LACMA COVID-19 Physician Playbook by Los Angeles County Medical Association

TABLE OF CONTENTS

2 LACMA CEO: RAPID RESPONSE INITIATIVE 3 Playbook Quick Links FINANCE & REIMBURSEMENT 4 Paycheck Protection Program: Borrowers Information 5 CMS Expands Accelerated Payment Program to Help Physicians with COVID-19 Cash Flow Challenges 16 Worried About Your Practice Surviving COVID-19? CMA and LACMA Are Working Hard to Help 17 What’s in the New CARES Act? 23 HHS Provider Relief Fund Portal Now Open TELEMEDICINE 6 LACMA COVID-19 CRISIS WHITEPAPER Why Telehealth is Not the Future It is the Present 18 LACMA Partners with PatientPop, Announces “Telesubsidy” for Members

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PUBLISHER Gustavo Friederichsen | gustavo@lacmanet.org EDITOR Sheri Carr | editor@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org LACMA OFFICERS PRESIDENT | Sion Roy, MD PRESIDENT-ELECT | Diana Shiba, MD TREASURER | Jeffery Lee, MD SECRETARY | Omer Deen, MD IMMEDIATE PAST-PRESIDENT | C. Freeman, MD, MBA, FAPA LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD (1) Jack Chou, MD, CMA Trustee Samuel Fink, MD (6) Po-Yin Samuel Huang, MD, Chair of the LACMA Delegation Sunny Jha, MD (1) Sion Roy, MD, CMA Trustee Karen Sibert, MD (5) Valencia Walker, MD (5) COUNCILORS Robert Bitonte, MD, JD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Marc Mendes, MD (D6) David Hopp, MD (D7) Steven Sawelson, MD (D9) Christine Phan, MD (D10) William Hale, MD (D14) Nancy Ellerbroek, MD (D17) Lisa Firestone, MD (SCPMG) Roxana Yoonessi, MD, JD (SCPMG) Heather Silverman, MD (SSGPF) Muntu Davis, MD (LA County) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Anna Yap, MD (Resident Councilor) Cecilia Leggett, MD (Alt. Resident Councilor) Ali Tafreshi (Student Councilor, USC) Stacy Songco (Alt. Medical Student Councilor, UCLA)

ADVOCACY & OPPORTUNITY 12 California Calls for Health Professionals for Help 14 CMA to Congress: Help Sustain Physician Practices 15 Applications Now Open for $200 Million in Provider Support from Blue Shield of CA 19 LACMA Launches LA4Docs.org in Support of LA County Physicians 20 Legislative Town Hall | Protecting Patients, Keeping Practices Running 22 CMS Offering MIPS, QPP Credit for COVID-19 Data 26 LACDPH Launches Roadmap to Recovery 30 LACMA Launches “Put It On” Media Campaign Featuring Local Physicians, Los Lobos

PRACTICE MANAGEMENT

LACMA’s Board of Directors consists of a group of 31 dedicated physicians working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, VP of Operations and Strategic Initiatives, at lisa@lacmanet.org or 213-226-0304.

24 Best Practices for Reopening a Medical Practice

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Los Angeles Medicine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Los Angeles Medicine, 10755 Scripps Poway Parkway, Suite 615 | San Diego, CA 92131. To inform us of a delivery problem, email editors@physiciansnewsnetwork.com. Acceptance of advertising in Los Angeles Medicine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Los Angeles Medicine, LACMA Services Inc. or the Los Angeles County Medical Association. Los Angeles Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Los Angeles Medicine is not responsible for unsolicited manuscripts.

28 LACDPH Launches Roadmap to Recovery

26 Reopening Guidelines for Plastic Surgery Practices

29 LACMA to Invest $100,000 in Minority, Womenowned Practices and Physician Practices Serving Communities of Color

LACMA CEO

G U S TAV O F R I E D E R I C H S E N

LACMA RAPID RESPONSE INITIATIVE:

COVID-19 Physician Playbook COVID 19 has taken lives, impacted livelihoods and changed a globe perhaps forever. Locally, our physician community is suffering; many are on the front lines serving the desperate needs of COVID 19 patients at any one of the County’s 76 hospitals. Physicians in group settings are seeing an influx of immune compromised and at-risk patient populations while solo and small practice physicians wear several hats, medical provider, business owner, employer.

The Physician Practice Playbook is a digital information resource that is updated multiple times a week.

What is LACMA doing for all providers, particularly those in community practices? We launched the LACMA Rapid Response Initiative. More than a slogan, it’s a promise. We’ve created an entire platform of resources to help solo and small practices access the latest information on financial assistance, telemedicine reimbursement guidelines and critical information from the Los Angeles County Department of Public Health, Centers for Disease Control, CMA and CMS. We’re making it easier, not complex to get information in a timely way.

The LACMA COVID-19 Physician Playbook is a digital information resource that is updated multiple times a week. It delivers today’s news, links to resources and how to access funds, masks and help. I hope you find it more than valuable, but a testament to our commitment to you, your practice and your livelihood. If it matters to you, at this difficult time, it matters to me,

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QUICK LINKS LA4DOCS.ORG LA COUNTY DEPARTMENT OF PUBLIC HEALTH LA COUNTY DEPARTMENT OF PUBLIC HEALTH FOR PROVIDERS CA DEPARTMENT OF PUBLIC HEALTH CALIFORNIA MEDICAL ASSOCIATION CENTERS FOR DISEASE CONTROL AND PREVENTION CALIFORNIA CORONAVIRUS (COVID-19) RESPONSE COVID 19 FINANCIAL ASSISTANCE TOOLKIT (CMA) COVID-19 CASE MAPPER

LISTEN: LACMA Virtual Town Halls 4/10 | Dr. Sion Roy, Dr. Daivd Aizuss, Senator Ben Allen, Senator Henry Stern 5/7 | Implementing Telehealth at Your Practice

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FINANCE & REIMBURSEMENT

Paycheck Protection Program: Borrowers Information The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. QUICK LINK: SBA PPP WEBSITE Fully Forgiven | Funds are provided in the form of loans that will be fully forgiven when used for payroll costs, interest on mortgages, rent, and utilities (due to likely high subscription, at least 75% of the forgiven amount must have been used for payroll). Loan payments will also be deferred for six months. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees. Must Keep Employees on the Payroll—or Rehire Quickly | Forgiveness is based on the employer maintaining or quickly rehiring employees and maintaining salary levels. Forgiveness will be reduced if full-time headcount declines, or if salaries and wages decrease. All Small Businesses Eligible | Small businesses with 500 or fewer employees—including nonprofits, veterans organizations, tribal concerns, self-employed individuals, sole proprietorships, and independent contractors—are eligible. Businesses with more than 500 employees are eligible in certain industries. When to Apply | Starting April 3, 2020, small businesses and sole proprietorships can apply. Starting April 10, 2020, independent contractors and self-employed individuals can apply. You are encourage you to apply as quickly as you can because there is a funding cap. How to Apply | You can apply through any existing SBA 7(a) lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating. All loans will have the same terms regardless of lender or borrower. A list of participating lenders as well as additional information and full terms can be found at www.sba.gov.

