May 2020 · 2020-06-03 · • Helping you navigate the federal financial stimulus package through webinar education. Of note, new U.S. House legislation known as the HEROES Act

Publication

of the Chicago

Medical Society

THE MEDICAL

SOCIETY OF

COOK COUNTY

Case Study: Making a Resolution into a Law

Physician Financial Relief

Plasma Drive Helps COVID-19 Patients

Has the COVID-19 Emergency Finally Given Telemedicine Its Day?

May 2020 | www.cmsdocs.org

Telemedicine

Publication

of the Chicago

Medical Society

THE MEDICAL

SOCIETY OF

COOK COUNTY

Case Study: Making a Resolution into a Law

Physician Financial Relief

Plasma Drive Helps COVID-19 Patients

Has the COVID-19 Emergency Finally Given Telemedicine Its Day?

May 2020 | www.cmsdocs.org

Telemedicine

http://www.cmsdocs.org

Have you or someone you know recovered from COVID-19?

We need your help now.

The simple act of donating your blood may save lives.

You can be a hero and make a difference. Go to covid19chi.org

SCAN HERE

Have you or someone you know recovered from COVID-19?

We need your help now.

The simple act of donating your

blood may save lives.

You can be a hero and make a

difference. Go to covid19chi.org

SCAN HERE

http://www.covid19chi.org

Volume 123 Issue 5 May 2020

PRESIDENT’S MESSAGE2 Preparing You for Life Post-COVID-19By A. Jay Chauhan, DO, FAOCO

PRACTICE MANAGEMENT4 Telehealth’s New Relevancy in an Age of COVID-19

PUBLIC HEALTH8 Case Study: Making a Resolution into a Law; Hope for COVID-19 Patients; AMA: Caution on Antibody Testing; Poll: Half of U.S. Adults Delayed Medical Care

FINANCE12 A Land of Opportunity

LEGAL13 Medicare Payments Hit Pause

14 Physician Financial Relief

16 COVID-19: Doctor Pay Cuts

HEALTHCARE INNOVATION18 The Adaptable Physician

MEMBER BENEFITS 28 How CMS Works for You

30 Calendar of Events

31 Classifieds

WHO’S WHO32 Striving to Make the World a Better PlaceDaniel Johnson, MD, is founder and director of ECHO-Chicago, an urban focused education outreach program for healthcare providers that uses high-end videoconferencing technology to help spread knowledge to underserved areas.

FEATURES20 Has the COVID-19 Emergency Finally Given Telemedicine Its Day?With the pandemic in full force, healthcare providers are encouraging patients to receive care remotely. Will telemedicine simply become medicine? By Howard Wolinsky

20

May 2020 | www.cmsdocs.org | 1

Volume 123 Issue 5 May 2020

PRESIDENT’S MESSAGE2 Preparing You for Life Post-COVID-19By A. Jay Chauhan, DO, FAOCO

PRACTICE MANAGEMENT4 Telehealth’s New Relevancy in an Age of COVID-19

PUBLIC HEALTH8 Case Study: Making a Resolution into a Law; Hope for COVID-19 Patients; AMA: Caution on Antibody Testing; Poll: Half of U.S. Adults Delayed Medical Care

FINANCE12 A Land of Opportunity

LEGAL13 Medicare Payments Hit Pause

14 Physician Financial Relief

16 COVID-19: Doctor Pay Cuts

HEALTHCARE INNOVATION18 The Adaptable Physician

MEMBER BENEFITS 28 How CMS Works for You

30 Calendar of Events

31 Classifieds

WHO’S WHO32 Striving to Make the World a Better PlaceDaniel Johnson, MD, is founder and director of ECHO-Chicago, an urban focused education outreach program for healthcare providers that uses high-end videoconferencing technology to help spread knowledge to underserved areas.

FEATURES20 Has the COVID-19 Emergency Finally Given Telemedicine Its Day?With the pandemic in full force, healthcare providers are encouraging patients to receive care remotely. Will telemedicine simply become medicine? By Howard Wolinsky

20



MESSAGE FROM THE PRESIDENT

EDITORIAL & ARTE X E C U T I V E D I R E C T O R

Theodore D. Kanellakes

C R E AT I V E D I R E C T O R

Thomas Miller | @thruform

E D I T O R / E D I T O R I A L

Elizabeth C. Sidney

E D I T O R I A L C O N S U LTA N T

Cheryl England

C O N T R I B U T O R S

A. Jay Chauhan, DO, FAOCO; Melinda S. Malecki, JD, MS; Anthony

Pellegrino; Robert Perlmuter, MD; Jim Watson, MBA; Howard Wolinsky

ADVERTISING

Fox Associates, Inc. 800-440-0231

[email protected] Chicago • New York • Los Angeles

Detroit • Phoenix

CHICAGO MEDICAL SOCIETY

OFFICERS OF THE SOCIETY

P R E S I D E N T

A. Jay Chauhan, DO

P R E S I D E N T - E L E C T

Tariq Butt, MD

S E C R E TA R Y

Raj B. Lal, MD

T R E A S U R E R

Tariq Butt, MD C H A I R O F T H E C O U N C I L

Christine P. Bishof, MD

V I C E C H A I R O F T H E C O U N C I L

Victor M. Romano, MD

I M M E D I AT E P A S T P R E S I D E N T

Vemuri S. Murthy, MD

CHICAGO MEDICINE 515 N. Dearborn St.Chicago IL 60654

312-670-2550www.cmsdocs.org

Chicago Medicine (ISSN 0009-3637 is published monthly for $30 per year by the Chicago Medical Society, 515 N. Dearborn St. Chicago, IL. 60654. Periodicals postage paid at Chicago, IL. and additional mailing offices. Postmaster: Send address changes to Chicago Medicine, 515 N. Dearborn St., Chicago, IL 60654. Telephone: 312-670-2550. Copyright 2020, Chicago Medicine. All rights reserved.

Preparing You for Life Post-COVID-19

THE CHICAGO Medical Society is committed to helping physicians and their practices navigate the coronavirus crisis long-term.

Since the onset, we’ve been assessing the impact on employed physicians and those in small

practices. CMS wants to hear from you, so please take a few minutes to respond to our timely polls.

When it comes to practice support and education we’re working for you and rolling out new member benefits to secure your future. They include:

• Partnering with digital health startup PhysIQ to bring remote patient monitoring technology to physicians, hospitals and health systems at reduced cost.

• Helping physicians procure PPE through a medical supply purchasing program. We know from recent surveys our members need help and we plan to answer that need under a new service with the company Professional Medical (ProMed).

• Developing HIPAA-compliant telemedicine services for members. This comes after our polling data show 80% of respondents are using telemedicine, up from 7% prior to the Covid-19 outbreak. Many of you, 43%, said you would consider using a telemedicine service provided by the Chicago Medical Society.

• Preparing physicians to open up their practices. A recent educational webinar delved into the legal implications and safety issues. The program offered strategies to ensure the safety of healthcare providers and patients.

• Helping you navigate the federal financial stimulus package through webinar education. Of note, new U.S. House legislation known as the HEROES Act proposes another $3 trillion infusion. The bill provides funding for struggling practices, improvements to the Medicare Accelerated and Advance Payment Program, and haz-ard pay for physicians. It expedites visas for IMGs to enter the country for training and patient care, permanently authorizing the Conrad 30 Program.

On behalf of patients, the Chicago Medical Society has renewed its historic public health mission through our ongoing plasma collection project, which includes:

• Spearheading a media campaign to obtain convalescent plasma from recovered Covid-19 patients.

• Providing hospitals with plasma through our arrangement with Vitalant Blood Bank. • Planning for a second major plasma drive should the FDA grant approval for the

use of convalescent plasma in outpatients who have a Covid-19 diagnosis but are not seriously ill.

• Working with stakeholders to supply plasma for research aimed at identifying the best antibodies that could neutralize the virus.

Visit our Covid-19 Plasma Collection site at covid19chi.org to learn more.

As you can see, we are taking the Chicago Medical Society in a new and exciting direction. Please continue to share your voice through our polls or email me directly at [email protected].

A. Jay Chauhan, DO, FAOCOPresident, Chicago Medical Society

2 | Chicago Medicine | May 2020

MESSAGE FROM THE PRESIDENT

EDITORIAL & ARTE X E C U T I V E D I R E C T O R

Theodore D. Kanellakes

C R E AT I V E D I R E C T O R

Thomas Miller | @thruform

E D I T O R / E D I T O R I A L

Elizabeth C. Sidney

E D I T O R I A L C O N S U LTA N T

Cheryl England

C O N T R I B U T O R S

A. Jay Chauhan, DO, FAOCO; Melinda S. Malecki, JD, MS; Anthony

Pellegrino; Robert Perlmuter, MD; Jim Watson, MBA; Howard Wolinsky

ADVERTISING

Fox Associates, Inc. 800-440-0231

[email protected] Chicago • New York • Los Angeles

Detroit • Phoenix

CHICAGO MEDICAL SOCIETY

OFFICERS OF THE SOCIETY

P R E S I D E N T

A. Jay Chauhan, DO

P R E S I D E N T - E L E C T

Tariq Butt, MD

S E C R E TA R Y

Raj B. Lal, MD

T R E A S U R E R

Tariq Butt, MD C H A I R O F T H E C O U N C I L

Christine P. Bishof, MD

V I C E C H A I R O F T H E C O U N C I L

Victor M. Romano, MD

I M M E D I AT E P A S T P R E S I D E N T

Vemuri S. Murthy, MD

CHICAGO MEDICINE 515 N. Dearborn St.Chicago IL 60654

312-670-2550www.cmsdocs.org

Chicago Medicine (ISSN 0009-3637 is published monthly for $30 per year by the Chicago Medical Society, 515 N. Dearborn St. Chicago, IL. 60654. Periodicals postage paid at Chicago, IL. and additional mailing offices. Postmaster: Send address changes to Chicago Medicine, 515 N. Dearborn St., Chicago, IL 60654. Telephone: 312-670-2550. Copyright 2020, Chicago Medicine. All rights reserved.

Preparing You for Life Post-COVID-19

THE CHICAGO Medical Society is committed to helping physicians and their practices navigate the coronavirus crisis long-term.

Since the onset, we’ve been assessing the impact on employed physicians and those in small

practices. CMS wants to hear from you, so please take a few minutes to respond to our timely polls.

When it comes to practice support and education we’re working for you and rolling out new member benefits to secure your future. They include:

• Partnering with digital health startup PhysIQ to bring remote patient monitoring technology to physicians, hospitals and health systems at reduced cost.

• Helping physicians procure PPE through a medical supply purchasing program. We know from recent surveys our members need help and we plan to answer that need under a new service with the company Professional Medical (ProMed).

• Developing HIPAA-compliant telemedicine services for members. This comes after our polling data show 80% of respondents are using telemedicine, up from 7% prior to the Covid-19 outbreak. Many of you, 43%, said you would consider using a telemedicine service provided by the Chicago Medical Society.

• Preparing physicians to open up their practices. A recent educational webinar delved into the legal implications and safety issues. The program offered strategies to ensure the safety of healthcare providers and patients.

• Helping you navigate the federal financial stimulus package through webinar education. Of note, new U.S. House legislation known as the HEROES Act proposes another $3 trillion infusion. The bill provides funding for struggling practices, improvements to the Medicare Accelerated and Advance Payment Program, and haz-ard pay for physicians. It expedites visas for IMGs to enter the country for training and patient care, permanently authorizing the Conrad 30 Program.

On behalf of patients, the Chicago Medical Society has renewed its historic public health mission through our ongoing plasma collection project, which includes:

• Spearheading a media campaign to obtain convalescent plasma from recovered Covid-19 patients.

• Providing hospitals with plasma through our arrangement with Vitalant Blood Bank. • Planning for a second major plasma drive should the FDA grant approval for the

use of convalescent plasma in outpatients who have a Covid-19 diagnosis but are not seriously ill.

• Working with stakeholders to supply plasma for research aimed at identifying the best antibodies that could neutralize the virus.

Visit our Covid-19 Plasma Collection site at covid19chi.org to learn more.

As you can see, we are taking the Chicago Medical Society in a new and exciting direction. Please continue to share your voice through our polls or email me directly at [email protected].

A. Jay Chauhan, DO, FAOCOPresident, Chicago Medical Society


http://www.twitter.com/thruform

mailto:[email protected]

www.cms.org

http://covid19chi.org


Tirelessly defending the practice of

GOOD MEDICINE.We’re taking the mal out of malpractice insurance. By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal. See how at thedoctors.com

7604_IL_Chicago_Medicine_PD_May2020_v1.indd 17604_IL_Chicago_Medicine_PD_May2020_v1.indd 1 4/6/20 2:34 PM4/6/20 2:34 PM

Tirelessly defending the practice of

GOOD MEDICINE.We’re taking the mal out of malpractice insurance. By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal. See how at thedoctors.com

7604_IL_Chicago_Medicine_PD_May2020_v1.indd 1 4/6/20 2:34 PM

PRACTICE MANAGEMENT

TELEHEALTH HAS long been promised as a tool that could be used to leapfrog advances in access to care. Over recent years, the utility of telehealth has been clearly demonstrated, yet its

progression into the mainstream has been stalled as payers struggled with finalizing details around cov-erage and reimbursement. More recently, healthcare providers and healthcare payers have found ways to provide telehealth coverage, often via an add-on or carve-out on a per visit basis.

As of January 1, 2020, tele-behavioral health cov-erage was mandated for ACA plans. In many ways, this set the stage for what is now an almost overnight phenomenon driven by COVID-19. As the spread of the novel coronavirus evolved into a pandemic, the federal government and commercial payers moved with unprecedented speed to allow for the expansion of virtual health visits. Effective March 6, CMS is temporarily allowing Medicare and Medicare Advantage to reimburse clinicians for telehealth services provided to beneficiaries across the country in all care settings at the same rate as in-person visits. Healthcare Service Corporation/BlueCross BlueShield also announced coverage for telehealth visits, with all major insurers following closely.

What is Now Covered• Expanded Telehealth Coverage via COVID-19

Public Health Emergency (PHE): Effective for services starting March 6, 2020, and for the dura-tion of the COVID-19 Public Health Emergency, Medicare will pay for Medicare telehealth services furnished to patients in broader circum-stances. For example, Medicare recipients will be allowed to use telehealth services to replace common office visits, including evaluation and management appointments, behavioral health counseling and preventive health screenings.

• Expanded Telehealth Coverage via Expanded Sites of Service: Starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings (previ-ous Medicare coverage was limited to very spe-cific settings). Medicare will pay for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

• Considered same as in-person visits and paid at same rate: These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.

• No costly technology required: The new waiver explicitly allows HHS to authorize the use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. In addition, effective immediately, the HHS OCR will exercise enforcement discretion and waive penalties for noncompliance with HIPAA Rules against providers that serve patients in good faith through communication technologies listed in the Notification of Enforcement Discretion for Telehealth. Appointments can be conducted over a smartphone with video capability or any device using video technology, such as a tablet or a laptop. For some appointments a simple check-in over the phone without video capabilities may suffice.

• Patient Cost Share Waiver: The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

Questions Healthcare Organizations Should ConsiderThere are three types of virtual visits. (See “Type of Service” on page 5).

Can I get paid for telehealth services? Medicare has issued codes and reimbursement amounts for all three levels of care. BCBSIL has done the same. Billing and payment:

• Clinicians can bill immediately for dates of ser-vice starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services.

• Medicare telehealth services are generally billed as if the service had been furnished in-person.

• For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.

• Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibil-ity for healthcare providers to reduce or waive

Telehealth’s New Relevancy in an Age of COVID-19Evolving to the virtual care of tomorrow By Jim Watson, MBA


PRACTICE MANAGEMENT

TELEHEALTH HAS long been promised as a tool that could be used to leapfrog advances in access to care. Over recent years, the utility of telehealth has been clearly demonstrated, yet its

progression into the mainstream has been stalled as payers struggled with finalizing details around cov-erage and reimbursement. More recently, healthcare providers and healthcare payers have found ways to provide telehealth coverage, often via an add-on or carve-out on a per visit basis.

As of January 1, 2020, tele-behavioral health cov-erage was mandated for ACA plans. In many ways, this set the stage for what is now an almost overnight phenomenon driven by COVID-19. As the spread of the novel coronavirus evolved into a pandemic, the federal government and commercial payers moved with unprecedented speed to allow for the expansion of virtual health visits. Effective March 6, CMS is temporarily allowing Medicare and Medicare Advantage to reimburse clinicians for telehealth services provided to beneficiaries across the country in all care settings at the same rate as in-person visits. Healthcare Service Corporation/BlueCross BlueShield also announced coverage for telehealth visits, with all major insurers following closely.

What is Now Covered• Expanded Telehealth Coverage via COVID-19

Public Health Emergency (PHE): Effective for services starting March 6, 2020, and for the dura-tion of the COVID-19 Public Health Emergency, Medicare will pay for Medicare telehealth services furnished to patients in broader circum-stances. For example, Medicare recipients will be allowed to use telehealth services to replace common office visits, including evaluation and management appointments, behavioral health counseling and preventive health screenings.

• Expanded Telehealth Coverage via Expanded Sites of Service: Starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings (previ-ous Medicare coverage was limited to very spe-cific settings). Medicare will pay for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

• Considered same as in-person visits and paid at same rate: These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.

• No costly technology required: The new waiver explicitly allows HHS to authorize the use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. In addition, effective immediately, the HHS OCR will exercise enforcement discretion and waive penalties for noncompliance with HIPAA Rules against providers that serve patients in good faith through communication technologies listed in the Notification of Enforcement Discretion for Telehealth. Appointments can be conducted over a smartphone with video capability or any device using video technology, such as a tablet or a laptop. For some appointments a simple check-in over the phone without video capabilities may suffice.

• Patient Cost Share Waiver: The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

Questions Healthcare Organizations Should ConsiderThere are three types of virtual visits. (See “Type of Service” on page 5).

Can I get paid for telehealth services? Medicare has issued codes and reimbursement amounts for all three levels of care. BCBSIL has done the same. Billing and payment:

• Clinicians can bill immediately for dates of ser-vice starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services.

• Medicare telehealth services are generally billed as if the service had been furnished in-person.

• For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.

• Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibil-ity for healthcare providers to reduce or waive

Telehealth’s New Relevancy in an Age of COVID-19Evolving to the virtual care of tomorrow By Jim Watson, MBA


PRACTICE MANAGEMENT

cost-sharing for telehealth visits by paid federal healthcare programs.

• For more information: read the CMS Fact Sheet and Frequently Asked Questions on the CMS website.

• To view HCSC/BCBSIL telehealth coverage announcements, visit www.bcbsil.com.

What do patients know about telehealth? Most payers have sent communications to their members related to COVID-19 and coverage for telehealth and testing. As time passes, more and more patients will be interested in telehealth, especially those who require non-urgent or behavioral health services that can be conducted virtually. During this period of office closures, we expect that telehealth may become a prime revenue generator as patients continue to try to mitigate their risk of exposure to COVID-19. With this in mind, you are well served to understand telehealth, and be proactive in educating your patient base.

The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal. Standard Part B cost-sharing applies to both. In addition, separate from these virtual check-in services, captured video or images can be sent to a physician (HCPCS code G2010).

• HCPCS code G2012: Brief communication technology-based service, such as virtual check- in, by a physician or other qualified healthcare professional who can report evaluation and

management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appoint-ment; 5-10 minutes of medical discussion.

• HCPCS code G2010: Remote evaluation of recorded video or images submitted by an estab-lished patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

E-Visits In all types of locations including the patient’s home, and in all areas, established Medicare patients may have non-face-to-face patient- initiated communications with their doctors without going to the doctor’s office by using online patient portals. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

• These services can only be reported when the billing practice has an established relationship with the patient.

• For e-visits, the patient must generate the initial inquiry; communications can occur over a 7-day period.

• The patient must verbally consent to receive

Type of Service What Is the Service HCPCS/CPT Code

Patient Relationship with Provider

Medicare Telehealth Visits

A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include:

• 99201-99215 (Office or other outpatient visits)• G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)• G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

For a complete list go to www.cms.gov.

For new* or established patients.

To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency

Virtual Check-In

A brief (5-10 minutes) check-in with the practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

• HCPCS code G2012• HCPCS code G2010

For established patients

E-Visits A communication between a patient and provider through an online patient portal.

• 99431• 99422• 99423• G2061• G2062• G2063



PRACTICE MANAGEMENT

cost-sharing for telehealth visits by paid federal healthcare programs.

• For more information: read the CMS Fact Sheet and Frequently Asked Questions on the CMS website.

• To view HCSC/BCBSIL telehealth coverage announcements, visit www.bcbsil.com.

What do patients know about telehealth? Most payers have sent communications to their members related to COVID-19 and coverage for telehealth and testing. As time passes, more and more patients will be interested in telehealth, especially those who require non-urgent or behavioral health services that can be conducted virtually. During this period of office closures, we expect that telehealth may become a prime revenue generator as patients continue to try to mitigate their risk of exposure to COVID-19. With this in mind, you are well served to understand telehealth, and be proactive in educating your patient base.

The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal. Standard Part B cost-sharing applies to both. In addition, separate from these virtual check-in services, captured video or images can be sent to a physician (HCPCS code G2010).

• HCPCS code G2012: Brief communication technology-based service, such as virtual check- in, by a physician or other qualified healthcare professional who can report evaluation and

management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appoint-ment; 5-10 minutes of medical discussion.

