WORKWEEK

Covid is still spreading through communities and is by no means “over.” However, this week, the government is likely to decide whether to extend the public health emergency (PHE). If the PHE isn’t renewed, what will the implications be? 

Implications for Hospitals, Clinicians and Providers

• Reimbursement ➡️ Medicare has increased reimbursement to hospitals by 20% for treating Covid-19 patients. From Jan ‘20 to Nov ‘21, hospitals have treated over 1M Covid patients with traditional Medicare and have been reimbursed at around $24,000 per patient. If the PHE isn’t renewed, reimbursement for patients with Covid will return to traditional reimbursement.
• Emergency Use Authorization ➡️ Doctors and other providers won’t be able to administer the tests, medications or vaccines approved for emergency use authorization. The FDA fully approved Pfizer’s and Moderna’s vaccines for adults, so they’ll be used post-PHE.
• Liability ➡️ Providers were granted medical immunity to help increase access to tests and vaccines. For example, providers in one state could vaccinate patients across state lines. Liability protections will no longer be available once the PHE ends unless states make their own rules.
• Telehealth ➡️ CMS increased telehealth flexibilities during the pandemic, such as coverage for telehealth visits, including some audio-only, regardless of the patient’s location relative to the healthcare provider. Congress plans to extend telehealth flexibilities made during the pandemic for up to five months after the public health emergency ends. I hope that these flexibilities become permanent.

Implications for Beneficiaries 

• Medicaid ➡️ The Families First Coronavirus Response Act (FFCRA) gave states a 6.2% increase in the federal share of Medicaid spending as long as they provide continuous insurance coverage for Medicaid enrollees, even if enrollees make too much income. Once the PHE ends, millions of Medicaid’s 76.7M enrollees will inevitably lose insurance.

• ACA Subsidies ➡️ The American Rescue Plan Act (ARPA) expanded Marketplace tax credits for patients with incomes higher than 400% FPL. This led to 14.5M Americans signing up for health insurance during open enrollment this year, a 21% increase from 2021. While the ARPA isn’t linked to the PHE, it’s set to expire at the end of this year, which means millions of Americans may lose access to insurance.

Take-Home Message

Clinicians don’t provide health care in a bubble. Rather, they provide care within the larger healthcare system, which is run by health policy. The best clinicians know medical care and know the policy that affects how they deliver that medical care.