COVID 19 FINANCIAL ASSISTANCE TOOLKIT (CMA) GETTING CASH FOR YOUR SMALL BUSINESS THROUGH THE CARES ACT (Forbes.com) CORONAVIRUS EMERGENCY LOANS GUIDE AND CHECKLIST (US Chamber of Commerce)

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FINANCE & REIMBURSEMENT

CMS Expands Accelerated Payment Program to Help Physicians with COVID-19 Cash Flow Challenges The Centers for Medicare & Medicaid Services (CMS) on Saturday announced an expansion of its accelerated and advance payment program for participating Medicare providers and suppliers. This expansion is intended to lessen the financial hardships of providers facing extraordinary challenges related to the COVID-19 pandemic, which is causing significant disruption to the health care industry, and ensures the nation’s providers can focus on patient care. Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/ or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. CMS is expanding the program to all Medicare providers and supplier throughout the country for the duration of the public health emergency related to COVID-19. The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers. To qualify for accelerated or advance payments, the provider or supplier must:

• Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form, • Not be in bankruptcy, • Not be under active medical review or program integrity investigation, and • Not have any outstanding delinquent Medicare overpayments. Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. California physicians should submit a request to Noridian, California’s Medicare contractor. Physicians can request 100% of their historical Medicare payment amount for a three-month period. CMS anticipates that the payments will be issued within seven days of the provider’s request. Repayment of the advance payments are due 120 days after the issuance of the advance payment. Physicians have 210 days from the issuance of the advance payment to repay the entire balance due to CMS. For more information, see the QUICK LINK: CMS FACT SHEET: ACCELERATED/ADVANCE PAYMENT PROCESS.

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T E L E H E A LT H

PART 1 OF A SERIES | LACMA COVID 19 CRISIS WHITE PAPER FOR SOLO AND SMALL PRACTICE

Why Telehealth is Not the Future It is the Present ARTICLE QUICK LINKS:

The Advantages of Telehealth How Does the Telehealth Process Work? What Are My Practice’s General Telehealth Options? Choosing a High-Quality Telehealth Solution Telehealth-Related State Requirements in California Telehealth Reimbursement

As COVID-19 sweeps California and the nation, solo- and small-practice physicians like you are eagerly embracing telehealth platforms to confront a new reality in real-time: a historic health care crisis, vulnerable patients, and financial shocks. The “wild west” of healthcare is here, and physicians in solo and small practices are looking for answers. This document aims to give you specific, actionable information that complements the latest telemedicine guidelines. The first section discusses the desirability of adopting a telehealth solution during the COVID-19 crisis, general telehealth options, and tips on choosing a highquality platform. The second section discusses state requirements — including physician licensing, authorization for out-of-state personnel, and patient consent and documentation — as well as federal telehealth reimbursement information. The Current Situation

Is your practice experiencing reduced patient volume or increased appointment cancellations? With returning patients and new patients? Have your office’s operations and workflow been disrupted? Including difficulties with billing, scheduling, prescriptions, and communications?

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You’re not alone. Google searches for “telehealth” skyrocketed in the past few weeks. As of this writing, 35 states have implemented stay-at-home orders. But nearly 80% of practices are not prepared to deploy telemedicine, according to a 2019 American Well survey — even though they desperately need a solution allowing them to see patients, care for patients, and generate much-needed revenue. Now they — and you — feel the pressure to adopt a quick, cheap fix.

UPDATE: April 9, 2020 The Department of Managed Health Care issued new guidance for telehealth billing. According to a new All Plan Letter, practices should document telehealth visits as if they had occurred in person, select the most appropriate CPT code, bill with place of service 02 to indicate it was provided via telehealth, and use modifier 95 for synchronous telemedicine or GQ for asynchronous telemedicine.

Thinking Telehealth Through | It’s crucial for solo- and small-practice physicians to resist that pressure:

• Cheap telehealth solutions don’t provide robust tools for patients or providers, making virtual care inefficient and requiring extensive workarounds to piece together multiple processes

• Native mobile-phone technologies, such as Apple’s FaceTime, don’t provide HIPAA compliance or high-quality video. - Update: Zoom health, a low-cost video chat platform, is currently being sued in New York and California. According the Associated Press, “after a user logged on, Zoom gave Facebook the person’s customer information, including what device a person used to access Zoom, the device’s model and the device’s unique advertising identifier.”

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T E L E H E A LT H

Even when the COVID-19 crisis has passed, a reliable, high-quality telehealth solution will be an integral component of your practice. After all, the traditional system was already poor: • The average patient wait time is 18 minutes for an in-person visit, not including travel • Patients must leave work, or leave family at home for an appointment • Options for quality care may be limited in some regions Now, in the midst of COVID-19, the health risk may convince many patients not to seek out treatment at all. Finally, telehealth is only going to become more common — it’s already making major inroads: • 40% of patients in rural areas have used telehealth • 76% of U.S. hospitals employ telehealth for ICU and stroke • From 2016 to 2017, telehealth utilization increased 53% • When patients opted for virtual visits over emergency room visits, the average savings was $1,800, according to a United Healthcare study The Advantages of Telehealth | Once your practice has made the transition, a high-quality telehealth solution provides lasting benefits, especially for prescriptions and payments. PRESCRIPTIONS | The prescribing process has always had its weaknesses, and in the current crisis, you and your patients need to eliminate as many obstacles as possible. For prescriptions, telehealth offers: • Improved security resulting from the elimination of paper pads • Faster for providers and more expedient for patients — providers can save frequent prescriptions and quickly retrieve them • Reduced paperwork and bureaucratic hassle — no more lost notes, with everything saved on your platform; no more patient visits for simply filling another prescription, since patients can quickly receive a new prescription with a follow-up from home • Improved safety, with the use of a keyboard minimizing mistakes and increasing fidelity PAYMENTS | Right now, many practices are missing payments and using office staff inefficiently because free telehealth platforms don’t integrate payment, or because patient phone calls or other circumstances force them to bill patients later. • A high-quality telehealth platform improves payment efficiency by: • Allowing patients to enter billing information during registration and before an appointment • Saving insurance information or credit card data to each patient profile — collecting payment after a session can be as simple as clicking “collect payment” • Automatically submitting and processing co-pays

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That means a smoother flow of revenue in the door of your practice. And cash payments, which are often preferred, become cheaper for the patient while all income goes to the physician. How Does the Telehealth Process Work? | In the COVID-19 era, the integration and application of useful, affordable and deployable technology is no longer a “wait-and-see” option for physicians in solo and small practices. It is the option.

