Halfway through an historic week;

here is your NCMS Morning Rounds!

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  March 18, 2020

Remember: Check the sites below frequently for the most timely and credible information.
NC Department of Health and Human Services Covid-19 website
Centers for Disease Control and Prevention website
• For immediate questions/concerns from members of the public, please call 866-462-3821.
• For non-urgent health care provider questions, please email [email protected].
• For urgent provider or local health department questions, please call 919-733-3419 (available 24/7). Please do NOT give this number to patients and members of the public.
• The NCMS website also has culled a list of the most important resources based on what we hear our members are needing. Access our Covid-19 site.

We are grateful to you — the many health care professionals responding selflessly to ensure the health of our communities.

Keeping up with Covid-19 – NC Health Care Coalition Seeks to Coordinate Response

Yesterday, the first virtual meeting of the NC Health Care Coalition brought together the key health care organizations in the state to help ensure open communication, collaboration and coordination of efforts in response to Covid-19. The NC Department of Health and Human Services (NCDHHS) assembled the coalition and NCDHHS Secretary Mandy Cohen, MD, MPH, opened the conference call describing the response to this pandemic as an “unprecedented, historic endeavor.”

She added that North Carolina is taking an “aggressive posture” in response to mitigating and containing the spread of the virus “to make sure the health care system is not overwhelmed.” This has necessitated and will continue to necessitate “difficult choices,” like the closing of the public schools, which has an enormous and multi-faceted impact, she said.

Members of the state’s response team from the Office of Emergency Management Services and NCDHHS outlined the critical areas they are working hard to address including testing and personal protective equipment (PPE) supplies, assessing hospital bed and surge capacity, waivers and payment issues and staffing and child care.

The state is working hard to ramp up testing and PPE supplies. More commercial labs are coming on line to provide tests, thanks in part to the FDA relaxing some of the guidance. Testing supplies are more available, but the screening criteria to have a test remains the same for the moment. PPE shortage is a national issue, and North Carolina is diligently working to obtain this essential equipment, working with the Strategic National Stockpile, which recently delivered a shipment to the state. The distribution of this equipment is being prioritized to acute care and first responders as the state seeks to strategically manage these scarce resources.

Kimberly Clement, MPH, health care preparedness program manager for the NC Office of Emergency Management, outlined how NCDHHS hopes to gather data on bed capacity from hospitals statewide to better assess and allocate necessary resources. In answer to a question, the state is also looking at possible field hospitals or using empty facilities to manage a surge in patients.

Dave Richard, deputy secretary for NC Medicaid said that the state had submitted its 1135 waiver request to the Centers for Medicare and Medicaid Services (CMS) seeking flexibility around physician licensing allowing out-of-state physicians to practice in North Carolina, for instance, and expanding care settings to increase access for patients.

To help ensure adequate health care staffing, the state is working to set up child care facilities with all necessary screening and health protocols in place so health care workers can report to duty. A 1-800 number is being established to help people find child care in their community. Watch your NCMS Morning Rounds and our Covid-19 webpage for that number, once it is set up.

The Coalition will have frequent calls in the coming weeks and months to coordinate efforts. The NCMS will be participating in these meetings and passing key information along to you.

Medicare Telehealth Coverage Update from CMS + HIPAA Regulations Relaxed

[Visit the NCMS Covid-19 webpage for updated information on the commercial insurers’ telehealth policies.]

Yesterday CMS announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their doctors without having to travel to a health care facility. Beginning on March 6, 2020, Medicare will temporarily pay clinicians to provide telehealth services.

Read the Fact Sheet on this announcement

Frequently Asked Questions about Medicare telehealth

In related news, the US Department of Health and Human Services Office for Civil Rights will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA).

Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules.

However, today’s announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.

For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.

Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules.

Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn’t confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.

Additional information can be found at this notice from Department of Health and Human Services (HHS).

NCMS Members/Legislators Offer Covid-19 Insights

Two North Carolina elected officials who also happen to be NCMS member physicians have gone on social media to dispel some of the false information about Covid-19 and offer their insights and advice.

US Rep. Greg Murphy, MD, (R-3rd District) posted this brief, 2-minute video on Twitter explaining why it’s important to ‘flatten the curve’ in response to a public health emergency like Covid-19. Watch the video.

NC Rep. Perrin Jones, MD, (R-Pitt) was a guest on this 14-minute Talk of the Town radio interview, speaking about Covid-19. Listen here.

In the News

Explaining a Mass Quarantine: What Does It Mean to Shelter in Place? And Who Has the Right to Call for It?, STAT, 3-17-20

Learning Opportunity

Blue Cross NC invites provider systems and clinical leaders in telehealth to join a “Virtual Rounds: COVID-19 and Telehealth” on Friday, March 20 beginning at 3 p.m. Leaders from provider systems and practices are invited to learn about Blue Cross NC’s recent measures to expand telehealth services and share your strategies for virtual care response to COVID-19. Register here.