• HCPCS code G2010: Remote evaluation of recorded video or images submitted by an estab-lished patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

E-Visits In all types of locations including the patient’s home, and in all areas, established Medicare patients may have non-face-to-face patient- initiated communications with their doctors without going to the doctor’s office by using online patient portals. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

• These services can only be reported when the billing practice has an established relationship with the patient.

• For e-visits, the patient must generate the initial inquiry; communications can occur over a 7-day period.

• The patient must verbally consent to receive

Type of Service What Is the Service HCPCS/CPT Code

Patient Relationship with Provider

Medicare Telehealth Visits

A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include:

• 99201-99215 (Office or other outpatient visits)• G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)• G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

For a complete list go to www.cms.gov.

For new* or established patients.

To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency

Virtual Check-In

A brief (5-10 minutes) check-in with the practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

• HCPCS code G2012• HCPCS code G2010


E-Visits A communication between a patient and provider through an online patient portal.

• 99431• 99422• 99423• G2061• G2062• G2063



http://www.bcbsil.com

http://www.cms.gov


PRACTICE MANAGEMENT

MEDICARE PATIENTS may use tele-communication technology for office, hospital visits and other services that generally occur in-person.

• The provider must use an interactive audio and video telecommunications system that permits real-time com-munication between the distant site and the patient at home.

• Distant site practitioners who can furnish and receive payment for covered telehealth services (subject to state law) can include physicians, nurse practitioners, physician assis-tants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.

• CMS is waiving the requirement that you must have a prior existing

relationship with a patient and is providing flexibility for providers to reduce or waive cost-sharing for telehealth visits.

Virtual Check-Ins In all areas, established Medicare patients in their home may have a brief communication service with practitio-ners via several communication technol-ogy modalities, including a synchronous discussion over a telephone or the exchange of information through video or image. We expect that these virtual services will be initiated by the patient; however, practitioners may need to edu-cate beneficiaries on the availability of the service prior to the patient initiation. Medicare pays for “virtual check- ins” (or brief communication technology-based service) for patients to communicate

with their doctors in order to avoid unnecessary trips to the doctor’s office. • Virtual check-ins are for patients with

an established (or existing) relationship with a physician or certain practitio-ners where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).

• The patient must verbally consent to receive virtual check-in services.

• The Medicare coinsurance and deductible would generally apply to these services.

Doctors and certain practitioners may bill for these virtual check-in services furnished through several communica-tion technology modalities, such as telephone (HCPCS code G2012).

Telehealth Visits

virtual check-in services. The Medicare coinsur-ance and deductible would apply to these services.

Medicare Part B also pays for e-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits can bill these codes:

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes.

• 99422: Online digital evaluation and manage-ment service, for an established patient, for up to 7 days cumulative time during the 7 days; 11–20 minutes.

• 99423: Online digital evaluation and manage-ment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evalu-ation and management visits (for example, physical therapists or clinical psychologists) can also provide these e-visits and bill the following codes:

• G2061: Qualified non-physician healthcare professional online assessment and manage-ment, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes.

• G2062: Qualified non-physician healthcare profes-sional online assessment and management service,

for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes.

• G2063: Qualified non-physician qualified healthcare professional assessment and manage-ment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Strategic ConsiderationsDuring the pandemic, the broad deployment of telehealth is more of an infection control strategy than a business strategy. As you think through telehealth as a longer-term care delivery strategy and a business strategy, consider these questions:

• Do we want patients/consumers to become accustomed to the quick, convenient model of virtual check ins and e-visits?

• How will this affect competition across indepen-dent physicians, employed medical groups and even payers who will likely enter this space to control revenue streams and referral patterns?

• How does your practice strategy align with the broader industry trend of private equity (PE) investment in consumer-driven delivery models like telehealth?

• How do you balance activating and engaging your patient base to telehealth, while protecting your revenue levels from historical in-person visits?

Jim Watson, MBA, is a principal, healthcare advi-sory, for the BDO Center for Healthcare Excellence & Innovation. Contact him at: [email protected].


PRACTICE MANAGEMENT

MEDICARE PATIENTS may use tele-communication technology for office, hospital visits and other services that generally occur in-person.

• The provider must use an interactive audio and video telecommunications system that permits real-time com-munication between the distant site and the patient at home.

• Distant site practitioners who can furnish and receive payment for covered telehealth services (subject to state law) can include physicians, nurse practitioners, physician assis-tants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.

• CMS is waiving the requirement that you must have a prior existing

relationship with a patient and is providing flexibility for providers to reduce or waive cost-sharing for telehealth visits.

Virtual Check-Ins In all areas, established Medicare patients in their home may have a brief communication service with practitio-ners via several communication technol-ogy modalities, including a synchronous discussion over a telephone or the exchange of information through video or image. We expect that these virtual services will be initiated by the patient; however, practitioners may need to edu-cate beneficiaries on the availability of the service prior to the patient initiation. Medicare pays for “virtual check- ins” (or brief communication technology-based service) for patients to communicate

with their doctors in order to avoid unnecessary trips to the doctor’s office. • Virtual check-ins are for patients with

an established (or existing) relationship with a physician or certain practitio-ners where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).

• The patient must verbally consent to receive virtual check-in services.

• The Medicare coinsurance and deductible would generally apply to these services.

Doctors and certain practitioners may bill for these virtual check-in services furnished through several communica-tion technology modalities, such as telephone (HCPCS code G2012).

Telehealth Visits

virtual check-in services. The Medicare coinsur-ance and deductible would apply to these services.

Medicare Part B also pays for e-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits can bill these codes:

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes.

• 99422: Online digital evaluation and manage-ment service, for an established patient, for up to 7 days cumulative time during the 7 days; 11–20 minutes.

• 99423: Online digital evaluation and manage-ment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evalu-ation and management visits (for example, physical therapists or clinical psychologists) can also provide these e-visits and bill the following codes:

• G2061: Qualified non-physician healthcare professional online assessment and manage-ment, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes.

• G2062: Qualified non-physician healthcare profes-sional online assessment and management service,

for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes.

• G2063: Qualified non-physician qualified healthcare professional assessment and manage-ment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Strategic ConsiderationsDuring the pandemic, the broad deployment of telehealth is more of an infection control strategy than a business strategy. As you think through telehealth as a longer-term care delivery strategy and a business strategy, consider these questions:

• Do we want patients/consumers to become accustomed to the quick, convenient model of virtual check ins and e-visits?

• How will this affect competition across indepen-dent physicians, employed medical groups and even payers who will likely enter this space to control revenue streams and referral patterns?

• How does your practice strategy align with the broader industry trend of private equity (PE) investment in consumer-driven delivery models like telehealth?

• How do you balance activating and engaging your patient base to telehealth, while protecting your revenue levels from historical in-person visits?

Jim Watson, MBA, is a principal, healthcare advi-sory, for the BDO Center for Healthcare Excellence & Innovation. Contact him at: [email protected].



http://www.goldstonefinancialgroup.com

PUBLIC HEALTH

DAVID J. PALMER, MD, clinical associate professor in the Department of Ophthalmology at Northwestern Medicine and a Chicago Medical Soci-ety member, had an 85-year-old female

patient who was having discomfort after her cataract surgery. He knew that she had both financial and transportation issues that would prevent her from get-ting to a pharmacy to have a prescription filled to ease the discomfort. Yet, he also knew that he couldn’t give her the remaining ointment that he had been using at the hospital for the discomfort to take home with her.

“For a number of years, I’ve been bothered by the fact that perfectly good topical medications were being discarded in the operating room and emergency room after only a couple of uses instead of being given to the patient,” said Dr. Palmer. “On some occasions, my colleagues would give medica-tions to patients to take home but they would be reported since the practice violated hospital policy.”

So Dr. Palmer decided to do something to both help his patients and curb hospital wastage. In 2019, he authored a resolution to the Chicago Medical Society—Topical Operating Room or Emergency Room Medications for Post-discharge Patient Use—that required CMS and the Illinois State Medical Society to pursue legislation that would allow patients to take home unused topical medications post-surgery that were needed for healing. The resolution was adopted as written by both CMS and ISMS, becoming policy for both Societies. It is now bound for the American Medical Association. In February of this year, the resolution was introduced into the Illinois 101st General Assembly by Senator Laura Fine (D) as SB 3266 “An ACT Concerning Health.”

Making AmendmentsIn short, SB 3266 amends the Illinois Hospital Act, the Ambulatory Surgical Treatment Center Act, the

Hospital Licensing Act, and the Pharmacy Practice Act. It requires hospitals, facilities, and pharmacies to offer a patient any unused portion of a facility-provided medication upon discharge when it is administered to a patient at the hospital, facility, or pharmacy and is required for continuing treatment.

“We are talking about topical medications that patients need for healing—and for which they have already been charged by the hospital,” said Dr. Palmer. The “Illinois Pharmacy Practice Act and other Acts, in addition to surgical facility policies, cause impediments to this practice. Hospitals and their pharmacies are often not staffed to imple-ment the Pharmacy Practice Act as it is written. For example, many hospital pharmacies are not equipped to label medications per the requirements of the Pharmacy Practice Act or counsel patients on medication usage. We either needed to modify existing facility policies or change the Acts.”

In preparing the resolution, Dr. Palmer contacted many subspecialties, finding that there was widespread agreement that the practice of discarding unused topical medications was a prob-lematic issue in hospitals, often creating duplicate costs to patients when repurchasing the same medication post-discharge. The Illinois Society of Eye Physicians and Surgeons consequently sent a survey to 700 ophthalmologists statewide asking about their experience. While the survey is not yet public, Dr. Palmer stated the results showed that quality of care was affected negatively when patients were not given their medications to take home. For example, physicians reported seeing more infections and inflammation after surgery when patients who had barriers such as transporta-tion, cost or home support to getting prescriptions filled were not sent home with unused medication.

Dr. Palmer credits CMS with helping him reach out to other specialties while researching his resolution and for enthusiastically supporting the

Case Study: Making a Resolution into a LawCMS member’s proposal evolves into a bill By Cheryl England

THE CHICAGO Medical Society wants to hear from you! As the leading voice of physicians in Cook County, CMS advances many proposals to the Illinois State Medical Society and the American Medical Association. CMS’ resolutions process allows all mem-

bers to influence policy and action. Resolutions document a problem and propose action CMS should undertake. They shape our legislative agenda, our conversations with lawmakers, our policy goals and objectives.

When you introduce a resolution

to CMS you join a grassroots coalition working to improve physician practice and healthcare at all levels.

If you are new to the resolution-writing process, CMS offers help with the wording and format. To learn more, please call 312-670-2550.

Call for Resolutions


PUBLIC HEALTH

DAVID J. PALMER, MD, clinical associate professor in the Department of Ophthalmology at Northwestern Medicine and a Chicago Medical Soci-ety member, had an 85-year-old female

patient who was having discomfort after her cataract surgery. He knew that she had both financial and transportation issues that would prevent her from get-ting to a pharmacy to have a prescription filled to ease the discomfort. Yet, he also knew that he couldn’t give her the remaining ointment that he had been using at the hospital for the discomfort to take home with her.

“For a number of years, I’ve been bothered by the fact that perfectly good topical medications were being discarded in the operating room and emergency room after only a couple of uses instead of being given to the patient,” said Dr. Palmer. “On some occasions, my colleagues would give medica-tions to patients to take home but they would be reported since the practice violated hospital policy.”

So Dr. Palmer decided to do something to both help his patients and curb hospital wastage. In 2019, he authored a resolution to the Chicago Medical Society—Topical Operating Room or Emergency Room Medications for Post-discharge Patient Use—that required CMS and the Illinois State Medical Society to pursue legislation that would allow patients to take home unused topical medications post-surgery that were needed for healing. The resolution was adopted as written by both CMS and ISMS, becoming policy for both Societies. It is now bound for the American Medical Association. In February of this year, the resolution was introduced into the Illinois 101st General Assembly by Senator Laura Fine (D) as SB 3266 “An ACT Concerning Health.”

Making AmendmentsIn short, SB 3266 amends the Illinois Hospital Act, the Ambulatory Surgical Treatment Center Act, the

Hospital Licensing Act, and the Pharmacy Practice Act. It requires hospitals, facilities, and pharmacies to offer a patient any unused portion of a facility-provided medication upon discharge when it is administered to a patient at the hospital, facility, or pharmacy and is required for continuing treatment.

“We are talking about topical medications that patients need for healing—and for which they have already been charged by the hospital,” said Dr. Palmer. The “Illinois Pharmacy Practice Act and other Acts, in addition to surgical facility policies, cause impediments to this practice. Hospitals and their pharmacies are often not staffed to imple-ment the Pharmacy Practice Act as it is written. For example, many hospital pharmacies are not equipped to label medications per the requirements of the Pharmacy Practice Act or counsel patients on medication usage. We either needed to modify existing facility policies or change the Acts.”

In preparing the resolution, Dr. Palmer contacted many subspecialties, finding that there was widespread agreement that the practice of discarding unused topical medications was a prob-lematic issue in hospitals, often creating duplicate costs to patients when repurchasing the same medication post-discharge. The Illinois Society of Eye Physicians and Surgeons consequently sent a survey to 700 ophthalmologists statewide asking about their experience. While the survey is not yet public, Dr. Palmer stated the results showed that quality of care was affected negatively when patients were not given their medications to take home. For example, physicians reported seeing more infections and inflammation after surgery when patients who had barriers such as transporta-tion, cost or home support to getting prescriptions filled were not sent home with unused medication.

Dr. Palmer credits CMS with helping him reach out to other specialties while researching his resolution and for enthusiastically supporting the

Case Study: Making a Resolution into a LawCMS member’s proposal evolves into a bill By Cheryl England

THE CHICAGO Medical Society wants to hear from you! As the leading voice of physicians in Cook County, CMS advances many proposals to the Illinois State Medical Society and the American Medical Association. CMS’ resolutions process allows all mem-

bers to influence policy and action. Resolutions document a problem and propose action CMS should undertake. They shape our legislative agenda, our conversations with lawmakers, our policy goals and objectives.

When you introduce a resolution

to CMS you join a grassroots coalition working to improve physician practice and healthcare at all levels.

If you are new to the resolution-writing process, CMS offers help with the wording and format. To learn more, please call 312-670-2550.

Call for Resolutions


resolution’s adoption by ISMS. And Dr. Palmer himself is no newcomer to writing resolutions that turn into law. For example, in 2015 he co-wrote a resolution that became HB 3137, “Topical Eye Medication Prescription Act.” It was introduced into the 99th General Assembly by Senator Fine, passed in the legislature and became effective January 1, 2016. The bill basically states that com-mercial insurers must offer refills on prescriptions of topical eye medications to patients at the co-pay rate after at least 23 days of use.

Current groups to date supporting SB 3266 include the Illinois Society of Plastic Surgeons, Illinois Dermatological Society, Chicago Laryngological and Otological Society, Illinois College of Emergency Physicians, American Academy of Ophthalmology, American Glaucoma Society, and the American Society of Cataract and Refractive Surgery.

Next Up: Multi-dose MedicationsWhile Dr. Palmer, CMS and ISMS are currently forging ahead on a statewide solution that allows patients to take topical medications home from the hospital, Dr. Palmer is also eying possible future related legislation to save cost, prevent waste, and protect the environment. Of particular interest is the issue of allowing multi-dose topical medications, such as eye drops, to be used on multiple patients. Currently the practice is broadly prohibited by the U.S. Department of Health and Human Services due to safety concerns.

A recent study, conducted in conjunction with the University of Michigan at the Aravind Eye Hospital system in southern India, looked at potential bottle tip contamination in multi-use situations. The primary objective of the study was to evaluate for contamination between bottle tip and the ocular surface or adnexa when trained assistants administer eyedrops to patients. The assistants used multidose containers of eyedrops in the preoperative setting. A total of 1839 patients were videographically studied. The authors concluded that when ancillary staff is trained on the proper eyedrop instillation technique, there was no contact with the patients’ ocular adnexae or microbial contamination of the dropper tip. In addition, the study concludes, “The use of multi-dose preoperative eyedrops for cataract surgery is safe, cost-effective, and eliminates waste.”

The amount of money saved in using multi-dose medications on multiple patients in the operating room is substantial. A study published in JAMA Ophthalmology on August 1, 2019, investigated the financial cost of unused medications in cataract surgery. The study included four surgical sites in the northeastern United States. A total of 116 unique drugs were surveyed among the four centers.

The study found that unused quantities of surveyed drugs averaged 45% at all four centers with a mean of $148 per case. When doing a cost analysis, the study found that the ambulatory care center (the unit with

the greatest surgical volume) had the highest unused drug cost per case followed sequentially by the tertiary care center, federally run medical center, and outpa-tient center. Considering that about 3.8 million cataract procedures are performed in the U.S. annually, the total cost of discarded medications potentially runs into the hundreds of millions of dollars.

Dr. Palmer says the survey results ring true. “A lot of medications come in 10ml bottles, which gives you about 100 drops of medicine,” he says. “But on a typical day we may only use three drops per bottle in the operating room—the rest of the medication is thrown away. The wastage is tremendous.”

One Group’s StoryThe Surgical Eye Center of Morgantown, WV, went all the way to the U.S. Department of Health and Human Services to get permission to use multi-use medications on multiple patients. The center, an ASC serving a large, rural geographic area in West Virginia and Maryland, decided in 2015 to expand their facility. But when the Medicare inspectors from the West Virginia Department of Health and Human Resources arrived for their inspection things took a bad turn.

The Medicare nurse reviewers focused on how the center administered preoperative eye drops to patients—using a multi-use drop with a sterile technique. They indicated that the center was not following appropriate protocol, and explained that each patient requires a separate bottle to comply with the single-use protocol, which applies to every medication in the prep area and in the OR.

The center then received a summary of deficien-cies that specifically addressed their multi-use protocol. The group petitioned the West Virginia Department of Health and Human Resources, citing numerous references and outlining a detailed defense position for the practice. The department rejected their argument; similarly a direct appeal to the executive director of the health department was rejected because he was simply following existing federal directives. Fortunately, the director was willing to discuss the issue with the HHS. The response from the HHS was a complete reversal. Federal HHS officials agreed with ASORN, the Joint Commission, and ASCRS that if proper training, protocols, and monitoring are in place, an ASC can use multi-dose eye drop bottles. The center stated that had they lost on appeal, the added cost of eye drops would have increased by more than $200 per patient—a prohibitive amount since the center’s reimbursement for cataract surgery is fixed at $878.

In the era of COVID-19, facility volumes and reimbursements are reduced, but overhead obliga-tions remain. Similarly, patients suffer physically and financially and cost-saving approaches are even more imperative. Reducing OR and ER medication wastage with policy adjustments is one step towards attaining a positive fiscal and environmental impact.

PUBLIC HEALTH


resolution’s adoption by ISMS. And Dr. Palmer himself is no newcomer to writing resolutions that turn into law. For example, in 2015 he co-wrote a resolution that became HB 3137, “Topical Eye Medication Prescription Act.” It was introduced into the 99th General Assembly by Senator Fine, passed in the legislature and became effective January 1, 2016. The bill basically states that com-mercial insurers must offer refills on prescriptions of topical eye medications to patients at the co-pay rate after at least 23 days of use.

Current groups to date supporting SB 3266 include the Illinois Society of Plastic Surgeons, Illinois Dermatological Society, Chicago Laryngological and Otological Society, Illinois College of Emergency Physicians, American Academy of Ophthalmology, American Glaucoma Society, and the American Society of Cataract and Refractive Surgery.

Next Up: Multi-dose MedicationsWhile Dr. Palmer, CMS and ISMS are currently forging ahead on a statewide solution that allows patients to take topical medications home from the hospital, Dr. Palmer is also eying possible future related legislation to save cost, prevent waste, and protect the environment. Of particular interest is the issue of allowing multi-dose topical medications, such as eye drops, to be used on multiple patients. Currently the practice is broadly prohibited by the U.S. Department of Health and Human Services due to safety concerns.

A recent study, conducted in conjunction with the University of Michigan at the Aravind Eye Hospital system in southern India, looked at potential bottle tip contamination in multi-use situations. The primary objective of the study was to evaluate for contamination between bottle tip and the ocular surface or adnexa when trained assistants administer eyedrops to patients. The assistants used multidose containers of eyedrops in the preoperative setting. A total of 1839 patients were videographically studied. The authors concluded that when ancillary staff is trained on the proper eyedrop instillation technique, there was no contact with the patients’ ocular adnexae or microbial contamination of the dropper tip. In addition, the study concludes, “The use of multi-dose preoperative eyedrops for cataract surgery is safe, cost-effective, and eliminates waste.”

The amount of money saved in using multi-dose medications on multiple patients in the operating room is substantial. A study published in JAMA Ophthalmology on August 1, 2019, investigated the financial cost of unused medications in cataract surgery. The study included four surgical sites in the northeastern United States. A total of 116 unique drugs were surveyed among the four centers.

The study found that unused quantities of surveyed drugs averaged 45% at all four centers with a mean of $148 per case. When doing a cost analysis, the study found that the ambulatory care center (the unit with

the greatest surgical volume) had the highest unused drug cost per case followed sequentially by the tertiary care center, federally run medical center, and outpa-tient center. Considering that about 3.8 million cataract procedures are performed in the U.S. annually, the total cost of discarded medications potentially runs into the hundreds of millions of dollars.

Dr. Palmer says the survey results ring true. “A lot of medications come in 10ml bottles, which gives you about 100 drops of medicine,” he says. “But on a typical day we may only use three drops per bottle in the operating room—the rest of the medication is thrown away. The wastage is tremendous.”