What Are My Practice’s General Telehealth Options? | There are three standard ways a practice can incorporate a telehealth solution into its daily workflow: patient portal solutions, EMR-integrated solutions, and stand-alone solutions. A fourth method — ad hoc telehealth solutions — represents the stopgap measures practices are taking during the COVID-19 crisis. PATIENT PORTAL SOLUTIONS | Your existing patient portal may already have a built-in telehealth option, so you may already be familiar with many of its system-wide features and functions. EMR-INTEGRATED SOLUTIONS | Your existing EMR platform may already support one or more third-party telehealth solutions, allowing relatively smooth integration. STAND-ALONE SOLUTIONS | Stand-alone solutions only manage remote patient communications — your existing EMR system deals with scheduling, documentation, and billing. AD HOC SOLUTIONS | During the COVID-19 outbreak, the discretionary enforcement of federal privacy standards allows practices to temporarily employ non-public-facing remote connections for telehealth visits with Medicare patients. These cheap, quick stand-ins include Apple’s FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype. Note: California has not waived enforcement of state privacy laws. CMA has requested a waiver of these privacy rules during the COVID-19 crisis.

Integrating EMR Systems and Telehealth Platforms in Small Practices | It’s essential to integrate your electronic medical record system with any telehealth platform. And it’s vital for this integration to feature a bi-directional interface — two-way communication in which both systems, the EMR and the telehealth platform, send and receive data. With such integration, the telehealth platform records data from a virtual visit, such as biometric data, which automatically populates the EMR. This streamlined workflow allows doctors to see more patients throughout the day without overburdening office-visit scheduling — all while raising revenue. It also increases efficiency and improves the quality of care by allowing physicians to work with a single platform rather than duplicating work on both.

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T E L E H E A LT H

UPDATE: Google is making changes to search results to make it easier for people to find virtual health care options, according to The Verge. The changes, which will be rolling out “over the coming week,” appear to make it easier to find telehealth services, which have seen a surge in demand due to the COVID-19 pandemic. Health care providers that offer virtual care options will be able to add a link to their virtual care website on their business profile, and that link will appear in both search results and on Google Maps. If a health care provider has a page dedicated to COVID-19related information, Google says it will automatically surface a link to that page as well. READ MORE

Choosing a High-Quality Telehealth Solution | Choosing a High-Quality Telehealth Solution So, you’ve decided to avoid the pitfalls of the “budget approach” — but what should you look for instead? A high-quality telehealth solution with lasting utility should have these capabilities: • Affordability is a key factor for practices considering telehealth adoption, but fortunately, most solutions offer month-to-month commitments for flexibility • Excellent picture quality requires two-way video offering 1.5 megapixels up and 1.5 megapixels down and optimized for picture resolution overall, not frame rate • HD is the standard, allowing you to properly diagnose ailments and providing patients crucial face-to-face interaction • A smooth patient experience that’s personable, seamless, efficient, and free of tech glitches while allowing accurate diagnosis • High security that provides HIPAA-compliant handling of images, photos, and messages • Extensive charting, allowing notes, assessments, plans, and discharge instructions — all of which is downloadable as a PDF after the appointment and in real-time • Flexibility for physician preference — for example, allowing note-logging during sessions but also allowing for end-of-day referencing and downloading, as well as emailing and sharing with other physicians and staff when needed

Telehealth-Related State Requirements in California PHYSICIAN LICENSING | In California, physicians using telehealth must be licensed in the state. For more information, visit the Medical Board of California telehealth website: QUICK LINK: Medical Board of CA >> Telehealth Technology AUTHORIZATIONS FOR OUT-OF-STATE MEDICAL PERSONNEL | California is conducting expedited authorizations of out-of-state medical personnel to respond to COVID-19. For more information, visit the California Emergency Medical Services Authority COVID-19 website: QUICK LINK: California Emergency Medical Services Authority >> Coronavirus Disease 2019 >> Authorization of Out-Of-State Medical Personnel PATIENT CONSENT AND DOCUMENTATION | California requires that physicians initiating telehealth must inform the beneficiary, obtain consent for the telehealth encounter, and maintain documentation. Physicians or practices that employ a general-consent protocol that refers to telehealth as a modality of practice already satisfy the consent requirement. Note: The California Medical Association has requested non-enforcement of the consent requirement from the state during the COVID-19 outbreak.

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Telehealth Reimbursement | While historically tricky, reimbursement for telehealth during the COVID-19 outbreak is quickly becoming simplified. At the federal and state levels, laws and commercial payor policies are being amended, waived, or subjected to enforcement discretion to ease reimbursement and to achieve parity with face-to-face visits. March 6, Medicare began temporarily paying doctors and hospitals for a broad range of telehealth services, according to Modern Healthcare magazine. CMS will pay for office and hospital telehealth visits, as well as a wide range of providers. HIPAA enforcement has been relaxed, with the US Department of Health and Human Services Office for Civil Rights allowing telehealth services for any diagnostic or treatment purpose rendered in â&#x20AC;&#x153;good faith.â&#x20AC;? For more information, visit the Telehealth section of the CMA COVID-19 Resources page: QUICK LINK: CMA COVID-19 Resources >> Telehealth Under standard CMS rules, telehealth visits require real-time communication between providers and patients using both audio and video through a patient portal. The agency also typically requires providers to have a pre-existing relationship with a Medicare beneficiary.

This COVID 19 Crisis White Paper is part I of a series designed to provide useful information for physicians in solo and small practices. If you would like to learn more about telehealth in this rapidly evolving environment, please reach out to me, Gustavo Friederichsen at QUICK LINK: Gustavo@LACMAnet.org

or call me at 760-685-2823. LACMA is here to provide real solutions alongside the latest information from CMA, the CDC and the Los Angeles County Department of Public Health to ensure that you have the tools, equipment, and resources to continue providing care safely and efficiently. Next in the series: EMR-Only Versus Telehealth Platforms

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ADVOCAC Y & OPPORTUNIT Y

California Calls on Health Professionals for Help California is preparing for an increase in the number of people who urgently need health care in our communities during the COVID-19 outbreak. To meet this moment, weâ&#x20AC;&#x2122;re opening additional health care sites to treat people affected by COVID-19 and to relieve the pressure on our health care system by providing care for non-COVID-19 cases. To ensure adequate staff for health care sites throughout California, weâ&#x20AC;&#x2122;re calling on healthcare providers, behavioral health professionals, and health care administrators to register today. California needs:

Physicians (MD, DO), including medical residents Pharmacists Dentists Nurse practitioners Physician assistants Nurses (RN, LVN, CNA), including nursing students Behavioral health professionals (psychiatrist, psychiatric technicians psychologist, psychiatric nurse practitioner, LCSW, LMFT, LPCC) Respiratory therapists Paramedics Medical assistants Emergency medical technicians You will be paid and will be given malpractice insurance coverage. Locations will vary, but we will try to match your geographical preferences. You have the opportunity to play a critical role in responding to this public health emergency

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ADVOCAC Y & OPPORTUNIT Y

in your region. To care for Californians who need your help, please sign up.

