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April 6, 2020

Health Headlines – April 6, 2020


CMS Releases Additional Section 1135 Waivers and Flexibilities to Assist the U.S. Healthcare System with COVID-19 Patient Surge – On March 30, 2020, CMS issued additional Section 1135 blanket waivers to provide the American healthcare system with additional flexibility to respond to the COVID-19 pandemic. CMS is authorized under Section 1135 of the Social Security Act, to waive certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements and conditions of participation, as a result of the President’s declaration of a national emergency, coupled with Secretary Azar’s earlier declaration of a public health emergency (PHE) in accordance with Section 319 of the Public Health Service Act. These regulatory changes are effective retroactively to March 1st and will apply across the US healthcare system for the entirety of the emergency declaration. CMS additionally issued the interim final rule (IFR), Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, detailing changes to telehealth, billing and payment and other requirements. The IFC may be found here.

CMS has updated its website to include fact sheets regarding the 1135 blanket waivers, which are now organized by provider type. The fact sheets may be found here.  CMS’s recent actions provide for the following:

Increased Hospital Capacity

Under normally applicable federal requirements, hospitals must provide services within their own buildings. The temporary waivers enable hospitals and health systems to provide healthcare services at other non-hospital buildings and spaces, such as ambulatory surgical centers (ASCs), inpatient rehabilitation hospitals, hotels and dormitories. ASCs can temporarily enroll as hospitals and provide hospital services to address the need to increase hospital capacity. Other relevant entities, such as freestanding emergency departments, can additionally pursue enrollment as an ASC and then convert their enrollment to that of a hospital during the PHE. These entities may enroll and bill as hospitals during the PHE, unless inconsistent with their State’s Emergency Preparedness or Pandemic Plan.

Ambulances are now permitted to transport patients to a multitude of locations where transportation would not normally be deemed medically appropriate. Ambulances may transport patients to any destination which is able to provide treatment to the patient in a manner that is consistent with state and local Emergency Medical Services protocols where the services are being furnished.

Home Testing

Medicare will now pay laboratory technicians to travel to a beneficiary’s home to collect specimens for COVID-19 testing. Medicare will additionally cover the specimen collection fee.

Increased Flexibilities for Dialysis Facilities

42 CFR 494.180(d) requires dialysis facilities to provide services on its main premises or contiguous premises. Dialysis facilities can now provide services to patients in nursing homes or skilled nursing facilities for the duration of the PHE. Dialysis facilities may additionally establish special purpose facilities to care for patients with COVID-19. CMS is waiving the “on-time” requirements for initial and follow-up comprehensive assessments of patients and has waived certain emergency preparedness and equipment maintenance and fire safety inspections.

Increased Flexibilities for Hospice Care

CMS has waived the requirement that hospices use volunteers and the requirement for hospices to provide certain non-core hospice services during the national emergency, such as physical, occupational and speech-language therapies. CMS is additionally extending the timeframes for hospices to complete their assessments of patients and is waiving requirements for onsite visits to determine if aides are providing care consistent with the care plan. Hospice providers can provide services to Medicare patients through telehealth if it is feasible and appropriate to do, such as the face-to-face physician visit that is necessary for recertification.

Blanket Waivers of Sanctions under the Physician Self-Referral Law (Stark Law)

CMS issued blanket waivers of sanctions under the federal physician self-referral law (the Stark Law) related to certain activities for purposes of responding to the COVID-19 pandemic (collectively, the Stark Waivers).  The Stark Waivers are effective retroactively to March 1, 2020, apply nationwide, and may be used without notifying CMS. Providers that wish to use a Stark Waiver to protect an otherwise prohibited financial relationship or referral must satisfy all conditions of the waiver to avoid triggering the Stark Law’s sanctions.

The Stark Waivers apply only to financial relationships and referrals related to specified “COVID-19 Purposes” (e.g., increasing capacity, providing diagnosis or treatment, securing professional services). Where a financial relationship or referral is for a COVID-19 Purpose, CMS is waiving the sanctions for noncompliance with the requirements specified in the Stark Waivers. This means CMS will permit certain referrals and the submission of related claims that would otherwise violate the Stark Law.  The Stark Waivers are available here.  A more detailed explanation about the Stark Waivers is available here.