One Group’s StoryThe Surgical Eye Center of Morgantown, WV, went all the way to the U.S. Department of Health and Human Services to get permission to use multi-use medications on multiple patients. The center, an ASC serving a large, rural geographic area in West Virginia and Maryland, decided in 2015 to expand their facility. But when the Medicare inspectors from the West Virginia Department of Health and Human Resources arrived for their inspection things took a bad turn.

The Medicare nurse reviewers focused on how the center administered preoperative eye drops to patients—using a multi-use drop with a sterile technique. They indicated that the center was not following appropriate protocol, and explained that each patient requires a separate bottle to comply with the single-use protocol, which applies to every medication in the prep area and in the OR.

The center then received a summary of deficien-cies that specifically addressed their multi-use protocol. The group petitioned the West Virginia Department of Health and Human Resources, citing numerous references and outlining a detailed defense position for the practice. The department rejected their argument; similarly a direct appeal to the executive director of the health department was rejected because he was simply following existing federal directives. Fortunately, the director was willing to discuss the issue with the HHS. The response from the HHS was a complete reversal. Federal HHS officials agreed with ASORN, the Joint Commission, and ASCRS that if proper training, protocols, and monitoring are in place, an ASC can use multi-dose eye drop bottles. The center stated that had they lost on appeal, the added cost of eye drops would have increased by more than $200 per patient—a prohibitive amount since the center’s reimbursement for cataract surgery is fixed at $878.

In the era of COVID-19, facility volumes and reimbursements are reduced, but overhead obliga-tions remain. Similarly, patients suffer physically and financially and cost-saving approaches are even more imperative. Reducing OR and ER medication wastage with policy adjustments is one step towards attaining a positive fiscal and environmental impact.

PUBLIC HEALTH



PUBLIC HEALTH

Hope for Covid-19 Patients Plasma units arrive at area hospitals for critically ill patients

THE CHICAGO Medical Society’s all-out effort to drive donations of con-valescent plasma provides new hope for patients with Covid-19. As of May 15, hundreds of plasma donations had

been directed across the metro region, thanks to a media campaign and CMS’ hardworking Covid-19 Taskforce.

A single donation can supply antibodies for three patients in need. To be accepted for the pro-gram, donors must have had a Covid-19 diagnosis and be symptom-free for at least 14 days.

The Medical Society and Metro Infectious Disease Consultants launched this collaborative effort in early April, with CMS opening a special donor registration site and consulting with blood banks and hospitals. After inking a deal with Vitalant Blood Service, donations began to reach Chicagoland hospitals. The official kickoff event took place in early May.

Initial data available from studies using Covid-19 convalescent plasma for the treatment of individuals with severe disease indicate that a single dose of 200 mL showed benefit for some patients, leading to improvement, according to the FDA, which approved the therapy in April for investigational use.

As clinical trials proceed across the country, the FDA is also supporting an expanded access program to collect and provide convalescent plasma. The Mayo Clinic serves as the lead institution for the clinical trials and the expanded access program. Administration of convalescent plasma must be under an IND (a traditional institutional IND, the Mayo EA IND, or a

single-patient emergency IND application). The Mayo Model, however, is best suited for

academic centers, while the Chicago Medical Society program coordinates donations and directs plasma to hospitals outside the Mayo Model. As a result, CMS broadens access, ensur-ing that patients at community hospitals and underserved areas can benefit. All donor plasma facilitated through CMS remains in Illinois.

The process of using the antibodies from some-one who has recovered from an infectious disease to help another patient still afflicted with the same infection dates back to 1918 and the Spanish Flu. Antibodies have the ability to neutralize the virus.

Until better treatment comes along, the convalescent plasma approach offers a very real opportunity to help patients, CMS Taskforce Chair Vishnu Chundi, MD, says. “Hydroxychloroquine may or may not work,” according to Dr. Chundi, who has more than 25 years’ experience with Metro Infectious Disease Consultants. “If you are hospitalized with Covid-19, other than oxygenation and support, there’s not much else we can do.”

Recovered patients who wish to donate their plasma are encouraged to go to the CMS donor registration site at covid19chi.org or call us at 877-CMS-DOCS.

Dollars Needed to Fund Program To keep plasma donations flowing, the Medical Society needs your help sustaining the program. Our GoFundMe page seeks financial contributions for our plasma effort. Your generosity will allow CMS to continue speeding this potentially lifesav-ing therapy to Covid-19 patients in dire need.

WITH A GROWING number of tests claiming to identify people who are potentially immune to Covid-19, the American Medical Association is cautioning against using these tests to determine individual immunity or to make decisions about the need for physical distancing or returning to work. At present there is not yet scientific evidence showing if, when and for how long individuals might become immune to Covid-19.

The AMA does encourage physicians to only use antibody tests authorized by the FDA and only for the purposes of population-level studies, for evalu-ating recovered individuals for convalescent plasma

donations, or along with other clinical information as part of well-defined testing plans.

Many antibody tests now on the market may return a significant number of false positive results, as well as show cross-reactivity—meaning the tests also identify antibodies for other corona-viruses, like those causing the common cold.

Concerns continue to mount about performance and fraudulent labeling. The vast majority of tests have not been authorized by the FDA, despite mar-keting claims. Physicians should pay close attention to the regulatory status of all available antibody tests by checking the FDA’s website.

AMA: Caution on Antibody Testing Pay close attention to the regulatory status of these products


PUBLIC HEALTH

Hope for Covid-19 Patients Plasma units arrive at area hospitals for critically ill patients

THE CHICAGO Medical Society’s all-out effort to drive donations of con-valescent plasma provides new hope for patients with Covid-19. As of May 15, hundreds of plasma donations had

been directed across the metro region, thanks to a media campaign and CMS’ hardworking Covid-19 Taskforce.

A single donation can supply antibodies for three patients in need. To be accepted for the pro-gram, donors must have had a Covid-19 diagnosis and be symptom-free for at least 14 days.

The Medical Society and Metro Infectious Disease Consultants launched this collaborative effort in early April, with CMS opening a special donor registration site and consulting with blood banks and hospitals. After inking a deal with Vitalant Blood Service, donations began to reach Chicagoland hospitals. The official kickoff event took place in early May.

Initial data available from studies using Covid-19 convalescent plasma for the treatment of individuals with severe disease indicate that a single dose of 200 mL showed benefit for some patients, leading to improvement, according to the FDA, which approved the therapy in April for investigational use.

As clinical trials proceed across the country, the FDA is also supporting an expanded access program to collect and provide convalescent plasma. The Mayo Clinic serves as the lead institution for the clinical trials and the expanded access program. Administration of convalescent plasma must be under an IND (a traditional institutional IND, the Mayo EA IND, or a

single-patient emergency IND application). The Mayo Model, however, is best suited for

academic centers, while the Chicago Medical Society program coordinates donations and directs plasma to hospitals outside the Mayo Model. As a result, CMS broadens access, ensur-ing that patients at community hospitals and underserved areas can benefit. All donor plasma facilitated through CMS remains in Illinois.

The process of using the antibodies from some-one who has recovered from an infectious disease to help another patient still afflicted with the same infection dates back to 1918 and the Spanish Flu. Antibodies have the ability to neutralize the virus.

Until better treatment comes along, the convalescent plasma approach offers a very real opportunity to help patients, CMS Taskforce Chair Vishnu Chundi, MD, says. “Hydroxychloroquine may or may not work,” according to Dr. Chundi, who has more than 25 years’ experience with Metro Infectious Disease Consultants. “If you are hospitalized with Covid-19, other than oxygenation and support, there’s not much else we can do.”

Recovered patients who wish to donate their plasma are encouraged to go to the CMS donor registration site at covid19chi.org or call us at 877-CMS-DOCS.

Dollars Needed to Fund Program To keep plasma donations flowing, the Medical Society needs your help sustaining the program. Our GoFundMe page seeks financial contributions for our plasma effort. Your generosity will allow CMS to continue speeding this potentially lifesav-ing therapy to Covid-19 patients in dire need.

WITH A GROWING number of tests claiming to identify people who are potentially immune to Covid-19, the American Medical Association is cautioning against using these tests to determine individual immunity or to make decisions about the need for physical distancing or returning to work. At present there is not yet scientific evidence showing if, when and for how long individuals might become immune to Covid-19.

The AMA does encourage physicians to only use antibody tests authorized by the FDA and only for the purposes of population-level studies, for evalu-ating recovered individuals for convalescent plasma

donations, or along with other clinical information as part of well-defined testing plans.

Many antibody tests now on the market may return a significant number of false positive results, as well as show cross-reactivity—meaning the tests also identify antibodies for other corona-viruses, like those causing the common cold.

Concerns continue to mount about performance and fraudulent labeling. The vast majority of tests have not been authorized by the FDA, despite mar-keting claims. Physicians should pay close attention to the regulatory status of all available antibody tests by checking the FDA’s website.

AMA: Caution on Antibody Testing Pay close attention to the regulatory status of these products


http://covid19chi.org

PUBLIC HEALTH

Poll: Half of U.S. Adults Delayed Medical Care Postponing procedures may raise liability concerns

AS STATES slowly reopen, nearly half of adults say they have deferred medical care due to the closure of hos-pitals and other facilities for non-emer-gency services, according to the latest

Kaiser Family Foundation’s Health Tracking Poll. The poll finds that nearly half of adults (48%) say

they or someone in their household has postponed or skipped medical care due to the coronavirus outbreak, including a higher share of women than men (54% vs. 42%).

Almost all say they will eventually get the care that has been postponed, including 68% (32% of adults overall) who expect to get the care within the next three months.

Most adults (86%) and at least eight in ten across age groups said their physical health has “stayed about the same” since the outbreak began. Few adults say their physical health has gotten better (6%) and a similar share say their physical health has gotten worse (8%) since the coronavirus

outbreak began in the U.S.Notably, 11% of adults said their or their family

member’s condition got worse as a result of post-poning or skipping medical care due to coronavirus.

Postponing elective procedures may raise liability concerns.

On May 13, 2020, Illinois Gov. J.B. Pritzker issued an executive order that clarifies the legal immunity available to hospitals, provider facilities, and physicians during the Covid-19 emergency.

Under the update, and as before, hospitals and professionals providing services in the hospital who continue to cancel elective procedures are immune from civil liability when rendering assistance to the state in response to the Covid-19 outbreak. In addition, those hospitals, facilities and physicians who resume surgeries and procedures in the hospital or facility on May 11 are eligible for immunity for any injury related to the diagnosis, transmission, or treatment of Covid-19 when ren-dering assistance during the emergency period.

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While times may be uncertain, your dedication to patients never is. That’s why we’re committed to providing our malpractice insurance policyholders with personalized customer service, individual attention, and stability they can trust. And that means the focus stays where it belongs: on the patients.

We’re all in this together.

Malpractice insurance is underwritten by Professional Solutions Insurance Company(doing business in California as PSIC Insurance Company). ©2020 PSIC NFL 9140-200349

FIND OUT MORE: psicinsurance.com/physicians


PUBLIC HEALTH

Poll: Half of U.S. Adults Delayed Medical Care Postponing procedures may raise liability concerns

AS STATES slowly reopen, nearly half of adults say they have deferred medical care due to the closure of hos-pitals and other facilities for non-emer-gency services, according to the latest

Kaiser Family Foundation’s Health Tracking Poll. The poll finds that nearly half of adults (48%) say

they or someone in their household has postponed or skipped medical care due to the coronavirus outbreak, including a higher share of women than men (54% vs. 42%).

Almost all say they will eventually get the care that has been postponed, including 68% (32% of adults overall) who expect to get the care within the next three months.

Most adults (86%) and at least eight in ten across age groups said their physical health has “stayed about the same” since the outbreak began. Few adults say their physical health has gotten better (6%) and a similar share say their physical health has gotten worse (8%) since the coronavirus

outbreak began in the U.S.Notably, 11% of adults said their or their family

member’s condition got worse as a result of post-poning or skipping medical care due to coronavirus.

Postponing elective procedures may raise liability concerns.

On May 13, 2020, Illinois Gov. J.B. Pritzker issued an executive order that clarifies the legal immunity available to hospitals, provider facilities, and physicians during the Covid-19 emergency.

Under the update, and as before, hospitals and professionals providing services in the hospital who continue to cancel elective procedures are immune from civil liability when rendering assistance to the state in response to the Covid-19 outbreak. In addition, those hospitals, facilities and physicians who resume surgeries and procedures in the hospital or facility on May 11 are eligible for immunity for any injury related to the diagnosis, transmission, or treatment of Covid-19 when ren-dering assistance during the emergency period.

UNPARALLELED SERVICE FOR UNPRECEDENTED TIMES

While times may be uncertain, your dedication to patients never is. That’s why we’re committed to providing our malpractice insurance policyholders with personalized customer service, individual attention, and stability they can trust. And that means the focus stays where it belongs: on the patients.

We’re all in this together.

Malpractice insurance is underwritten by Professional Solutions Insurance Company(doing business in California as PSIC Insurance Company). ©2020 PSIC NFL 9140-200349

FIND OUT MORE: psicinsurance.com/physicians


http://www.psicinsurance.com/physicians


FINANCE

AS I WRITE THIS , the news is bleak, both within the U.S. and abroad. COVID-19 cases and unem-ployment claims are on the rise. Questions abound regarding when

it might be safe to reopen our economy—and how everything might be different once we do.

Yet out of the dark comes light. The events of the last two months have once again proven how resilient the human spirit is. Every day, I hear sto-ries of how people and businesses have stepped up to serve their communities, adapting and adjusting to meet others’ needs.

That “helper” quality is demonstrated at its highest level in our medical professionals. I can’t stress enough how much I appreciate your dedication, your fortitude and your commitment to your fellow humans. From all of us at Goldstone Financial Group, thank you for everything you’ve done for all of us throughout the Chicago area.

While you focus on our physical and emo-tional health, I have been concentrating on our collective financial health. The market slide that began in late February and lasted into late March was an especially jarring reminder for most investors that markets fall—and some-times, they fall hard.

Yet, again, out of the dark comes light. Opportunities exist even in times of market decline. Already, we have seen markets rebound somewhat, although they are still far from the highs we saw earlier in the year.

Every crisis provides a chance for us to regroup, reset, refocus. The key to moving forward financially is to assess the damage and realign our course if needed. History tells us that markets come back; we don’t know when that will happen, but now is the time to position ourselves to be ready when they do.

What opportunities are available for investors right now? Here’s what I’m sharing with my clients:

1. Proactive tax planning is more critical than everThe Federal Reserve and the U.S. government have given out trillions in aid over the past two months. Tax rates are currently relatively low. It’s an elec-tion year. The pieces are in place for tax rates to increase over the next several years.

There are strategies you can take today to ensure you pay less in taxes tomorrow. For example, this may be a good year to consider a Roth IRA conversion or harvest losses on invest-ments, if those fit your situation.

2. Required minimum distributions were waived for 2020The CARES Act waived required minimum distri-butions (RMDs) for 2020. This impacts retirement account owners who turned 70 ½ on or before July 1, 1949, or who turned 72 after January 1, 2020. It also affects owners of beneficiary retirement accounts, who are also required to take RMDs.

Why is this important? First, it reduces the amount of taxable income resulting from RMDs. Second, it allows that money to remain in the account and continue to grow for future use.

3. The time is right to reassess risk When we do a risk assessment with clients, we look at several factors, one of which is how much risk they’re comfortable with. Sometimes, they assure us they’re okay with risk—but when push comes to shove, they find out they’re really not. The recent market drop is still fresh in our minds and has highlighted for many people how truly risky they are when it comes to their money.

If you have questions about your money and want honest, in-depth advice about ways you can take advantage of current opportunities, we’re here to help. Visit www.goldstonefinancialgroup.com to schedule your complimentary 30-minute consulta-tion. We want to serve our medical community with the same dedication, fortitude and commit-ment that you have demonstrated to us.

Anthony Pellegrino is the principal of Goldstone Financial Group. Hear him every Saturday at 10 a.m. on WLS AM 890 in the “Securing Your Financial Future” radio show. Visit www.goldstonefinan-cialgroup.com for more information. Investment advisory services are offered through Goldstone Financial Group, LLC, a Registered Investment Advisor. Insurance and annuity product guarantees are backed by the financial strength and claims-paying ability of the issuing insurance company.

“History tells us that markets come back; we don’t know when that will happen, but now is the time to position ourselves to be ready when they do.”

A Land of OpportunityQuestions about our economy linger, but opportunities exist even in a down market By Anthony Pellegrino


FINANCE

AS I WRITE THIS , the news is bleak, both within the U.S. and abroad. COVID-19 cases and unem-ployment claims are on the rise. Questions abound regarding when

it might be safe to reopen our economy—and how everything might be different once we do.

Yet out of the dark comes light. The events of the last two months have once again proven how resilient the human spirit is. Every day, I hear sto-ries of how people and businesses have stepped up to serve their communities, adapting and adjusting to meet others’ needs.

That “helper” quality is demonstrated at its highest level in our medical professionals. I can’t stress enough how much I appreciate your dedication, your fortitude and your commitment to your fellow humans. From all of us at Goldstone Financial Group, thank you for everything you’ve done for all of us throughout the Chicago area.

While you focus on our physical and emo-tional health, I have been concentrating on our collective financial health. The market slide that began in late February and lasted into late March was an especially jarring reminder for most investors that markets fall—and some-times, they fall hard.

Yet, again, out of the dark comes light. Opportunities exist even in times of market decline. Already, we have seen markets rebound somewhat, although they are still far from the highs we saw earlier in the year.

Every crisis provides a chance for us to regroup, reset, refocus. The key to moving forward financially is to assess the damage and realign our course if needed. History tells us that markets come back; we don’t know when that will happen, but now is the time to position ourselves to be ready when they do.

What opportunities are available for investors right now? Here’s what I’m sharing with my clients:

1. Proactive tax planning is more critical than everThe Federal Reserve and the U.S. government have given out trillions in aid over the past two months. Tax rates are currently relatively low. It’s an elec-tion year. The pieces are in place for tax rates to increase over the next several years.

There are strategies you can take today to ensure you pay less in taxes tomorrow. For example, this may be a good year to consider a Roth IRA conversion or harvest losses on invest-ments, if those fit your situation.

2. Required minimum distributions were waived for 2020The CARES Act waived required minimum distri-butions (RMDs) for 2020. This impacts retirement account owners who turned 70 ½ on or before July 1, 1949, or who turned 72 after January 1, 2020. It also affects owners of beneficiary retirement accounts, who are also required to take RMDs.

Why is this important? First, it reduces the amount of taxable income resulting from RMDs. Second, it allows that money to remain in the account and continue to grow for future use.

3. The time is right to reassess risk When we do a risk assessment with clients, we look at several factors, one of which is how much risk they’re comfortable with. Sometimes, they assure us they’re okay with risk—but when push comes to shove, they find out they’re really not. The recent market drop is still fresh in our minds and has highlighted for many people how truly risky they are when it comes to their money.

If you have questions about your money and want honest, in-depth advice about ways you can take advantage of current opportunities, we’re here to help. Visit www.goldstonefinancialgroup.com to schedule your complimentary 30-minute consulta-tion. We want to serve our medical community with the same dedication, fortitude and commit-ment that you have demonstrated to us.

Anthony Pellegrino is the principal of Goldstone Financial Group. Hear him every Saturday at 10 a.m. on WLS AM 890 in the “Securing Your Financial Future” radio show. Visit www.goldstonefinan-cialgroup.com for more information. Investment advisory services are offered through Goldstone Financial Group, LLC, a Registered Investment Advisor. Insurance and annuity product guarantees are backed by the financial strength and claims-paying ability of the issuing insurance company.

“History tells us that markets come back; we don’t know when that will happen, but now is the time to position ourselves to be ready when they do.”

A Land of OpportunityQuestions about our economy linger, but opportunities exist even in a down market By Anthony Pellegrino





ON APRIL 26, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it was suspending its Advance Payment Program to Part B Suppliers, effective immediately. Additionally, CMS announced that it

would reevaluate the amounts to be paid out under the Acceler-ated Payment Program.

As of late April, the federal CMS had paid out $40.4 billion to Part B suppliers and $59.6 billion to Part A providers under the two programs. CMS has also updated its fact sheet about the Accelerated Payment Program and the Advance Payment Program to reflect these changes.

The federal CMS is no longer accepting applications for the Advance Payment Program, and it will be reevaluating all pending and new applications for Accelerated Payments “in light of historical direct payments made available through HHS’ Provider Relief Fund.” To date, $175 billion has been appropri-ated for healthcare provider relief payments.

Significant additional funding will remain available to hos-pitals and other healthcare providers through other programs, the agency said. HHS’ Provider Relief Fund will continue to be distributed to support healthcare-related expenses dur-ing the Covid-19 pandemic. For information on the CARES Act Provider Relief Fund and how to apply, visit hhs.gov/providerrelief.

The American Medical Association (AMA) is calling for the prompt reinstatement of the Accelerated and Advance Payment Program. A letter to Centers for Medicare and Medicaid Services Administrator Seema Verma urged the agency to include more f lexible terms as well as expanding the program to Medicaid providers. Specifically, CMS should authorize advance payments or retainer payments by state Medicaid programs to provide critically needed funds to Medicaid physicians, clinicians, and other providers and suppliers, the AMA said.