Step 1 – Are you eligible? To be eligible for COVID-19 emergency medical staffing roles, you must: Be 18 years of age or over Be eligible to work in the United States Have a valid driver’s license or passport, and a social security card Have a valid California License for clinical practice (if you are a MD, DO, etc.) OR are a medical resident or nursing student Have no negative licensure/certification actions (for licensed/certified professionals)

Step 2 – Register in the California Health Corps system Both licensed professionals and students will have to register. This is the system we’ll use to verify your medical license (if you have one) and identify your deployment preferences.

Step 3 – Once verified, we will ask you to submit an application This process may require you to fill out additional paperwork to complete the hiring process.

Step 4 – Once you’ve applied We will review your skills, experience, location preferences and interests to see where you match our placement needs.

Step 5 – Finalize hiring and placement process You will be hired at time of placement. Bring a formal valid driver’s license and a social security card to provide at time of hire.

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ADVOCAC Y & OPPORTUNIT Y

CMA Urges Congress: Take Additional Actions to Help Physician Practices The California Medical Association (CMA) on Thursday sent a letter to the California Congressional Delegation, urging Congress to take additional steps to sustain physician practices during this trying time so they are able to remain on the front lines serving patients. While CMA is grateful for the work Congress has done thus far to address the needs of Californians and physicians confronting the coronavirus pandemic—most recently with the passage of the $4 trillion “Coronavirus Aid, Relief and Economic Security Act (CARES Act)— we are extremely concerned that there is not enough immediate and direct support to maintain the viability of physician practices during the COVID-19 public health emergency. CARES Act Public Health and Social Service Emergency Fund provides a $100 billion infusion of direct financial assistance to health care providers for unreimbursed health care-related expenses or lost revenue attributable to COVID-19. CMA’s letter asks for Congress’ assistance with the implementation of the CARES Act in the following ways:

• Disperse the funding immediately in a way that is not administratively burdensome for physicians; • Set aside a significant portion of the total funding for physicians; • Prioritize funding to providers in the greatest need in the areas most impacted by the outbreak; • Prioritize funding for distressed physician practices who have lost substantial revenue so that they can be available to care for patients during the surge. • CMA also strongly emphasized the urgent need for immediate deployment of personal protective equipment and testing kits with the appropriate supplies (media and swabs) and for them to be prioritized for health care workers and emergency responders in the nation’s hot zones. CMA is urging Congress to take additional actions including: Requiring all payors to cover and pay for audio-only TELEPHONE consultations between physicians and patients. Telephone service payment must be the same as in-person payment rates during the COVID-19 emergency. Increase Medicare and Medicaid payments to physicians during the COVID-19 emergency. CMA recommends enhanced payments to cover the additional costs of treating patients with COVID-19, the additional costs of personal protective equipment, testing kits, and other related

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medical supplies, the additional costs related to staff sick and medical leave associated with higher exposure risks, and the downturn in revenues because physicians were asked to reduce non-essential services. CMA continues to urge the Centers for Medicare and Medicaid Services (CMS) to withdraw the proposed Medicaid Fiscal Accountability Rule (MFAR) 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. QUICK LINK: View CMA’s letter here.

4.21.2020

Applications Now Open for $200 Million in Provider Support from Blue Shield of CA To apply, email FINANCECOMMUNICATION@BLUESHIELDCA.COM Blue Shield of California recently announced it would be providing $200 million in direct support to physician practices and other health care providers. This week, the payor started accepting applications for the support, which will be offered in a number of categories: Loans: Blue Shield is providing up to $100 million in provider loans. Loan amounts must not exceed $2 million. Advance Payments: Blue Shield is providing up to $100 million in advance payments for contracted Blue Shield providers. There is a grace period of six months and must be repaid in full by 12 months either directly or through offset of future claims. Value-Based/Risk Sharing Contracts: Physicians can convert their contracts to value-based contracts (where available) or risk-sharing contracts, which provide a monthly base revenue stream. Providers can also opt to receive the patient cost-sharing portion of the bill at the time the claim is paid, eliminating the time and expense of collecting patient out-of-pocket costs. The California Medical Association is encouraging interested physicians to apply as soon as possible, as the available funding is limited.

95% of physicians are worried about their practices’ financial health due to the financial stress they are experiencing as a result of the COVID-19 public health emergency according to CMA’s statewide survey of physicians last week.

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Worried About Your Practice Surviving COVID-19? CMA and LACMA Are Working Hard to Help Signed into law on March 27, the CMA-supported CARES Act (Coronavirus Aid, Relief, and Economic Security Act, HR 748) supports physicians financially through several channels, but CMA and LACMA are concerned it may not be enough to keep practices afloat during the COVID-19 crisis.

To help doctors navigate the many helpful provisions in the CARES Act, LACMA has partnered with Los Angeles-based 1st Century Bank (www.1cbank.com). To learn more, contact: • LACMA CEO Gustavo Friederichsen: gustavo@lacmanet.org • 1st Century Bank Senior Vice President Robert Rodriguez: rrodriguez@1cbank.com “Society cannot afford to lose physicians at a time when we need them more than ever,” says CMA in a Mar. 26 letter asking the California Congressional delegation for additional help. Now that the CARES Act is law, CMA is asking Congress to implement it with measures that would help practices combat the financial strain of sick staff, lack of child care, PPE shortages, the shortfall of patient visits, and other hits to revenues. These measures are: • Immediate distribution of the Act’s $100 billion in direct financial assistance to offset COVID-19-related expenses and losses • Setting aside a large share of that $100 billion for physicians • Prioritize funding to providers in high-impact areas in the greatest need • Prioritize funding for distressed physician practices • Ensure quick implementation of Small Business Administration loans and grants, as well as employer tax credits, with priority for distressed physician practices • Immediate deployment of personal protective equipment (PPE) and testing kits, prioritized for health care workers and emergency responders in the nation’s hot zones

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Finally, CMA is urging Congress to take additional legislative actions to protect physicians, practices, and patients during the COVID-19 crisis. These are: • Requiring all payers to cover telephone consultations between physicians and patients with payment rates identical to in-person rates during the COVID-19 emergency • Enhancing Medicaid and Medicare payments to physicians • Enacting grant programs to sustain physician practices, such as the “Immediate Relief for Rural Facilities and Providers Act of 2020” amendment introduced by Senators Bennett and Barrasso, but not included in the final CARES Act • Urging the CMS to withdraw the proposed Medicaid Fiscal Accountability Rule that would cut state and federal Medicaid funding by as much as 50% • Requiring all payers to suspend unnecessary prior-authorization requirements to allow physicians to focus on patient care

What’s in the Newly Passed CARES Act?