Expansion of the Healthcare Workforce

CMS has issued numerous waivers to enable healthcare systems to rapidly expand their workforce. For teaching hospitals, medical residents will have more flexibility to provide services under the direction of a teaching physician. During the PHE, teaching physicians can now provide supervision virtually using audio/video communication technology.

CMS is additionally waiving requirements to allow for physicians whose privileges are about to expire to continue practicing at the hospital, and for new physicians to begin practicing in the hospital before the medical staff and governing body have given approval. CMS has additionally waived the requirement that a certified registered nurse anesthetist (CRNA) perform services under the supervision of a physician. Further, hospitals are no longer required to designate in writing the personnel qualified to perform specific respiratory care procedures.

Pursuant to 42 CFR 482.12(c), Medicare patients must normally be under the care of a physician. CMS has issued waivers permitting hospitals to use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan.

Expansion of Telehealth Services

To mitigate the risk of the spread of the coronavirus, CMS is continuing to expand access to telehealth services for Medicare patients. CMS will now allow for more than 80 additional services to be furnished via telehealth. A complete list of covered telehealth services may be found here. Clinicians can provide remote patient monitoring services to both new and established patients suffering from acute or chronic conditions. Remote patient monitoring can now be used for patients with only one disease.

Previously, Virtual Check-In services, where a patient and a doctor have a brief check-in regarding the patient’s health, could only be provided to patients that had an established relationship with the physician. Doctors are now permitted to provide these services to both new and established patients.

Home Health Agencies can provide services to beneficiaries using telehealth within the 30-day episode of care, as long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered by the plan of care.

CMS is further enabling clinicians to provide remote patient monitoring services to patients with acute and chronic conditions. Providers are now permitted to evaluate beneficiaries who have audio phones, only. In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies, instead of requiring in-person presence.

Reprioritization of PACE, Medicare Parts C and D Program and RADV Audits

CMS is reprioritizing scheduled program audits for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans and PACE organizations. CMS will prioritize investigation and resolution of instances of noncompliance where the health and safety of beneficiaries are at serious risk and complaints alleging infection control concerns.

CMS is additionally suspending Risk Adjustment Data Validation (RADV) activities related to the payment year 2015 audit and will not initiate any additional contract-level audits until after the PHE has ended. Organizations are instructed to suspend solicitation of RADV-related medical records from providers.

Changes to “Paperwork” Requirements

CMS has implemented changes to numerous “paperwork” requirements to encourage and allow clinicians to spend more time with patients. For example, while the PHE is in effect, hospitals are not required to have written policies regarding visitation rights for patients in COVID-19 isolation, do not have to provide information about its advance directive policies to patients, and will have more time to provide patients with a copy of their medical record.

CMS is additionally expanding its current Accelerated and Advance Payments Program to address potential disruptions in claims submissions and processing. CMS is authorized to provide accelerated or advance payments during the PHE to any Medicare provider or supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the specific qualifications. Each MAC will work to review the requests and issue payments within seven calendar days of receiving the requests. Additional details regarding the Accelerated and Advance Payments Program may be found here.

CMS is additionally removing limitations set by National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), that cover respiratory related devices. The current NCDs and LCDs that restrict coverage of these devices and services to patients with particular clinical characteristics no longer apply during the PHE. Medicare will therefore cover non-invasive ventilators, respiratory assist devices and continuous positive airway pressure devices based on the clinician’s assessment of the patient.

In addition to providing new blanket waivers, CMS has additionally continued to evaluate and approve individual State Medicaid 1135 waiver requests.  All Section 1135 approval letters can be found here.

Reporter, Jennifer Siegel, Los Angeles, +1 213 443-4389, jsiegel@kslaw.com.

CMS Issues Broad Blanket Waivers of Stark Law Sanctions for COVID-19 Purposes – On March 30, 2020, CMS issued blanket waivers of sanctions under the Federal physician self-referral law (the Stark Law) for purposes of responding to the COVID-19 pandemic (Stark Waivers or Waivers). The Stark Waivers, issued under Section 1135 of the Social Security Act, are effective retroactively to March 1, 2020, apply nationwide, and may be used without notifying CMS. CMS has indicated that it may revise the Stark Waivers as necessary.  Revisions that narrow or terminate the Waivers will be effective on a prospective basis only.  Providers that wish to use a Stark Waiver to protect an otherwise prohibited financial relationship must satisfy all Waiver conditions to avoid triggering the Stark Law’s sanctions.  The Stark Waivers are available here.  We have also prepared a table that crosswalks the Stark Waivers to the CMS examples of arrangements that would qualify for those Waivers. The chart here is available here. We set forth below an overview of the Waivers and include at the end some comments on practical implementation.

