ACC Advocacy in Action: Summary of Ongoing Efforts to Protect Clinicians and Patients During COVID-19

Updated Oct. 16, 2020

The ACC continues to stress the need for more personal protective equipment (PPE) and other critical supplies to enable caregivers to safely help patients on the front lines, along with continued telehealth flexibility; liability protection for clinicians during this public health emergency; and essential support for the medical workforce, practices, and institutions to maintain patient access. ACC leaders have been hard at work carrying these same messages to the president and vice president, the administration and members of Congress. Highlights of these activities are below:

Oct. 15: Responding to a key recommendation made by ACC and other stakeholders, the Centers for Medicare and Medicaid Services (CMS) used emergency rulemaking authority to add cardiac rehabilitation (rehab) and intensive cardiac rehab services to the list of approved telehealth services outside the annual rulemaking process. This announcement came shortly after ACC members highlighted the importance of cardiac rehab services to members of Congress during virtual Legislative Conference visits last week. Read more.

Oct. 4 – 6: Over 600 ACC Grassroots members convened virtually for ACC's annual Legislative Conference! Attendees learned about ongoing policy issues affecting the cardiovascular profession and patients and were able to meet virtually with their members of Congress. ACC President Athena Poppas, MD, FACC, noted in her opening remarks the many ways the COVID-19 pandemic has underscored the importance of advocacy. Save the date for Legislative Conference 2021.

Oct. 1: After ongoing requests by ACC and others, the Department of Health and Human Services (HHS) announced a third round of Provider Relief Funding. The newest funding is available to eligible clinicians who have previously received funds, behavioral health providers, and new providers who started practicing in the first quarter and would not have had historical documents on which to base prior distribution allocations. Get specific details about terms/conditions and applications here.

Sept. 30: Congress passed a stopgap spending bill to keep the federal government operating through Dec. 11 at FY '20 funding levels. The spending measure includes changes to the Medicare Accelerated and Advance Payment Program, which provided financial assistance to clinicians on the front lines of the COVID-19 public health emergency, extending both the period before repayment begins and the period before the balance must be repaid in full. The bill also includes an extension of expiring health care programs, and availability of funding for multiyear research grants supported by the National Institutes of Health. Read more.

Sept. 14: ACC submitted comments in response to the proposed 2021 Medicare Physician Fee Schedule strongly urging CMS – alongside other requests – to use its authority under the public health emergency (PHE) declaration to preserve patient access to care and mitigate financial distress due to the pandemic by implementing the office visit increases as planned while waiving budget neutrality requirements for the new Medicare office visit payment policy. Read the full comments.

Sept. 10: ACC launches its new Physician Fee Schedule Calculator to allow clinicians and practice managers to estimate the practice impact of changes included in the proposed 2021 Medicare Physician Fee Schedule and related addenda. The tool helps facilitate a thorough understanding of impacts from one year to the next, especially as clinicians rapidly pivot to address changes during the COVID-19 public health emergency. Download the tool.

August 20: ACC Advocacy leaders joined together for a special Summer COVID-19 Summer Education Series session dedicated to advocacy. ACC's Health Affairs Committee Chair Samuel O. Jones, MD, MPH, FACC, moderated the session and virtual discussion about the ongoing importance of advocacy in ensuring clinicians are able to provide the best care possible to patients during this time. Other sessions discussed a range of clinical topics as well as clinician well-being, health disparities and the latest research.

August 12: Registration opens for ACC's 2020 Virtual Legislative Conference, Oct. 4 – 6! Learn more about Virtual Legislative Conference here.

August 11: The Centers for Medicare and Medicaid Services (CMS) extended the Educational and Operations Testing Period for the Appropriate Use Criteria (AUC) program through 2021. ACC and others had advocated to delay the program's official start, given the need for clinicians to focus resources and energy on changes to patient care and practice management as a result of COVID-19. Read more.

August 5: ACC joined with eight other medical specialty societies on a letter to Congress urging the temporary provision and reimbursement for telehealth delivered home-based cardiovascular rehabilitation/pulmonary rehabilitation services for the duration of the COVID-19 public health emergency. Read the full letter.

