June 17, 2020: What is coming out of Washington DC these days during COVID? How are health systems receiving funding? Is there more on the way? What is the sentiment around distribution? We also discuss the Cares Act. Joining us is Mari Savickis, VP of Public Policy at CHIME and Andrew Tomlinson, Director of Federal Affairs also from CHIME.
COVID Series: Washington DC Spotlight with CHIME Advocacy
Episode 267: Transcript - June 17, 2020
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[00:00:00] Bill Russell: Welcome to This Week in Health IT where we imply great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Well, we have some special requests here with the programming team at this week in health, it would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months.
This is in direct response [00:00:30] to comments. We're hearing on the show as well as comments I'm hearing in my consulting practice, before he dropped me an email. I need solutions that have successful client stories. I receive about 10 emails a week from companies that want to highlight their product on the show.
And my first question is always put me in touch with a reference client and amazingly, okay. 90% of those requests fall away, which I find really interesting. we want to see what kind of response we get from you guys, and then we will determine how we're going [00:01:00] to. You know, get this integrated into our programming and get it out there.
So, you know, send in your responses bill at thisweekinhealthit.com. Love to hear from you. Love to hear what you guys are doing that is showing hard dollar savings, real money savings for healthcare. this episode, every episode, since we started the COVID-19 series, it has been sponsored by Sirius Healthcare.
They reached out to me to see how we might partner during this time. And that's how we've been able to produce daily shows. and you know, it's just a special thanks to Sirius for supporting the show's efforts during the [00:01:30] crisis. Now onto today's show this morning, we're joined by Mari Savickis, VP of Public Policy for chime and Andrew Tomlinson, Director of Federal Affairs for CHIME as well. Good morning. And welcome. Welcome back to the show.
Andrew Tomlinson: Good morning.
Mari Savickis: Thanks. For having us.
Bill Russell: I'm looking forward to the conversation. If I was being a wise guy, I guess I would start with, so what's new. you know, over the last 60 days, there's so much coming out of Washington that you guys have [00:02:00] been incredibly, incredibly busy.
We're going to try to do it in 25 minutes or less, Talk about all the things that are coming out of, of, of Washington these days, you know, let's, let's start with, gosh, there's so much money flowing around. Let's start with the cares act and, you know, how health systems are receiving funding during this COVID time. Talk a little bit about the cares act. You know, obviously we're on the other side of this, roughly a hundred billion ish for [00:02:30] hospitals. what's the, you know, how are people viewing this? Was it, is there more on the way? What's the sentiment around distribution as well?
Mari Savickis: Yeah, I think it's a little bit of a mixed bag. And, there's a, you know, I know that from our perspective, our members, for example, have been applying for, some of the FCC money with, they have a new pot of money that they've established and Indra can go in a little bit more detail, but that's been one of the pieces that we focused on pretty heavily because it establishes money for connected care.
[00:03:00] So Andrew do you want to elaborate a little bit. Yeah.
Andrew Tomlinson: I mean, I think one of the big pieces that came out of that care, Zack was some of the support for telehealth and the FCC connected care pilot program was already in the works it's before the pandemic hit. But the COVID-19 telehealth program is the new program that came out of the cares act.
It's 200 million in funding to help providers set up and recoup funding. That's gone into expansion of those telehealth services that have been able to give to their patients that don't feel comfortable or aren't able to make it [00:03:30] into. To the hospital. I mean, it's one of the big discussions you've seen at least in the last few weeks has been that care needs to continue even in the face of the pandemic.
And telehealth is a huge piece of that care to have, to be able to have that care available. Patients allow patients to be able to continue to see their provider. So they've just announced their seventh round of funding about 50 million has been earmarked so far. The program remains open throughout the rest of the public health emergency.
And then they're going to continue to award are [00:04:00] really earmark because it's a it's a reimbursable program until that 200 million has been expended.
Bill Russell: Yeah. So we, we talked to, we talked a bunch about this on the show 200 millions available. It's really wide open. It's not the broadest thing I've ever seen in terms of.
What you can get funded as long as it's providing care in some way through a, through a digital means. And you're saying about 50 million of that 200 millions have been snatched up. our, our health systems making the move on this. Cause that sounds a little low to [00:04:30] me. I mean, given, given how broad it is and how much money is available?
Andrew Tomlinson: You know, there's been some discussion on the Hill. The chairman Ajit Pi testified last week. There was a discussion about how little has actually been invoiced. The way that the program functions is that the providers submit a list of what they're want to have reimbursed underneath the program. The FCC approves, whatever parts of that. Plan from them, they're going to be able to cover.
And then they provide a certified invoice back to the FCC. It [00:05:00] sounds like a low amount of funding, but I think the key is that, you know, we're only part way through this and the hotspots seem to continue to shift. I know that was concern up front was, is this program going to be viable for potentially another fall resurgence or different areas that need to have wider access to telehealth?