Application: The Stark Waivers apply only to financial relationships and referrals related to the COVID-19 national emergency and must be solely related to the “COVID-19 Purposes” identified below.  Covered remuneration must be directly between an entity that furnishes designated health services (DHS) and: (1) the physician or the physician organization in whose shoes the physician stands; or (2) the physician’s immediate family member.

Recordkeeping Requirement: Parties using the Stark Waivers must keep records relating to the use and make them available to the government upon request.  CMS encourages parties to develop and maintain records in a timely manner as a best practice.   

Individual Waivers Still Available: Providers seeking to enter unexcepted financial relationships that are outside the Stark Waivers may still seek individual waivers from CMS. Information about requesting an individual waiver is available here.

COVID-19 Purposes: The Stark Waivers are available for the following “COVID-19 Purposes”:

  • Diagnosis or medically necessary treatment of COVID-19 for any patient or individual;
  • Securing the services of physicians and other practitioners and professionals to furnish medically necessary patient care services, including services not related to the diagnosis and treatment of COVID-19, in response to the COVID-19 outbreak (Outbreak);
  • Ensuring the ability of providers to address patient and community needs due to the Outbreak;
  • Expanding the capacity of providers to address patient and community needs due to the Outbreak;
  • Shifting the diagnosis and care of patients to appropriate alternative settings due to the Outbreak; or
  • Addressing medical practice or business interruption due to the Outbreak to maintain the availability of medical care and related services for patients and the community.

Stark Waivers: Where a financial relationship or referral is for a COVID-19 Purpose, CMS is waiving the sanctions for noncompliance with the Stark Law requirements summarized below.  The waiver notice also includes a non-exhaustive list of practical examples of remuneration, referrals, and other conduct that would qualify for Waivers (subject to meeting other applicable requirements of a Stark exception).          

  • Writing and Signature Requirements: Noncompliance with the writing or signature requirements by a compensation arrangement between an entity and a physician, so long as the arrangement meets all other non-waived requirements of an applicable exception.   
  • Fair Market Value Compensation
    • Personally-Performed Services: Remuneration from an entity to a physician that is above or below the fair market value (FMV) for services personally performed by the physician for the entity.
    • Payments to a Physician for Items or Services: Remuneration from an entity to a physician that is below FMV for items or services purchased by the entity from the physician.
    • Payments by a Physician for Items, Services, or Premises: Remuneration from a physician to an entity that is below FMV for the use of the entity’s premises or for items or services purchased by the physician from the entity.
  • Rental of Office Space or Equipment: Rental charges paid by an entity to a physician, or vice versa, that are below FMV for the lease of office space or equipment.
  • Medical Staff Incidental Benefits: Remuneration from a hospital to a physician in the form of medical staff incidental benefits that exceeds the per occurrence limit under the applicable Stark exception—currently $36.
  • Nonmonetary Compensation: Remuneration from an entity to a physician in the form of nonmonetary compensation that exceeds the annual limit under the applicable Stark exception—currently $423.
  • Loans to Physicians: A loan from an entity to a physician: (1) with a sub-FMV interest rate; or (2) on terms that are unavailable from a lender that is not a recipient of the physician’s referrals or business generated by the physician.
  • Loans to Entities: A loan from a physician to an entity: (1) with a sub-FMV interest rate; or (2) on terms that are unavailable from a lender that is not in a position to generate business for the physician.
  • Physician-Owned Hospitals & ASCs: Referrals by a physician owner of a hospital that:
    • temporarily expands its bed capacity above the level specified in the Stark Law’s whole hospital exception, without prior application or approval to CMS; or
    • converts from a physician-owned ASC to a hospital on or after March 1, 2020, provided the hospital meets certain additional requirements.
  • Home Health: A physician’s referral of a Medicare patient to a home health agency: (1) that does not qualify as a rural provider; and (2) in which the Physician has an ownership or investment interest.
  • Group Practice; In-Office Ancillary Services: The referral by a physician in a group practice for medically necessary DHS furnished by the group practice:
    • in a location that does not qualify as a “same building” or “centralized building” under the Stark Law’s in-office ancillary services exception; or
    • to a patient in his or her private home, an assisted living facility, or independent living facility, even though the referring physician’s principal medical practice does not consist of treating patients in their private homes.
  • Intra-Family Rural Referrals: The referral by a physician to an entity with which the physician’s immediate family member has a financial relationship if the referred patient resides in a rural area.

