Todd Askew on AMA’s advocacy support for physicians reopening their practices

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In the second of a two-part series, AMA Chief Experience Officer Todd Unger speaks with AMA Senior Vice President of advocacy Todd Askew on AMA's latest advocacy efforts, including physician practice funding, PPE efforts and practice liabilities during the COVID-19 pandemic.

Learn more at the AMA COVID-19 resource center.

Speakers

• Todd Askew, senior vice president, AMA

Unger: Hello, this is the American Medical Association’s COVID-19 update. Today we continue with part two of a two part series on AMA advocacy efforts. I'm joined today by Todd Askew AMA's senior vice president of advocacy in Washington, DC. I'm Todd Unger AMA's chief experience officer in Chicago.

Unger: Well, let's talk a little bit more about the challenges that physicians are facing in reopening their practices, number one, being the financial impact of COVID-19. Can you speak to AMA’s efforts to support physicians in this arena?

Askew: Absolutely. Now this has been one of the—as the patient population essentially disappeared for awhile—one of the great struggles has been able to keep physician practices financially viable. There were a number of federal programs that were rolled out. Each program provided a different amount of relief to differently situated practices. There was no one program that was a panacea for everybody. The payroll protection program enabled some physician practices to keep their doors open and keep their staff employed during that period of time, and efforts have been made recently to expand that, to make it a little more usable and a little more accessible to more practices. So that's an option for some.

The Medicare advanced payment programs provided a needed lifeline to a lot of positions to take advanced payments on future Medicare revenue. Not an easy program though, to maintain in the long term because the repayment time is pretty quick. The interest rate after the initial week payment period is very high. And so a lot of folks looked at it and thought it may not be a very good opportunity. And we continue to work with the administration. They've paused the program now, but working with the administration and Congress to make some significant improvements, including significantly lowering the interest rate, significantly increasing the amount of time physicians have to repay those funds, and also making sure that only a small portion of each future Medicare payment is recouped as the way to repay loans that were made through the program.

Another significant program obviously has been the provider relief funds that have been provided as direct grants from HHS. It was difficult to roll it out in an effort to move the funds out quickly. They were able to get funding to large numbers of physician practices that had significant Medicare business, because that's where they had the data, they knew where Medicare revenues had gone. And so that's how the initial funds rolled out. In subsequent tranches of funding, they have attempted to give dollars and support to practices that may be more reliant on Medicaid and other third-party payers.

The second tranche achieved that, but again, folks that were significantly Medicaid dependent were left out. And right now, just in the last few days, they have now implemented the third tranche for physicians to access, which is for those Medicaid providers who did not benefit from previous distributions of federal funding. These funds cover not only the cost of preparing for and caring for COVID patients, but also a portion of lost revenues seen during that period. And they are a grant intended to keep the physician workforce and physician practices viable and able to meet the health care needs of their patients as we begin to emerge from the current phase of the pandemic.

So those are three important programs that are out there to help physician practices stay viable. We continue to work on all of them to encourage refinements, to make it more accessible to physician practices and we will continue to look for other opportunities going forward to support physician practices.

Unger: Yes. And beyond the financial difficulties, one of the very, very practical issues that has been in place since the beginning of this pandemic has been around PPE. And it's still quite a problem. Can you bring us up to date on PPE and what the AMA is doing to help physicians there?

Askew: Well, Todd you're absolutely right. There is been such a challenge in obtaining PPE. Initially, obviously we saw a huge surge in demand, especially from hospitals that kept maybe a few days' supply and suddenly supply chains were being inundated, and it was difficult to get new supplies on hand. Manufacturing since that time has increased significantly. I think something like 300%, a great increase in the manufacturing capacity for certain medical PPE. FEMA helped to establish an air bridge from China, which helped at least get rather than a month on a ship, it would be a couple of days via plane to get those supplies manufactured overseas into the supply chain.

And so we have seen a big increase in the supply chain, but it hasn't helped everybody. Hospitals, big health systems, these are big institutional customers of the distributors of PPE, and those distributors are struggling to meet the demand from their current customers. Unfortunately, we see a lot of small physician practice, especially, and this is not to downplay other difficulties because everybody is having difficulty obtaining necessary supplies, nursing homes are a great and tragic example of the inability to obtain necessary supplies. But as we look at physician practices, some are making very small orders. Some may not have had an ongoing relationship with a supplier for the types of supplies they need now, the N95 masks, the gowns, the face shields, all these new precautions that are necessary for physician offices and dentist offices significantly also to reopen and begin to see patients.

And so while the big guys are able to obtain some of these supplies, the small physician practices, especially, have really struggled and continue to struggle to get access.

Now we have strongly encouraged the federal government to take a much stronger role pushing the distribution, the acquisition also of these supplies, to help identify those ambulatory care settings, where the needs are not being met and help direct supplies in that direction. But everybody is looking for supplies and the manufacturing capacity is maxed out. We would love if the federal government could push more manufacturing, but there even questions there about whether or not the basic raw materials that are necessary are available given the high demand. And so it is an ongoing challenge, it will remain an ongoing challenge and we'll continue to explore every option we can to increase the accessibility of PPE for physicians, because it is a really critical element in order for physicians to be able to begin to meet the health care needs of their patients again.

Unger: Well, that's the question around liability, the pandemic has created a lot of situations where this is now a greater factor for physicians. Can you talk a little bit about the sources of liability issues and what we're doing to support physicians there?

Askew: Absolutely. Obviously, this is a situation that to this extent, health care providers today have never faced and people are continuing to do things, to meet the needs of their patients that they may not have done. You have physicians working in ward that they may not have worked in, maybe doing things that they haven't done since residency. You've also on the other hand had elective procedures postponed. You've had important diagnostic tests postponed. You've had to make difficult decisions about allocation of limited supplies. And so there is a host of potential liability concerns going forward.

Now, there are liability concerns in all industries related to COVID, but they're particularly acute, I believe, in the health care space, given the overwhelming impact the disease has had both in caring for the sick and also not caring for those who are well and not being able to provide the diagnostic and preventive care.

So there is some support, there is significant support on the Senate side, and we are working to build support on the house side. There is bipartisan legislation in the house side, headed by Dr. Rowe from Tennessee and others, to provide liability relief for physicians related solely to COVID care and not egregious cases of liability, but those dealing essentially with unintended consequences of making the decisions that were necessary during this pandemic.

And so we are hopeful that some of those provisions will find their way into law, and we can offer a little bit of assurance to those who continue to fight this disease on the front lines every day, that they don't have to have that fear in the back of their mind that they are going to be held liable for an outcome that may have been beyond their control.

Unger: Well, Mr. Askew thank you and the AMA Advocacy Team for channeling the voices of physicians and patients into action in DC and beyond.

That completes our two-part series on the AMA’s advocacy efforts during the pandemic. Thank you, Mr. Askew, for being here today and sharing your perspective. If you missed part one, you can find it on AMAs YouTube channel. We'll be back tomorrow with another COVID-19 update. For updated resources on COVID-19 go to ama-assn.org/COVID-19. Thanks for joining us.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.