Letter Templates For Elected Officials, Payors, etc

Communication
1

John Canning and I were working on a letter template for pediatricians to share with their payors when Dr. David Topa posted a really great letter for independent practices to use as a guide for communicating with their elected officials. He is glad to share it here, so I’ve attached it as both a word doc and with the text below. Bravo, Dr. Topa!

LetterToElectedOfficials-1.docx (13.9 KB)

Dear [ELECTED OFFICIAL],

As a steward of the mental and physical health and well-being of the children of [YOUR MUNICIPALITY], I write to inform you that the foundation for their care is crumbling due to the COVID19 pandemic. The majority of pediatricians in the area are members of independently owned private practices consisting of between one and ten physicians. For each physician, our practices employ between 2 and 5 support staff, and run on very tight margins compared to the larger hospital system owned practices, and do not have significant cash reserves on hand.

The COVID19 crisis threatens the very existence of our practices in many ways:
• The threat of infection has caused families to defer care.
• In order to prevent the spread of infection, practices have voluntarily restricted well visits to those for children up to age 2 who need vaccinations to prevent a measles or pertussis outbreak from occurring on the heels of the COVID19 pandemic.
• We are only seeing the most urgent cases in our offices, encouraging our nurses to spend extra time on the phones providing advice to our patients’ families.
• As we convert to telemedicine appointments so we can serve our patients, the insurance companies have been slow to implement protocols to quickly process our claims. Additionally, any attempts to extend reimbursement to cover telemedicine well-visits (essential for detecting emotional and developmental abnormalities) have been stalled by the insurance companies.

The above factors, especially the final one, threaten the very existence of these small businesses which are working to keep children out of the emergency rooms and urgent care facilities, and maintain immunization rates, which benefits both the community and the insurers. While federal help appears to be on the way, there is no guarantee that it will arrive soon enough to keep our practices open. At this critical time in the local healthcare system, when hospitals and urgent care providers will not have the additional capacity to absorb the care of pediatric patients, we implore you to implement additional supports for pediatric practices and pressure the insurance companies to equitably pay us for our services. It is only a matter of time before the insurers will approach Congress for a rescue package and it will be very difficult to support those efforts if they have already allowed the foundation for the care of children to fall apart.

Sincerely,

3 Likes
2

Here’s the message we’re planning to share with our clients shortly. We’re not done with it, so consider this a draft. But please take from it any helpful language!

Dear Provider Relations.docx (7.6 KB)

Dear Provider Relations -

My name is and I am an owner of [practice name], an independent pediatric practice in [city, town.] Our practice has served our community for X years and presently oversees the care of X,000 children. [Other accolades here - PCMH, Medicaid coverage, vaccines given last year]

In response to the COVID-19 Pandemic, our Governor declared a State of Emergency on March X and the President of the United States declared a National Emergency on March 13, 2020. Under both declarations, everyone in our state has been instructed to socially distance themselves and to stay at home. Both declarations also described our medical practice as an essential service. In the words of our President, my fellow pediatricians and I, along with our staff, “have an obligation to maintain our work schedule.”

In an effort to comply with these decrees, to provide necessary medical care and advice to our patients and their families, to keep our patients from seeking care in overrun and virus-filled emergency rooms, and to reduce the spread of the COVID-19 virus, we are following the advice of the American Academy of Pediatrics and are only seeing patients in person that are seriously ill or that require immunizations. We are also following their advice, and the instructions from CMS/HHS, to see all other patients via Telehealth.

We are following the instructions provided by the AAP and CMS/HHS for documenting and billing the Telehealth services. We are using the regular CPT codes for each service we provide, adding the appropriate Telehealth modifier, and are adjusting the Place of Service code. We have not increased our fees in any way to reflect the additional costs associated with Telehealth or operating our medical office during a pandemic.

We expect that your company is making the necessary changes to accommodate the COVID-19 Pandemic and will follow CMS’s instructions and Medicare guidelines to pay us for these Telehealth services at the same rate you would have if we had seen the patients in our office. We expect that you will cover the live video visits to include 99214 and 99215 E&Ms. We expect that you will eliminate the patient contributions (copays, etc.) but not shift that burden to us, the physicians. We also expect that you will work with CMS and the AAP to develop an appropriate method to deliver preventive care via Telehealth.

Earlier this week, the Trump administration announced that Medicare providers could apply for upfront or accelerated payments for anticipated claims volume. In announcing this plan, Seema Verma states that, “The major disruptions to the healthcare system caused by COVID-19 are a significant financial burden on providers. Today’s action will ensure they have the resources they need to maintain their all-important focus on patient care during the pandemic.” I expect that your company will soon offer a similar program to the providers, such as us, who put our own health and safety at risk, in your network. We would like to apply for this accelerated payment program as soon as it becomes available.

Sincerely,

Managing Partner

2 Likes
3

Thanks so much for this template.