So, yeah, it is, it is a low amount of funding. But, you know, we haven't heard from any of our members or anybody that we've talked to, that there's ever been anything other than the ability to implement their telehealth systems. There may [00:05:30] be a lag in the approval process that they're still waiting on, but none of them have seemed to indicate that's been an inhibition for them.
Bill Russell: So the cares act might be old news. What's what do we, what are we looking for? You know, we saw the heroes act that, put forward and that from, you know, different sides looking at this, that might be DOA. but what's, what's next? What, what is the next conversation we're going to have around potentially, more, funding being made available to hospitals and health systems.
Mari Savickis: Yeah. [00:06:00] I mean, I think that there is good. There'd be a discussion about the PPP. there's not at all consensus right now, with lawmakers on the Hill. And so I think that they're are pretty far apart right now. I don't think we're gonna see any movement really until the end of June. So they're in their respective camps.
It's become fairly partisan. but I think that PBE will have to be addressed again. As well as some other pieces that, you know, it's, I think there's going to be a fight for whether or not this turns into like another kitchen sink sort of thing, where like our, like the proverbial Christmas tree. [00:06:30] And, there are some concerns about like how much has been spent so far and there's some need for oversight for the monies that have already been issued.
So I think those are things that are weighing on lawmakers minds.
Bill Russell: You know, it's interesting. I think people would actually the fact that all we're going to talk about his COVID, but there is so much going on 21st century cures act, information blocking, you guys actually put together, I was looking at your, Washington briefing.
Then they send out a particular, a great information blocking cheat sheet. it has a [00:07:00] great, table in there after definition of the ONC rule changes from the proposal, penalties and, and clarifications in the rule. I recommend it to anybody who's, who's responsible for making this a reality. it really does great work.
Where are we? Where are we at right now? with regard to the information blocking in 21st century cures?
Mari Savickis: The pandemic has really taken center stage. And so these rules are so seismic that we consider them to be, a barometer of what's to come for the next decade. [00:07:30] But. Because everything, you know, has been turned upside down with the, with the Kobe crisis, that some of our folks are just now starting to emerge and pay attention to that.
So, I'm sure Andrew was about to fill you in, on some of the activities that were. that we've got going on in addition to our cheat sheets.
Andrew Tomlinson: Yeah. I think, you know, is right. We are still in the middle of this pandemic and CMS and ONC, and the finalization of those rules did give some leeway, you know, a few delays on some of [00:08:00] those requirements and deadlines within those rules, but we're still looking at November 2nd is going to be the, the enforcement deadline for these information blocking requirements.
Even though right now, the only outline enforcement activity has been through the office of the inspector general. And their rule that outlines how the health information exchange is health information networks, and the vendors are going to face civil, monetary penalties. Everyone is going to be required to comply with those information blocking rules when it comes to November.
[00:08:30] Bill Russell: Wow. So people shouldn't expect that date to get pushed back at all.
Andrew Tomlinson: We haven't heard anything. I mean, you know, I'm always hesitant to say never, but you know, there hasn't been any indication at this point and that is what's within the rules. So that would require changes to the final rule itself to be able to extend that deadline out.
Bill Russell: So it's interesting. Everything, you know, everything sort of has been turned on its head as it should be, to address the pandemic but [00:09:00] some of this stuff is still moving forward. We're still having conversations around 20, 21st century cures, inpatient perspective, payment system cybersecurity, is also being talked about, what, what, unique patient identifier still, front and center.
When something like this, give people a perspective of what it's like, on, in Washington at this point with all those other initiatives that were sort of had momentum, had a lot of work going on. [00:09:30] I mean, do they really take a significant back burner or do they continue sort of. with, without the spotlight that they would normally get given the, the, the pandemic.
Mari Savickis: It's a little bit of both. I mean, I hope it has been fairly distracting and I think it also depends on which member you are. some of our members are experiencing layoffs and furloughs, which obviously means that there's fewer people to do the same amount of work. It's not as if you know the [00:10:00] information blocking policies or the cyber criminals are.
You know, taking a break there. They're not, so this is all has to move forward. I think, you know, the healthcare system can only absorb so much change at once. So as you said, some of our we're just starting to emerge and start educating our members on information blocking after, you know, after several months of like, usually we would have done this much sooner.
And in fact, Andrew held an excellent webinar yesterday. And for those of you who missed it, we're happy to. You know, get folks to link with, ONC [00:10:30] and we're going to do a four part series in June, so right around the corner. And that's going to break down each information, blocking excession and quite a detailed manner, and it will be accompanied by, we have a 25 page summary for.