August 3: The Centers for Medicare and Medicaid Services (CMS) released the proposed 2021 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Rules, addressing Medicare payment and quality provisions for physicians in 2021. Of note, the proposed rule PFS includes a number of important telehealth policy proposals, including expansion of the list of telehealth services that will remain permanent beyond the COVID-19 public health emergency. It also proposes Category I and Category III codes, some of which will remain on the list through the calendar year in which the public health emergency ends. CMS also limited the number of significant changes to the Quality Payment Program in 2021 due to COVID-19. Read ACC's analysis.

July 29: ACC introduced a resolution supporting state efforts to reduce barriers to health care access and support telehealth service expansion at the National Lieutenant Governors Association (NLGA) virtual annual meeting. It received bipartisan support and passed unanimously. Read it here.

July 24: ACC President Athena Poppas, MD, FACC, submits a letter to Congressional leaders reiterating needs for next COVID-19 supplemental legislation, in line with ACC's Advocacy priorities. Read the letter.

July 21: The Cardiac Advocacy Alliance, a subcommittee of the ACC's Health Affairs Committee, held a virtual Capitol Hill fly-in from July 21 – 23. Issues discussed included ensuring practice stability throughout the COVID-19 pandemic, the importance of telehealth flexibilities, opportunities to reduce administrative burdens, and the need for clinician liability protections during the current health crisis.

July 14: "COVID-19, if nothing else, has demonstrated the power and importance of advocacy," write ACC HeartPAC Chair Sandra J. Lewis, MD, FACC, and ACC Health Affairs Committee Chair Samuel O. Jones, MD, MPH, FACC, in a Leadership Page highlighting the importance of ACC Advocacy activities during the COVID-19 pandemic. Read the full leadership page here.

June 22: ACC member Pascha E. Schafer, MD, FACC, shared her knowledge and experiences working during the COVID-19 crisis as "doctor of the day" for the Georgia state legislature. ACC members across the country like Schafer are using their voices to educate lawmakers and share their insights about the impacts of the COVID-19 pandemic.

June 9: ACC joined the American Medical Association in urging congressional leadership to protect those treating COVID-19 on the front lines by including liability protections for physicians, in particular the protections detailed in the bipartisan Coronavirus Provider Protection Act, in the next COVID-19 relief package. Read the full letter.

June 6: ACC was honored to have U.S. Surgeon General Jerome Adams, MD, help kick off its Summer COVID-19 Education Series. Dr. Adams focused his plenary comments on the opportunities for the cardiovascular community to come together around the three tenets of care, health and recovery. He also noted the work ACC members have been doing on the front lines to save lives, adapt their institutions, gather new knowledge, and work in new teams to meet the needs of the pandemic. Watch his speech on demand.

June 5: ACC President Athena Poppas, MD, FACC; ACC Chief Innovation and Science and Quality Officer John S. Rumsfeld, MD, PhD, FACC; and Heartbeat Health CEO Jeffrey D. Wessler, MD, MPhil, FACC, discussed regulatory changes in telehealth supported by the College's Health Affairs Committee, such as relaxation of state-line telehealth restrictions and shifting reimbursement to equivalence with in-person visit, and explored possibilities for the future in a JACC Leadership Page. Read it here.

May 27: In continuing to recognize the critical contributions of International Medical Graduates (IMG) on the front lines of the COVID-19 pandemic, ACC joined colleagues such as the American Medical Association and American College of Physicians in supporting recent bipartisan and bicameral legislation, the Healthcare Workforce Resilience Act (H.R. 6788/S. 3599). Read more.

May 20: Understanding that health care workers are working longer hours and more shifts with stressful and physically demanding work due to the COVID-19 pandemic, ACC revamped its Clinician Well-Being Portal, including CDC-recommended strategies on what workers can do when they feel too fatigued to work safely and steps employers can take to reduce workplace fatigue for workers. View the Portal.