SEVERAL MEASURES COULD BE A LIFELINE FOR YOUR PRACTICE

Provisions in the now-effective CARES Act offer several types of financial help, including: • An emergency $100 billion fund providing direct payments to offset COVID-19 expenses and lost revenue • Low-interest SBA loans and grants • Expanded telehealth coverage at the federal level • Funding to increase the production of crucial supplies, especially PPE and testing kits • Tax credits, including refundable employer payroll credits and credits offsetting paid sick and medical leave • Medical student loan deferrals • Reversing the Medicare sequestration cut of 2% • Medicare telehealth expansions for dialysis and hospice • Public health and scientific research investments in the CDC, NIH, BARDA and NSF • Extension of certain expiring health care programs and reauthorization of expiring health care workforce programs

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T E L E H E A LT H

On March 18, 2020, the Department of Managed Health Care (DMHC) announced health plans would be immediately required to reimburse providers for telehealth services, including telephonic visits, at the same rate as those provided in-person, when medically appropriate. In essence, if the service is one that would otherwise have been provided in-person but is now being provided via telehealth the plans should reimburse as though it was provided in-person. For more information about providing telehealth services during the COVID-19 emergency, see CMA’s Telehealth Overview. This document will be updated regularly as new information becomes available.

LACMA Partners with PatientPop, Announces “Telesubsidy” for Members For more information on how to sign up for PatientPop and receive your subsidy please contact Gustavo@lacmanet.org The Los Angeles County Medical Association, in an effort to help physicians in smaller medical practices, has partnered with Santa Monica-based PatientPop, endorsing their PatientPop Telehealth solution to ensure their physician members have the technology, resources and tools they need to serve their patients during the COVID-19 crisis. “We are providing doctors in smaller practices what they need to see patients, using an advanced and comprehensive telehealth solution, from the locally-owned PatientPop,“ said Gustavo Friederichsen, LACMA Chief Executive Officer. “In addition, LACMA will help all new and existing LACMA doctors by offering a set subsidy for the PatientPop telehealth solutions only through the TeleSubsidy Initiative, our commitment to provide financial support to help them launch virtual care visits.” LACMA has a standing partnership with PatientPop, and many LACMA members already use the PatientPop practice growth platform. Now, the new easy-to-use, secure, and 100% HIPAA-compliant PatientPop Telehealth solution delivers everything a provider needs to deliver care virtually including: • Digital patient registration • HD two-way video • Electronic charting • Payment collection • ePrescription capabilities • Chat • Photo sharing, and more Providers can choose to use PatientPop Telehealth as a standalone solution or with the practice growth platform to attract and retain patients for life, plus provide virtual care when patients need a safe and convenient way to see their doctor. “We are thrilled to work with LACMA to bring virtual care to their members at a time when providers need it most,” said Jessica Neyer, Senior Director of Strategy at PatientPop. “Patient needs have rapidly changed because of COVID-19, and telehealth is providing the continuity of care that people require. Moving forward, private practices must adopt telehealth to meet patient demand or risk losing patients to telehealth networks. PatientPop is best positioned to help practices adopt telehealth because our platform manages the entire end-to-end patient journey.”

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ADVOCAC Y & OPPORTUNIT Y

LACMA Launches LA4Docs.org in Support of LA County Physicians LACMA is proud to announce the launch of LA4Docs.org, a website created exclusively in support of Physicians in Los Angeles County. “LACMA continues to find ways to support physicians on the front lines of the COVID-19 crisis, those caring for patients, those with practices that have closed or laid off staff. LA4Docs.org offers free and discounted products and services for physicians,” said LACMA CEO Gustavo Friederichsen. “The site will also feature a place for community colleagues thanking colleagues, and the community can share their sentiments, thanking physicians for what they do each and every day. I encourage physicians to visit the site and post a message or video.” QUICK LINKS TO LA4Docs.org: Healthcare Workers Discounts Giving Blood Help Hospitals Keeping Los Angeles Safe Linking Suppliers with Organizations in Need Masks Mental Health Services Thank Doctors "Since 1871, LACMA has supported physicians. Never before in the nearly 150 years of existence has the organization witnessed physician stress, anguish, pain turn to resilience, strength, perseverance and dignity as physicians continue to put their own lives on the line from New York to Los Angeles, Rome to Wuhan," the website explains. "It is for this reason, physicians and health care workers giving so much and not asking for anything in return, that LACMA has created the LA4Docs effort."

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ADVOCAC Y & OPPORTUNIT Y

LISTEN TO THE TOWNHALL

IN FIRST LEGISLATIVE TOWN HALL ON COVID-19,

LACMA Doctors Focus on Protecting Patients, Keeping Practices Running STATE SENATORS BEN ALLEN AND HENRY STERN JOIN LACMA LEADERS WITH DETAILS ON LIABILITY COVERAGE, GRANTS, CALIFORNIA’S BROADER ANTI-COVID EFFORTS, MORE

At the first legislative Town Hall hosted by the Los Angeles County Medical Association, members lobbed a range of questions focused on how to protect patients and — relatedly — making sure they can continue working. State Senators Ben Allen (SD-26) and Henry Stern (SD-27) joined LACMA President Dr. Sion Roy and Past President Dr. David Aizuss in fielding members’ questions and in providing websites for specific information and requests, as well as a rundown of COVID efforts by state and federal governments, LACMA, and the California Medical Association. What are LACMA doctors concerned about? Protecting patients and staying in business topped the list of LACMA members’ concerns. This lightly edited Q&A provides a broad overview of member questions, with answers by Drs. Roy and Aizuss and Sens. Allen and Stern.

Q: For physicians coming out of retirement to fight the pandemic, how do we deal with liability concerns? A: Dr. Aizuss — Nationally, AMA is vigorously pursuing relaxing liability laws in order to protect us. For example, the states of Massachusetts and New York have issued broad civil immunity against liability in dealing with COVID and other patients. CMA has been communicating the need for this at the state level to the governor, who may already be considering it. Also, U.S. Health and Human Services Secretary Alex Azar has issued recommended executive orders for governors to issue concerning liability protections. Sen. Allen — Concerning those coming out of retirement, the health corps has its own malpractice insurance built in. That may not deal with the broader liability issue that Aizuss was talking about, but it should lessen the burden. Q: Do we have to apply for the Medicare grant? 2 0 L A C M A | C O V I D -1 9 P H Y S I C I A N P L AY B O O K

A: Dr. Aizuss — The medicare grant from the $30 billion pool (of the larger $100 billion pool) is automatic; it’s based on your 2019 medicare allowable billings. It’s approximately 6.19% of what you collected from Medicare last year. Q: Why are grants given only to those participating in Medicare, what about pediatricians? A: Dr. Aizuss — There are going to be similar grants to pediatricians, children’s hospitals, and particularly others who accept Medicaid. CMS administrator Sima Verma said that distribution’s probably going to happen in the next two weeks. Q: Certain specialties may have trouble with their PECO ID numbers and getting checks from Medicare. How do we deal with this? A: Dr. Aizuss — If you have trouble with your PECO ID number or processing, our local Medicare carrier in California, Meridian, has