Practical Implementation Comments

  • Medical Practice/Business Interruption: Many medical practices are facing serious business interruption due to the Outbreak.  Parties may wish to consider rent abatement or other actions to mitigate the impact of the disruptions.  However, to qualify for Waiver protection under the medical practice/business interruption COVID-19 Purpose, an action must be taken “to maintain the availability of medical care and related services for patients and the community.”  Parties should think carefully about whether this requirement is met and what additional actions could be included in an arrangement to satisfy the requirement, or whether an individual waiver may still be required.  There are calls for CMS to expand this COVID-19 Purpose.
  • Indirect Compensation Arrangements Analysis: The Waivers applicable to compensation arrangements only apply to so-called “direct compensation arrangements” in which the remuneration in question passes directly between the entity providing Stark designated health services (the DHS Entity) and either an individual physician or the physician organization in whose shoes the physician owners stand.  As a practical matter, however, actions like those addressed by the Waivers may need to occur between intervening entities, such as when a health system real estate affiliate that is not a DHS Entity proposes to abate the medical office space rent owed by a physician or physician group.  In such cases, it may be that there is no Stark-regulated “indirect compensation arrangement,” if the aggregate compensation to the physicians does not vary with or take into account the volume or value of referrals or other business generated by the physicians for health system DHS Entities affiliated with the real estate company.  As is always the case, this will depend on the particular circumstances. Again, there are calls for CMS to expand the Waivers to apply to indirect arrangements that otherwise would qualify for a given Waiver in order to avoid potential vulnerability associated with relying on an indirect compensation arrangement analysis instead of being able to rely on the clear protection of a Waiver.
  • Waiver of Writing/Signature Requirements: The Waiver of writing and signature requirements is a critical measure to enable parties to take necessary actions in real time without the practical impediment of needing to formalize a writing and obtain signatures prior to taking action.  Parties still should implement prudent measures to document actions under a Waiver in order to meet the recordkeeping requirements of the Blanket Waivers and to be able readily to furnish documentation to CMS upon request.

Reporters, Robert Keenan, Atlanta, +1 404 572 3591, rkeenan@kslaw.com, and Kyle Gotchy, Sacramento, +1 916 321 4809, kgotchy@kslaw.com.

OCR Announces Temporary Waiver of Penalties for Certain PHI Disclosures by Business Associates During COVID-19 Public Health Emergency – On April 2, 2020, the Office of Civil Rights (OCR) issued a notification stating that it will not impose penalties for violations of certain provisions of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule against healthcare providers or their business associates for good faith uses and disclosures of protected health information (PHI) for public health activities during the COVID-19 nationwide public emergency. The HIPAA Privacy rule already permits covered entities to provide this type of information, but OCR has extended this permission to business associates for the time being. OCR uses its enforcement discretion in temporarily waiving these penalties for business associates.

In a press release last Thursday, HHS stated that OCR issued this notification “to support Federal public health authorities and health oversight agencies like the Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS), state and local health departments, and state emergency operations centers who need access to COVID-19 related data, including PHI.”

OCR Director, Roger Severino, stated that “granting HIPAA business associates greater freedom to cooperate and exchange information with public health and oversight agencies can help flatten the curve and potentially save lives.”

OCR has a new webpage with all COVID-19 related materials issued by OCR available here.

Reporter, Elizabeth Han, Houston, +1 713 276 7319, ehan@kslaw.com  

Government Files False Claims Act Suit Against Anthem for Allegedly Submitting Inaccurate Diagnosis Codes Used in Risk Adjustment Payments—On March 26, 2020, the Manhattan U.S. Attorney’s Office filed suit against Anthem, Inc. for violations of the False Claims Act.  The complaint alleges that between 2014–2018, Anthem submitted inaccurate diagnosis codes to CMS for hundreds of thousands of Medicare beneficiaries covered by Medicare Part C (Medicare Advantage) plans.  As a result, the government argues, Anthem unlawfully obtained and retained millions of dollars in payments under the risk adjustment payment system, which CMS uses to calculate payments to Medicare Advantage organizations.

