The California Medical Association, in conjunction with other state medical associations — representing hundreds of thousands of physicians who are on the front lines caring for patients during the novel coronavirus (COVID-19) pandemic—sent a letter to congressional leaders on Friday.

The letter urges Congress to consider additional issues to protect the viability of physician practices as they struggle to meet the needs of their patients and staff during this unprecedented public health emergency.

COVID-19 is testing the capacity of our health care system. Congress must help physicians overcome supply shortages, health care staffing shortages and the related financial challenges to ensure that our communities are appropriately served.     

The letter outlined the following priorities:

• Personal Protective Equipment (PPE), ventilators, test kits and related supplies:  Immediately implement the executive order triggering wartime law to speed the manufacture, production and distribution of supplies; and prioritize distribution to health care workers, emergency workers and the nation’s hot zones.
• Telemedicine: The Medicare and Medicaid waivers must be clarified to include telephone visits. Telephone visits to Medicare patients should be paid at parity with commercial or Medicare in-person rates and the requirement that such visits be patient-initiated should be removed.  
• ERISA Mandate: Because ERISA plans are not regulated by the states and comprise 50-80% of the commercials health care marketplace, we urge Congress to also require ERISA plans to pay physicians at in-person rates for covered services provided via telehealth, including the telephone. 
• Support for Physician Practices: With CMS and many states ordering physicians to suspend non-essential surgeries and other procedures, many physician practices are under great financial strain. We fully support those orders to ensure the health care system has the capacity to handle the COVID-19 surge, physicians and their staff will need financial help to maintain stability in their practices. While small businesses across the country are hard hit, CMA is urging Congress to make special considerations for the physician workforce that is so vital to fighting the pandemic.  Such considerations could include direct financial support, grants, no-interest or forgivable small business loans for physician practices, deferment of medical student loan payments and other health care business grants to assist practices.
• Medicare and Medicaid Rates: To provide further stability for physician practices, CMA is urging Congress to suspend several upcoming Medicare and Medicaid funding cuts, including the Medicare sequestration cuts and the Medicare MACRA payment freeze. We are urging that Congress instead replace the freeze with a meaningful payment update.
• Medicaid Fiscal Accountability Rule: CMA is urging Congress to block implementation of this rule that would cut state and federal Medicaid funding by as much as 50% in all 50 states. There is broad recognition that states will need Medicaid resources to fight the outbreak, particularly among the fragile elderly and disabled who are served by Medicaid.  If this rule is implemented, state budgets will be devastated at a time when health care resources are needed more than ever.
• Administrative Practice Burdens: CMA is urging Congress to suspend all MACRA MIPS Quality Payment Program reporting and other administrative burdens for 2019-2020 so that physicians can focus on patient care.
• Prior Authorization: To ensure physicians can respond quickly to patient needs during this crisis, CMA is urging Congress to suspend all prior authorization requirements and enact prior authorization reform (HR 3107) for Medicare and ERISA plans regulated by the federal government. 

The medical associations who signed on to this letter include CMA, the Florida Medical Association, the Massachusetts Medical Society, the Medical Society of the State of New York, the Texas Medical Association and the Washington State Medical Association.

View the joint letter to Congress.