Those, we tried to break it down into as much a planning. It was just possible. So we're going to have to start rolling this out, but it, back to your original question, I think it depends on who you are and what situation you're in. You might be peaking right now, in which case it's all hands on deck.
Right? We've heard from some of our members, they had just, put [00:11:00] aside, you know, lifts and technology. They have had to repurpose a security personnel all to address the pandemic. And so. I think it, depending on where you are in the midst of this, you, you know, and again, I think more and more books are coming out of it, but we're also looking forward to the possibility.
And I don't mean looking forward in a good way, but to an emergence this fall. And so we're sensitive here in, you know, in the child public policy shop, how will this affect our members and what kind of things do we need to advocate for so that they don't feel crushed [00:11:30] by. The tsunami of regulations and requirements, even as the government is trying to lift some of these off their plate.
Bill Russell: Yeah. It's interesting. We've been talking to, we've been dropping an episode a day talking to a lot of different health systems and one of the recurring themes is we've gone from a, from one crisis to another. We've gone from a pandemic to really a financial, crisis for a bunch of health systems, in, in healthcare and where we've heard about the furloughs.
and right now, I think what we're [00:12:00] experiencing at this, you know, late may timeframe is the reality of those financial, situations is starting to hit. And there is going to be this situation of doing more with less, you know, more, more projects with less. And so you talk about that, that burden and, It's going to be interesting to see how health systems are going to be able to address these things as well as there's a whole host of pandemic related projects that have sort of popped up.
you know, if you've [00:12:30] already started building a tower of, you know, a couple of hundred million to a billion dollar tower, that's still going to continue to progress. So there, there is going to be this burden on, on healthcare systems. Moving forward. Talk a little bit about, so, let's see, president Trump issued a, a new executive order to remove regulatory barriers. Can you talk about that a little bit? What is that about?
Andrew Tomlinson: The executive order in itself is aimed at economic recovery, right? We've just talked about some of the economic barriers to success [00:13:00] that providers can be facing, especially coming to the fall. When they're going to be seeing an influx of patients that are going to be.
Able and comfortable and willing to come back to them, the space and the, the, the executive order itself. Well, not specifically aimed at telehealth has been mentioned. Specifically as one of those regulatory barriers that could be removed, it's supposed to help these providers continue to have viable revenue streams, ultimately as the country continues to move throughout the pandemic.
So, you know, all of the CMS flexibilities that have been [00:13:30] announced to date with a few exceptions here and there are all grounded in the understanding that they continue. Through the length of the public health emergency. So this executive order directs secretary ASR at HHS to look at what different flexibilities they've provided.
You know, a majority of those being tele-health and seeing which one should stay and continue throughout. Both of the CMS, interim final rules are, one of them closes for con comment, I think on the 1st of June and the other one a little bit later, you know, they're [00:14:00] already looking to find out what things, people and providers and groups like ours are looking at it and thinks should remain in place.
But this executive order opens up another Avenue for them to continue. Whether it's beyond the. Public health emergency or, you know, into the future as a, as a permanent new program. So it doesn't necessarily guarantee anything happens immediately, but it does continue the press and the push to understand that some of these flexibilities that came about very quickly are good in the long run call, not just during a public health emergency.
[00:14:30] Bill Russell: So This Week in Health ITwe're going to be talking to health IT professionals across the board. How do they get their voice heard through China?
Mari Savickis: I'm glad you asked that question. there are so many different ways B we actually put on pause our weekly debrief. until I think about two weeks ago, we had put a pause on it, just acknowledging that our members were very busy and we didn't want to overload their inboxes, but we're back to polishing our debrief and it comes out now every Tuesday.
And one of the ways that you can get [00:15:00] involved is just respond to us and let us know if you want to get engaged in a work group. And. one of the workups we actually have underway and we still would welcome to hear from every, any member. And we're always open to doing, one-on-one phone calls is we're doing a work group on VR, virtual care.
And so we're trying to understand, get a pulse check on what it is that folks could maybe live without and what must they live with moving forward. Acknowledging, and I think some people don't totally understand that. that analogy about putting [00:15:30] the toothpaste back in the tube, but it's not the best analogy, but, once a waiver is gone, which is tied to the public health emergency, then it actually does dry up.
And so this is in a lot of ways. This is a congressional play. There may be some. Limited flexibilities that HHS could unearth. And we hope, we certainly hope that they do that, especially in light of what Andrew just discussed around the executive order, but we're trying to go through and, and Andrew had, a great letter to CMS responding to the rules that they publish on Kobe [00:16:00] that address virtual care and picking apart.
There's very discreet policies in there. That touch on different provider groups around virtual care. And so we need to go through those, like the audio piece, right. That payment parody. So we'd love to hear from our members about what they think. And I don't know if Andrew wants to add so that,
Andrew Tomlinson: yeah, I mean, I think continuing to have the discussion around what's working, what's not being able to get real world examples of how these flexibilities have helped.