The Chicago Medical Society joins with the AMA and other partnering organizations in urging Congress to take immediate action to support employers and workers by protecting and expanding high quality, affordable healthcare coverage. Key recommendations include:

1. Provide employers with temporary subsidies to preserve health benefits.

2. Cover the cost of coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).

3. Expand use of Health Savings Accounts (HSA). 4. Increase eligibility for federal subsidies for the health insur-

ance marketplaces.

Medicare Payments Hit Pause Physicians seek quick reinstatement of emergency funding in wake of Covid-19


ON APRIL 26, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it was suspending its Advance Payment Program to Part B Suppliers, effective immediately. Additionally, CMS announced that it

would reevaluate the amounts to be paid out under the Acceler-ated Payment Program.

As of late April, the federal CMS had paid out $40.4 billion to Part B suppliers and $59.6 billion to Part A providers under the two programs. CMS has also updated its fact sheet about the Accelerated Payment Program and the Advance Payment Program to reflect these changes.

The federal CMS is no longer accepting applications for the Advance Payment Program, and it will be reevaluating all pending and new applications for Accelerated Payments “in light of historical direct payments made available through HHS’ Provider Relief Fund.” To date, $175 billion has been appropri-ated for healthcare provider relief payments.

Significant additional funding will remain available to hos-pitals and other healthcare providers through other programs, the agency said. HHS’ Provider Relief Fund will continue to be distributed to support healthcare-related expenses dur-ing the Covid-19 pandemic. For information on the CARES Act Provider Relief Fund and how to apply, visit hhs.gov/providerrelief.

The American Medical Association (AMA) is calling for the prompt reinstatement of the Accelerated and Advance Payment Program. A letter to Centers for Medicare and Medicaid Services Administrator Seema Verma urged the agency to include more f lexible terms as well as expanding the program to Medicaid providers. Specifically, CMS should authorize advance payments or retainer payments by state Medicaid programs to provide critically needed funds to Medicaid physicians, clinicians, and other providers and suppliers, the AMA said.

The Chicago Medical Society joins with the AMA and other partnering organizations in urging Congress to take immediate action to support employers and workers by protecting and expanding high quality, affordable healthcare coverage. Key recommendations include:

1. Provide employers with temporary subsidies to preserve health benefits.

2. Cover the cost of coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).

3. Expand use of Health Savings Accounts (HSA). 4. Increase eligibility for federal subsidies for the health insur-

ance marketplaces.

Medicare Payments Hit Pause Physicians seek quick reinstatement of emergency funding in wake of Covid-19


http://hhs.gov/providerrelief



LEGAL

THE DEPARTMENT of Health and Human Services (HHS) has begun distrib-uting the second tranche of funds from the $100 billion in funds to hospitals and other healthcare providers impacted by

the coronavirus response. The funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19. HHS announced that $50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers which billed Medicare in 2019, and are impacted by COVID-19, based on providers’ 2018 net patient revenue. Of this $50 billion, the initial $30 billion was distributed between April 10 and April 17, and payments to pro-viders from that $30 billion were calculated based on providers’ portion of Medicare fee-for-service revenue.

HHS has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. Please note there is conflicting information about whether a provider who hasn’t previously received money from the first round of funding can apply for this round. The American Medical Association (AMA) is trying to clarify this and other questions with HHS. The new FAQs can be found at www.hhs.gov/sites/default/files/20200425-general-distribution-portal-faqs.pdf.

According to a state-by-state breakdown, Illinois received an initial $30 billion from the general distribution fund, with money going to 12,609 pro-viders and health systems, for a final distribution totaling $1,204,103,180.

Starting on April 24, a portion of providers were to automatically receive an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file were advised to submit their revenue informa-tion to the General Distribution Portal for additional general distribution funds. Initially some states and specialties thought that physicians must also submit cost reports, but the American Medical Association verified with HHS that this is not the case.

Physicians, however, do need to submit their revenue information so that it can be verified via the General Distribution Portal. The portal is now open. The customer service line confirmed that anyone who has a Billing TIN (including a pediat-ric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.

The AMA has put together the following guid-ance to help physicians pull together the informa-tion they need to submit to the portal. Readers will also find additional information from HHS regarding the distribution. Below are key links from HHS with further explanations:

• https://covid19.linkhealth.com/docusign/#/step/1• https://chameleoncloud.io/

review/2977-5ea0af98f0fd0/prod

Additional Funding Related to Treatment of the Uninsured A portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured. Physicians are eligible for this funding. Every healthcare provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding. Steps involve: enrolling as a provider participant; checking patient eligibility and benefits; submitting patient information; submitting claims; and receiving payment via direct deposit.

Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsured-claim.hrsa.gov.

AMA Guidance for HHS General Allocation Fund Portal As part of the distribution of the remaining $70

Physician Financial ReliefInitial $30 billion of general distribution goes to 12,609 Illinois providers and health systems

Appendix A: Federal Tax Classification Matrix

Federal Tax Federal Tax ClassificationClassification ProvideProvide FromFrom On IRS FormOn IRS Form Upload IRS FormUpload IRS Form

Sole Proprietor/Disregarded Entity (LLC)

Gross receipts or Sales Box 1 1040, Schedule C 1040 and Schedule C

C Corporation Gross receipts or Sales Box 1a 1120 1120

S Corporation Gross receipts or Sales Box 1a 1120-S 1120-S

Partnership Gross receipts or Sales Box 1a 1065 1065

Trust Gross receipts or Sales Box 1 1040, Schedule C 1041 and Schedule C

Tax-Exempt Organization Program Service Revenue Box 9 990 990


LEGAL

THE DEPARTMENT of Health and Human Services (HHS) has begun distrib-uting the second tranche of funds from the $100 billion in funds to hospitals and other healthcare providers impacted by

the coronavirus response. The funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19. HHS announced that $50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers which billed Medicare in 2019, and are impacted by COVID-19, based on providers’ 2018 net patient revenue. Of this $50 billion, the initial $30 billion was distributed between April 10 and April 17, and payments to pro-viders from that $30 billion were calculated based on providers’ portion of Medicare fee-for-service revenue.

HHS has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. Please note there is conflicting information about whether a provider who hasn’t previously received money from the first round of funding can apply for this round. The American Medical Association (AMA) is trying to clarify this and other questions with HHS. The new FAQs can be found at www.hhs.gov/sites/default/files/20200425-general-distribution-portal-faqs.pdf.

According to a state-by-state breakdown, Illinois received an initial $30 billion from the general distribution fund, with money going to 12,609 pro-viders and health systems, for a final distribution totaling $1,204,103,180.

Starting on April 24, a portion of providers were to automatically receive an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file were advised to submit their revenue informa-tion to the General Distribution Portal for additional general distribution funds. Initially some states and specialties thought that physicians must also submit cost reports, but the American Medical Association verified with HHS that this is not the case.

Physicians, however, do need to submit their revenue information so that it can be verified via the General Distribution Portal. The portal is now open. The customer service line confirmed that anyone who has a Billing TIN (including a pediat-ric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.

The AMA has put together the following guid-ance to help physicians pull together the informa-tion they need to submit to the portal. Readers will also find additional information from HHS regarding the distribution. Below are key links from HHS with further explanations:

• https://covid19.linkhealth.com/docusign/#/step/1• https://chameleoncloud.io/

review/2977-5ea0af98f0fd0/prod

Additional Funding Related to Treatment of the Uninsured A portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured. Physicians are eligible for this funding. Every healthcare provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding. Steps involve: enrolling as a provider participant; checking patient eligibility and benefits; submitting patient information; submitting claims; and receiving payment via direct deposit.

Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsured-claim.hrsa.gov.

AMA Guidance for HHS General Allocation Fund Portal As part of the distribution of the remaining $70

Physician Financial ReliefInitial $30 billion of general distribution goes to 12,609 Illinois providers and health systems

Appendix A: Federal Tax Classification Matrix

Federal Tax Federal Tax ClassificationClassification ProvideProvide FromFrom On IRS FormOn IRS Form Upload IRS FormUpload IRS Form

Sole Proprietor/Disregarded Entity (LLC)

Gross receipts or Sales Box 1 1040, Schedule C 1040 and Schedule C

C Corporation Gross receipts or Sales Box 1a 1120 1120

S Corporation Gross receipts or Sales Box 1a 1120-S 1120-S

Partnership Gross receipts or Sales Box 1a 1065 1065

Trust Gross receipts or Sales Box 1 1040, Schedule C 1041 and Schedule C

Tax-Exempt Organization Program Service Revenue Box 9 990 990


http://www.hhs.gov/sites/default/files/20200425-general-distribution-portal-faqs.pdf

http://www.hhs.gov/sites/default/files/20200425-general-distribution-portal-faqs.pdf

https://covid19.linkhealth.com/docusign/#/step/1

https://chameleoncloud.io/review/2977-5ea0af98f0fd0/prod

https://chameleoncloud.io/review/2977-5ea0af98f0fd0/prod

http://coviduninsuredclaim.hrsa.gov

http://coviduninsuredclaim.hrsa.gov

LEGAL

billion in funds, HRSA is asking providers who have already received payments from the initial distribution of $30 billion to supply information from IRS tax filings and to supply estimates of lost revenues in March and April of 2020, if they wish to be eligible to receive additional funds. HRSA will be distributing an additional $20 billion to these providers.

Any person authorized by the provider organiza-tion may complete this form. The AMA would recommend that it be completed by an organization’s CFO or accounting professional.

Have the following information on hand before you begin:

• Taxpayer Identification Number (TIN) that has received prior Provider Relief Fund payments.

• TINs of subsidiary organizations that have received prior Provider Relief Funds but do not

file separate tax forms (subsidiary organiza-tions that are accounted for in the parent organization’s tax filing).

• The portal’s customer service line responded that anyone with a billing TIN (including pedia-tricians and gynecologists) should complete the application.

• Amount of payments received.• Lost March 2020 revenues.• Estimated lost April 2020 revenues.• Relief Fund payment transaction numbers /

check numbers.• A copy of your most recently filed tax forms. See

Appendix A: Federal Tax Classification Matrix (you will need to upload these forms in the application).

For more information, please visit hhs.gov/pro-viderrelief or call the CARES Provider Relief line at 866-569-3522.

FEDERAL SUPPORT to healthcare providers fighting the COVID-19 pan-demic through the bipartisan CARES Act provides $100 billion in relief funds to hospitals and other healthcare providers impacted by the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get treatment for COVID-19.

In allocating the funds, the Adminis-tration is working, among other things, to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures, as well as the economic impact on providers incurring additional expenses caring for COVID-19 patients, and to do so as transparently as possible.

$50 billion General Allocation $50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers which billed Medicare in 2019, and are impacted by COVID-19, based on providers’ 2018 net patient revenue. Of this $50 billion, the initial $30 billion was distributed between April 10 and April 17, and payments to providers from that $30 billion were calculated based on providers’ portion of Medicare fee-for-service revenue.

HHS will begin distribution to providers of the remaining $20 billion of the $50 bil-

lion general allocation on Friday, April 24. Payment to providers from this $20

billion are calculated so that a provider’s allocation from the entire $50 billion general distribution will be in proportion to such provider’s 2018 net patient reve-nue. Total revenues of Medicare facilities and providers in 2018 is estimated to be $2.5 trillion. Providers can estimate their expected general revenue distribution through the following formula:

(Individual Provider 2018 Revenue/$2.5 Trillion) x $50 Billion = Expected General Distribution

General Allocation Payment On April 24, a portion of providers will receive a second payment derived from revenue data previously submit-ted in CMS cost reports. This payment, together with the initial payment received earlier in April, will represent the total allocation from the $50 billion general distribution.

All providers, including those paid off the revenue data already submitted in CMS cost reports, are required under the terms and conditions to submit revenue information to the provider portal for later verification.

Information on steps providers will need to take are included below.

What Can Payments Be Used For? As required by the terms and condi-

tions, all payments may only be used to prevent, prepare for, and respond to coronavirus, and that the payment shall reimburse the recipient only for health-care related expenses or lost revenues that are attributable to coronavirus. If a recipient does not have lost revenues or increased expenses due to COVID-19 equal to the amount received a recipient must return the funds.

How Will Payments Be Distributed?HHS is partnering with UnitedHealth Group to funds to eligible providers. All relief payments are made to provider billing organizations based on their Taxpayer Identification Numbers (TINs). Each organization’s payment will be delivered via the Automated Clearing House (ACH) to the Medicare routing number and account number that the provider has on file with HHS. The auto-matic payments will come via Optum Bank with “HHSPAYMENT” as the pay-ment description. Payments will be sent to the group’s central billing office.

What Action Should Recipients Take?Providers that receive an automatic payment:

Within 30 days of receiving the payment, each recipient must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment.

Fact Sheet: Provider Relief Fund General Distribution 2


LEGAL

billion in funds, HRSA is asking providers who have already received payments from the initial distribution of $30 billion to supply information from IRS tax filings and to supply estimates of lost revenues in March and April of 2020, if they wish to be eligible to receive additional funds. HRSA will be distributing an additional $20 billion to these providers.

Any person authorized by the provider organiza-tion may complete this form. The AMA would recommend that it be completed by an organization’s CFO or accounting professional.

Have the following information on hand before you begin:

• Taxpayer Identification Number (TIN) that has received prior Provider Relief Fund payments.

• TINs of subsidiary organizations that have received prior Provider Relief Funds but do not

file separate tax forms (subsidiary organiza-tions that are accounted for in the parent organization’s tax filing).

• The portal’s customer service line responded that anyone with a billing TIN (including pedia-tricians and gynecologists) should complete the application.

• Amount of payments received.• Lost March 2020 revenues.• Estimated lost April 2020 revenues.• Relief Fund payment transaction numbers /

check numbers.• A copy of your most recently filed tax forms. See

Appendix A: Federal Tax Classification Matrix (you will need to upload these forms in the application).

For more information, please visit hhs.gov/pro-viderrelief or call the CARES Provider Relief line at 866-569-3522.

FEDERAL SUPPORT to healthcare providers fighting the COVID-19 pan-demic through the bipartisan CARES Act provides $100 billion in relief funds to hospitals and other healthcare providers impacted by the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get treatment for COVID-19.

In allocating the funds, the Adminis-tration is working, among other things, to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures, as well as the economic impact on providers incurring additional expenses caring for COVID-19 patients, and to do so as transparently as possible.

$50 billion General Allocation $50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers which billed Medicare in 2019, and are impacted by COVID-19, based on providers’ 2018 net patient revenue. Of this $50 billion, the initial $30 billion was distributed between April 10 and April 17, and payments to providers from that $30 billion were calculated based on providers’ portion of Medicare fee-for-service revenue.

HHS will begin distribution to providers of the remaining $20 billion of the $50 bil-

lion general allocation on Friday, April 24. Payment to providers from this $20

billion are calculated so that a provider’s allocation from the entire $50 billion general distribution will be in proportion to such provider’s 2018 net patient reve-nue. Total revenues of Medicare facilities and providers in 2018 is estimated to be $2.5 trillion. Providers can estimate their expected general revenue distribution through the following formula:

(Individual Provider 2018 Revenue/$2.5 Trillion) x $50 Billion = Expected General Distribution

General Allocation Payment On April 24, a portion of providers will receive a second payment derived from revenue data previously submit-ted in CMS cost reports. This payment, together with the initial payment received earlier in April, will represent the total allocation from the $50 billion general distribution.

All providers, including those paid off the revenue data already submitted in CMS cost reports, are required under the terms and conditions to submit revenue information to the provider portal for later verification.

Information on steps providers will need to take are included below.

What Can Payments Be Used For? As required by the terms and condi-

tions, all payments may only be used to prevent, prepare for, and respond to coronavirus, and that the payment shall reimburse the recipient only for health-care related expenses or lost revenues that are attributable to coronavirus. If a recipient does not have lost revenues or increased expenses due to COVID-19 equal to the amount received a recipient must return the funds.

How Will Payments Be Distributed?HHS is partnering with UnitedHealth Group to funds to eligible providers. All relief payments are made to provider billing organizations based on their Taxpayer Identification Numbers (TINs). Each organization’s payment will be delivered via the Automated Clearing House (ACH) to the Medicare routing number and account number that the provider has on file with HHS. The auto-matic payments will come via Optum Bank with “HHSPAYMENT” as the pay-ment description. Payments will be sent to the group’s central billing office.

What Action Should Recipients Take?Providers that receive an automatic payment:

Within 30 days of receiving the payment, each recipient must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment.

Fact Sheet: Provider Relief Fund General Distribution 2





LEGAL

WE HAVE received many calls from our physician clients in the midst of the COVID-19 pan-demic. The calls pertain mainly to issues about their employ-

ment agreements. The pandemic has had a signifi-cant effect on the economy, has forced practices to downsize and reduce expenses while retaining the employed physician, at least on a temporary basis. The question arises: Is this legally allowed?

Most employment contracts contain language stating they can only be changed by a mutually agreed upon written amendment which must be signed by both parties. Therefore, an employer cannot unilater-ally amend an employment contract without your con-sent if the language in your contract requires a written amendment. Even if this is the case, in thinking about what to do you should also consider whether your contract has an early termination provision wherein either party may terminate the contract without cause upon notice. “Without cause” means for any reason or no reason. Usually the “notice” period ranges in the number of days (60 or 90). If you and your employer cannot agree on an amendment, the employer may resort to early termination as an alternative.

Possible considerations include:

• Agree to a temporary amendment. If you do this you should have the amendment state how long it will be in effect. Stating “until the pandemic ends” or language to that effect is too vague and too subjective. A better way would be to state the start and end dates for the amendment. You can always re-evaluate and move ahead upon further mutual agreement but using specific dates will avoid allowing your employer to continue the agreement as amended indefinitely.

• Do not agree to an amendment and proceed to legally enforce contractual rights in which case the employer can likely still terminate without cause upon notice.

• Do not agree to an amendment and risk early

termination without cause. If this is used by the employer you will still need to work during the notice period; however, if you are not allowed to work you will likely be entitled to compensation during the notice period depending upon the language in the contract.

• 4. Terminate the contract yourself by using the early termination provision. If you do this you will need to work during the notice period; however, if you are not allowed to work you will likely be entitled to compensation during the notice period, depending upon the language in the contract.

• Think through the consequences of any termination. Is there a restrictive covenant (non-compete) in the contract? Be prepared for it to be enforced by the employer especially if you terminate without cause.

• Are you responsible for tail insurance coverage post-termination of the contract? If so, what does that mean in terms of cost for you?

• From a business perspective, how important is it for you to stay in a positon until you have another? This is most often the case, especially for new physicians and/or those who are in specialties that are not in frequent demand.

• If you and/or your employer decide to part ways, you should consult with your attorney about how notice should be provided and what other agreements should be considered (a separation agreement that contains certain provisions, such as a non-disparagement agreement).

This article offers some insight into the type of issues arising out of the COVID-19 pandemic. While there are other legal issues, not all of them can be anticipated. As always, each contract must be analyzed individually.

Melinda S. Malecki, JD, MS, practices at the Elmhurst-based firm of Malecki & Brooks Law Group, LLC. For more information visit www.mbhealthlaw.com.

COVID-19: Doctor Pay Cuts Contract considerations for employed physicians facing salary reductions By Melinda S. Malecki, JD, MS

“The pandemic has had a significant effect on the economy, has forced practices to downsize and reduce expenses while retaining the employed physician, at least on a temporary basis.”

THE CHICAGO Medical Society and the American Bar Association have established a formal relationship to address medical-legal issues affecting CMS members and their practices. This legal section is sponsored by the Health Law Section of the American Bar Association.

For CMS members this means that you get monthly articles from legal experts who specialize in health law. The articles will focus on subjects of current interest to the medical profes-sion as well as new laws and regulations as they are implemented. The authors will vary every month in order to bring

you the best information possible from the attorney who specializes in the subject matter.

If you have a particular question or would like more information on a sub-ject, please send us your suggestions. You can send an email to Elizabeth at [email protected].

Working With the Bar


LEGAL

WE HAVE received many calls from our physician clients in the midst of the COVID-19 pan-demic. The calls pertain mainly to issues about their employ-

ment agreements. The pandemic has had a signifi-cant effect on the economy, has forced practices to downsize and reduce expenses while retaining the employed physician, at least on a temporary basis. The question arises: Is this legally allowed?

Most employment contracts contain language stating they can only be changed by a mutually agreed upon written amendment which must be signed by both parties. Therefore, an employer cannot unilater-ally amend an employment contract without your con-sent if the language in your contract requires a written amendment. Even if this is the case, in thinking about what to do you should also consider whether your contract has an early termination provision wherein either party may terminate the contract without cause upon notice. “Without cause” means for any reason or no reason. Usually the “notice” period ranges in the number of days (60 or 90). If you and your employer cannot agree on an amendment, the employer may resort to early termination as an alternative.

Possible considerations include:

• Agree to a temporary amendment. If you do this you should have the amendment state how long it will be in effect. Stating “until the pandemic ends” or language to that effect is too vague and too subjective. A better way would be to state the start and end dates for the amendment. You can always re-evaluate and move ahead upon further mutual agreement but using specific dates will avoid allowing your employer to continue the agreement as amended indefinitely.

• Do not agree to an amendment and proceed to legally enforce contractual rights in which case the employer can likely still terminate without cause upon notice.

• Do not agree to an amendment and risk early

termination without cause. If this is used by the employer you will still need to work during the notice period; however, if you are not allowed to work you will likely be entitled to compensation during the notice period depending upon the language in the contract.

• 4. Terminate the contract yourself by using the early termination provision. If you do this you will need to work during the notice period; however, if you are not allowed to work you will likely be entitled to compensation during the notice period, depending upon the language in the contract.