ADVOCAC Y & OPPORTUNIT Y

staff devoted to helping with that. The CMA Center for Economic Services can also help physicians with these economic issues. Q: Can you comment on the progress of the governor’s COVID-19 testing task force? A: Sen. Allen — I don’t have a lot to say. Scaling our testing needs is in the top 2 or 3 logistical challenges. They have pulled together a really good team, and they’re going to be plugging away pretty intensely. Certainly, if people have any ideas, we want to hear them. Dr. Aizuss — The current PCR test has a false-negative rate of around 30%; a second, serological test should help determine the prevalence of subclinical and asymptomatic infections, and they can figure out how quickly we can begin unlocking the state. Two studies are relevant here, one in L.A. County and another now being conducted by researchers at Stanford. Among CMA members, the head of infectious disease at UC Davis is involved in the task force, as well as an infectious disease physician from Permanente Medical Group in Northern California. Q: Can you comment on increasing testing screening sites in areas with high AfricanAmerican populations? A: Roy — I was on a call with Assemblymember Reggie Jones-Sawyer last night, and in South L.A., the Department of Public Health just opened up free clinics related to COVID-19. This racial disparity is probably related to access to care for this vulnerable population. Unfortunately, we are still months away from having a strategy where we can effectively test a broad number of people and implement a plan for going back to work and co-mingling. Q: I applied to the EDD Workshare program weeks ago after reducing staff hours, and I

haven’t heard anything back. When should I? A: Sen. Allen — The governor is committed to a fast response, but I know that they’re taking at least three weeks. EDD is totally swamped. I can’t emphasize that enough. They’ve gotten more claims in the past two weeks than the entire year of 2019. Be persistent. But if there’s a unique problem, or something unusual is happening, get in touch with our office and we’ll see what we can do. Q: Some of the supermarkets cancel preordered pickups, which can leave seniors in a hole, while trying to get deliveries can be a crapshoot. How can we make supermarkets behave more fairly? A: Sen. Allen — I’d love for my staff to follow up with you to get some more information. At the very least, we can do some inquiring, but this might be a good press article. I hate to say it, but a lot of these companies need to be called out. If they’re feeling at risk of an article in the L.A. Times or a callout from a government agency, they may be less willing to play games. Dr. Roy — On a related note, LACMA has been working with the big chains and the state grocer’s association to create something similar to Cosco’s system — allowing healthcare workers to go to the front of the line. Q: Has there been any consideration of providing post-COVID-19 mental health care, for both survivors and caregivers? A: Dr. Aizuss — CMA’s Care for the Caregivers is training nurses, psychologists, and physicians on how to help caregivers during the current crisis, as well as going forward. I don’t know what formal programs the state has at this point, but I know it’s something that we’ve been talking about.

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ADVOCAC Y & OPPORTUNIT Y

CMS Offering MIPS, QPP Credit for COVID-19 Data The Centers for Medicare & Medicaid Services (CMS) is encouraging clinicians in the Quality Payment Program (QPP) to contribute to scientific research and reporting efforts to help curb the spread of COVID-19. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS), a performance-based track of QPP that incentivizes quality and value, for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. This action will provide vital data to help drive improvement in patient care and develop innovative best practices to manage the spread of COVID-19 within communities.

To view a database of privately and publicly funded clinical studies currently being conducted visit: https://clinicaltrials.gov/ “[This] action encourages clinicians to report data that will help us monitor the spread of the virus, find innovative medical solutions, and unleash scientific discovery as we seek to overcome this terrible disease,” said CMS Administrator Seema Verma, M.D. In order to receive credit for the new MIPS COVID-19 Clinical Trials improvement activity, clinicians must attest that they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study. “The new improvement activity provides flexibility in the type of clinical trial, which could include the traditional double-blind placebo-controlled trial to an adaptive or pragmatic design that flexes to workflow and clinical practice,” according to the CMS announcement. “It also carries a high weight from a scoring perspective. This means that clinicians who report this activity will automatically earn half of the total credit needed to earn a maximum score in the MIPS improvement activities performance category, which counts as 15% of the MIPS final score.”

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FINANCE & REIMBURSEMENT

NOW OPEN HHS Provider Relief Fund Portal All providers with a Medicare billing TIN are now eligible to apply for a portion of this $20 billion by submitting data about their annual revenues (through their IRS tax filings) and estimated COVID-related lost revenue for March and April 2020 via the Provider Relief Fund General Distribution Portal. The U.S. Department of Health and Human Services (HHS) on April 23, 2020, announced a $20 billion phase two round of funding for health care providers from the $175 billion CARES Act Provider Relief Fund. HHS is dispersing the additional $20 billion to providers based on a percentage of each provider’s 2018 net patient revenue from all payors, not just Medicare fee-for-service payments. The funds are grants and do not need to be repaid. Hospitals that submit cost reports to the Centers for Medicare and Medicaid Services (CMS) automatically received direct deposits on April 24, 2020. Physicians will need to apply to HHS to receive phase two payments. All providers with a Medicare billing TIN are now eligible to apply for a portion of this $20 billion by submitting data about their annual revenues (through their IRS tax filings) and estimated COVID-related lost revenue for March and April 2020 via the Provider Relief Fund General Distribution Portal. For more information, see the HHS FAQ and application guide. HHS continues to assure CMA that the third wave of funding will be dedicated to physicians and physician specialties who do not have Medicare-heavy caseloads, such as Medicaid providers.

MAY 7 | Provider Relief Update from CMA

Only those who received payment in phase 1 able to apply for phase 2 The U.S. Department of Health and Human Services (HHS) on April 23, 2020, announced a $20 billion phase two round of funding for health care providers from the $175 billion CARES Act Provider Relief Fund. There is, however, conflicting information about whether a provider who has not previously received funding from the Provider Relief Fund in phase one can apply for this second round of funding. Since the portal opened, the California Medical Association (CMA) has heard from physicians that they were kicked out of the application if they indicated that they did not receive a payment from the $30 billion phase one direct deposit disbursement prior to April 25, 2020. CMA and the American Medical Association (AMA) continue to seek clarification on this matter. In the meantime, absent further guidance from HHS, physicians who did not receive a phase one payment should not apply for phase two funding. For those practices that are eligible for phase two funding, CMA wants to emphasize that you need to submit your most recent tax return, revenue losses from March 2020 and estimated revenue loss for April 2020 from all payers. More details on the submission requirements can be found in CMA’s Financial Toolkit for Medical Practices. CMA also urges all physicians to read the terms and conditions carefully and make decisions based on their practice circumstances. Practices should also thoroughly document the expenditures from this allocation because they could eventually be audited. Physicians who did not receive phase one funds and believe they should have been eligible for a payment from the initial $30 billion disbursement should see CMA’s Financial Toolkit for Medical Practices for more information. HHS said it is working to disburse additional funding to providers with lower shares of Medicare reimbursement (such as pediatricians and OB-GYNs) and Medicaid providers.

