Trinity Health Urges President Trump to Prioritize Support for the Health Care Industry

In a letter to President Trump dated March 24, 2020, Trinity Health President and CEO, Mike Slubowski, wrote:

Dear Mr. President,

Thank you for the actions you have taken to respond to the COVID-19 pandemic, including the declaration of a national emergency, which has resulted in much needed flexibility for our health system. The ongoing spread of COVID-19 is a significant public health concern. As a national health system with facilities in 22 states and thousands of staff on the front lines, we are experiencing considerable resource and supply strains.

There remain important administrative actions the federal government can take to ensure our health system, and others across the country, can continue to respond to this pandemic crisis.

PAYMENTS TO HOSPITALS AND HEALTH CARE PROVIDERS TO CARE FOR PATIENTS AND COMBAT COVID-19

It is imperative the Administration supports legislation that places first the health of patients and the safety of health care providers. This includes funding to ensure all hospitals have reliable financial resources to maintain an adequate workforce, buy critical supplies, create additional infrastructure, and keep our doors open to care for patients and our communities. In addition, we ask the Administration to push for legislation to create a health system stabilization emergency fund to provide direct funding to hospitals during COVID-19 and times of emergencies.

IMMEDIATELY ADDRESS SUPPLY SHORTAGES

Across Trinity Health, our supply of masks, isolation gowns, face shields, eye protection and N95 respirators are already in short supply. We urge you to immediately use your Executive Authority to invoke the Defense Production Act to allow for increased production of critical supplies.

REMOVE REGULATORY BARRIERS THAT IMPEDE PANDEMIC RESPONSE

To allow community hospitals and health systems the ability to address the growing demand of services in response to COVID-19, we need more regulatory relief from the federal government. Among areas of greatest concern:

• Provide periodic interim payments to hospitals to address cash flow challenges.
• Require all payers to reimburse audio only consultations through telehealth.
• Allow for maximum telehealth flexibility – all payers should provide the same telehealth flexibilities the Centers for Medicare and Medicaid Services has provided for Medicare.
• Ensure all state licensure flexibilities also extend to telehealth. This includes cross state licensure and reimbursement for health professionals.
• Apply consistent prescribing rules to controlled substances via telehealth.
• Require health plans suspend administrative requirements in line with guidance issued by the state of New York.
• Allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible.
• Allow patients with HDHPs to use HSA funds to pay the monthly fee to a “direct primary care,” or concierge, physician practice that typically provides more remote care, including telehealth.
• Allow physician assistants, nurse practitioners and other professionals to order home health services for Medicare beneficiaries.
• Provide telehealth flexibilities for the delivery of home health.
• Allow home health agencies to bill separately for remote patient monitoring.
• Allow home health agencies and hospices to achieve face-to-face requirement via telehealth and bill for telehealth visits.
• Require payers suspend laboratory testing requirements that require tests be sent to specific labs.
• Require payers suspend prior authorization review requirements, document requests, and associated penalties.
• Require payers suspend the authorization process for skilled nursing facilities and other site-of-care transfers.
• Require payers to waive utilization review to allow hospitals to redeploy employees to care delivery areas.
• Require payers to refrain from using claim denials and suspend claim edits.
• Require payers suspend timely filing requirements for claims.
• Require payers extend current appeal and peer-to-peer request timeframes.
• Align 42 CFR Part 2 with existing patient protections under the Health Insurance Portability and Accountability Act to eliminate barriers to coordinated care for individuals with substance use disorder.
• Suspend all routine audits of facilities.
• Create a special enrollment period for health insurance marketplaces.
• Forego finalizing the Medicaid Fiscal Accountability Regulation to avoid disrupting state financing and the health care system.

PROTECT PARTICPANTS IN VALUE-BASED CARE ARRANGEMENTS

Federal policymakers should act quickly to ensure entities providing value-based care are not penalized when extreme costs are incurred in addressing the COVID-19 pandemic and can continue to focus exclusively on furnishing care, including:

• Harmonize requirements for ACO/BPCIA waivers with the 1135 disaster relief waivers to clinically and administratively simplify.
• Treat telehealth codes like other E&M codes for ACOs, for example include them in attribution logic.
• Provide relief from face-to-face components to complete annual wellness visits—a critical activity to address underlying conditions, create a patient-centered plan of care, and close clinical gaps for Medicare beneficiaries.
• Allow ACOs and BPCIA episode initiators to elect by June 30 2020 to continue in the program with no financial reconciliation for PY2020, similar to what was provided for the Pioneer ACO model in Y1. While it might be possible to adjust ACO benchmarks to fairly account for regional differences in disease prevalence, there are simply too many unknowns at this point.
• Do not include 2020 as a baseline year as models move forward.
• Provide a one-year extension of the Next Generation ACO Model – staff who are working to meet application deadlines to allow for continued participation in the Direct Contracting Model or the Medicare Shared Savings Program have been redeployed to support patients and front-line staff.
• Delay implementation of the Direct Contracting Model to 1/1/22.
• Pause monthly compliance monitoring audits for ACOs without any prior material findings or remediation plans.

Thank you for your leadership at this difficult time. Please do not hesitate to reach out to me should you want to further discuss our COVID-19 efforts.

About Trinity Health

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 106 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Michigan, and with annual operating revenues of $19.3 billion and assets of $27 billion, the organization returns $1.2 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 129,000 colleagues, including about 7,500 employed physicians and clinicians. For more information, visit www.trinity-health.org. You can also follow us on Facebook or Twitter.