• Think through the consequences of any termination. Is there a restrictive covenant (non-compete) in the contract? Be prepared for it to be enforced by the employer especially if you terminate without cause.

• Are you responsible for tail insurance coverage post-termination of the contract? If so, what does that mean in terms of cost for you?

• From a business perspective, how important is it for you to stay in a positon until you have another? This is most often the case, especially for new physicians and/or those who are in specialties that are not in frequent demand.

• If you and/or your employer decide to part ways, you should consult with your attorney about how notice should be provided and what other agreements should be considered (a separation agreement that contains certain provisions, such as a non-disparagement agreement).

This article offers some insight into the type of issues arising out of the COVID-19 pandemic. While there are other legal issues, not all of them can be anticipated. As always, each contract must be analyzed individually.

Melinda S. Malecki, JD, MS, practices at the Elmhurst-based firm of Malecki & Brooks Law Group, LLC. For more information visit www.mbhealthlaw.com.

COVID-19: Doctor Pay Cuts Contract considerations for employed physicians facing salary reductions By Melinda S. Malecki, JD, MS

“The pandemic has had a significant effect on the economy, has forced practices to downsize and reduce expenses while retaining the employed physician, at least on a temporary basis.”

THE CHICAGO Medical Society and the American Bar Association have established a formal relationship to address medical-legal issues affecting CMS members and their practices. This legal section is sponsored by the Health Law Section of the American Bar Association.

For CMS members this means that you get monthly articles from legal experts who specialize in health law. The articles will focus on subjects of current interest to the medical profes-sion as well as new laws and regulations as they are implemented. The authors will vary every month in order to bring

you the best information possible from the attorney who specializes in the subject matter.

If you have a particular question or would like more information on a sub-ject, please send us your suggestions. You can send an email to Elizabeth at [email protected].

Working With the Bar


http://www.mbhealthlaw.com

http://www.mbhealthlaw.com

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http://www.cms-ins.com

THERE IS NO dispute that modern-day primary care is far removed from tra-ditional methods of practice. Technology, which has led to better and more acces-sible treatment, improved care and effi-

ciency, and the use of software to improve care and control disease, has added new responsibilities. Phy-sicians are no longer singularly focused on the direct medical care of their patients. They also must run a business, manage a staff and complete documenta-tion while complying with regulations in accordance with measured and achieved metrics. This must be accomplished in a manner of excellence, while deliv-ering optimal patient care in a landscape of different payment models and contracts.

As a practicing physician, I understand these challenges. I see innovation as essential to improvements that will not only resolve the admin-istrative challenges we face, but also lead to highly effective and personalized levels of care.

Following are five emerging macro-trends in healthcare—some near, some far off—that will achieve micro-improvements over time that sup-port our role as physicians.

Data analytics designed to support effective population management at the point of care

An important aspect of improving outcomes is proactively managing conditions by anticipating what patients may need—and early enough so interventions can be impactful in delivering high-quality patient care. Furthermore, migration to value-based care supports providers’ commitment to, and responsibility for, providing optimal, fis-cally responsible care to patients.

With the effective use of data-driven tools, we can enhance care for patients with chronic diseases such as COPD, heart failure and diabetes, among others. Cutting-edge operating systems that utilize machine learning and algorithms can assist us in identifying patients’ needs and providing proactive interventions. Plus, greater efficiency reduces the cost of care delivery. An example of an innovative tool that supports physicians with value-based contracts is VillageMD’s docOS operating system, a technology platform used to identify and manage patient populations. It can break down information silos to extract clinical and financial data from electronic medical records (EMRs), practice systems, payer claims systems, and hospitals and skilled nursing facilities.

Solutions designed to improve quality and effi-ciency are key. These technology platforms identify and manage patient populations by extracting clinical and financial data from clinic EMRs, payer

The Adaptable PhysicianFive emerging trends that will optimize patient health at the point of care By Robert Perlmuter, MD

HEALTHCARE INNOVATION

VillageMD works with physician groups, independent practice associations, and health systems to achieve a primary care-led, high-value clinical model. As a provider of healthcare, VillageMD offers tools, technology, operations, and staffing support needed for physicians to drive high quality clinical results across a population.


THERE IS NO dispute that modern-day primary care is far removed from tra-ditional methods of practice. Technology, which has led to better and more acces-sible treatment, improved care and effi-

ciency, and the use of software to improve care and control disease, has added new responsibilities. Phy-sicians are no longer singularly focused on the direct medical care of their patients. They also must run a business, manage a staff and complete documenta-tion while complying with regulations in accordance with measured and achieved metrics. This must be accomplished in a manner of excellence, while deliv-ering optimal patient care in a landscape of different payment models and contracts.

As a practicing physician, I understand these challenges. I see innovation as essential to improvements that will not only resolve the admin-istrative challenges we face, but also lead to highly effective and personalized levels of care.

Following are five emerging macro-trends in healthcare—some near, some far off—that will achieve micro-improvements over time that sup-port our role as physicians.

Data analytics designed to support effective population management at the point of care

An important aspect of improving outcomes is proactively managing conditions by anticipating what patients may need—and early enough so interventions can be impactful in delivering high-quality patient care. Furthermore, migration to value-based care supports providers’ commitment to, and responsibility for, providing optimal, fis-cally responsible care to patients.

With the effective use of data-driven tools, we can enhance care for patients with chronic diseases such as COPD, heart failure and diabetes, among others. Cutting-edge operating systems that utilize machine learning and algorithms can assist us in identifying patients’ needs and providing proactive interventions. Plus, greater efficiency reduces the cost of care delivery. An example of an innovative tool that supports physicians with value-based contracts is VillageMD’s docOS operating system, a technology platform used to identify and manage patient populations. It can break down information silos to extract clinical and financial data from electronic medical records (EMRs), practice systems, payer claims systems, and hospitals and skilled nursing facilities.

Solutions designed to improve quality and effi-ciency are key. These technology platforms identify and manage patient populations by extracting clinical and financial data from clinic EMRs, payer

The Adaptable PhysicianFive emerging trends that will optimize patient health at the point of care By Robert Perlmuter, MD


VillageMD works with physician groups, independent practice associations, and health systems to achieve a primary care-led, high-value clinical model. As a provider of healthcare, VillageMD offers tools, technology, operations, and staffing support needed for physicians to drive high quality clinical results across a population.


claims systems, and hospital and skilled nursing facility EMRs. Algorithms normalize data and analyze it to predict diagnoses, discover patient-enhanced engagement opportunities and identify gaps in care. Access to high-quality, relevant and current data, in real time, makes it usable and meaningful at the point of care.

Telehealth to support effective patient-physician engagementThis approach to care is on the rise as physicians realize the benefits of seeing patients virtually. More than half of U.S. hospitals use video and other technology to connect with patients and consulting practitioners. Nearly every state Medicaid program has some form of coverage for telehealth services. Private payers are also embracing coverage.

Telehealth offers patients convenience while providing access to medical counsel. Behavioral health applications show great promise in this area, and they can be used as a model for integration into primary care. Often times, depressive symp-toms are associated with patients diagnosed with diabetes. In these cases, a primary care physician may provide a behavioral health referral, making a telehealth visit with a therapist a viable technology solution for integrated care. Furthermore, by del-egating the behavioral health component of care, the physician may experience reduced clinical time required with the patient.

Adjunct support for more efficient and effective codingCoding impacts numerous areas of care, such as level of specialty care, what insurers will and will not pay for, and practice costs. Yet missed coding opportunities are common. Coding is also one of the most time-consuming tasks for physicians. Solutions in electronic transcription, including live-scribing at the point of care or post-care transcription of a digital recording, are increasing accuracy, reducing paperwork and helping physi-cians reclaim time with patients, making care more meaningful, efficient and responsive.

Enhanced pharmaceutical services to increase medication adherenceAbout one in five new prescriptions is never filled. But partnerships with pharmacists and innovations in pharma support are improving adherence. Examples include full-service PCP clinics co-located with pharmacies, patient one-on-one visits with clinical pharmacists, Rx delivery services and pre-sorted pill packs—all designed to increase medicine compliance and therefore improve patient outcomes.

Hospital in the homeBuilding on the benefits of primary care in a home setting, hospital in the home is equipping a physician-led team to deliver on-demand acute care to patients

in their home if they meet specific criteria. The model includes a combination of clinical and non-clinical services, technology, equipment, supplies, medication and specialty expertise. According to an article in the Harvard Business Review, hospital in the home is one of the most studied innovations in health care. Early indicators demonstrate that it may improve outcomes related to high-acuity illnesses while delivering meaningful economic value.

We’re living in an age in which the practice of medicine includes the crucial and time-consuming task of managing a business. How can we deliver agile, adaptable, excellent patient care? The best innovations not only identify and clarify where problems exist, but also offer healthcare teams direction for implementing and measuring efficient technology. And who knows? These solutions might just allow us some well-deserved free time.

Robert Perlmuter, MD, FACP, is a board-certified physician associated with Northwestern Medicine and St. Joseph Hospital. He is affiliated with VillageMD, a leading national provider of primary care.


Share Your Innova-tion Stories with Chicago Medicine

Hospitals and health systems are invited to submit articles under a physician’s byline about the innovations and advances taking place at their institu-tions. All submissions should be accompa-nied by high-resolu-tion headshot photos and charts or other graphic material. For details, please contact Elizabeth at [email protected] or call 312-329-7335.

Illinois State Licensing and Regulatory BoardsDrug Enforcement Administration (DEA)State Medicaid AgenciesCenters for Medicare and Medicaid Services (CMS)Federal Drug Administration (FDA)Drafting Legal Opinion LettersAvailable for Co-counsel on CasesLicensure and Provider Application Submission

Providing legal and consultation services within the healthcare field for over 19 years in the following areas:

•••

••••

•

If you need assistance obtaining a professional license or defending against disciplinary action, we are here to help!

630-310-1267www.jjblawoce.com | [email protected]

JOSEPH J. BOGDAN, PHARM.D., J.D., LLCThe Law Offices of


claims systems, and hospital and skilled nursing facility EMRs. Algorithms normalize data and analyze it to predict diagnoses, discover patient-enhanced engagement opportunities and identify gaps in care. Access to high-quality, relevant and current data, in real time, makes it usable and meaningful at the point of care.

Telehealth to support effective patient-physician engagementThis approach to care is on the rise as physicians realize the benefits of seeing patients virtually. More than half of U.S. hospitals use video and other technology to connect with patients and consulting practitioners. Nearly every state Medicaid program has some form of coverage for telehealth services. Private payers are also embracing coverage.

Telehealth offers patients convenience while providing access to medical counsel. Behavioral health applications show great promise in this area, and they can be used as a model for integration into primary care. Often times, depressive symp-toms are associated with patients diagnosed with diabetes. In these cases, a primary care physician may provide a behavioral health referral, making a telehealth visit with a therapist a viable technology solution for integrated care. Furthermore, by del-egating the behavioral health component of care, the physician may experience reduced clinical time required with the patient.

Adjunct support for more efficient and effective codingCoding impacts numerous areas of care, such as level of specialty care, what insurers will and will not pay for, and practice costs. Yet missed coding opportunities are common. Coding is also one of the most time-consuming tasks for physicians. Solutions in electronic transcription, including live-scribing at the point of care or post-care transcription of a digital recording, are increasing accuracy, reducing paperwork and helping physi-cians reclaim time with patients, making care more meaningful, efficient and responsive.

Enhanced pharmaceutical services to increase medication adherenceAbout one in five new prescriptions is never filled. But partnerships with pharmacists and innovations in pharma support are improving adherence. Examples include full-service PCP clinics co-located with pharmacies, patient one-on-one visits with clinical pharmacists, Rx delivery services and pre-sorted pill packs—all designed to increase medicine compliance and therefore improve patient outcomes.

Hospital in the homeBuilding on the benefits of primary care in a home setting, hospital in the home is equipping a physician-led team to deliver on-demand acute care to patients

in their home if they meet specific criteria. The model includes a combination of clinical and non-clinical services, technology, equipment, supplies, medication and specialty expertise. According to an article in the Harvard Business Review, hospital in the home is one of the most studied innovations in health care. Early indicators demonstrate that it may improve outcomes related to high-acuity illnesses while delivering meaningful economic value.

We’re living in an age in which the practice of medicine includes the crucial and time-consuming task of managing a business. How can we deliver agile, adaptable, excellent patient care? The best innovations not only identify and clarify where problems exist, but also offer healthcare teams direction for implementing and measuring efficient technology. And who knows? These solutions might just allow us some well-deserved free time.

Robert Perlmuter, MD, FACP, is a board-certified physician associated with Northwestern Medicine and St. Joseph Hospital. He is affiliated with VillageMD, a leading national provider of primary care.


Share Your Innova-tion Stories with Chicago Medicine

Hospitals and health systems are invited to submit articles under a physician’s byline about the innovations and advances taking place at their institu-tions. All submissions should be accompa-nied by high-resolu-tion headshot photos and charts or other graphic material. For details, please contact Elizabeth at [email protected] or call 312-329-7335.

Illinois State Licensing and Regulatory BoardsDrug Enforcement Administration (DEA)State Medicaid AgenciesCenters for Medicare and Medicaid Services (CMS)Federal Drug Administration (FDA)Drafting Legal Opinion LettersAvailable for Co-counsel on CasesLicensure and Provider Application Submission

Providing legal and consultation services within the healthcare field for over 19 years in the following areas:

•••

••••

•

If you need assistance obtaining a professional license or defending against disciplinary action, we are here to help!

630-310-1267www.jjblawoffice.com | [email protected]

JOSEPH J. BOGDAN, PHARM.D., J.D., LLC





http://www.jjblawoce.com


http://www.jjblawoffice.com


TELEMEDICINE


TELEMEDICINE


THE PATIENT, let’s call him Jim, was in his late 70s. He had just undergone a knee replacement and needed a follow-up visit with his orthopedic surgeon Victor “Rocky” Romano, MD, of Oak

Park. But Jim had been advised to stay home in isolation with his wife Martha and not potentially expose himself to the COVID-19 virus. He had been having his groceries and meds delivered.

Dr. Romano, who is vice chairman of the Chicago Medical Society Council, recommended a video call via Doxy.me, a free cloud-based electronic medical record (EMR) and telemedicine platform. Doxy.me, one of several systems on the market, allows patients to start sessions by clicking on a URL shared via email or SMS. Doxy.me is HIPAA-compliant and available as an Android or iOS app on a mobile device.

Performing an Orthopedic Exam on VideoAll Jim had to do to launch his visit was enter a URL. He was instantly connected with Dr.

Romano. The orthopedic surgeon was able to con-duct the exam on video—with Martha’s assistance. Under Dr. Romano’s direction, Martha tested Jim’s strength and the range of motion in his knee.

Then, Dr. Romano observed Jim walking across the room. “That was cool. It worked out nicely,” Dr. Romano said. Martha shared images of Jim’s wound, which Dr. Romano said was healing well. Dr. Romano taught Martha how to palpate the wound.

“One of the things you worry about in cases like this is blood clots, and [Jim’s wound] didn’t look swollen to me, but I asked his wife to feel behind the cast. I asked her: ‘Does it feel soft?’ She said, ‘Yeah.’ And I asked Jim, ‘Does it hurt?’ and he said, ‘No.’ I said ‘Good, you don’t have to worry about blood clots.’ The biggest things I worry about are infection, blood clots, and how the incision looks.”

Dr. Romano then demonstrated stretching exercises Jim should do to aid in his healing. The orthopedic surgeon could observe over video how Jim performed them and offer corrections.

Dr. Romano concluded that Jim was making

TELEMEDICINE

Has the COVID-19 Emergency Finally Given Telemedicine its Day?Will telemedicine simply become medicine? By Howard Wolinsky

JUST DAYS after President Trump’s emergency declaration on March 17, including a waiver to lift Medicare’s restrictions on coverage of tele-medicine effective retroactively to March 6, the State of Illinois had its own executive order from Governor J.B. Pritzker. On March 19, the Illinois governor issued an order expanding telehealth services across the state as part of the continued effort to mitigate the COVID-19 crisis. The governor ordered all health insurance issuers regulated by the Department of Insur-ance to cover the costs of all telehealth services rendered by in-network providers. Large insurers jumped on board, expanding in-network telehealth benefits for all fully insured members for the duration of the Gubernatorial Disaster Proclamation.

Effective March 19, Blue Cross and

Blue Shield of Illinois began provid-ing benefits to insured members for healthcare services provided by both in-network and out-of-network providers for all medically necessary covered care and treatments consistent with the terms of the member’s benefit plan. As of March 28, the insurer began to accept billing codes for psychiatry, mental health treatment, substance use disorder treatment and related services regardless of the patient’s location via electronic or telephonic methods includ-ing, FaceTime, Facebook Messenger, Google Hangouts, or Skype.

Utilization Review Cancelled During EmergencyDuring this period, health insurers may not impose utilization review require-ments for telehealth services that are unnecessary, duplicative, or unwar-

ranted or treatment limitations that are more stringent than those applicable to in-person healthcare services. Insur-ers may not impose prior authorization requirements for in-network provid-ers of telehealth services related to COVID-19, nor cost-sharing obligations for telehealth services from in-network providers, except for non-preventative care services for enrollees in high-deductible health plans. However, based on recently issued IRS guidance, COVID-19 testing, treatment, and potential vaccination are considered preventative care.

Although the coronavirus outbreak is still unfolding, it could have a long-lasting impact on the future of tele-health, leading to permanent changes in the way insurers and government payers cover telehealth and remote monitoring devices.

Illinois Acts to Expand Telemedicine

Chicago Medicine’s Covid-19 Series


THE PATIENT, let’s call him Jim, was in his late 70s. He had just undergone a knee replacement and needed a follow-up visit with his orthopedic surgeon Victor “Rocky” Romano, MD, of Oak

Park. But Jim had been advised to stay home in isolation with his wife Martha and not potentially expose himself to the COVID-19 virus. He had been having his groceries and meds delivered.

Dr. Romano, who is vice chairman of the Chicago Medical Society Council, recommended a video call via Doxy.me, a free cloud-based electronic medical record (EMR) and telemedicine platform. Doxy.me, one of several systems on the market, allows patients to start sessions by clicking on a URL shared via email or SMS. Doxy.me is HIPAA-compliant and available as an Android or iOS app on a mobile device.

Performing an Orthopedic Exam on VideoAll Jim had to do to launch his visit was enter a URL. He was instantly connected with Dr.

Romano. The orthopedic surgeon was able to con-duct the exam on video—with Martha’s assistance. Under Dr. Romano’s direction, Martha tested Jim’s strength and the range of motion in his knee.

Then, Dr. Romano observed Jim walking across the room. “That was cool. It worked out nicely,” Dr. Romano said. Martha shared images of Jim’s wound, which Dr. Romano said was healing well. Dr. Romano taught Martha how to palpate the wound.

“One of the things you worry about in cases like this is blood clots, and [Jim’s wound] didn’t look swollen to me, but I asked his wife to feel behind the cast. I asked her: ‘Does it feel soft?’ She said, ‘Yeah.’ And I asked Jim, ‘Does it hurt?’ and he said, ‘No.’ I said ‘Good, you don’t have to worry about blood clots.’ The biggest things I worry about are infection, blood clots, and how the incision looks.”

Dr. Romano then demonstrated stretching exercises Jim should do to aid in his healing. The orthopedic surgeon could observe over video how Jim performed them and offer corrections.

Dr. Romano concluded that Jim was making

TELEMEDICINE

Has the COVID-19 Emergency Finally Given Telemedicine its Day?Will telemedicine simply become medicine? By Howard Wolinsky

JUST DAYS after President Trump’s emergency declaration on March 17, including a waiver to lift Medicare’s restrictions on coverage of tele-medicine effective retroactively to March 6, the State of Illinois had its own executive order from Governor J.B. Pritzker. On March 19, the Illinois governor issued an order expanding telehealth services across the state as part of the continued effort to mitigate the COVID-19 crisis. The governor ordered all health insurance issuers regulated by the Department of Insur-ance to cover the costs of all telehealth services rendered by in-network providers. Large insurers jumped on board, expanding in-network telehealth benefits for all fully insured members for the duration of the Gubernatorial Disaster Proclamation.

Effective March 19, Blue Cross and

Blue Shield of Illinois began provid-ing benefits to insured members for healthcare services provided by both in-network and out-of-network providers for all medically necessary covered care and treatments consistent with the terms of the member’s benefit plan. As of March 28, the insurer began to accept billing codes for psychiatry, mental health treatment, substance use disorder treatment and related services regardless of the patient’s location via electronic or telephonic methods includ-ing, FaceTime, Facebook Messenger, Google Hangouts, or Skype.

Utilization Review Cancelled During EmergencyDuring this period, health insurers may not impose utilization review require-ments for telehealth services that are unnecessary, duplicative, or unwar-

ranted or treatment limitations that are more stringent than those applicable to in-person healthcare services. Insur-ers may not impose prior authorization requirements for in-network provid-ers of telehealth services related to COVID-19, nor cost-sharing obligations for telehealth services from in-network providers, except for non-preventative care services for enrollees in high-deductible health plans. However, based on recently issued IRS guidance, COVID-19 testing, treatment, and potential vaccination are considered preventative care.

Although the coronavirus outbreak is still unfolding, it could have a long-lasting impact on the future of tele-health, leading to permanent changes in the way insurers and government payers cover telehealth and remote monitoring devices.