May 14: The ACC has submitted comments to the Centers for Medicare and Medicaid Services (CMS) thanking the Agency for the significant amount of flexibility granted through recent emergency regulations, while also requesting continued and future flexibilities to help both patients and clinicians during and after the COVID-19 peak. Read more.

May 13: ACC Grassroots achieved a new milestone, with over 10,000 messages sent directly to members of Congress detailing personal front line experiences and ongoing policy needs during COVID-19. Members can still contact their legislators by using the action alert tool here.

May 11: Price transparency, graduate medical education, and changes to the Hospital Inpatient Quality Reporting (IQR) Program and to the Medicare and Medicaid Promoting Interoperability Programs are included as part of the proposed 2021 Hospital Inpatient Prospective Payment System Proposed (IPPS) rule released by the Centers for Medicare and Medicaid Services (CMS). ACC Advocacy staff are continuing to analyze member implications and will submit comments by the July 10 deadline. Learn more.

May 7: The College has developed an "open letter" that ACC members can send to health plans and their RBMs urging "additional flexibility for all procedure and testing decisions" during the COVID-19 pandemic, especially in regards to ongoing prior authorization challenges. Read more.

May 5: Good news! The Centers for Medicare and Medicaid Services (CMS) indicates it will recognize interstate license compacts licenses as "valid and full licenses" for the purposes of meeting federal license requirements. The guidance does not indicate this clarification is time-limited to the current public health emergency, so communication with local Medicare Administrative Contractors could prove helpful going forward. ACC's State Advocacy team suggests that for clinicians licensed in a state that has adopted a licensure compact, a compact license is an option to consider for continuation of care across state lines after the expiration of temporary COVID-19 state-level emergency measures, such as waiver of licensure requirements or temporary licensure. A compact license will continue to be valid after those stop-gap state policies expire. Clinician eligibility for a compact license is dependent upon a number of factors, including whether their state of primary licensure has adopted the compact, as has the state(s) in which they want to obtain a compact license. See the article here.

May 4: ACC submitted a letter to the Center for Medicare and Medicaid Innovation (CMMI) on May 4, requesting flexibility for Innovation Center payment models during the COVID-19 pandemic. The requests specifically focus on the voluntary Bundled Payments for Care Improvement Advanced (BPCI Advanced) program, which is the most cardiovascular-specific CMMI program to date. Read more.

April 30: Several key ACC requests, including expanded access to COVID-19 testing and important telehealth waivers and flexibilities, were included in the Centers for Medicare and Medicaid Services second final-interim rule. Learn more.

April 30: With clinicians and practices needing to take specific actions as part of the CARES Act Provider Relief Funding, the ACC has developed a high-level resource with links to attestation portals and deadlines. Get the details.

April 29: The ACC joined with 40+ other medical societies on a joint statement with the Infectious Diseases Society of America calling on "federal, state and local authorities to adhere to evidence and public health expertise in making decisions on when to lift measures that include shelter-in-place orders and closures of non-essential businesses." The statement calls for leaders to use regional and local data to gauge preparedness levels and ensuring "capacities for widespread testing, contact tracing, patient management and the public health and health care workforces and medical supplies." Read the letter.

April 26: The Centers for Medicare and Medicaid Services (CMS) announced it is reevaluating the Accelerated Payment Program and suspending the Advance Payment Program to Part B suppliers, in light of Provider Relief Funds included in the CARES Act that are being distributed by HHS. Learn more about the Provider Relief Funds.

April 24: The Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) was signed into law, providing $484 billion for small businesses, health care providers and expanded testing to address the COVID-19 emergency. The package is widely considered an extension of the $2.2 trillion CARES Act, which passed in late March and included many recommendations urged by ACC and other leading health care organizations. Learn more.

April 20: As Congress continues negotiations around the next COVID-19 supplemental package, the ACC sent a letter to Senate and House leaders regarding additional support for ongoing patient and clinician needs. Additionally, the College is encouraging members to contact their members of Congress. Get the details.

April 10: In a joint letter to CMS sent April 10, the ACC and more than 40 other medical specialty societies asked the Agency to encourage Medicare Advantage and Part D plans to relax prior authorization and step therapy standards for medically necessary prescribed or ordered treatments and services during national pandemics.

