The COVID-19 pandemic has led to a multitude of changes: children being taught virtually, a visit to the grocery store becoming an arduous task, and quiet streets. It’s also radically changed what’s happening with pediatric practices, with many seeing much lower caseloads than would be typical during the spring. This lower caseload has led to shaky financial situations for many practices, which moved the president of the American Academy of Pediatrics (AAP), Sara H. Goza, MD, FAAP, to write a letter to the US Department of Health and Human Services (HHS) stating that the nation’s pediatricians need immediate no-strings financial help.1
The letter, addressed to HHS Secretary Alex M. Azar II, discusses the potential ramifications for communities if a practice is forced to close its doors. Delays in vaccinations could leave communities unprotected against outbreaks of other diseases, even as COVID-19 continues to rage on. Developmental delays could go undiagnosed, which would prevent early intervention that could ensure optimal outcomes. Families who can’t speak to a pediatrician either through an in-person visit or via telehealth could go untreated for mental health issues such as suicidal ideation and anxiety that have been exacerbated by the epidemic or may have started because of it.
“[I]t is absolutely essential for the future health and safety of the country that pediatricians have the financial support to continue seeing children throughout this pandemic,” Goza writes. “As such, we urge [HHS} to deliver immediate, direct financial relief payments to pediatricians, including pediatric medical subspecialists and pediatric surgical specialists, much like what has been provided for physicians who participate in Medicare.”
Call for financial relief
In her letter, Goza urges the HHS to disburse 2 months of average practice expenses to every active pediatrician in the United States. She also reminds the HHS that pediatricians are not eligible for other financial relief policies that the government has issued because of the focus on Medicare. The funds should be provided to pediatricians via either direct deposit or check. The only requirements should be to confirm that funds were received; care was provided after January 31, 2020; the practice is not currently terminated from participation in Medicare and not excluded from participation in Medicaid, Medicare, or other federal health programs; and the practice has not had Medicare billing privileges revoked.
If the HHS does not want to follow this request, the AAP requests that it follow certain guiding principles.
· Money should be allocated and delivered immediately via direct deposit or check. The money should be a grant and not a loan.
· Requiring accounting practices beyond what a physician who bills to Medicare needs to provide discriminates against non-Medicare providers.
· Money should be allocated as needed and not capped in advance. A cap to funds could leave some providers in unnecessarily bad situations or create a situation where providers have to compete with one another to get money.
· Every pediatrician should be included, regardless of whether he or she participated in Medicaid or payer mix. If the HHS uses Medicaid claims to establish payout amounts, a minimum amount should be determined.
· If the National Provider Identifier registry isn’t used to identify pediatricians, HHS should work with national payers to find pediatricians who do not participate in Medicare or Medicaid.
· Funding requirements should match the criteria developed for the $30 billion given to Medicare fee-for-service providers and not limited to certain expenses.
Goza also emphasized the critical need to strengthen Medicaid and the Children’s Health Insurance Program (CHIP) that provide affordable, comprehensive health care services to more than 35 million children and to protect the pediatric practices that participate in these programs from closing.
1. Goza SH. Letter to Alex M. Azar II, Secretary, US Department of Health and Human Services. Published April 16, 2020. Accessed April 21, 2020. https://downloads.aap.org/DOFA/AAP_CARESfunding_HHS_16Apr2020.pdf