Illinois Acts to Expand Telemedicine

Chicago Medicine’s Covid-19 Series


http://Doxy.me

http://Doxy.me

http://Doxy.me


satisfactory progress and didn’t need to come into Dr. Romano’s office for an in-person check-up. If patients can’t figure out Doxy.me, Dr. Romano encourages them to use Facetime on their Apple phones.

Welcome to the new world of telemedicine.

Could Telemedicine have Started in the Days of the First Phones?Charles Doarn, MBA, editor-in-chief of the Telemedicine and E-health journal, MPH program director, and director of the Telemedicine and e-Health Program at the University of Cincinnati’s College of Medicine, has been involved with telemedicine since 1990 and also serves as special assistant to the NASA chief health and medical officer at NASA Headquarters. He noted that telemedicine actually isn’t anything new. The first telemedicine call in the United States likely occurred sometime after Alexander Graham Bell received a patent for the telephone in 1876, he said.

Doarn said the advent of smartphones, which have as much computing power on board as was used to land the astronauts on the moon, has opened instantaneous communication and new possibilities for medicine, new possibilities that up to now have not come to fruition. But for a variety of reasons telemedicine—both old-fashioned phone calls and video calls—had not caught on. Experts in the field estimate that of the 1.1 billion doctor office visits per year in the U.S., only about 1% were made on the phone or video conferencing.

What Are the Barriers? Doctors and patients alike have been acculturated to face-to-face office visits. They don’t know what can and can’t be accomplished on a phone call let alone a video call.

Krista Drobac, executive of the Alliance for Connected Care, a Washington, DC-based lobbying group for telemedicine organizations, including tech companies, telehealth providers and health systems, said telehealth “has been slowly adopted because it’s new and different. A lot of the problem is because doctors didn’t get paid for it by Medicare. They didn’t set it up in their offices. If your doctor’s not offering it and you like your doctor, you don’t try it.”

Drobac, former health advisor to Senator Dick Durbin (D-Ill.) and also deputy director of the Illinois Department of Healthcare and Family Services under Gov. Rod Blagojevich, said, “The commercial market got into covering telemedicine early, about eight years ago. It started with employ-ers offering telemedicine as a separate benefit to their employees. And then insurers eventually started integrating telemedicine into the insurance products. Now about 90% of large employers offer telemedicine in some form, either through the employer or through the insurer.”

Medicare Lagged Conventional InsuranceDrobac said, however, Medicare has been “a lag-ging market for telemedicine.” But the COVID-19 pandemic changed that—at least for the moment. Before the pandemic, Medicare only paid for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they can’t leave their home and go to a clinic, hospital, or certain other type of medical facility for the service.

The new coronavirus, first diagnosed in the U.S. in January, changed everything. On March 17, President Trump signed an emergency and tempo-rary declaration including a waiver to lift Medicare’s restrictions on coverage of telemedicine effective

Dr. Victor Romano, vice chairman of the Chicago Medical Society Council; Charles Doarn, MBA, editor-in-chief of the Telemedicine and E-health jour-nal; Janet Furman, PA-C, director of Advanced Practice Provider Competency and Education at Rush University Medical Center.

TELEMEDICINE


satisfactory progress and didn’t need to come into Dr. Romano’s office for an in-person check-up. If patients can’t figure out Doxy.me, Dr. Romano encourages them to use Facetime on their Apple phones.

Welcome to the new world of telemedicine.

Could Telemedicine have Started in the Days of the First Phones?Charles Doarn, MBA, editor-in-chief of the Telemedicine and E-health journal, MPH program director, and director of the Telemedicine and e-Health Program at the University of Cincinnati’s College of Medicine, has been involved with telemedicine since 1990 and also serves as special assistant to the NASA chief health and medical officer at NASA Headquarters. He noted that telemedicine actually isn’t anything new. The first telemedicine call in the United States likely occurred sometime after Alexander Graham Bell received a patent for the telephone in 1876, he said.

Doarn said the advent of smartphones, which have as much computing power on board as was used to land the astronauts on the moon, has opened instantaneous communication and new possibilities for medicine, new possibilities that up to now have not come to fruition. But for a variety of reasons telemedicine—both old-fashioned phone calls and video calls—had not caught on. Experts in the field estimate that of the 1.1 billion doctor office visits per year in the U.S., only about 1% were made on the phone or video conferencing.

What Are the Barriers? Doctors and patients alike have been acculturated to face-to-face office visits. They don’t know what can and can’t be accomplished on a phone call let alone a video call.

Krista Drobac, executive of the Alliance for Connected Care, a Washington, DC-based lobbying group for telemedicine organizations, including tech companies, telehealth providers and health systems, said telehealth “has been slowly adopted because it’s new and different. A lot of the problem is because doctors didn’t get paid for it by Medicare. They didn’t set it up in their offices. If your doctor’s not offering it and you like your doctor, you don’t try it.”

Drobac, former health advisor to Senator Dick Durbin (D-Ill.) and also deputy director of the Illinois Department of Healthcare and Family Services under Gov. Rod Blagojevich, said, “The commercial market got into covering telemedicine early, about eight years ago. It started with employ-ers offering telemedicine as a separate benefit to their employees. And then insurers eventually started integrating telemedicine into the insurance products. Now about 90% of large employers offer telemedicine in some form, either through the employer or through the insurer.”

Medicare Lagged Conventional InsuranceDrobac said, however, Medicare has been “a lag-ging market for telemedicine.” But the COVID-19 pandemic changed that—at least for the moment. Before the pandemic, Medicare only paid for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they can’t leave their home and go to a clinic, hospital, or certain other type of medical facility for the service.

The new coronavirus, first diagnosed in the U.S. in January, changed everything. On March 17, President Trump signed an emergency and tempo-rary declaration including a waiver to lift Medicare’s restrictions on coverage of telemedicine effective

Dr. Victor Romano, vice chairman of the Chicago Medical Society Council; Charles Doarn, MBA, editor-in-chief of the Telemedicine and E-health jour-nal; Janet Furman, PA-C, director of Advanced Practice Provider Competency and Education at Rush University Medical Center.

TELEMEDICINE


http://Doxy.me

retroactively to March 6. The waiver is in place until the public health emergency officially ends.

When it was clear in early to mid-March that the COVID-19 pandemic was going to hit Chicago hard, local hospitals and medical practices shifted gears to meet the need. They canceled elective surgeries. They tried to convert in-office visits to telemedicine visits—either on the phone or over video.

COVID-19 Boosted TelemedicineFor example, Rush University Medical Center added a module to its Rush On-Demand video visit plat-form “Concern for coronavirus -19” that the patient could choose and be connected to a provider. Loyola Medicine rapidly adopted a virtual visit program a year earlier than planned. The University of Chicago Medicine accelerated plans for video conferencing, initially starting with phone visits and then switch-ing to video in mid-April.

Well before the COVID-19 pandemic took off, Rush University Medical Center, an early adopter of tele-medicine, had launched Rush On-Demand in August 2019, a telemedicine program offering care to patients who paid out-of-pocket or with insurance if available, said Janet Furman, PA-C, director of Advanced Practice Provider Competency and Education, who set up the coronavirus module that went live March 4. Before the pandemic, the video visit volume was about 250 per month. When the pandemic began, visit volume grew to over 150 visits per day.

The program completed 4,000 visits in March and April. On-Demand asynchronous visits, known as e-visits, and video visit services, known as Video Visits, have been helpful to patients with certain conditions such as a rash.

Connections are made through Rush’s MyChart portal online. During a video visit, patients talk to a provider via video chat, receive a diagnosis on the call

and get a treatment plan. If they need prescriptions, they’ll be sent directly to their pharmacy.

When the pandemic hit, Rush pivoted to serve COVID-19 patients, said Furman, who helped to set up the On-Demand telemedicine program COVID Response.

Rush Uses Telemed to Screen for COVID-19On-Demand patients who suspect they have COVID-19 based on such symptoms as a dry cough, tiredness and fever, can either schedule a video visit or call a hotline where they are greeted by a nurse. The nurse performs a “forward nursing triage” to determine who should see the patient. “If someone’s really sick, can’t breathe, the nurse will tell them to go to the emergency department,” Furman said.

If it’s felt the patient does not need to go to the ED, a video visit will be initiated over a secure live video connection. “We can help assess their symptoms, help them to manage their symptoms at home, decide whether they might need testing, or refer them to professionals in urgent or emergent care,” Furman said. “If their symptoms are mild, we don’t want them to go to the emergency room and be infected or infect others. We’re trying to avoid sick people congregating in waiting rooms.”

Shortcomings of TelemedFurman said one of the issues with video visits is that technology can break down. “If it’s not working well, in that particular moment, it can be frustrating for both the patient and the provider. We don’t encounter that much. But certainly there can be difficulties with connection, for example, if the patients’ wi-fi connection is not that strong. There are basic technology issues that sometimes have to be overcome.”

Dr. Richard Freeman, regional chief clinical officer at Loyola Medicine; Dr. Neil Gupta, Loyola Medicine’s regional director of digestive health; Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine.

TELEMEDICINE


retroactively to March 6. The waiver is in place until the public health emergency officially ends.

When it was clear in early to mid-March that the COVID-19 pandemic was going to hit Chicago hard, local hospitals and medical practices shifted gears to meet the need. They canceled elective surgeries. They tried to convert in-office visits to telemedicine visits—either on the phone or over video.

COVID-19 Boosted TelemedicineFor example, Rush University Medical Center added a module to its Rush On-Demand video visit plat-form “Concern for coronavirus -19” that the patient could choose and be connected to a provider. Loyola Medicine rapidly adopted a virtual visit program a year earlier than planned. The University of Chicago Medicine accelerated plans for video conferencing, initially starting with phone visits and then switch-ing to video in mid-April.

Well before the COVID-19 pandemic took off, Rush University Medical Center, an early adopter of tele-medicine, had launched Rush On-Demand in August 2019, a telemedicine program offering care to patients who paid out-of-pocket or with insurance if available, said Janet Furman, PA-C, director of Advanced Practice Provider Competency and Education, who set up the coronavirus module that went live March 4. Before the pandemic, the video visit volume was about 250 per month. When the pandemic began, visit volume grew to over 150 visits per day.

The program completed 4,000 visits in March and April. On-Demand asynchronous visits, known as e-visits, and video visit services, known as Video Visits, have been helpful to patients with certain conditions such as a rash.

Connections are made through Rush’s MyChart portal online. During a video visit, patients talk to a provider via video chat, receive a diagnosis on the call

and get a treatment plan. If they need prescriptions, they’ll be sent directly to their pharmacy.

When the pandemic hit, Rush pivoted to serve COVID-19 patients, said Furman, who helped to set up the On-Demand telemedicine program COVID Response.

Rush Uses Telemed to Screen for COVID-19On-Demand patients who suspect they have COVID-19 based on such symptoms as a dry cough, tiredness and fever, can either schedule a video visit or call a hotline where they are greeted by a nurse. The nurse performs a “forward nursing triage” to determine who should see the patient. “If someone’s really sick, can’t breathe, the nurse will tell them to go to the emergency department,” Furman said.

If it’s felt the patient does not need to go to the ED, a video visit will be initiated over a secure live video connection. “We can help assess their symptoms, help them to manage their symptoms at home, decide whether they might need testing, or refer them to professionals in urgent or emergent care,” Furman said. “If their symptoms are mild, we don’t want them to go to the emergency room and be infected or infect others. We’re trying to avoid sick people congregating in waiting rooms.”

Shortcomings of TelemedFurman said one of the issues with video visits is that technology can break down. “If it’s not working well, in that particular moment, it can be frustrating for both the patient and the provider. We don’t encounter that much. But certainly there can be difficulties with connection, for example, if the patients’ wi-fi connection is not that strong. There are basic technology issues that sometimes have to be overcome.”

Dr. Richard Freeman, regional chief clinical officer at Loyola Medicine; Dr. Neil Gupta, Loyola Medicine’s regional director of digestive health; Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine.

TELEMEDICINE



She said the inability to do a thorough physical exam is another downside. “Sometimes that’s really, really needed. You can do things like have the patient take their pulse, or if they have a smartwatch they often can track their pulse. You can have them measure their respiratory rate. You have them take their temperature. If they have a blood pressure cuff at home, they can do that. We certainly do have vital signs if we need them,” Furman said.

“But,” she continued, “You can’t lay hands on the patient. And that’s probably the biggest downside but it doesn’t preclude providing care in most cases.”

Loyola Scrambled to Take its System Online in a Matter of DaysRichard Freeman, MD, regional chief clinical officer at Loyola Medicine, said when COVID-19 hit, Loyola was in the process of adopting a new electronic records system across its medical centers, clinics and other facilities. Loyola got its system online in a matter of days, going live on March 23, just as federal and state regulations allowed telemedicine visits to be reimbursed.

“With COVID-19 on the radar, the first thing we did is start to contact our vulnerable populations and ask them not to come to the clinic or the hospital, like transplant or oncology patients, for instance,” he said. “We initially called them on the phone. In the meantime, we started to really push to get our telehealth platform up and running. Ours originally was scheduled to be here in a year or so with our new electronic health record. And so we moved that up.”

After that first group of high-risk patients, the telemedicine service was opened up to all patients seeking care.

Neil Gupta, MD, Loyola Medicine’s Regional

Director of Digestive Health, who spearheaded the telehealth effort, said up until March Loyola had only very specialized telehealth services, such as its telestroke program launched in 2010 to provide neurology services to intensive care units that didn’t have neurologists on premises. “Our [tele-stroke] program has the ability to video see the patient, has the ability to talk to the local doctor on staff using that same platform, review scans, such as CT scans or MRIs of the brain to help provide care or consultations for those stroke patients,” he noted.

It took three days to deploy the new telemedi-cine system, which went live on March 23, just as state and federal regulation allowed reimburse-ment for all patients because of COVID-19.

Dr. Gupta said the new HIPAA-compliant system, like others in the Chicago area, uses the electronic records system as a means to connect patient and doctor on video, comparing the connec-tion on computer or phone to Apple’s FaceTime and Microsoft’s Skype. The Loyola system is web-based and doesn’t require the patient to download an app or specialized software. All they need is a com-puter equipped with a camera and a microphone.

“Our new [telemedicine] system was really pushed through rapidly to help provide outpatient care for patients who either are at the greatest risk to come in-person for a clinic appointment, or just to help provide care for patients who are trying to practice as much social distancing as possible,” he said. “And so that’s really designed to be across all specialties, physicians, ranging from primary care docs to cardiologists. Surgeons can now provide a video-based consultation or office visit with a patient at home and the doctor being either on-site at one of our clinics or even the doctor being at home.”

Dr. Jayant Pinto, an ear, nose and throat specialist at the University of Chicago Medicine, wears the protective gear needed for an in-person patient visit; Thomas Kelly, a neurologist at the University of Chicago, consults with a patient on video; Dr. Mark Friedman, chief medical officer at First Stop Health.

TELEMEDICINE


She said the inability to do a thorough physical exam is another downside. “Sometimes that’s really, really needed. You can do things like have the patient take their pulse, or if they have a smartwatch they often can track their pulse. You can have them measure their respiratory rate. You have them take their temperature. If they have a blood pressure cuff at home, they can do that. We certainly do have vital signs if we need them,” Furman said.

“But,” she continued, “You can’t lay hands on the patient. And that’s probably the biggest downside but it doesn’t preclude providing care in most cases.”

Loyola Scrambled to Take its System Online in a Matter of DaysRichard Freeman, MD, regional chief clinical officer at Loyola Medicine, said when COVID-19 hit, Loyola was in the process of adopting a new electronic records system across its medical centers, clinics and other facilities. Loyola got its system online in a matter of days, going live on March 23, just as federal and state regulations allowed telemedicine visits to be reimbursed.

“With COVID-19 on the radar, the first thing we did is start to contact our vulnerable populations and ask them not to come to the clinic or the hospital, like transplant or oncology patients, for instance,” he said. “We initially called them on the phone. In the meantime, we started to really push to get our telehealth platform up and running. Ours originally was scheduled to be here in a year or so with our new electronic health record. And so we moved that up.”

After that first group of high-risk patients, the telemedicine service was opened up to all patients seeking care.

Neil Gupta, MD, Loyola Medicine’s Regional

Director of Digestive Health, who spearheaded the telehealth effort, said up until March Loyola had only very specialized telehealth services, such as its telestroke program launched in 2010 to provide neurology services to intensive care units that didn’t have neurologists on premises. “Our [tele-stroke] program has the ability to video see the patient, has the ability to talk to the local doctor on staff using that same platform, review scans, such as CT scans or MRIs of the brain to help provide care or consultations for those stroke patients,” he noted.

It took three days to deploy the new telemedi-cine system, which went live on March 23, just as state and federal regulation allowed reimburse-ment for all patients because of COVID-19.

Dr. Gupta said the new HIPAA-compliant system, like others in the Chicago area, uses the electronic records system as a means to connect patient and doctor on video, comparing the connec-tion on computer or phone to Apple’s FaceTime and Microsoft’s Skype. The Loyola system is web-based and doesn’t require the patient to download an app or specialized software. All they need is a com-puter equipped with a camera and a microphone.

“Our new [telemedicine] system was really pushed through rapidly to help provide outpatient care for patients who either are at the greatest risk to come in-person for a clinic appointment, or just to help provide care for patients who are trying to practice as much social distancing as possible,” he said. “And so that’s really designed to be across all specialties, physicians, ranging from primary care docs to cardiologists. Surgeons can now provide a video-based consultation or office visit with a patient at home and the doctor being either on-site at one of our clinics or even the doctor being at home.”

Dr. Jayant Pinto, an ear, nose and throat specialist at the University of Chicago Medicine, wears the protective gear needed for an in-person patient visit; Thomas Kelly, a neurologist at the University of Chicago, consults with a patient on video; Dr. Mark Friedman, chief medical officer at First Stop Health.

TELEMEDICINE


A Video Visit Can Almost Match an In-Person Visit Dr. Gupta said a virtual visit offers most of the functionality of an in-person exam, though some types of care that have a physical component, such as an x-ray, a nasal swab, a digital rectal exam, or a blood draw, are not conducive to video visits. “These patients could have a consultation or visit through the video visit platform. But then your doctor may advise you to come to a local facility to have those additional tests completed,” he said.

Jeffrey Linder, MD, MPH, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine primary care physician, said, “We’ve always delivered a lot of care over the phone and through our electronic health portal. But that’s always been viewed as a required side part of the job, and we’ve been really focused on care that’s delivered in-person.”

COVID-19 changed that, placing an emphasis on video and phone visits with patients, said Dr. Linder, who is involved in federally funded research on the prescription of antibiotics with telemedicine. He is collaborating with Teladoc Health Inc., a major telemedicine company.

Half of Visits Don’t Require an MDDr. Linder said he has long held that at least 50% of doctor visits do not require the physical presence of a doctor and patient in the room. He said there has been a slow acceptance of telemedicine over the phone or the Internet because of the way insurers pay for medical care. “The way we’ve structured and financed healthcare makes it a relic of the 1970s or ‘60s, where we’re not taking advantage of modern technology,” he said. “But with the requirement that we [doctors and patients] all stay away from each other, it has made it mandatory to use telemedicine since the COVID-19 emergency began and until it ends.”

He sees major advantages to telemedicine—dur-ing the pandemic and even post-pandemic. He said telemedicine can enable a doctor to see more patients in a shorter time. “Hopefully, doctors, patients, and health systems kind of realize the benefits and convenience that we’re seeing with all of the phone visits and video visits that people are doing right now,” he said,

Dr. Linder added, “One of the major advantages to patients is saving time. They avoid driving, parking, the check-in staff, a nurse to triage you, somebody to maybe give you an injection when you’re leaving, check-out staff. You can in most cases accomplish 80% of what you really need to accomplish just from the comfort of your own home. Isn’t that an improvement?”

Dr. Linder said that as a primary care physician, he can take care of most things he does with patients. However, if it’s a musculoskeletal com-plaint, there’s no substitute for being there with the person and seeing what’s going on with a joint.

Dr. Linder said he has found that dermatologists

are divided over whether they can get adequate images for a tele-dermatology exam over the phone. The internist said he discovered in his practice that “it helps to see a patient at least a bit with video, but probably most things can be done on the phone.”

Dr. Linder, like other physicians, finds some patients can’t handle the technology needed for a tele-visit or prefer a face-to-face encounter. Also, he thinks that not all cameras in laptops and smartphones may be up to the task. In addition, he said office visits offer the advantage of the doctor picking up problems they might miss over the phone. “You can tell a lot just by watching some-body walking into an exam room, such as arthritis that a patient downplays,” he said.

In mid-March, doctors at University of Chicago Medicine switched patients, when possible, to vis-its via phone. By the second week of April, patients were seen on video using a HIPPA-compliant version of Zoom.

Jayant Pinto, MD, an ENT at U of C, said the university had pre-existing plans to roll out a video service, which, because of the pandemic, were accelerated considerably, and they have now been implemented across the medical center in essentially all the clinics. “Our clinic patients in general have been very receptive to either deferring care that can wait until they can come in or discussing their care over the phone or doing a video visit,” he said.

Patients Still Need In-Person ExamsThomas Kelly, MD, a neurologist at the University of Chicago, said he initially was concerned that video conferencing would not work well in neurology, a specialty that is heavily dependent on physical exams. “There’s only so much one can do through video. But I think an experienced neurolo-gist in most cases can get most of the information that we need, with the exception of sensory examinations or reflexes, etc.,” he said.

