What’s in the COVID stimulus bill for doctors and practices?

When it comes to health care, most of the focus on the $1.9 trillion COVID stimulus bill, formally known as the American Rescue Plan Act, has been on how it will make insurance coverage available or more affordable for more Americans. But the bill also contains provisions that benefit doctors and medical practices.

To learn more about these, Medical Economics spoke with Shari Erickson, MPH, vice president for governmental affairs and medical practice for the American College of Physicians. The interview has been edited for brevity and clarity.

Medical Economics: Let’s dive right in and talk about the ways this law helps doctors and practices.

Shari Erickson: There are three aspects I would highlight. One has to do with coverage for providing vaccines, particularly for practices with any Medicaid population. Provisions in the law will now cover the treatment of Medicaid patients at a matching percentage, or 100% match, to Medicare. So it really helps to improve access for the Medicaid insured population, which are underserved in many cases.

I would add, and this is not a component of the law but is something Medicare recently did, was to increase their payment for COVID vaccine administration to $40. Previously it had been much less, and not sufficient from our perspective to cover the costs associated with doing that.

So those two changes in particular will help practices once they have more vaccines provided to them for provision to their Medicare and Medicaid populations. And as you know, private payers do tend to follow Medicare and we hope that will be the case here.

ME: Getting the vaccine is free for Medicare and Medicaid patients, correct?

SE: Yes, and this law ensures that there would be no beneficiary cost-sharing for Medicaid patients, same as with Medicare.

ME: That’s important given today’s circumstances.

SE: Right. Unfortunately, at this point a lot of community-based practices haven’t yet been able to access COVID vaccines to provide to their patients. But this will certainly apply to the larger hospitals or systems providing vaccine administration to their patients, so we’re hoping that as we move into more vaccine being available that the community-based practices will be included in distribution of the vaccine to their patient populations. They need to become a key part of vaccine provision and we’re hopeful that will happen soon.

ME: Will the greater availability of the vaccine to community health centers make it possible to address some of the inequities we’ve seen in terms of people who’ve been getting vaccinated?

SE: Yes, absolutely, and there’ some funding in this law to help community health centers so they can provide better services to their patients related to COVID vaccinations and treatment. In addition, there’s a significant amount of funding in this law for things like contact tracing and testing and treatment for those who’ve been diagnoses with the virus.

ME: Talk about funding in this law for rural health

SE: There is funding in the law for those providing medical service in rural areas. That includes hospitals as well as physician practices. It includes $8.5 billion in relief funds being made available to those providers.

ME: And will this also help to address vaccination inequities?

SE: Yes, and that’s been a big challenge that we’ve heard from our members and others about across the country.

ME: Is this something the ACP advocated for?

SE: Absolutely. In fact all of these are issues we’ve been advocating for, even prior to the Rescue Act. Trying to achieve greater funding for the vaccination provision, for Medicare to increase the payment, ensuring the Medicaid match was there, continuing to ensure there would be no beneficiary cost sharing for these treatments. And along with that, being sure that if you’re not having beneficiary cost sharing that those practices are made whole because that is something they typically collect. And then ensuring that people in rural and underserved areas are getting the care they should be getting,

ME: It sounds like you’re really trying to not let this crisis go to waste.

SE: I guess every challenge is also an opportunity, and this has certainly been one of the most horrific health challenges our country has ever faced, given not just the number of deaths associated with the virus, but also the morbidity associated with it. There’s a lot more beyond this law we’ll be continuing to advocate for, including ensuring that there is better methodology around the payments so that physician practices can continue to provide access to care.

There were so many practices that have had to shut down or cut back on their services during the pandemic due to the challenges associated with fee-for-service payments. We were able to implement telehealth in a month or two, which has opportunities and challenges associated with it.

We’re trying to figure out how to evolve what we’ve learned out of this whole challenge into something that gets us to a better delivery system where not only is the payment appropriate, but patients are getting the care they need when they need it, using the most appropriate modality, whether through telehealth or an in-person visit or some combination thereof. Ensuring they’re getting the right ongoing care and treatment patients need for the virus or any other ongoing conditions they have. So as challenging as this has all been, we’re hopeful it will serve as a catalyst to get us to really meaningful change in the health care delivery system.