The government’s overarching allegation against Anthem is that it reviewed the medical charts it received from providers “only to submit additional diagnosis codes to CMS while turning a blind eye to negative results where chart reviews could not substantiate the diagnosis codes that Anthem had previously submitted to CMS.”  (emphasis added)  In other words, “Anthem made ‘revenue enhancement’ the sole purpose of its chart review program,” according to the government.  The government provides several specific examples of alleged fraud in the complaint.  In one example, the government alleges that Anthem coded a beneficiary as having active lung cancer.  Despite this coding, “Anthem’s chart review program did not substantiate the active lung cancer diagnosis.”  The government then contends that, for this same beneficiary, Anthem added three additional superfluous codes, which resulted in an overpayment of $7,081.     

Earlier this year, DOJ singled out these types of risk adjustment cases as a top priority for False Claims Act enforcement in 2020.  The case against Anthem further confirms the government’s commitment.  The complaint is available here.

Reporter, Ahsin Azim, Washington, D.C., + 1 202 626 9262, aazim@kslaw.com.

Ninth Circuit Holds That Medical Opinions Do Not Automatically Preclude FCA Liability at the Pleading Stage – In late March, the United States Court of Appeals for the Ninth Circuit revived a whistleblower lawsuit under the False Claims Act (FCA) in which a former employee accused a healthcare provider of submitting reimbursement claims to Medicare for hospital stays that were purportedly “medically unnecessary.”  The Ninth Circuit reversed the trial court’s dismissal of the complaint, holding that patient admissions were not automatically outside the FCA’s purview.

The case is Winter ex rel. United States v. Gardens Regional Hospital and Medical Center, Inc., No. 18-55020 (Mar. 23, 2020) (Winter). The relator-whistleblower was Jane Winter, a registered nurse that claimed to review the hospital’s inpatient admissions using criteria that the hospital had established.  The nurse claimed to have noticed a spike in admissions shortly after an operator of skilled nursing facilities acquired a stake in the hospital management company.  She purportedly identified more than five dozen admissions that did not meet the hospital’s admission criteria, and further observed that the hospital admitted an exceedingly high percentage of patients who arrived from skilled nursing facilities that were affiliated with the co-owner of the hospital management company.  She was allegedly terminated after she brought her concerns to hospital management.  In her FCA lawsuit against the hospital, she alleged that the hospital had submitted claims to Medicare in which it falsely certified that certain patient hospitalizations were medically necessary. 

The trial court in Winter dismissed the plaintiff’s lawsuit against the hospital before pretrial discovery could occur.  The trial court found that, even if all of the plaintiff’s allegations were true, the plaintiff had not stated an FCA claim against the hospital because her allegations were based on a disagreement between medical opinions as to patient admissions and could not, therefore, be proven to be “objectively false.”

On appeal, the Ninth Circuit reversed the trial court and held that “objective falsehood” allegations were not required to state an FCA claim at the pleading stage.  The Court held the FCA was broader than common law fraud, which precluded certain types of professional opinions serving as a basis for a fraud claim.  The Ninth Circuit concluded that a physician’s certification of medical necessity for inpatient hospitalization “can be false or fraudulent for the same reasons any opinion can be false or fraudulent” if those opinions are not honestly held, or if they imply the existence of facts that do not exist.  The Ninth Circuit focused on allegations that hospital management had pressured physicians to increase admissions and highlighted corroborating statements allegedly made by one physician.

The Ninth Circuit reasoned that Winter did not conflict with the “objective falsehood” requirement in the Eleventh Circuit Court of Appeals decision in United States v. Aseracare, Inc.,  938 F.3d 1278 (11th Cir. 2019), because the Aseracare decision was predicated on findings of fact after a trial, in which the evidence involved a dispute over the medical judgment of predicting the deterioration of a patient’s condition to warrant hospice care—there was no proof of undue influence or pressure.  By contrast, the complaint in Winter alleged that medical decisions were being directed and influenced by new ownership for financial gain, which led doctors to falsify the certifications for admission of patients.

It is important to note that this case was decided at the pleading stage, and the court assumed the truth of the assertions.  Winter appears to align with decisions from the Third, Fifth, and Tenth Circuits that expressly or implicitly rejected defendants’ challenge that Aseracare’s “objective falsehood” was a requisite element that must be pled in the complaint to survive a motion to dismiss. The Ninth Circuit concluded that Aseracare “did not necessarily apply to a physician’s certification of medical necessity” and, in any event, addressed a different stage in a case, where evidence had been presented and the dispute of falsity was based, solely, on a reasonable disagreement between physicians “without more.”