Dr. Pinto said some patients of course still require visits in-person. He said he treats these visits as if he were performing surgery, donning gloves, gown, face mask and eye shield. Patients likewise wear masks. Some doctors have rigged up one-way valves to insert laryngoscopes to look through the nose or throat. He noted that in Wuhan, China, where the pandemic started, ENTs and ophthalmologists were reported to be amongst the specialties with the highest mortality rates since they are close up to patients during exams and potentially exposed to the virus.

He said the biggest limitation of phone and video exams is the lack of physical contact. “We’re learning quite quickly what parts of the exam are really important and that we absolutely need immediately and which parts of the exam are less important. It’s pushing us to think very carefully about each patient and what information is critical and how we can get that information, either in alternative ways or in bringing them in for exams.”

TELEMEDICINE


A Video Visit Can Almost Match an In-Person Visit Dr. Gupta said a virtual visit offers most of the functionality of an in-person exam, though some types of care that have a physical component, such as an x-ray, a nasal swab, a digital rectal exam, or a blood draw, are not conducive to video visits. “These patients could have a consultation or visit through the video visit platform. But then your doctor may advise you to come to a local facility to have those additional tests completed,” he said.

Jeffrey Linder, MD, MPH, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine primary care physician, said, “We’ve always delivered a lot of care over the phone and through our electronic health portal. But that’s always been viewed as a required side part of the job, and we’ve been really focused on care that’s delivered in-person.”

COVID-19 changed that, placing an emphasis on video and phone visits with patients, said Dr. Linder, who is involved in federally funded research on the prescription of antibiotics with telemedicine. He is collaborating with Teladoc Health Inc., a major telemedicine company.

Half of Visits Don’t Require an MDDr. Linder said he has long held that at least 50% of doctor visits do not require the physical presence of a doctor and patient in the room. He said there has been a slow acceptance of telemedicine over the phone or the Internet because of the way insurers pay for medical care. “The way we’ve structured and financed healthcare makes it a relic of the 1970s or ‘60s, where we’re not taking advantage of modern technology,” he said. “But with the requirement that we [doctors and patients] all stay away from each other, it has made it mandatory to use telemedicine since the COVID-19 emergency began and until it ends.”

He sees major advantages to telemedicine—dur-ing the pandemic and even post-pandemic. He said telemedicine can enable a doctor to see more patients in a shorter time. “Hopefully, doctors, patients, and health systems kind of realize the benefits and convenience that we’re seeing with all of the phone visits and video visits that people are doing right now,” he said,

Dr. Linder added, “One of the major advantages to patients is saving time. They avoid driving, parking, the check-in staff, a nurse to triage you, somebody to maybe give you an injection when you’re leaving, check-out staff. You can in most cases accomplish 80% of what you really need to accomplish just from the comfort of your own home. Isn’t that an improvement?”

Dr. Linder said that as a primary care physician, he can take care of most things he does with patients. However, if it’s a musculoskeletal com-plaint, there’s no substitute for being there with the person and seeing what’s going on with a joint.

Dr. Linder said he has found that dermatologists

are divided over whether they can get adequate images for a tele-dermatology exam over the phone. The internist said he discovered in his practice that “it helps to see a patient at least a bit with video, but probably most things can be done on the phone.”

Dr. Linder, like other physicians, finds some patients can’t handle the technology needed for a tele-visit or prefer a face-to-face encounter. Also, he thinks that not all cameras in laptops and smartphones may be up to the task. In addition, he said office visits offer the advantage of the doctor picking up problems they might miss over the phone. “You can tell a lot just by watching some-body walking into an exam room, such as arthritis that a patient downplays,” he said.

In mid-March, doctors at University of Chicago Medicine switched patients, when possible, to vis-its via phone. By the second week of April, patients were seen on video using a HIPPA-compliant version of Zoom.

Jayant Pinto, MD, an ENT at U of C, said the university had pre-existing plans to roll out a video service, which, because of the pandemic, were accelerated considerably, and they have now been implemented across the medical center in essentially all the clinics. “Our clinic patients in general have been very receptive to either deferring care that can wait until they can come in or discussing their care over the phone or doing a video visit,” he said.

Patients Still Need In-Person ExamsThomas Kelly, MD, a neurologist at the University of Chicago, said he initially was concerned that video conferencing would not work well in neurology, a specialty that is heavily dependent on physical exams. “There’s only so much one can do through video. But I think an experienced neurolo-gist in most cases can get most of the information that we need, with the exception of sensory examinations or reflexes, etc.,” he said.

Dr. Pinto said some patients of course still require visits in-person. He said he treats these visits as if he were performing surgery, donning gloves, gown, face mask and eye shield. Patients likewise wear masks. Some doctors have rigged up one-way valves to insert laryngoscopes to look through the nose or throat. He noted that in Wuhan, China, where the pandemic started, ENTs and ophthalmologists were reported to be amongst the specialties with the highest mortality rates since they are close up to patients during exams and potentially exposed to the virus.

He said the biggest limitation of phone and video exams is the lack of physical contact. “We’re learning quite quickly what parts of the exam are really important and that we absolutely need immediately and which parts of the exam are less important. It’s pushing us to think very carefully about each patient and what information is critical and how we can get that information, either in alternative ways or in bringing them in for exams.”

TELEMEDICINE



Telemedicine is nothing new for Chicago-based First Stop Health. Over the past seven years, its doctors, part-time or full-time independent con-tractors, have treated patients using smartphones or computers.

When the company launched, there was no pandemic spurring it on. “It was an idea whose time had come,” said Mark Friedman, MD, chief medical officer at First Stop Health, based in the East Loop’s Illinois Center. “Everyone was trying to help reduce costs in healthcare. This was one strategy to do that, and as with any good idea, it was recognized by people who said, ‘Yes, that’s a good idea!’ First thing you know, you’ve got lots of competition,” he said.

Dr. Friedman, who trained as an emergency spe-cialist, said First Stop Health offers care to patients in all 50 states and several U.S. territories. Cases are allocated to physicians based on where they are licensed, said Dr. Friedman, who is himself licensed in 21 states,

The COVID-19 pandemic has doubled the waiting time for patients seeking care at First Stop Health. Before the pandemic, waiting time aver-aged below five minutes. Now, Dr. Friedman said, it averages 10 minutes.

First Stop Health patients have the telemedicine service as an insurance benefit through their employers, including Ulta Beauty, ActiveCampaign and PowerReviews. First Stop Health receives no Medicare or Medicaid reimbursement.

Convenience for MDs and PatientsDr. Friedman said the appeal of First Stop Health is convenience—to doctors and patients. The ser-vice also reduces registration time and eliminates sitting in waiting rooms for hours at a time.

Calls initially are phone calls. “Most of the calls actually are just phone calls, audio. You can do video. It’s at the patient’s request, basically, although there are a couple states—Arkansas and New Hampshire that I can name offhand—where the state medical board has decided that the first telemedicine call needs to be a video consult to

establish a doctor-patient relationship,” he said.“People are using First Stop Health, and they’re

seeing how useful it is, and how it reduces the cost of care. Doctors are now getting experience with telemedicine, and many of them are seeing that it really is useful, that they can do it,” Dr. Friedman said, “They can see more patients this way than they can face-to-face because it takes less time.

“They’re protected from infectious diseases. I’ve screened lots of potential COVID cases, several of which I’m sure had it, but I’m not at risk for infection,” he said. “My colleagues in the ER are showing great courage. They have to intubate people with COVID-19. They have to put tubes down their [patients’] throats. They’re at high risk of getting infected.”

What Does the Future Hold?What happens to telemedicine after the COVID-19 emergency ends? Will Medicare tighten its restrictions on telemedicine? Or will telemedicine become indistin-guishable from medicine? Many health professionals think the genie has been let out of the bottle now that patients have seen the upsides of telehealth.

Rush’s Furman said, “We saw telemedicine expanding before the pandemic. Now that people have been exposed to this type of visit, I think we will only see an increase not only for urgent care or on-demand complaints, but for routine follow-ups from specialty offices.”

Northwestern’s Dr. Linder said: “Some of us are hoping the telemedicine genie is out of the bottle now that a lot of people will have had the experi-ence. I’ve heard anecdotally from patients and doctors, ‘Hey, this is great! I can do something just over the phone. It’s much more convenient.’ And so I think it might be a little bit tough to put the genie back in the bottle once this emergency has passed.”

Howard Wolinsky is an instructor at Northwestern University’s Medill School of Journalism. He is the former medical and technology reporter for the Chicago Sun-Times and a former staff writer for American Medical News.

TWO YEARS AGO, approximately 18% of physicians said they were using telemedicine to treat patients, according to the Physicians Founda-tion’s 2018 Survey of America’s Physi-cians conducted by Merritt Hawkins. That number has increased to 48%, the latest survey found. The use of telemedicine has been rapidly acceler-ated by the COVID-19 epidemic, which

has spurred changes to reimbursement policies that had previously limited its use, Travis Singleton, executive vice president of Merritt Hawkins, said.

“One positive result of the pandemic is that barriers to accessing physician services through telemedicine may be reduced, which will be critical as the nation deals with a growing physician shortage,” Singleton noted.

Other surveys confirm rising use of telemedicine. According to Sage Growth Partner and Black Book Market Research, 25% of consumer respondents said they had used telehealth prior to the current COVID-19 pandemic. Now, 59% report they are more likely to use telehealth services than in the past, and 33% would even leave their current physician for someone who offered telehealth access.

A Silver Lining? Surveys Show Use of Telemedicine Rising

TELEMEDICINE


Telemedicine is nothing new for Chicago-based First Stop Health. Over the past seven years, its doctors, part-time or full-time independent con-tractors, have treated patients using smartphones or computers.

When the company launched, there was no pandemic spurring it on. “It was an idea whose time had come,” said Mark Friedman, MD, chief medical officer at First Stop Health, based in the East Loop’s Illinois Center. “Everyone was trying to help reduce costs in healthcare. This was one strategy to do that, and as with any good idea, it was recognized by people who said, ‘Yes, that’s a good idea!’ First thing you know, you’ve got lots of competition,” he said.

Dr. Friedman, who trained as an emergency spe-cialist, said First Stop Health offers care to patients in all 50 states and several U.S. territories. Cases are allocated to physicians based on where they are licensed, said Dr. Friedman, who is himself licensed in 21 states,

The COVID-19 pandemic has doubled the waiting time for patients seeking care at First Stop Health. Before the pandemic, waiting time aver-aged below five minutes. Now, Dr. Friedman said, it averages 10 minutes.

First Stop Health patients have the telemedicine service as an insurance benefit through their employers, including Ulta Beauty, ActiveCampaign and PowerReviews. First Stop Health receives no Medicare or Medicaid reimbursement.

Convenience for MDs and PatientsDr. Friedman said the appeal of First Stop Health is convenience—to doctors and patients. The ser-vice also reduces registration time and eliminates sitting in waiting rooms for hours at a time.

Calls initially are phone calls. “Most of the calls actually are just phone calls, audio. You can do video. It’s at the patient’s request, basically, although there are a couple states—Arkansas and New Hampshire that I can name offhand—where the state medical board has decided that the first telemedicine call needs to be a video consult to

establish a doctor-patient relationship,” he said.“People are using First Stop Health, and they’re

seeing how useful it is, and how it reduces the cost of care. Doctors are now getting experience with telemedicine, and many of them are seeing that it really is useful, that they can do it,” Dr. Friedman said, “They can see more patients this way than they can face-to-face because it takes less time.

“They’re protected from infectious diseases. I’ve screened lots of potential COVID cases, several of which I’m sure had it, but I’m not at risk for infection,” he said. “My colleagues in the ER are showing great courage. They have to intubate people with COVID-19. They have to put tubes down their [patients’] throats. They’re at high risk of getting infected.”

What Does the Future Hold?What happens to telemedicine after the COVID-19 emergency ends? Will Medicare tighten its restrictions on telemedicine? Or will telemedicine become indistin-guishable from medicine? Many health professionals think the genie has been let out of the bottle now that patients have seen the upsides of telehealth.

Rush’s Furman said, “We saw telemedicine expanding before the pandemic. Now that people have been exposed to this type of visit, I think we will only see an increase not only for urgent care or on-demand complaints, but for routine follow-ups from specialty offices.”

Northwestern’s Dr. Linder said: “Some of us are hoping the telemedicine genie is out of the bottle now that a lot of people will have had the experi-ence. I’ve heard anecdotally from patients and doctors, ‘Hey, this is great! I can do something just over the phone. It’s much more convenient.’ And so I think it might be a little bit tough to put the genie back in the bottle once this emergency has passed.”

Howard Wolinsky is an instructor at Northwestern University’s Medill School of Journalism. He is the former medical and technology reporter for the Chicago Sun-Times and a former staff writer for American Medical News.

TWO YEARS AGO, approximately 18% of physicians said they were using telemedicine to treat patients, according to the Physicians Founda-tion’s 2018 Survey of America’s Physi-cians conducted by Merritt Hawkins. That number has increased to 48%, the latest survey found. The use of telemedicine has been rapidly acceler-ated by the COVID-19 epidemic, which

has spurred changes to reimbursement policies that had previously limited its use, Travis Singleton, executive vice president of Merritt Hawkins, said.

“One positive result of the pandemic is that barriers to accessing physician services through telemedicine may be reduced, which will be critical as the nation deals with a growing physician shortage,” Singleton noted.

Other surveys confirm rising use of telemedicine. According to Sage Growth Partner and Black Book Market Research, 25% of consumer respondents said they had used telehealth prior to the current COVID-19 pandemic. Now, 59% report they are more likely to use telehealth services than in the past, and 33% would even leave their current physician for someone who offered telehealth access.

A Silver Lining? Surveys Show Use of Telemedicine Rising

TELEMEDICINE


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Access career resources, job searching tips and tools.

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Your next medical career

opportunity is right at your

fingertips!

Search and apply to top medical jobs with organizations that value your credentials.

Upload your resume so employers can contact you. You remain anonymous until you choose to release your contact information.

Create job alerts and receive an email each time a job matching your criteria is posted.

Access career resources, job searching tips and tools.

Upload or update your resume today. Visit CMSDOCS-JOBS.CAREERWEBSITE.COM to get started.

http://cmsdocs-jobs.careerwebsite.com

MEMBER BENEFITS

THE CHICAGO Medical Society is the most active local group, uniting and fighting for physicians. Not only is CMS the hardest

working county in Illinois, it’s also the largest, serving an area with 17,000 physicians. Whether it’s representing medicine in Chicago, Springfield, or Washington, DC, developing educa-tional tools, studying complex issues, or advancing policies, members have many opportunities to see their dues dollars at work. The price of membership is a pit-tance when weighed against the cost of harmful bills CMS opposes and the pro-physician measures it promotes.

Some of the efforts being advanced by the Medical Society include:

• Promoting a legislative “Physician Bill of Rights” with fundamental principles to guide the employer-physician relationship.

• Improving the usability of EHRs through reduced regulation and elimi-nation of data blocking.

• Reducing the burden of Medicare reporting on physicians with simplified reporting programs.

• Working to limit Medicare audit look-back periods and improve fairness in payment recovery.

• Addressing systemic problems that impede physicians’ ability to practice in a wide variety of practice arrangements and compete in today’s rapidly evolving marketplace.

• Giving input on surprise billing legislation that protects patients from out-of-network charges while ensuring that insurers pay physicians fairly and transparently.

• Proposing a new CPT Code for time spent on prior authorizations.

• Reforming the Physician Payments Sunshine Act, known as “Open Payments,” to reduce paperwork burdens and other hassles.

The Chicago Medical Society was active on several successful efforts: preventing the proposed collapse of the E/M coding system; improving Medicare’s Quality Payment Program; passing a network adequacy and transparency law in Illinois;

removing pain as the fifth vital sign; and achieving new CPT payment codes for obesity counseling and end-of-life care discussions.

Legislative EngagementThe fields of engagement—the Illinois legislature, U.S. Congress, County and City government—are many. The Chicago Medical Society shapes public policy on behalf of physicians and patients. Not only do we make legislative rounds in Washington, DC, and work with top administrative staff, we also meet throughout the year in lawmakers’ local offices. All members who want to partici-pate in these talks are welcome to join.

Advocacy Mentorship CMS makes it easy for members to com-mit themselves to the advocacy process. Through our Key Contacts program, CMS mentors physician volunteers on how to form meaningful connections with their lawmaker or someone running for elected office. The program is flexible, accom-modating your busy schedule.

Democratic ForumsMany ideas and policy solutions take root in the Chicago Medical Society’s Governing Council. This makes CMS a launch site for county, state, and national initiatives. CMS also recognizes the necessity of a strong representative Society that engages all physicians, giving all groups opportunities to influence CMS’ future. Our Council structure reflects the physician community, with seats for academic medical centers, com-munity hospitals, safety net institutions, large group practices, ethnic and specialty groups, and federally qualified health centers. We provide a voice for everyone.

Committees at Work Committees form the backbone of all we do, and we rely on members to help identify topics for study. Our broad scope, deep well of policy resources and ties within the legal and legislative communi-ties expedite study and formulation of responses.

Grassroots Resolutions Chicagoland physicians enjoy visibility

at the state and national levels. CMS brings more proposals to the Illinois State Medical Society than any other region. These resolutions then dominate the Illinois delegation’s policy agenda at the American Medical Association. Many resolutions form the basis of bills introduced in Springfield and Washington, DC, by ISMS and AMA. Every member is welcome to introduce resolutions to CMS on issues affecting their professional needs and interests.

Medical-Legal EducationThe Chicago Medical Society’s educational programs reflect the latest legal and regulatory developments. As independent practice gives way to employment, we provide nonclinical CME most physicians won’t easily find. Our educational alliance with the American Bar Association brings health law attorneys and physicians together for sessions on a range of employment contracting issues. We believe that today’s physician needs to know the fac-tors that determine compensation, what due process means, and how to navigate noncompete provisions.

Programs also address health system consolidation, hospital and physician relationships, third-party payment issues, opioid prescribing and physician burnout. Top government officials also provide updates and answer questions.

Unity and Alignment Most physicians don’t have the time to march in the streets or on Capitol Hill. Physicians have common interests and we advance nonpartisan solutions to issues important to you and your profession.

Your goals are our goals. If you’re employed, you are likely to rely on your hospital, medical group or university medical center to advocate on your behalf. But an employer’s interests may not align with yours. Narrowly focused and competing medical specialty societies seldom succeed on a broad scale. It takes physician unity to achieve major victories in Springfield and Washington that benefit all physicians and the profession at large.

How CMS Works for You The Chicago Medical Society attacks practice burdens, scope intrusions, and payment woes


MEMBER BENEFITS

THE CHICAGO Medical Society is the most active local group, uniting and fighting for physicians. Not only is CMS the hardest

working county in Illinois, it’s also the largest, serving an area with 17,000 physicians. Whether it’s representing medicine in Chicago, Springfield, or Washington, DC, developing educa-tional tools, studying complex issues, or advancing policies, members have many opportunities to see their dues dollars at work. The price of membership is a pit-tance when weighed against the cost of harmful bills CMS opposes and the pro-physician measures it promotes.

Some of the efforts being advanced by the Medical Society include:

• Promoting a legislative “Physician Bill of Rights” with fundamental principles to guide the employer-physician relationship.

• Improving the usability of EHRs through reduced regulation and elimi-nation of data blocking.

• Reducing the burden of Medicare reporting on physicians with simplified reporting programs.

• Working to limit Medicare audit look-back periods and improve fairness in payment recovery.

• Addressing systemic problems that impede physicians’ ability to practice in a wide variety of practice arrangements and compete in today’s rapidly evolving marketplace.

• Giving input on surprise billing legislation that protects patients from out-of-network charges while ensuring that insurers pay physicians fairly and transparently.

• Proposing a new CPT Code for time spent on prior authorizations.

• Reforming the Physician Payments Sunshine Act, known as “Open Payments,” to reduce paperwork burdens and other hassles.

The Chicago Medical Society was active on several successful efforts: preventing the proposed collapse of the E/M coding system; improving Medicare’s Quality Payment Program; passing a network adequacy and transparency law in Illinois;

removing pain as the fifth vital sign; and achieving new CPT payment codes for obesity counseling and end-of-life care discussions.

Legislative EngagementThe fields of engagement—the Illinois legislature, U.S. Congress, County and City government—are many. The Chicago Medical Society shapes public policy on behalf of physicians and patients. Not only do we make legislative rounds in Washington, DC, and work with top administrative staff, we also meet throughout the year in lawmakers’ local offices. All members who want to partici-pate in these talks are welcome to join.

Advocacy Mentorship CMS makes it easy for members to com-mit themselves to the advocacy process. Through our Key Contacts program, CMS mentors physician volunteers on how to form meaningful connections with their lawmaker or someone running for elected office. The program is flexible, accom-modating your busy schedule.

Democratic ForumsMany ideas and policy solutions take root in the Chicago Medical Society’s Governing Council. This makes CMS a launch site for county, state, and national initiatives. CMS also recognizes the necessity of a strong representative Society that engages all physicians, giving all groups opportunities to influence CMS’ future. Our Council structure reflects the physician community, with seats for academic medical centers, com-munity hospitals, safety net institutions, large group practices, ethnic and specialty groups, and federally qualified health centers. We provide a voice for everyone.

Committees at Work Committees form the backbone of all we do, and we rely on members to help identify topics for study. Our broad scope, deep well of policy resources and ties within the legal and legislative communi-ties expedite study and formulation of responses.

