In The News

CDC no Longer Recommends Universal Masking in Health Facilities

The Hill / By Nathaniel Weixel

The Centers for Disease Control and Prevention no longer recommends universal masking in health care settings, unless the facilities are in areas of high COVID-19 transmission.

The agency quietly issued the updates as part of an overhaul to its infection control guidance for health workers published late Friday afternoon [09/23/22]. It marks a major departure from the agency’s previous recommendation for universal masking.

“Updates were made to reflect the high levels of vaccine-and infection-induced immunity and the availability of effective treatments and prevention tools,” the CDC’s new guidance says.

Now, the CDC says facilities in regions without high transmission can “choose not to require” all doctors, patients, and visitors to mask. Transmission is different from the community levels CDC uses to guide non-health care settings.

Community transmission refers to measures of the presence and spread of SARS-CoV-2, CDC said.

“It is the metric currently recommended to guide select practices in healthcare settings to allow for earlier intervention, before there is strain on the healthcare system and to better protect the individuals seeking care in these settings,” CDC said.

Right now, about 73 percent of the US is experiencing “high”rates of transmission. 

Community levels “place an emphasis on measures of the impact of COVID-19 in terms of hospitalizations and healthcare system strain, while accounting for transmission in the community,” the CDC said. 

Only 7 percent of counties are considered high risk, while nearly 62 percent of counties are considered low.

In addition, the new guidance includes a list of exceptions when people might choose to mask, compared to the previous guidance that included a list of exceptions when masking was not recommended. 

Even if masking is not universally required, if a provider works in a part of the facility experiencing a COVID-19 outbreak, or if they care for immunocompromised patients, they should wear a mask. 

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Telehealth Better Than In-Person Visits on Some Quality Measures: Study

Modern Healthcare / By Mari Devereaux
Telehealth visits for primary care can be comparable in quality to in-person visits, suggesting remote testing and screenings are valuable tools to augment patient care.
The finding follows a study of more than 500,000 patients across 200 outpatient care sites in Pennsylvania and Maryland who either had exposure to telemedicine or only had in-person visits between March 1, 2020, and November 30, 2021.
The report examines the care quality performance of telemedicine and in-person patient groups for 16 Health Care Effectiveness Data and Information Set measures selected across five domains of primary care: cardiovascular, diabetes, prevention and wellness, behavioral health and pulmonary. 
In 13 of 16 medication, testing and counseling-based measures, exposure to telemedicine was associated with similar or significantly better quality performance. The study was published in JAMA Network Open.
Higher quality scores for telemedicine prove that remote care is worth the cost of reimbursement just like in-office care, said Dr. Derek Baughman, an author of the study and medical director at Barksdale Air Force Base and Medical Clinic. 
“This isn't just one or two measures, it's showing that for most of the measures, we're providing at least comparable quality,” he said. “We're not making these measures worse.”
For all counseling and testing-based measures—including vaccinations, cardiovascular disease and diabetes testing and screenings for depression and cancer—telehealth care encounters were more likely to meet HEDIS quality benchmarks than solely in-person patients. 
The results are examples of clinical domains where telemedicine could be used as an alternative to in-office care, Baughman said. Prioritizing telehealth visits for chronic disease management and preventive care could lead to better quality outcomes as well as more affordable care.

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Repayment and Recovery of COVID-19 CAAP

The Health Group

In March 2021, CMS began recovering COVID-19 Accelerated and Advance Payment (“CAAP”) balances.  After one year, the recovery of the advanced monies was made at twenty-five percent (25%) over eleven months, followed by fifty percent (50%) over the following six (6) months.  Thereafter, any unrecovered monies will be collected at one hundred percent (100%) of Medicare payments until such time as all monies are recovered including four percent (4%) interest.

Depending on when the provider received the CAAP, 100% withholdings may have already started to recover remaining balances.  At the end of the 29th month following the receipt of CAAP, the Medicare Administrative Contractor (“MAC”) should have issued a demand for repayment of any remaining balance.  The provider has all repayment and recoupment options normally available when dealing with other Medicare overpayments.  These options include requesting an Extended Repayment Schedule.

An Extended Repayment Schedule (“ERS”) is a statutorily authorized debt payment schedule, which allows a provider or supplier experiencing financial hardship to pay debts over time in monthly installments, including interest.  An ERS can be extended to as many as five years if certain extreme hardship criteria are met. Providers and suppliers may request an ERS after the Medicare Administrative Contractor (MAC) issues a demand letter requiring repayment of a debt. Providers and suppliers should contact their MAC for information on how to request an ERS. A provider or supplier must meet certain statutory and regulatory requirements to be eligible for an ERS and also will need to meet specified criteria related to financial “hardship” or “extreme hardship” under 42 C.F.R. 401.607(c)(2) in order to be eligible for an ERS.

CAAP FAQ is available here


Audit of Cares Act Provider Relief Funds by CMS

The Health Group 

The 2022 OIG Work Plan includes the audit of CARES Act Provider Relief Funds.  The Work Plan includes the following:

“The Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act appropriated $175 billion for the Provider Relief Fund (PRF) to support health care providers affected by the COVID-19 pandemic.  In April 2020, the Health Resources and Services Administration began distributing the funds through general distributions to Medicare providers based on 2018 net patient revenue and targeted distributions for certain provider types (e.g., providers in areas particularly impacted by COVID-19, skilled nursing providers, and providers in rural areas).  Providers such as hospitals may be eligible for PRF payments from the general and targeted distributions.  We will select for audit a statistical sample of providers that received general and/or targeted distributions.  Our objective is to determine whether providers that received PRF payments complied with certain Federal requirements, and the terms and conditions for reporting and expending PRF funds.”

The process has begun as selected providers are being notified of upcoming audits.  The OIG audit notification letter includes the following:

“To expedite completion of our work, we request that you have the documentation pertinent to your entity’s use and reporting of PRF payments available at the time of our meeting. We appreciate your cooperation in this matter and will make every effort to minimize any disruption to the work of your office.”


Emotional PPE Kit

The challenges of working in the U.S. health care system have been an existential threat to clinician well-being for years. The pandemic has only exacerbated the pressures confronting clinicians, accelerating the rates of depression, anxiety, burnout, moral distress, moral injury, trauma, grief, etc.

The Emotional PPE toolkit provides resources that clinicians and teams can use to support well-being. CAPC firmly believes that it is the responsibility of organization, state, and federal leaders to create a more supportive and sustainable environment for health care clinicians. We have included individual resources to normalize your experiences and help bridge the gap if you are struggling. However, we urge leaders to consider participating in advocacy and initiatives that can help change the U.S. health care landscape.

Get immediate help if you are in crisis.

Visit the Emotional PPE Toolkit website for resources for individuals who have 5-10 Minutes, 10-30 Minutes or 30-60 Minutes; Team Wellness Planning resources; and Literature and Thought Pieces on Emotional PPE

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