON, DC, January 6, 2021—Today, the FCC released a Public Notice seeking comment on how to allocate an additional $250 million that Congress recently appropriated for the FCC’s COVID-19 Telehealth Program.  This new funding will allow the FCC to launch a second round of this successful telehealth initiative, building on the $200 million that Congress provided and the FCC awarded through this telehealth program last year.

Commissioner Carr has been leading the FCC’s efforts to develop telehealth initiatives that enable Americans to access high-quality care from their homes or anywhere outside the confines of a health care facility.  The FCC’s COVID-19 Telehealth Program builds off of those efforts.

“Over two years ago, we identified a new trend in telehealth,” Commissioner Carr stated.  “The delivery of high-quality care is no longer limited to the confines of traditional brick-and-mortar facilities.  With smartphones and other connected devices, Americans can now access health care services right from their homes or anywhere they have an Internet connection.  FCC staff have worked tirelessly to support this new trend in care, and the agency’s work to stand up the FCC’s COVID-19 Telehealth Program has been part of those efforts.  Congress has recognized that delivering care at a distance is part of the bright future for telehealth.  And it has now authorized an additional $250 million for the FCC to allocate through a second round of this successful program.

“I have had the chance to meet with many of the health care heroes that received Round 1 funding, and the FCC’s Telehealth Program provided them with critical support as they saw demand for telehealth services skyrocket in the wake of COVID-19.  I look forward to working with my FCC colleagues as we launch a second round of this successful initiative.”

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Office of Commissioner Brendan Carr: (202) 418-2200

www.fcc.gov/about/leadership/brendan-carr

BAMBERG, SC—Palmetto Care Connections (PCC) Chief Executive Officer Kathy Schwarting announces that Breanna Parham, NRCMA, PCT has been named Telehealth Coordinator.

In her position, Parham assists with the implementation and ongoing management of telehealth care in conjunction with standards, protocols, guidelines, policies and procedures. She works with pharmacies, churches and schools and other telehealth providers to set up telehealth programs, assisting as a tele-presenter when needed, and providing education and training on the use of telehealth equipment and services.

Parham’s strong clinical experience includes positions as a medical assistant and patient care technician for a busy Urology practice, phlebotomist for a regional hospital, and certified nursing assistant for a full-service nursing home. She received certification as a Nationally Registered Certified Medical Assistant (NRCMA) and as a Patient Care Technician (PCT) from Orangeburg-Calhoun Technical College.

“Breanna brings a wealth of clinical experience to our team,” said Schwarting. “Originally from Cordova S.C., she knows what it’s like to grow up and live in a rural area. Her background, combined with her career experience in medical settings have already proven to be tremendous assets in PCC’s initiatives to implement innovative telehealth programs in rural S.C.”

A resident of Rowesville, in her spare time Parham enjoys creating art and crafts using Cricut vinyl applications, gardening and spending time with family and friends.

Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in S.C. PCC leads South Carolina’s broadband consortium which facilitates broadband connections throughout the state. PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, partnering with health care organizations and providers to improve health care access and delivery for all South Carolinians.

By:  Cara Murez

TUESDAY, Jan. 5, 2021 (HealthDay News) — In late December, Dr. Ada Stewart asked her staff to check on a patient who had missed an appointment.

She soon learned that the patient had no transportation for the 45-minute drive, so Stewart offered to conduct the appointment by phone instead.

“It still accomplished so much. I was able to see how their diabetes was doing, how they were preparing for the holiday season, how they were really feeling mentally,” said Stewart, a family physician at Eau Claire Cooperative Health Centers in Columbia, S.C., and president of the American Academy of Family Physicians.

That’s just one example of how doctors are using telemedicine – having appointments by phone or video call – to check in with their patients.

Telemedicine isn’t new, but the COVID-19 pandemic has really put the technology front and center, with clinics closing for certain services after state and local governments issued stay-at-home orders to help prevent the spread of the virus.

And even when doctors’ offices were open, some patients avoided in-person appointments due to COVID-19 fears.

Besides giving telemedicine a boost, the pandemic has also fostered the rise of innovative medical services, everything from getting prescriptions by mail to drive-through virus testing and pharmacy-based vaccinations.

Many of those innovative approaches to health care are likely to linger long after the pandemic ebbs, experts say.

“We saw the benefits that telehealth provided,” Stewart said. “People were able to receive access to health care. We were able to reach out to our patients who were afraid to come into the office to be seen. It really afforded that opportunity to still take care of our patients and do so in a safe way.”

Telemedicine also gave physicians the ability to keep their practices, which might otherwise have been shuttered as patients stayed home.

“We had to pivot,” Stewart explained. “We had always talked about telehealth and incorporating it into our practices,” but 2020 brought the technology to the fore.

The American Academy of Family Physicians distinguishes between telehealth and telemedicine. Telemedicine, the academy says, is using technology to deliver care from a distance, whereas telehealth is the technology and services to provide that distance care.

Prior to the pandemic, telemedicine was already growing in the United States, especially in mental health services. But it still only reached a small minority of patients, about 4% of the population, according to Lori Uscher-Pines, a senior policy researcher at the nonprofit RAND Corporation, which works to impact policy through research and analysis.

Restrictions on telemedicine delivery were a major barrier to growth. For example, many insurance providers would only reimburse telemedicine visits under specific circumstances.

However, “at the start of the public health emergency, payers across the board really relaxed restrictions on telemedicine, so patients could be served at home and that would support social distancing and help patients continue to get the care that they need,” Uscher-Pines said. “As a result, we’ve seen telemedicine use really skyrocket.”