Grassroots Resolutions Chicagoland physicians enjoy visibility

at the state and national levels. CMS brings more proposals to the Illinois State Medical Society than any other region. These resolutions then dominate the Illinois delegation’s policy agenda at the American Medical Association. Many resolutions form the basis of bills introduced in Springfield and Washington, DC, by ISMS and AMA. Every member is welcome to introduce resolutions to CMS on issues affecting their professional needs and interests.

Medical-Legal EducationThe Chicago Medical Society’s educational programs reflect the latest legal and regulatory developments. As independent practice gives way to employment, we provide nonclinical CME most physicians won’t easily find. Our educational alliance with the American Bar Association brings health law attorneys and physicians together for sessions on a range of employment contracting issues. We believe that today’s physician needs to know the fac-tors that determine compensation, what due process means, and how to navigate noncompete provisions.

Programs also address health system consolidation, hospital and physician relationships, third-party payment issues, opioid prescribing and physician burnout. Top government officials also provide updates and answer questions.

Unity and Alignment Most physicians don’t have the time to march in the streets or on Capitol Hill. Physicians have common interests and we advance nonpartisan solutions to issues important to you and your profession.

Your goals are our goals. If you’re employed, you are likely to rely on your hospital, medical group or university medical center to advocate on your behalf. But an employer’s interests may not align with yours. Narrowly focused and competing medical specialty societies seldom succeed on a broad scale. It takes physician unity to achieve major victories in Springfield and Washington that benefit all physicians and the profession at large.

How CMS Works for You The Chicago Medical Society attacks practice burdens, scope intrusions, and payment woes


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Refinance student loans or Parent PLUS loans at SoFi.com/cmsdocs to get an additional 0.25%1 discount toward your loans.

Chicago Medical Society and SoFi have teamed up to help you take down student debt—with student loan benefits, exclusively for CMS members, family and friends.

Why refinance student loans with SoFi?

Claim your 0.25%1 discount toward your student loans at SoFi.com/cmsdocsChecking your rate will not affect your credit score.2

Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. See SoFi.com/elgibility for details. SoFi refinance loans are private loans and do not have the same repayment options that the federal loan program offers such as Income Based Repayment or Income Contingent Repayment or PAYE. Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. Information as of July 2018.

1 Additional terms and conditions apply. If you apply and are approved, the interest rate shown in the Final Disclosure Statement will include an additional 0.125% rate discount because of your involvement with a SoFi partnercompany at the time of loan origination. Offer good for new customers only. Cannot be combined with other rate discounts, with the exception of the 0.25%AutoPay rate discount. SoFi reserves the right to change or terminate the Rate Discount Program to unenrolled participants at any time with or without notice.

2 To check the rates and terms you may qualify for, SoFi conducts a soft credit pull that will not affect your credit score. A hard credit pull, which may impact your credit score, is required if you apply for a SoFi product afterbeing pre-qualified.

How to apply:Find your rate at sofi.com/cmsdocs. If approved, select your rate and term. Upload identity, income, and

loan information. Celebrate your savings.1 2 3 4

STUDENT LOAN REFINANCING

Pay off student debt sooner. Save thousands.

Serious savings.

Low rates.

Members save

thousands they

refinance

Low variable and fixed

rate options may reduce

your interest rate.

Federal and private.You can consolidate and

refinance both federal and

private loans.

No extra fees.

No application/origination

fees or prepayment

penalties—ever.

Membership perks.

Refinance student loans or Parent PLUS loans at

o i.com/ to get an additional

%1 toward your loans.

and SoFi have teamed up to help you take down student debt—with student loan benefits, exclusively for

Why refinance student loans with SoFi?

Claim your 1 toward your student loans at o i.com/Checking your rate will not affect your credit score.2

Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. See SoFi.com/elgibility for details. SoFi

Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. Information as of July 2018.

1 Additional terms and conditions apply. If you apply and are approved, the interest rate shown in the Final Disclosure Statement will include an additional 0.125% rate discount because of your involvement with a SoFi partnercompany at the time of loan origination. Offer good for new customers only. Cannot be combined with other rate discounts, with the exception of the 0.25%AutoPay rate discount. SoFi reserves the right to change or terminate the Rate Discount Program to unenrolled participants at any time with or without notice.

2 To check the rates and terms you may qualify for, SoFi conducts a soft credit pull that will not affect your credit score. A hard credit pull, which may impact your

How to apply:Find your rate at o i.com/ . If approved, select your rate and term. Upload identity, income, and

loan information. Celebrate your savings.1 2 3 4

http://www.sofi.com/cmsdocs

Calendar of EventsMAY

20 CMS Executive Committee Meets once a month to plan Council meeting agendas; conduct business between quarterly Council meetings; and coordinate Council and Board functions. 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

JUNE

2 COVID-19 in Pediatric Populations (webinar)Join this didactic and an extensive Q&A led by ECHO-Chicago (Extension for Community Health Outcomes) Director & Infectious Disease specialist Dr. Daniel Johnson. The Chicago Medical Society has partnered with ECHO and the University of Chicago to support community providers in addressing the pandemic. 5:30-6:30 p.m.; Registration is required. Go to: https://www.echo-chicago.org.

10 COVID-19 in Adult Populations (webinar)Join this didactic led by infec-tious disease specialists, Drs. Jennifer Pisano and Stephen Schrantz, and geriatrician Dr. Kate Thompson, followed by case presentations. The Chicago Medical Society has partnered with ECHO-Chicago (Extension for Community Health Outcomes)to support community provid-ers in addressing COVID-19. 5:30-6:30 p.m.; Registration is required. Go to: https://www.echo-chicago.org/

16 COVID-19 in Pediatric Populations (see webinar description for June 2)

20 CMS Executive Committee 8:00-9:00 a.m. CMS Building; 515 N.

Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

20 CMS Board of Trustees 9:00-11:00 a.m. CMS Building, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

24 COVID-19 in Adult Populations (see webinar description for June 10)


JULY

15 CMS Executive Committee 7:00-8:00 a.m. Online meeting. Contact Ruby 312-670-2550, ext. 344; or [email protected].

18 Advanced Cardiovascular Life Support (ACLS) 8:30 a.m.-4:00 p.m.; Chicago Medical Society, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

AUGUST

15 CMS Executive Committee 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].


22 Parliamentary Procedures Workshop 10:00 a.m.-2:00 p.m.; CMS Building; 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

SEPTEMBER

8 CMS Council Meeting The

MEMBER BENEFITS

Society’s governing body meets four times a year to conduct business on behalf of the Society. The policymak-ing Council sets the CMS legislative agenda among other matters brought by leadership, committees, councilors, or other CMS members. 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, contact Ruby 312-670-2550, ext. 344; or [email protected].

10-12 Physicians Legal Issues: Healthcare Delivery and Innovations Conference Hosted annually by the American Bar Association’s Health Law Section and the Chicago Medical Society, this educational event offers physicians and their admin-istrative partners access to national speakers. Attorneys provide critical information on issues affecting employer and hospital relationships, business and industry and payer consolidation. Experts share everyday “survival” techniques for physicians. Hotel InterContinental; 505 N. Michigan Ave., Chicago. For details, contact Ruby 312-670-2550, ext. 344; or [email protected].

16 Chicago Gynecological Society Annual Dinner 6:00 p.m. For details, contact Megan 312-670-2550, ext. 332; or [email protected]


23 OSHA Training: Bloodborne Pathogens and Beyond 9:30 a.m.-12:00 p.m.; CMS Building; 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

OCTOBER

17 CMS Executive Committee 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St., Chicago. For information, contact Ruby 312-670-2550, ext. 344; or [email protected].

17 CMS Board of Trustees 9:00-11:00 a.m. CMS Building, 515 N. Dearborn St., Chicago. For information, contact Ruby 312-670-2550, ext. 344; or [email protected].

NOVEMBER

4 Chicago Gynecological Society General Meeting. 6:00 p.m. For details and to RSVP, contact Megan 312-670-2550, ext. 332; or [email protected].

10 CMS Council Meeting The Society’s governing body meets four times a year to set the Medical Society’s legislative agenda among other matters brought by officers, trustees, committees, council-ors, or other CMS members. 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, contact Ruby 312-670-2550, ext. 344; or [email protected].

14-17 American Medical Association House of Delegates Your Society participates in the American Medical Association’s meet-ings to advance physician practice reforms. Grassroots resolutions from CMS often result in AMA adopting new national policy and pursuing legislative remedies. CMS encourages you to be part of this process, which ensures your voice is heard at the highest levels of medicine. Manchester Grand Hyatt, One Market Place, San Diego, CA. For more information, please go to www.ama-assn.org.


Calendar of EventsMAY

20 CMS Executive Committee Meets once a month to plan Council meeting agendas; conduct business between quarterly Council meetings; and coordinate Council and Board functions. 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

JUNE

2 COVID-19 in Pediatric Populations (webinar)Join this didactic and an extensive Q&A led by ECHO-Chicago (Extension for Community Health Outcomes) Director & Infectious Disease specialist Dr. Daniel Johnson. The Chicago Medical Society has partnered with ECHO and the University of Chicago to support community providers in addressing the pandemic. 5:30-6:30 p.m.; Registration is required. Go to: https://www.echo-chicago.org.

10 COVID-19 in Adult Populations (webinar)Join this didactic led by infec-tious disease specialists, Drs. Jennifer Pisano and Stephen Schrantz, and geriatrician Dr. Kate Thompson, followed by case presentations. The Chicago Medical Society has partnered with ECHO-Chicago (Extension for Community Health Outcomes)to support community provid-ers in addressing COVID-19. 5:30-6:30 p.m.; Registration is required. Go to: https://www.echo-chicago.org/


20 CMS Executive Committee 8:00-9:00 a.m. CMS Building; 515 N.

Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].


24 COVID-19 in Adult Populations (see webinar description for June 10)


JULY


18 Advanced Cardiovascular Life Support (ACLS) 8:30 a.m.-4:00 p.m.; Chicago Medical Society, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

AUGUST

15 CMS Executive Committee 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].


22 Parliamentary Procedures Workshop 10:00 a.m.-2:00 p.m.; CMS Building; 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

SEPTEMBER

8 CMS Council Meeting The

MEMBER BENEFITS

Society’s governing body meets four times a year to conduct business on behalf of the Society. The policymak-ing Council sets the CMS legislative agenda among other matters brought by leadership, committees, councilors, or other CMS members. 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, contact Ruby 312-670-2550, ext. 344; or [email protected].

10-12 Physicians Legal Issues: Healthcare Delivery and Innovations Conference Hosted annually by the American Bar Association’s Health Law Section and the Chicago Medical Society, this educational event offers physicians and their admin-istrative partners access to national speakers. Attorneys provide critical information on issues affecting employer and hospital relationships, business and industry and payer consolidation. Experts share everyday “survival” techniques for physicians. Hotel InterContinental; 505 N. Michigan Ave., Chicago. For details, contact Ruby 312-670-2550, ext. 344; or [email protected].

16 Chicago Gynecological Society Annual Dinner 6:00 p.m. For details, contact Megan 312-670-2550, ext. 332; or [email protected]


23 OSHA Training: Bloodborne Pathogens and Beyond 9:30 a.m.-12:00 p.m.; CMS Building; 515 N. Dearborn St. Contact Ruby 312-670-2550, ext. 344; or [email protected].

OCTOBER

17 CMS Executive Committee 8:00-9:00 a.m. CMS Building, 515 N. Dearborn St., Chicago. For information, contact Ruby 312-670-2550, ext. 344; or [email protected].

17 CMS Board of Trustees 9:00-11:00 a.m. CMS Building, 515 N. Dearborn St., Chicago. For information, contact Ruby 312-670-2550, ext. 344; or [email protected].

NOVEMBER

4 Chicago Gynecological Society General Meeting. 6:00 p.m. For details and to RSVP, contact Megan 312-670-2550, ext. 332; or [email protected].

10 CMS Council Meeting The Society’s governing body meets four times a year to set the Medical Society’s legislative agenda among other matters brought by officers, trustees, committees, council-ors, or other CMS members. 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, contact Ruby 312-670-2550, ext. 344; or [email protected].

14-17 American Medical Association House of Delegates Your Society participates in the American Medical Association’s meet-ings to advance physician practice reforms. Grassroots resolutions from CMS often result in AMA adopting new national policy and pursuing legislative remedies. CMS encourages you to be part of this process, which ensures your voice is heard at the highest levels of medicine. Manchester Grand Hyatt, One Market Place, San Diego, CA. For more information, please go to www.ama-assn.org.



https://www.echo-chicago.org/























http://www.ama-assn.org

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Whatever your health care practice, or even if you are a young professional entering the field, you need ongoing education to gain valuable insight and strategies. These CME and CLE webinars are held in conjunction with the American Bar Association. So, they are also invaluable for health care attorneys, whether new to the legal field or longtime practitioners. Offered exclusively by The Chicago Medical Society. Your resource f or high-quality education.

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DR. JOHNSON received his MD with distinction in 1982 from George Washington University in Washington, DC . He is board-certified in pediatrics and pediatric infectious disease . He was a pediatric resident from 1982-1985 at Children’s Hospital in Oakland, CA, and performed a pediatric infectious disease fellowship there from 1985-1986 . He practices at Comer Children’s Hospital, Edward Hospital, and Mount Sinai Hospital . At University of Chicago Medicine since 2007, his focus includes developing and improving community-based pediatric general and specialty services in underserved com-munities . From 1999-2007 Dr . Johnson served as chair of pediatrics for Chicago’s Mount Sinai Health System . Throughout his career he has enjoyed teaching medical students and residents . He currently serves on the board of Children’s Home and Aid and is the board treasurer for the Illinois Chapter of the American Academy of Pediatrics . He has authored more than a hundred peer-reviewed articles and abstracts and received numerous research and service grants .

DANIEL JOHNSON, MD, chief of the Section of Academic Pediatrics and interim chief of the Section of Pediatric Infectious Disease at the University of Chicago Medicine/Comer Children’s

Hospital, also is founder and director of ECHO-Chicago, a major program at UChicago Medicine. ECHO (Extension for Community Health Outcomes) is an urban focused education outreach program for healthcare providers—all of which is performed efficiently using high-end videoconferencing tech-nology. “As a native Chicago Southsider,” says Dr. Johnson, “I have seen the disparities in healthcare in our society and I have worked to correct them.”

As a professor of pediatrics at UChicago Medicine, Dr. Johnson also finds teaching to be an important part of his life. “ECHO combines both my work in correcting healthcare disparities with my love of teaching,” he says. “ECHO offers a way to impact a much wider audience through education than I could ever do one-on-one. Due to technology, instead of spending an educator’s time traveling, they can spend it entirely in education.”

In his roles heading up the sections of academic pediatrics and pediatric infectious disease, Dr. Johnson notes that, as with most people, COVID-19 has brought immense change to his working life. “Most days now,” he says, “I work remotely using technology to run the sections and contribute to our department and a combination of technology and personal visits to take care of patients. An immense amount of my time is now spent on changing care delivery models by our department as we move from personal visits to telehealth. ECHO-Chicago has always been remote, but now being remote touches my everyday life.”

Dr. Johnson also serves on the Chicago Medical Society’s COVID-19 Taskforce. “I was honored that

Tariq Butt, MD, president-elect of CMS, asked me to serve,” he says. “It’s given me a great opportu-nity to help others manage change due to COVID. CMS has an important role to play in the way in which our city and our state deliver healthcare in this new environment. Because I bring the perspective of both a pediatrician and an infectious disease specialist, I can help in designing and recommending policy changes.”

But to his patients, it is Dr. Johnson’s gift of listening to them that has lasting impact. “When I left UChicago to be the chair of pediatrics at Mount Sinai Hospital [1999-2007], many of my patients wrote me notes,” he says. “They told me it had been very meaningful to them that I always listened and made them feel valuable during the time we spent together. For me, the most important thing was to diagnose and treat them—for patients, however, it was showing them respect.”

WHO’S WHO

Striving to Make the World a Better PlacePediatrician works to correct disparities in healthcare By Cheryl England

Dr. Daniel Johnson is founder and director of ECHO-Chicago, an urban focused education outreach program for healthcare providers that uses high-end videoconferencing technology to help spread knowledge to underserved areas.

Dr. Johnson’s Career Highlights


DR. JOHNSON received his MD with distinction in 1982 from George Washington University in Washington, DC. He is board-certified in pediatrics and pediatric infectious disease. He was a pediatric resident from 1982-1985 at Children’s Hospital in Oakland, CA, and performed a pediatric infectious disease fellowship there from 1985-1986. He practices at Comer Children’s Hospital, Edward Hospital, and Mount Sinai Hospital. At University of Chicago Medicine since 2007, his focus includes developing and improving community-based pediatric general and specialty services in underserved com-munities. From 1999-2007 Dr. Johnson served as chair of pediatrics for Chicago’s Mount Sinai Health System. Throughout his career he has enjoyed teaching medical students and residents. He currently serves on the board of Children’s Home and Aid and is the board treasurer for the Illinois Chapter of the American Academy of Pediatrics. He has authored more than a hundred peer-reviewed articles and abstracts and received numerous research and service grants.

DANIEL JOHNSON, MD, chief of the Section of Academic Pediatrics and interim chief of the Section of Pediatric Infectious Disease at the University of Chicago Medicine/Comer Children’s

Hospital, also is founder and director of ECHO-Chicago, a major program at UChicago Medicine. ECHO (Extension for Community Health Outcomes) is an urban focused education outreach program for healthcare providers—all of which is performed efficiently using high-end videoconferencing tech-nology. “As a native Chicago Southsider,” says Dr. Johnson, “I have seen the disparities in healthcare in our society and I have worked to correct them.”

As a professor of pediatrics at UChicago Medicine, Dr. Johnson also finds teaching to be an important part of his life. “ECHO combines both my work in correcting healthcare disparities with my love of teaching,” he says. “ECHO offers a way to impact a much wider audience through education than I could ever do one-on-one. Due to technology, instead of spending an educator’s time traveling, they can spend it entirely in education.”

In his roles heading up the sections of academic pediatrics and pediatric infectious disease, Dr. Johnson notes that, as with most people, COVID-19 has brought immense change to his working life. “Most days now,” he says, “I work remotely using technology to run the sections and contribute to our department and a combination of technology and personal visits to take care of patients. An immense amount of my time is now spent on changing care delivery models by our department as we move from personal visits to telehealth. ECHO-Chicago has always been remote, but now being remote touches my everyday life.”

Dr. Johnson also serves on the Chicago Medical Society’s COVID-19 Taskforce. “I was honored that

Tariq Butt, MD, president-elect of CMS, asked me to serve,” he says. “It’s given me a great opportu-nity to help others manage change due to COVID. CMS has an important role to play in the way in which our city and our state deliver healthcare in this new environment. Because I bring the perspective of both a pediatrician and an infectious disease specialist, I can help in designing and recommending policy changes.”

But to his patients, it is Dr. Johnson’s gift of listening to them that has lasting impact. “When I left UChicago to be the chair of pediatrics at Mount Sinai Hospital [1999-2007], many of my patients wrote me notes,” he says. “They told me it had been very meaningful to them that I always listened and made them feel valuable during the time we spent together. For me, the most important thing was to diagnose and treat them—for patients, however, it was showing them respect.”

WHO’S WHO

Striving to Make the World a Better PlacePediatrician works to correct disparities in healthcare By Cheryl England

Dr. Daniel Johnson is founder and director of ECHO-Chicago, an urban focused education outreach program for healthcare providers that uses high-end videoconferencing technology to help spread knowledge to underserved areas.

Dr. Johnson’s Career Highlights


For more information, call 312.670.2550.

healthy vitalsProAssurance has been monitoring risk and protecting healthcare industry

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Chicago Medical Society_3.19.indd 1 3/27/19 9:17 AM

For more information, call 312.670.2550.

healthy vitalsProAssurance has been monitoring risk and protecting healthcare industry

professionals for more than 40 years, with key specialists on duty to diagnose complex risk exposures.

Work with a team that understands the importance of delivering flexible healthcare professional liability solutions.

Healthcare Professional Liability Insurance & Risk Resource Services

ProAssurance.com/Illinois When you are treated fairly you are confident in your coverage.

http://www.proassurance.com/illinois

As a physician-led insurer, ISMIE understands the immensechallenges healthcare professionals face every day –especially in recent weeks. Our Wellness Center includes awealth of resources to help you navigate personal andprofessional challenges, including private consultations.Learn more at ismie.com/wellness.

For other COVID-19 resources, visit ismie.com/covid-19.

20 N. Michigan Avenue, Suite 700, Chicago IL 60602 | 800-782-4767 | [email protected]© 2020 ISMIE Mutual Insurance Company. All rights reserved. The use of any portion of this document without the express written permission of ISMIE is prohibited and subject to legal action.

Now more than ever – we’re in this together.

As a physician-led insurer, ISMIE understands the immensechallenges healthcare professionals face every day –especially in recent weeks. Our Wellness Center includes awealth of resources to help you navigate personal andprofessional challenges, including private consultations.Learn more at ismie.com/wellness.

For other COVID-19 resources, visit ismie.com/covid-19.

20 N. Michigan Avenue, Suite 700, Chicago IL 60602 | 800-782-4767 | [email protected]© 2020 ISMIE Mutual Insurance Company. All rights reserved. The use of any portion of this document without the express written permission of ISMIE is prohibited and subject to legal action.

Now more than ever – we’re in this together.

http://www.ismie.com/wellness

http://www.ismie.com/covid-19

Documents

May 2020 · 2020-06-03 · • Helping you navigate the federal financial stimulus package through webinar education. Of note, new U.S. House legislation known as the HEROES Act