A copy of the Ninth Circuit’s decision in Winter ex rel. United States v. Gardens Regional Hospital and Medical Center, Inc. can be found here.

Reporter, Vinay Kohli, Los Angeles, +1 213 443 6851, vkohli@kslaw.com

OIG Survey Report Highlights Strategies Hospitals are Using to Address Shortages and Other COVID-19 Challenges – OIG recently released the results of a survey conducted from March 23-27 in which OIG asked hospital administrators from 323 hospitals across the U.S. to opine on the most significant challenges relating to the current pandemic and their strategies for mitigation. The greatest challenges reported include severe shortages of testing supplies, personal protective equipment (PPE), and ventilators, as well as general supplies such as IV poles, cleaning supplies, food, and linens. Additionally, administrators expressed concerns with staffing shortages, obstacles to expanding capacity, decreasing revenues, inconsistent guidance from governmental authorities, and delays in testing. Below is a summary of various novel, and in some cases drastic, measures highlighted in the report that hospitals are using to address these challenges.

Strategies to secure necessary PPE and supplies include:

  • Using nontraditional sources, such as online retailers, home supply stores, paint stores, autobody supply shops, and beauty salons.
  • Repurposing PPE from non-medical industries.
  • Purchasing expired PPE.
  • Using substitute materials (e.g., sandwich bags as thermometer covers).
  • Physically securing PPE to prevent theft or misuse.
  • Limiting PPE use to more intensive care settings.
  • Sterilizing and reusing PPE.

Strategies to address ventilator shortages include:

  • Renting ventilators or buying single-use emergency transport ventilators.
  • Entering sharing arrangements or patient-transfer arrangements with affiliated and non-affiliated facilities.
  • Converting anesthesia machines and bi-level positive airway pressure machines.
  • Fitting ventilators with additional hoses to connect multiple patients.

Strategies to address staffing needs include:

  • Providing assistance to staff with childcare, grocery deliveries, and laundry services in order to promote retention.
  • Offering hotel accommodations to staff needing to separate from elderly family members.
  • Cross-training staff (e.g., training anesthesiologists, hospitalists, and nurses to operate ventilators, and training non-emergency department physicians to assist with triage in emergency departments).
  • Supplementing with contractors, retired providers, nurse aids, and medical students.
  • Implementing screening centers outside hospitals to help prevent COVID-19 from spreading among staff.
  • Providing mental health clinicians for emotional and psychological support.

Strategies to deal with patient flow and capacity include:

  • Using ambulatory care providers and telehealth to triage patients outside of hospitals in clinics, in their cars, or over the phone.
  • Limiting the number of physical entrances and restricting access to common areas (e.g., making cafeterias take-out only).
  • Restricting visitors and dismissing volunteers performing nonessential services.
  • Splitting emergency departments into separate areas for respiratory and non-respiratory patients.
  • Converting an ambulance bay into a respiratory assessment unit with portable x-ray machines.
  • Establishing alternate care sites at local fairgrounds, vacated college dorms, and other facilities.
  • Eliminating elective procedures and reducing nonemergency services.
  • Reassigning clinic-based physicians to hospitals.
  • Using a buddy system to pair intensive and non-intensive providers together.

Strategies to protect financial viability include:

  • Using a line of credit to support payroll.
  • Reducing unnecessary inventory.
  • Evaluating pay cuts, furloughs, and layoffs.
  • Implementing mandatory and voluntary time off for nonessential staff.
  • Seeking grants and other funding opportunities.

For a copy of the OIG survey report, Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020, please click here.

Reporter, Gardner Armsby, Atlanta, +1 404 572 2760, garmsby@kslaw.com

Also in the News

Survey of State Shelter-in-Place / Stay-at-Home Orders – As COVID-19 continues its acceleration, states across the United States are responding with a variety of executive-level orders to protect the public health. While some states have chosen not to issue orders, King & Spalding has compiled a survey addressing the range of orders that have been issued to date, including orders with minimal restrictions up to orders affirmatively ordering individuals to “shelter in place” or “stay at home” with all non-essential business operations ceasing. The survey is available here.