News

Navigating the Compliance and Compensation Challenges Created by COVID-19

March 18, 2020

We are in communication with our clients regarding the evolving situation prompted by the COVID-19 pandemic. As we monitor the progress with the rest of the country, we understand that hospitals and healthcare providers are facing challenges on an unprecedented scale. We know this is impacting everyone from physicians and nurses to legal counsel, along with environmental services to administration, and appreciate their dedication to providing community health services.

As we continue the work of helping hospitals and health systems maintain compliance, we’d like to highlight some of the critical challenges and viable solutions that we can assist our clients in navigating.

Ensuring the Safety of Your Physicians and Nurses

Telehealth is taking a front seat in the battle against the COVID-19 pandemic by providing the ability to keep physicians and nurses safe, while at the same time being accessible to patients who truly need them.  Centers for Medicare and Medicaid Services (CMS) has increased access for Medicare patients. They are doing so under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.  Specifically, some of the key facets to the expansion of telehealth services include:

  • Originating site has now been expanded for beneficiaries to include “any healthcare facility and in their home”
  • Clinicians such as clinical psychologists and social workers may now provide telehealth services
  • Patients do not need to have a prior relationship with the provider
  • Reimbursement will be paid by CMS at the same physician fee schedule rate as a traditional in-person visit
  • HIPAA penalties waived for use of non-secure communication platforms

We are working closely with our clients to ensure that physicians are compensated accordingly for these telehealth services. In addition, we are ensuring hospitals are compliant with this expansion in telehealth services and the professional services agreements in place. Click this link for more information – https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak.

Ensuring Emergency Department Coverage

Physicians at key entry points into the system, such as the primary care office and/or emergency room departments, are being stretched thin whether it be in terms of increased volume of patients or greater number of hours/shifts worked. This is also occurring on an inpatient basis for providers specializing in such areas as hospitalist medicine and intensive care. We are currently working with systems faced with questions regarding increased compensation to reflect the extraordinary environment in which healthcare providers are working. This is not without precedent when you consider the concept of hazardous duty pay (5 U.S.C. 5343(c)(4)), imminent danger pay in the military, off-shore drilling compensation, etc.

We understand our clients’ need to secure coverage and compensate their providers at a level commensurate with the services provided. Our experience in other extraordinary circumstances, including the provider shortage post-Hurricane Katrina, as well as the population surge affecting local hospitals along the path of the Solar Eclipse of 2017, fosters our effectiveness at ensuring hospitals remain compliant with the regulatory framework under the Stark Law and Anti-Kickback Statute.

Securing Physicians in the Context of Business Disruption

In the wake of increased social distancing and reduction of non-essential healthcare services, such as elective surgeries, we understand concerns over departments meeting budget, as well as physicians worried about maintaining their base compensation levels.

Documentation is critical along with the establishment of specific criteria upon which to legitimize this support. The storyline informs the quantitative analysis. Compensating and keeping those physicians that are mission critical to the organization is not only possible, but achievable with guidance. We are actively helping our clients establish FMV support for physicians during this time of service intensification and interruption.

Partnering with Our Clients

As we move through the curve of the COVID-19 pandemic, we will be continuing to serve the valuation needs of hospitals and health systems across the nation, and will be closely monitoring the healthcare industry for continued changes and challenges.