AAP asks HHS for relief funds to help pediatricians stay open
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In a letter, AAP President Sara H. Goza, MD, FAAP, asked HHS for “immediate, direct financial relief payments” for pediatricians, pediatric medical subspecialists and pediatric surgical specialists “to keep practices open, pay staff, and procure needed supplies.”
The regular caseload for pediatricians has decreased significantly because of social distancing to as low as 20% to 30% of what it was before the COVID-19 pandemic, Goza said in the letter. Moreover, pediatricians must pay for personal protective equipment and training for their staff in order to keep their practices safe for patients.
“The dramatic drop in revenue compounded with higher costs is forcing practices to confront furloughs and layoffs, cancel vaccine orders, and in many cases, consider permanent closure,” Goza wrote.
Goza noted pediatricians’ critical role in vaccinating children and caring for children with special health care needs, who may not have access to their pediatric medical subspecialists or surgical specialists, which could negatively affect their health.
“Children and families who cannot access in-person or telehealth care from their pediatrician may miss important screening, referrals, and treatment for mental and behavioral health issues, including anxiety, depression, and suicidal ideation. These services cannot safely wait until the COVID-19 pandemic is over,” Goza wrote.
The letter suggests that grants equal to 2 months of average practice expenses —“multiplied by 2.6 to account for practice operating expenses” — be distributed to every active pediatrician in the U.S. from the Public Health and Social Services Emergency Fund, which received $100 billion through the CARES Act. It notes that pediatricians do not have access to financial relief policies issued by HHS because they focus on Medicare.
If funds are allocated through a different approach than the one suggested in the letter, Goza said the HHS should follow the following guiding principles:
- Funds should be allocated and delivered immediately with as few barriers as possible, such as through direct deposit and as a grant, not a loan.
- Requiring cumbersome accounting or reporting by pediatricians beyond what was required of physicians who bill Medicare unfairly discriminates against non-Medicare providers.
- Funds should be allocated as needed to provide adequate support — not capped in advance.
- All pediatricians regardless of Medicaid participation or payer mix should be included in the funding allocation.
- If National Provider Identifier Standards are not used to identify eligible pediatricians, the AAP recommends the HHS partner with other national payers as needed to ensure pediatricians who do not participate in Medicare or Medicaid are identified and included.
- The funding requirements should mirror the criteria set for the $30 billion issued to Medicare fee-for-service providers and should not be limited to certain allowable expenses.
Goza also requested that Congress provide additional funding and opportunities to strengthen Medicaid and the Children’s Health Insurance Program, such as increased Federal Medical Assistance Percentages and Medicaid payment equivalence with Medicare in upcoming relief packages. – by Ken Downey Jr.
Disclosure: Goza reports no relevant financial disclosures.
Perspective
Back to TopWilliam T. Gerson, MD, FAAP
Dr. Sara Goza’s letter on behalf of the AAP to Secretary Azar of HHS is dynamic, purposeful and comprehensive. It aptly describes the role of pediatric practitioners in the nation’s health care system and its particular vulnerabilities to the current crisis, and it comes the morning of news of the exhaustion of funding of the CARES Act Payroll Protection Program.
More importantly, it proposes a sensible and well-crafted solution to the financial crisis in pediatric offices. Cleverly, it defines for HHS how to accomplish this task rapidly, fairly and without placing burdensome hurdles on pediatric practices. By requesting grants rather than loans, it also is future-looking, realizing that short-term survival accomplished by advances or loans only puts off eventual collapse or contraction of services.
As a general pediatrician in private practice unaffiliated with any larger umbrella organization, the last 2 months have challenged me in ways I have never experienced in my 35 years of pediatrics. Our focus is always on providing excellence in clinical care. The business side to practice is a shared responsibility of the partners, and we exist on limited administrative and financial backstops. The sudden, unexpected collapse of the financial viability of a care model is as unprecedented as it is stressful. At a time when most of us await news on our applications for economic disaster loans, payroll protection and Medicaid retainers, this letter from the AAP reinforces all that is good about pediatrics.
Disclosure: Gerson reports no relevant financial disclosures.
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