ME: The Paycheck Protection Program was a real lifeline for a lot of practices last year. Is there anything in this new legislation that affects the PPP?

SE: There’s a little bit in there. They have added some more funds into the program and just extended the application deadline to May 31. Also, this law changes the rule in the original PPP that said loan applicants had to have fewer than 500 employees. That prevented some health care entities with multiple practices from applying for PPP loans and left some of those individual practices struggling to keep their doors open. The new law gives the opportunity for some of those smaller sites within a larger entity to receive Paycheck Protection funds, which is another positive development to come out of this.

There were some other changes with regard to some of the loan forgiveness aspects of the PPP which will certainly benefit many practices that have received funds to date and we’re looking forward to finding out more as they roll out more of the rules and guidance around this.

We hoped there would be some additional opportunity for funding for primary care through the Provider Relief Fund. I think there was some additional funding included in it, but it’s not clear if it will really get to everybody that needs it. So we’ll be looking into that more over time.

ME: Are there any changes doctors should know about in how to access these funds?

SE: There is a portal on the SBA website where they can apply for these funds. They need to check with their lenders as well and I believe the website identifies which lenders they may have available to them. So our recommendation is for them to check in with the potential lenders to find out what they need in order to apply for the funds.

It’s not always easy to submit these applications so the sooner they start looking at their ability to apply based on the changes in this law, or if they haven’t applied before, then they should start speaking to some of the available lenders now to determine what they need to submit and be sure they get it in on time.

ME: What do you think are the implications for primary care of the increased subsidies for health insurance premiums in the law and the federal government picking up more of the tab for states that haven’t expanded Medicaid? Will these steps help from a public health perspective, and bring in more patients to your members’ practices?

SE: I think there is a very strong potential for those to occur. It really is a game-changer for people who’ve been un- or underinsured. They have the opportunity now to obtain the tax credits they need in order to purchase coverage through the health insurance exchanges. So I do think our member physician practices should keep an eye out for potential new patients. That is going to be an opportunity and a challenge for primary care practices given that many of them are stretched thin.

Obviously having insurance doesn’t guarantee access, but hopefully some of the additional funds being provided to areas that are underserved would help some of these practices be able to not just keep their heads above water but thrive through being able to bring in additional patients. Or perhaps patients who have been on their rolls but haven’t pursued preventive care would now be able to have access, which we know over the long term is a huge savings to the health care system and certainly better for that patient.

If we are able to move away from being stuck on traditional fee-for-service and move into a space where payments allow doctors and practices to do more proactive outreach to their patient populations, provide more population health care, it would be very beneficial, particularly given that this virus is not going to go away anytime soon, if at all. We need to be able to better manage everyone’s chronic conditions so that if someone is exposed, they would have a better chance of having less morbidity associated with it.

So again, the hope is we can use this challenge as an opportunity to evolve the health care system and payment system to one that really enable practices to be more proactive.

ME: Is there anything else doctors need to know about the impact of the Recovery Act?

SE: The legislation is obviously a huge help from a variety of perspectives. It includes the opportunities for additional health insurance coverage for patients, it includes a few other aspects around vaccine payments and the Paycheck Protection Program and Medicaid coverage.

With that said there’s still more to do and that’s where we’re trying to help our members understand these changes and implement steps they need to be successful with these changes coming at them.

And then we’re working on next steps. For instance, I mentioned that community-based practices haven’t been that involved in vaccine administration to date. Yet they are the practices getting the phone calls from patients about the vaccine, addressing concerns, working to build vaccine confidence. And right now there is no opportunity for physicians to receive any reimbursement for providing consultations around the vaccine, unless they actually provide the vaccine. So that’s a pretty immediate need we’ve identified, and we’ve been working with CMS to try and implement some opportunities for payment around that to go with this increased payment for the Medicaid population as well as the Medicare population. They really go hand in hand if we’re going to try and address getting the entire population vaccinated.

ME: Thank you for your time, this has been very helpful.