Three Healthcare Business Implications For The End Of The Public Health Emergency
Earlier this year, the Biden administration announced that it would not extend the public health emergency beyond May 2023 if current COVID-19 trends continue. The public health emergency declared in March 2020 has had a significant impact on the activities of healthcare organizations for several years, including reimbursement and accrued expenses. Their end means big changes for payers, providers and patients. Many organizations have restructured opt-out mechanisms during the pandemic, and patients should prepare to graduate from PHE as telehealth and Medicaid enrollment increases.
D Healthcare CEO Munsch spoke with two experts from Hardt's medical practice about the impact of the change and what to do when PHE runs out. Bill Swart is a shareholder of Munsch Hardt in Dallas, which works with start-ups and mid-sized healthcare companies and other companies. Bradley Cook covers regulations, fraud and abuse, regulatory compliance, Medicare/Medicaid enrollment and more. is a specialized healthcare lawyer.
Strict law
Under normal circumstances, the Stark Act prohibits a physician from self-referencing, especially when a patient's Medicare or Medicaid physician refers the patient to a facility for treatment at a facility with which the physician has a financial relationship. During the pandemic, the federal government gave sellers a series of waivers so they could respond to the pandemic without fear of violating the Stark Act. Exceptions apply to office space, personal protective equipment and telemedicine services.
For example, when a pandemic hits and patients stop going to the doctor, many providers still have to pay rent for buildings rented by a hospital or other facility. The waivers allowed landlords to enter into special contracts with suppliers at below-market rates, keeping them in business without interfering with care or putting them out of business. Since the rent is not in line with the market rate, it will be a violation of the Stark Act once the public health emergency is over. If additional agreements are made for medical equipment or personal protective equipment, these agreements must be restructured and returned to the market before the PHE expires.
"Precautions that are perfectly legal during a public health emergency are now prohibited by Stark's law," Cooke said.
Health care
At the start of the pandemic, Congress directed that individuals formerly on Medicaid be placed on Medicaid lists until the end of the public health emergency. As a result of this demand, the number of uninsured people has declined and Medicaid enrollment has increased since the pandemic. When many people lost their jobs early in the pandemic, they may also have been eligible for Medicaid. Congress voted to suspend the provision in March, meaning states can remove individuals from Medicaid in April. The Kaiser Family Foundation estimates that between 5 and 14 million people will lose their health insurance due to the end of benefits. Many people now have jobs that disqualify them (in Texas, a person must earn less than $914 a month to qualify for regular Medicaid), but they can't afford commercial health insurance or private insurance.
How Texas will handle this remains to be seen, but it is possible that federally funded patients may now be low-income patients or unable to pay for essential services and need charitable assistance. For this reason, hospital associations are constantly pushing Texas to expand Medicaid, but if the state starts kicking people off the Medicaid list, it could hurt the provider's bottom line.
“We hope that as we go through the recovery process, these families will find new jobs and begin to improve their situation,” says Cook. “If they have to start joining the commercial insurance world, rather than government payers, as beneficiaries, what will be the consequences?” It will be interesting.
telemedicine
Prior to the pandemic, there were few face-to-face requirements with a provider to continue receiving care. But the waivers have allowed patients in skilled nursing facilities and other health care providers to make telemedicine visits to meet these requirements and continue to receive payments for these patients. These exemptions were supposed to expire when the PHE expired, but the omnibus legislation passed by Congress late last year made the provisions more permanent. Patients in skilled care facilities can use telehealth services to continue treatment without a face-to-face appointment until the end of 2024.
Other permanent changes in telemedicine services after the end of PHE is that behavioral telemedicine services are not geo-restricted in origin and can only be provided using audio platforms. Emergency rooms in rural hospitals can also be seen as a starting point for telemedicine services. During the pandemic, providers were allowed to use any non-public application to communicate with patients without being subject to federal fines, but this waiver will no longer apply after the end of public health emergencies, so providers should ensure they have a HIPAA-enabled communications portal. . . . . compatibility. Swart says out-of-state work is another rejection of the PHE era, which is coming to an end. “Particularly in the context of telemedicine, many companies will have to reconsider their ability to operate in other countries. Some large companies crossing borders will have less opportunity to do so, especially in the telemedicine industry.
writer
Will is Editor-in-Chief of D CEO Magazine and Editor-in-Chief of D CEO Healthcare. He wrote about health...
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