Yeah. Patients that may have not had access beforehand or areas of the country, you know, [00:16:30] before some of these flexibilities who was able to actually access telehealth was very restricted to having to live in specific parts of the country and that's been lifted. And, you know, not just being in a rural area, for instance, is a barrier to gaining in person care, there's work, there's childcare, there's the ability to make it to your provider.
There's the ability to make it in an hour. That makes sense for you and your family. So it's, it's going to be really interesting is. As we continue, but we would love to hear more from whether it's patients or providers, how the flex stability has been [00:17:00] helping them. And then that can help us, she to shape the conversations that we have with the administration on the Hill.
Bill Russell: So give us an idea of what it's going to take for these things to be become permanent within CMS, there has to be funding. There has to be a long pass to be funding pass for this. The executive order will run out at some point, in which case it will need a more permanent funding. Will that be. As part of a budget process or will that be its own its own bill bubble? What will that look [00:17:30] like?
Andrew Tomlinson: think you've seen it already. Some of it, some of those flexibilities can be included in rulemaking. We saw that the Medicare advantage rule that came out includes additional flexibilities, allowing different specialties to be included as tele-health under Medicare advantage plans.
Bill Russell: So if it's going to probably be a mix of rulemaking and guidance, You know, it's kinda hard to know for ins for sure. What's, what's gonna, it's kind of feels as if it's like a chicken and egg process at this point, which recreates, what gets, what, [00:18:00] whether, you know, additional fundings and it'd be needed if telehealth continues just because it's going to be a new.
Regulatory stream a new funding stream, but we're not really sure how the future is going to pan out on where that request is going to come from. Is that initiated within Congress or the administration? Is it both? I mean, both would, would really show and demonstrate that this, this is a needed flexibility that continues.
Absolutely. last question, unique patient identifier, any progress, where's that at? You know, as COVID [00:18:30] takes center stage.
Mari Savickis: I’ll start and I'll let Andrew finish because we have a two part, you know, we're dealing with the lawmakers on Capitol Hill and they're also dealing with the administration and I'll take the Capitol health piece and give it to Andrew.
so right now we actually just send out a member alert. So for all our members listing, go look at your email from, from our, we are once again in the appropriation cycle, it, you know, this year started with the probation cycle of being like really fast out of the gate because [00:19:00] it's an election year.
Folks are trying to get things wrapped up and then of course, Kobe hit. So. It's still a underway and we're still trying to get the ban, which has been in place since 1989, struck in from the, the base fill, what we call the base bill. The probation's labor has each, each adjust bill. And so that, that effort is still underway.
And we have, we're sending a letter to, lawmakers on this and we're hoping for as many folks to sign on as possible to. Show a tour de force. So, that's one thing [00:19:30] that we continue to repeatedly go after and it's, it's very hard and it doesn't necessarily have to replace with a number. it just striking the language is what we're asking to do so that we can have an honest and more transparent conversation with the administration about what the possibilities could be.
Andrew Tomlinson: And, and from the federal side of things, you know, part of while that ban is still in place last year, there was the option. There was the language included in there for ONC to do a report, looking at patient matching and patient identity as it relates to how it exists current day and any [00:20:00] potential recommendations.
And so on Monday, part of that process will be public. There'll be a working session held by ONC in which our own CEO, Russ Frenzel will be speaking, talking about. The importance of a unique patient identifier and how that can help really strengthen the health system that we have and help keep patients safe as they're navigating their way through what is healthcare that they need to access.
So that's available on Monday and there's links available on public for on the health it.gov for anybody that wants [00:20:30] to be able to. Listen in, but it's going to be a key piece of the, that moves forward and what ONC is. And I end up recommending and, and discussing with Congress within his report.
I was just going to add that, you know, in addition to our CEO, who's going to be on as well as one of our members check Christian representative, bill foster, who sponsored the amendment to strike the ban on the house side last year is also going to be making some more, some remarks as well.
So hopefully folks will tune in for that. so thanks [00:21:00] very much. Sorry. Get that in.
Bill Russell: Yeah, no, absolutely. I'm looking forward to that. Thank you very much for your time today. And for the, for the update, there's so much going on. It's, it's really, kind of, kind of amazing at this point. And, if people haven't listened to the, to the live session, we recorded a live session on tele-health.
that's available on YouTube. You guys can listen to that as well. Thanks again for coming on. I appreciate you too. And all the work that you guys are doing, that's all for this week. Special. Thanks to our sponsors, VMware [00:21:30] StarBridge advisors. Galen Healthcare, Health Lyrics, Sirius Healthcare and Pro Talent Advisers for choosing to invest in developing the next generation of health leaders.
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