AMA has also developed guidance to help physicians pull together the information they need to submit to the portal. L A C M A | C O V I D -1 9 P H Y S I C I A N P L AY B O O K 2 3

PRAC TICE MANAGEMENT

Best Practices for Reopening a Medical Practice As the COVID-19 pandemic spread throughout the world, California and the United States took steps to limit the transmission and impact of the virus by implementing stay at home orders. While this has so far prevented any surges overwhelming our hospitals, it has also meant that many other parts of the health care system have been idled to preserve resources and capacity in the system and limit opportunity for transmission or exposure of the virus. The California Medical Association (CMA) has developed a set of best practices for physicians to consider as they more to safely and cautiously reopen their medical practices for office visits. The document includes steps to take prior to reopening, financial and staffing considerations, and universal safety precautions.

STEPS TO TAKE PRIOR TO REOPENING A PRACTICE Click Here for more details on each step 1. Consult the Local Public Health Department 2. Construct a Financial and Staffing Plan for Reopening 3. Develop Safety Protocols 4. Assess the Supply of Personal Protective Equipment 5. Consider the Role Telehealth Will Play in Reopening | For more information on implementing and using telehealth, please see the CMA Telehealth Toolkit for Medical Practices. 6. Clearly Communicate with Patients about Practice Changes 7. Be Watchful of Medication Shortages FINANCIAL CONSIDERATIONS 1. Consider the Capital Needs of the Practice and Available Funding Sources | For more information about financial resources that can support practices, please see CMAâ&#x20AC;&#x2122;s COVID-19 Financial Practice Toolkit for Medical Practices. 2. Address Accounts Payable 3. Plan to Meet Existing Obligations 4. Develop a Monthly Budget 5. Talk to Vendors 6. Tackle Accounts Receivables Slowly 7. Verify Patient Contact and Insurance Information 8. Analyze Revenue Streams

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PRAC TICE MANAGEMENT

STAFFING CONSIDERATIONS 1. Right Size Physician and Staff Work Force | For more information on employment issues, please see the CMA COVID-19 Toolkit for Physician Employers. 2. Consider Options for Vulnerable Staff 3. Give Extra Care and Attention to the Emotional and Physical Needs of Staff | Practices looking for resources on addressing the mental and emotional needs of their staff should contact the CMA Wellness “Care 4 Caregivers Now” Program at cmadocs.org/care4caregivers. UNIVERSAL SAFETY PRECAUTIONS FOR PRACTICES & FACILITIES 1. Maintain Physical Distancing 2. Require Universal Face Covering 3. Implement Strict Sterilization Procedures 4. Continue to Use Telehealth, as Appropriate 5. Pre-Screen Patients for Possible COVID-19 Symptoms | Physicians should keep up to date on the recommendations for preventing spread of COVID-19 on CDC’s website. Guidance on prioritization for COVID-19 laboratory testing can be found here. General information about COVID-19 testing is available here. 6. Preservation of Personal Protective Equipment 7. Establish a Quarantine Policy Additional CMA Resources CMA is working to develop comprehensive resources to help physician practices through the COVD-19 pandemic and beyond. These resources are updated daily, to reflect the most up-todate information on this ever-changing situation. Practices can visit cmadocs.org/covid-19 for the latest news and most up-to-date tools. The California Department of Public Health also on Monday released guidance on

Resuming California’s Deferred and Preventive Health Care.

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PRAC TICE MANAGEMENT

Reopening Guidelines for Plastic, Aesthetic Surgery Practices On behalf of the Los Angeles County Medical Association (LACMA) I wanted to share some important information for those practices unaware of and/or confused relative to reopening their practices during COVID 19. Those in the plastic surgery and aesthetic surgery specialties can reopen practices as long as they adhere to local (LACDPH) state (California Department of Health Services) and federal (CDC) guidelines relative to reopening. Below are specifics: BACKGROUND | At the onset of the COVID-19 pandemic, CDC recommended that healthcare systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in healthcare settings. A consequence of the pandemic has been the under-utilization of important medical services for patients with non-COVID-19-related urgent and emergent health needs [1-3]. As the pandemic continues, healthcare systems must balance the need to provide necessary services while minimizing risk to patients and healthcare personnel (HCP). Because the effects of COVID-19 vary among communities, healthcare systems will also need to consider the local level of COVID-19 transmission when making decisions about the provision of medical services. This document provides a framework for the delivery of nonCOVID clinical care during the COVID-19 pandemic. Given the dynamic nature of the pandemic, considerations may change over time and vary by practice type and setting. KEY CONSIDERATIONS • Be prepared to rapidly detect and respond to an increase of COVID-19 cases in the community. - Stay informed. Consult regularly with your state or local health department for regionspecific information and recommendations. Monitor trends in local case counts and deaths, especially for populations at higher risk for severe illness. - Before expanding to provide elective services, healthcare systems must operate without crisis standards of careexternal icon. Ensure adequate HCP staffing and bed capacity, availability of personal protective equipment and other supplies, and access to other important tools to respond to a surge in cases if needed. Learn how healthcare systems can operate effectively during the COVID-19 pandemic. • Provide care in the safest way possible. - Optimize telehealth servicesexternal icon, when available and appropriate, to minimize the need for in-person services. - Follow recommended infection control practices to prevent transmission of infectious agents, including screening all patients for COVID-19 signs and symptoms, universal source control, and infection control practices specific to COVID-19. Be familiar with COVID-19 healthcare infection prevention and control recommendations specific to your setting. • Consider that services may need to expand gradually. - Make decisions for expanding necessary care based on the local epidemiology and in concert with recommendations from state and local officials. - Prioritize services that, if deferred, are most likely to result in patient harm. - Prioritize at-risk populations who would benefit most from those services (for example, those with serious underlying health conditions, those most at-risk for complications from delayed care, or those without access to telehealth). 2 6 L A C M A | C O V I D -1 9 P H Y S I C I A N P L AY B O O K

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A Crisis Demands Adjustments Before & After Practices Reopen | With nearly 40,000 COVID 19 cases, almost 2,000 deaths and more than 1,100 cases on May 19th in Los Angeles County alone, it is paramount for practices to consider modifications to practice environments, adjusting to social distancing, monitor local, state and federal updates. Keep staff and patients safe with proper PPEs and improved, more frequent cleaning measures and safeguards. These are recommendations outlined in the California Department of Public Health April 27th update, “Resuming Deferred and Preventive Care” Along with this Physician Playbook from the Los Angeles County Medical Association, you also have two additional resources to help you during this critical transition phase: First, the California Medical Association (CMA) “Recommendations for Reopening a Practice”, and the Public Health “Roadmap to Recovery” which has extensive information relative to ensuring public safety, protecting vulnerable populations, ensuring capacity in the healthcare delivery system and information regarding testing. We have combined these assets to bring you critical information you need to open your practice safely. LACMA will launch a Rapid Response Playbook designed specifically for plastic surgery and aesthetic surgery practices in the coming weeks. We hope this collaboration and resulting update brings some clarity and understanding as you transition with confidence. If you have any questions feel free to contact Gustavo at gustavo@ lacmanet.org. Gustavo Friederichsen | CEO/LACMA David Hopp, MD | LACMA Board Member; Member, Mayor of Beverly Hills COVID-19 Advisory Council

