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News & Press: Legislative and Regulatory News

5-4-2020 COVID-19 Update

Monday, May 4, 2020   (0 Comments)
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COVID-19 Pandemic – “News You Can Use in Pennsylvania”

Dear Colleagues – welcome to today’s COVID-19 Pandemic PSHP News

The goal of the PSHP’s Leadership Team here is to continue to provide value without inundating you with unnecessary information that is also coming to you through other forums.Thank you all.


PSHP COVID-19 Pharmacy Clinical Specialist Call - Tuesday, May 5, 2020-CANCELLED 

This afternoon’s call is CANCELLED and we will resume with this Clinical Specialist Call next week, May 12, 2020.  In the news this week and posted for your review are articles that have come from:  

1 – NEJM – Updates on the Covid-19 Pandemic which correlates cardiovascular Disease, Drug Therapy, and Mortality.
2 – Yale has released its Covid-19 Treatment Algorithms and an Article detailing it by Dr. Desai, including supportive therapies and risk factors for severe illness.      
3 -  FDA has released a Fact Sheet for Health Care Providers Emergency Use Authorization on  Remdesivir (GS-5734TM).  

Please read the next section and share with your Clinical Specialists to listen and participate in the next ASHP-sponsored COVID-19 Series Lecture Wednesday, May 6, 2020 from 3 – 4:00 pm, from Geisinger Health System presented by Michael Evans, Vice President /CPO, Jerry Greskovic, System Director for Amb. Pharmacy Services, and Kelly Guza, System Director for Acute Care Services.  


Integrated Care Delivery Response to COVID-19 in Enterprise Pharmacy at Geisinger
ASHP COVID-19 Free Webinar Series
Wed, May 6, 2020 3:00 PM - 4:00 PM EDT

This webinar will describe the COVID-19 response of Geisinger, an integrated care delivery network provider to central, south-central, and northeastern Pennsylvania and southern New Jersey. The Geisinger pharmacy team managed acute care COVID-19 challenges and maintained the practice of more than 90 ambulatory pharmacists involved in their telepharmacy call center, outpatient telephonic practice, retail/mail order pharmacy, and infusion services. 

Michael Evans, Vice President/CPO, 
Jerry Greskovic System Director for Ambulatory Pharmacy Services and 
Kelly Guza, System Director of Acute Care Services will share their perspectives and experience.
The webinar will be moderated by Paul Bush, ASHP’s Vice President for Global Resource Development and Consulting.

To register, click here.


Pennsylvania-Department of Health
COVID-19 and Treatment Drugs Frequently Asked Questions

Last Thursday, the Pennsylvania Department of Health published a quick reference guide to the most commonly asked questions concerning medications being used to treat COVID-19. What is currently out and approved by the FDA, what medications are being tried “off-label” (their names and approved indications), some questions that have come up often about commonly tried adjunct and prophylactic therapies, and where to go to get the real facts about treating COVID-19.  While the article advises the FDA, the world of pharmacists are also looked on as the experts in this field.  Please read this document and be prepared to handle the publics’ questions and concerns.

View the PDF document here.


COVID-19 Related Ambulatory Care Issues (Second Request-please):

1. The PSHP Ambulatory Care Task Force is requesting your feedback and would be greatly appreciated.
The Governor’s waivers issued on April 13 stated: “A pharmacist is a healthcare practitioner who may administer tests if administration of the test is delegated by a medical doctor. Therefore, for the purposes of preparing for and mitigating any effect of COVID-19 testing, licensed pharmacy practitioners are granted the requisite authority needed to carry out end-to-end COVID-19 testing, including but not limited to: ordering; testing; and communicating results.”  
Are any health systems planning to have pharmacists in any settings (community, specialty, 
home infusion, medical practice-based pharmacists) provide COVID-19 testing (including 
antibody testing)?

2. Billing for telemedicine services provided by pharmacists: As ambulatory care-based pharmacists move from face to face patient interactions to patient engagement via phone, online video session, etc.) how is this impacting payment for these services. Especially in light of the announcement yesterday by CMS to

 

  • "As auxiliary personnel, pharmacists can provide services incident to the professional services of a physician or nonphysician practitioner who bills Medicare Part B under the Physician Fee Schedule (PFS), if incident to rules are met and payment for the services is not made under Medicare Part D. The services must be provided in accordance with the pharmacist's scope of practice and applicable state law." CMS further clarified that this would include billing for comprehensive medication management services in Part B, provided no payment is claimed under Part D.
  • For services that are provided incident to a physician or other practitioner, direct supervision of the pharmacist may be "provided virtually using real-time audio/video technology."


Please share your experiences with Medicare and other payers on their willingness to provide payment for pharmacy services provided by “telehealth”. Please do not share specific payment information due to anti-trust considerations.
 