April 8: The ACC joined with roughly 40 other health care organizations and specialty societies in a letter to CMS urging additional emergency actions to “further enable physicians to provide necessary care to those suffering from COVID-19, as well as their broader patient populations as needed and appropriate.”

April 6: The ACC endorsed a statement from the American Society of Echocardiography that provides guidance to protect patients and providers during the COVID-19 pandemic. The statement has been published in the Journal of the American College of Cardiology.

April 6: The College wrote to U.S. Department of Health & Human Services (HHS) Secretary Alex M. Azar II to request quick and direct disbursement of "necessary Public Health and Social Services Emergency Fund resources to eligible health care providers, including specialty and multi-specialty practices."

April 2: The ACC joined with the Council of Medical Specialty Societies (CMSS) and its member societies to issue a statement that advocates for "action to ensure safer working conditions for physicians and other [health care] professionals on the [front lines] of direct patient care."

March 30: The Centers for Medicare and Medicaid Services (CMS) announced a broad package of flexibility, further loosening telehealth requirements, streamlining coverage and quality standards, and waiving several compliance activities to allow clinicians to best care for patients during the public health emergency, as recommended by the ACC and other stakeholders.

March 30: The ACC joined with the American Heart Association and 11 other cardiovascular and health care society leaders on a joint statement expressing concern "over the critical shortages of medical equipment, including ventilators, test kits and all types of personal protective equipment (PPE) such as masks, face shields and gowns, to adequately address the COVID-19 public health crisis."

March 27: The third COVID-19 emergency response bill, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, included significant funding and flexibility recommend by the ACC to address equipment and workflow gaps to protect the public and clinicians who care for patients. 

March 25: The College signed onto a joint letter with the American Medical Association that urged Congress "to include in the final 'stimulus' legislation specific provisions to help physicians sustain their practices and provide their patients with the best possible care during the COVID-19 emergency. Specifically, the legislation should support and sustain physicians and their practices during this unprecedented national emergency through tax relief, no-interest loans, direct payments, payment for virtual visits including phone calls, and other measures."

March 24: Members of ACC's Health Affairs Committee and other leaders joined in a call with CMS Administrator Seema Verma to offer insights from providers on the front lines. The call provided a forum for more than 5,000 participants to share best practices and addressed critical topics like triaging patients, telehealth and workforce issues. Mark F. Victor, MD, FACC, was called upon by the administrator and vocalized the concerns of ACC members around the need for telehealth flexibility and consistent guidance and support for practices for the duration of this public health emergency.

March 19: In a letter to Reps. Nancy Pelosi and Kevin McCarthy and Sens. Mitch McConnell and Charles Schumer, the ACC called for increased resources to help bolster the supply chain of lifesaving equipment, such as ventilators; increased resources for PPE; additional support from the federal government to ensure aggressive implementation of telehealth management; and reasonable liability protections for those on the front lines addressing an overwhelming crisis with limited supplies and protective gear. The letter also strongly urged congressional leaders to include economic support for medical practices and institutions to help them weather this crisis as they appropriately limit noncritical services.

March 18: ACC President Richard J. Kovacs, MD, FACC, met with President Trump, Vice President Pence and health care leaders. Kovacs stressed the need for more personal protection equipment and COVID-19 tests, continued support for telehealth, clarity on liability, and more and better data from which to model the effect and duration of the pandemic.

March 17: CMS announced new flexibility to provide Medicare Telehealth services to beneficiaries regardless of originating site location, an important and incremental step to mitigate spread. 

March 2: The ACC and the American College of Physicians urged policymakers to expand telehealth solutions as a mechanism to enhance social distancing and prevent community spread. Authority to waive some telehealth restrictions are included in the first COVID-19 emergency response bill on March 6.

Keywords: Coronavirus, COVID-19, Medicare, Public Health, Workflow, Caregivers, Pandemics, Medicaid, Coronavirus Infections, ACC Advocacy


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