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ADVOCAC Y & OPPORTUNIT Y

LACDPH Launches Roadmap to Recovery The LA County Department of Public Health last week issued a five-stage Roadmap to Recovery that describes a phased approach to relaxing select directives of the Safer at Home Order and a reopening process for certain business sectors. County officials discussed entering “Phase 2” of the recovery plan at a May 8 press conference delivering COVID-19 updates. Barbara Ferrer, PhD, MPH, MEd, Director of Public Health, discussed LACMA’s involvement in the recovery efforts. “We’re also working closely with the Los Angeles County Medical Association, known as LACMA, and they’ve done amazing work, including launching some COVID-19 rapid response teams, they’re working very closely with providers in some of the most impacted communities to make sure those providers have their PPE, and again enhancing testing capacity, so I urge people to look at the LACMA website for more information.” Phase 2 allows florists and some retailers to offer curbside pickup. Car dealerships, golf courses and trails can also open with appropriate safeguards in place. Physical distancing and infection control protocols must be adhered to and cloth facing coverings must be worn. Later next week additional restrictions will be lifted to include many retailers, manufacturers, and other recreational facilities. The next three stages include the potential opening in phases of higher-risk businesses like movie theaters, schools, colleges and universities, followed by conventions and spectator events, to finally normal operations. Each sector will have safe reopening protocols that must be adhered to. Until final stage five is reached, Health Officer Orders and directives will still continue to ensure that we slow the spread of COVID-19 to prevent an overwhelming surge of COVID-19 cases at healthcare facilities. Physical distancing, wearing cloth face coverings, frequent hand washing, self-isolation and self-quarantine will continue to be very important throughout the foreseeable future. People who have underlying health conditions will still be at much greater risk for serious illness from COVID-19, so it will continue to be very important for the County’s vulnerable residents to stay at home as much as possible, to have groceries and medicine delivered, and to know to call their providers immediately if they have even mild symptoms. An interactive dashboard is available that provides an overview of COVID-19 testing, cases and deaths along with maps and graphs showing testing, cases and death data by community poverty level, age, sex and race/ethnicity. To view Public Health’s COVID-19 Surveillance Dashboard, Click Here.

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LACMA to Invest $100,000 in Minority, Women-owned Practices and Physician Practices Serving Communities of Color

Successful COVID 19 Rapid Response Initiative Poised to Help Practices Needing Help with PPEs, Resources, Technology Thanks to Partnership with Patient Care Foundation and LACMA Districts

APPLY FOR FINANCIAL ASSISTANCE After a successful COVID 19 Rapid Response effort that helped more than 400 medical practices in need with $100,000 in grants and telemedicine subsidies, the Los Angeles County Medical Association (LACMA) announced today that it will launch a new $100,000 effort to support additional practices. These practices include those that are minority or women owned, or serve communities of color, thanks to the generous support from the Patient Care Foundation (PCF) in the form of a “match” of $25,000 to $25,000 from LACMA. LACMA Districts will also help practices in their local districts with a $50,000 contribution. “As we enter the fourth month of the pandemic, small medical practices are still suffering supply shortages, economic challenges, staffing issues and a lack of centralized resources to help them reopen. These problems have hit particularly hard women and minority owned practices, and those that serve communities of color, and LACMA is proud to partner with the PCF to help these physician practices so that we can preserve much needed access to care,” said Sion Roy, MD, president of LACMA. Roy went on to say, “It’s also incredible that our Districts, which represent nearly every community in the region, have collectively joined our efforts to help local practices in this time of need in every part of our county.” Dr. Troy Elander, chairman of the Patient Care Foundation said, “ PCF is proud to make a difference in the lives of struggling physicians and their practices due to the pandemic and economic downturn and its exciting for us impact the acquisition of much needed supplies and resources,” Elander said. Specifically, the LACMA District contribution will help support practices in need via two PPE distribution events this Summer. The LACMA and PCF contributions will help minority owned and women owned practices, and practices in communities of color, that need help to reopen, rehire staff and invest in technology.

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LACMA Launches “Put It On” Media Campaign Featuring Local Physicians, Los Lobos Public Service Announcements Featuring Local Physicians as well as the Band Los Lobos in Support of Public Health Officers, Need for Public to Wear Masks SHARE THE “PUT IT ON MESSAGE: Click the links below had share with your social media followers: Physician Video: Facebook | Twitter | LinkedIn | Instagram Los Lobos Video: Facebook | Twitter | LinkedIn | Instagram

The Los Angeles County Medical Association has launched the “Put It On” public service media campaign with two PSA videos encouraging Los Angelenos to wear masks in accordance with public guidelines. Further, the PSA campaign calls for support of Los Angeles’ public health officers for their commitment and tireless efforts to stop the spread of the COVID 19 virus. The first video, featuring local physicians on the front lines in the fight against the virus, calls on the community to support facts and science, not misinformation and fiction, associated with the COVID-19 pandemic. In the video physicians representing various Los Angeles County communities highlight the life and death importance of wearing a mask in accordance with public guidelines. The second video features members of beloved Los Angeles band Los Lobos sharing the “Put it On” message. “We stand shoulder to shoulder with our public health officers and call on the community to listen to medical experts who follow the science, facts and data,” said Gustavo Friederichsen, LACMA’s CEO. “LACMA is calling on the public to do its part by wearing masks to stop the spread of COVID 19 which has seen close to 90,000 cases and more than 3,000 deaths attributed to COVID 19 in Los Angeles County alone. “’Put it on’ (“Pontelo”) is the call to action in our campaign’, said Friederichsen. “It’s a simple message in English and Spanish so that Angelenos understand how essential it is to save lives; the lives of loved ones, friends and fellow citizens.” LACMA issued a forceful statement in the wake of Dr. Nichole Quick, Orange County’s public health officer, resigning after receiving death threats and people protesting outside her home after issuing a mask order. LACMA invited Dr. Quick to join a recent LACMA board of directors meeting to share her story as colleagues voiced their support. More recently, Dr. Barbara Ferrer, Director, Los Angeles County Department of Public Health conveyed publicly that she too had received death threats. The videos are the first in a series of PSA’s conveying simple messaging relative to complex topics namely: mask wearing, social distancing and staying at home.

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