For any feedback on either of these issues please email Steve Sheaffer (s.sheaff@usciences.edu) and Larry Jones (PSHP.execdir@gmail.com) so information can be shared with our ambulatory care task force and PSHP members to assist them in their transition to “telehealth”


CMS makes 2nd round of sweeping regulatory changes in response to COVID-19: 12 notes
Published in Becker’s Hospital Review -- Friday, May 1, 2020 

Hospital capacity and payment rates  

1. Hospitals and health systems that would normally have their Medicare payments cut if they added more beds will be able to do so without payment reductions. For example, teaching hospitals can increase their number of temporary beds without facing reduced payments for indirect medical education, and health systems that include rural health clinics can increase their bed capacity without affecting the clinics' payments. 
2. CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals for needs related to COVID-19, and hospitals without teaching programs that accept these residents will not be penalized. 
3. As mandated by the Coronavirus Aid, Relief and Economic Security Act, long-term acute care hospitals will be paid at a higher Medicare rate if they accept patients from acute care hospitals. 
4. Provider-based hospital outpatient departments that relocate off campus can obtain a temporary exception and continue to be paid under the Outpatient Prospective Payment System, instead of the lower site-neutral rate. 
Telehealth 
5. Hospital outpatient departments can now bill for certain Medicare telehealth services, and CMS is waiving limitations on the types of clinical practitioners that can provide Medicare telehealth services for the duration of the COVID-19 emergency. Physical therapists, occupational therapists and speech language pathologists are now able to provide telehealth services. 
6. CMS is allowing more telehealth services to be provided by audio-only connection, and increasing payments for these services to a range of about $46 to $110 per visit, up from $14 to $41. The payments are retroactive to March 1. 
ACOs
7. CMS is adjusting the financial methodology to account for COVID-19 costs to ensure Medicare ACOs will be treated equitably, regardless of the extent to which their patients are affected by the pandemic. 
8. CMS is forgoing the annual application cycle for 2021, giving ACOs whose participation is slated to end this year the option of extending for another year, and allowing ACOs to maintain their current financial risk level for next year, instead of automatically being advanced to the next risk level. 
COVID-19 testing
9. A written order from a physician or other healthcare practitioner is no longer required for Medicare beneficiaries to get tested for COVID-19, and pharmacists can perform certain COVID-19 tests, depending on their scope of practice and state law. With these changes, Medicare patients can get tested at "parking lot" test sites operated by pharmacies and other entities. 
10. Hospitals will be paid for seeing Medicare patients and collecting samples for COVID-19 tests, even if those are the only services the patient receives. 
11. Medicare and Medicaid will cover FDA-authorized antibody tests, which may help determine whether a person has developed an immune response and may not be at immediate risk for COVID-19 reinfection. 
Home health services 
12. Nurse practitioners, clinical nurse specialists and physician assistants can now order home health services, establish and review care plans for home health patients and certify that a patient is eligible for home health services. Previously, certification from a physician was required for Medicare and Medicaid beneficiaries to receive home health services.


Geospatial Health Advising Group at the University of Cincinnati (UC)

The article and research below shared their results with several groups, including the AHSP COVID-19 list-serve.  It makes for an interesting and timely read as we gear-up for re-engaging our communities and bringing everyone back together.  There are other groups within the country (some in Pennsylvania) working on exactly the same risk assessment models and how to safely reduce the risk of another wave. 

This research team that is a partnership between pharmacy, geography and mathematics, have developed predictions of the spread of COVID-19 and its impact on hospitalizations and ICU admissions as the various social distancing restrictions start to be relaxed. The group’s initial analysis focuses on Ohio although they hope to expand that and hopefully this might still be of interest/use even if you don't live in Ohio.  The website below depicts the UC story and their research.  Within the article is an interactive map of Ohio outlining the spread of COVID-19 hospitalizations and deaths under different levels of successful social-distancing efforts.  That interactive mapping app can drill down to several various scenarios, down to the county level in Ohio.  

View the article and research here.


NIOSH – List of Hazardous Drugs-2020 released by CDC

While not COVID-19 news, it is important and timely news we will all be dealing with shortly as we get back to more business as usual for healthcare.  The listing include several documents and can all be seen here.

There are several documents included in the link, noting the new format only includes two tables.

1.  Table 1: Drugs that contain MSHI in the package insert and/or meet the NIOSH definition of a hazardous drug and are classified by the NTP as "known to be a human carcinogen," and/or classified by the IARC as "carcinogenic" or "probably carcinogenic."
2.  Table 2: Drugs that meet the NIOSH definition of a hazardous drug but are not drugs that have MSHI or are classified by the NTP as "known to be a human carcinogen," or classified by the IARC as "carcinogenic" or "probably carcinogenic.


PSHP would like to thank all of our volunteer members who have assisted in supporting us and all of you in addressing state specific issues related to COVID-19 issues. Our leaders have continued to engage on your behalf with the PA Board of Pharmacy, the PA Department of Health, HAP, and the state medical organizations. PSHP is incurring additional expenses to support these efforts including staff from our association management firm in support of our daily messages. If you are not already a member of PSHP please consider joining. Better yet, please engage as a volunteer including sharing suggestions or comments related to the state's COVID-19 response.

Thank you for your active participation in the profession of pharmacy !


Other suggestions or related issues?

To make this information meaningful, please provide us feedback on what you would like to see in this BLAST and all are invited to please contribute information to post by submitting your information to us via email. 

Disclaimer: The information provided in these e-mail blasts is intended to be shared across all Directors of Pharmacy in Pennsylvania and our PSHP members for individual determination, to assist facilities with product and/or service alternatives (suggestions only) as appropriate for Peer Review.  It is not intended to be interpreted as a mandate or as a PSHP-supported modification nor as an acceptable regulation alternative.  For this the PA State Board of Pharmacy has the final authority.


Pennsylvania Society of Health-System Pharmacists

PO Box 22520, Philadelphia, PA 19110
info@pshp.org | (978) 364-5097 | www.pshp.org


 

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