Enhancing, not replacing, in-person care

A study recently published in JAMA Network Open evaluated how health services changed in March and April 2020, during the early part of the pandemic in the United States, among 6.8 million people covered by commercial insurance.

The study found that use of in-person medical services dropped by 23% in March and 52% in April, and that telemedicine services grew by more than 1000% in March and more than 4000% in April.

That doesn’t mean telemedicine completely replaced in-person care: The increase in telemedicine only offset about 40% of the decline in office visits.

Prior to the pandemic, Deidre Keeves and her team at UCLA Health in Los Angeles had been trying to get physicians to increase their use of video visits with modest success, averaging about 100 visits per day for several months. But from March through May of 2020 they jumped to 3,000 to 4,000 visits per day, Keeves said.

More recently, UCLA Health doctors were doing about 2,700 telemedicine visits a day. Keeves said she expects that pace to continue averaging that number, even once the pandemic is under control.

She sees telehealth as beneficial for patients, who save on time and travel, as well as for physicians, who can reach a geographically wider population.

“We think that telehealth is here to stay. Our patients are expecting it. Our doctors are very happy with it, and it’s a great avenue for care,” said Keeves, who is director of connected health applications at UCLA Health. “We’re expecting that about 20% of our volume is going to continue to be through telehealth.”

In-person visits continue to be necessary anytime a person needs a procedure, such as a biopsy, lab test or vaccine injection, Keeves said. Telehealth works for follow-up visits, medication instructions and talking with a mental health provider.

UCLA Health is located in Southern California, a current crisis area for COVID-19. Keeves said staff are also monitoring some coronavirus patients at home with the use of pulse oximetry (which measures blood oxygen levels) and regular check-ins with clinicians.

“We at UCLA Health don’t feel that video visits are a replacement for in-person care,” Keeves stressed. “We are not using technology to replace the doctor-patient relationship. We’re using technology to supplement and support that relationship.”

Direct-to-consumer safety valve

What’s known as “direct-to-consumer” telemedicine was also growing even before the pandemic, Uscher-Pines added. That involves scheduling a visit with a doctor who works for an online-only service provider. It’s typically used when someone has a minor acute illness, not a severe condition.

Uscher-Pines was an author on a study that appeared recently in the Journal of Medical Internet Research. The study focused on the experiences of one such telemedicine supplier, called Doctor On Demand, a national telehealth service provider.

Researchers compared data from February to June in 2019 and February to June 2020. They found that total visit volume increased from March through April 7, 2020, by 59% above the baseline, before declining to 15% above the baseline through the week of June 2, 2020. The growth wasn’t typically fueled by COVID-19 concerns, but rather by visits for issues of behavioral health and chronic illness.

In this way, “telehealth services may play a role as a ‘safety valve’ for patients who have difficulty accessing care during a public health emergency,” the study concluded.

Pharmacies also fill gaps

Other innovations that have expanded during the pandemic range from drive-through COVID-19 testing to pharmacy-based vaccinations for younger children.

In August, the U.S. Department of Health and Human Services (HHS) authorized state-licensed pharmacists to vaccinate children age 3 and up. That followed a U.S. Centers for Disease Control and Prevention report, issued in May 2020, that found a “troubling drop” in routine immunizations for children.

“What I love about pharmacy is we’ve really stepped up to be a very essential access point for people when a lot of other things might have been closed,” said Sandra Leal, president-elect of the American Pharmacists Association and executive vice president of SinfoniaRx, which works with health plans to do comprehensive medication reviews with patients via telehealth.

Another change Leal noted is that pharmacists can now conduct COVID-19 testing within their communities. In April, HHS allowed licensed pharmacists to test patients for COVID-19.

As the pandemic forced office closures, SinfoniaRx’s team worked with patients to do not only the usual work of ensuring they had no medication questions, but also talking about COVID-19.

“We’re finding that so many people have so many questions around COVID and the pandemic, and vaccines and when they’re going to be available to them,” Leal said. “We’re really trying to address those concerns.”

Ordering prescriptions by mail is a service that’s been around for a long time, Leal said. In May, the Wall Street Journal reported that mail-order prescriptions had risen 21% over the previous year during the last week in March. Yet, Leal said patients are concerned about postal delays, which can be a big problem for people with certain conditions, such as people with type 1 diabetes who need insulin.

Future depends on policy

The COVID-19 pandemic has highlighted health inequities, and the shift to a broader acceptance of telemedicine is an opportunity to improve health care in the United States, Stewart said. She would like to see telemedicine continue, along with the technology infrastructure to ensure that health care is equitable.

Uscher-Pines said that it may be difficult to return to the pre-pandemic status quo, with its focus on office visits, because providers and patients are now familiar with and appreciate the convenience of telemedicine.

“I think that what ultimately happens with telemedicine really depends on how the policy environment evolves,” she said. “There is a lot of action going on at both the state and federal level right now on telemedicine policy, and a lot of strategizing on what should stay permanent and what should go back.”

More information

The U.S. Centers for Disease Control and Prevention has more on telemedicine during COVID-19.

SOURCES: Ada Stewart, MD, family physician, Eau Claire Cooperative Health Centers, Columbia, S.C., and president, American Academy of Family Physicians; Lori Uscher-Pines, PhD, senior policy researcher and research quality assurance manager, RAND Corporation; Deidre Keeves, PT, director of connected health applications, UCLA Health, Los Angeles; Sandra Leal, PharmD, executive vice president, SinfoniaRx and president-elect, American Pharmacists Association; JAMA Network Open, Nov. 5, 2020, online; Journal of Medical Internet Research, Dec. 15, 2020, online; U.S. Department of Health and Human Services, Aug. 19, 2020; American Pharmacists Association, Nov. 4, 2020; Wall Street Journal, May 12, 2020