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Health Groups Turn Up Heat on 2021 Medicare Fee Schedule

WASHINGTON — Physician groups and other healthcare providers continued expressing their dissatisfaction with the 2021 Medicare physician fee schedule proposed rule from the Centers for Medicare & Medicaid Services (CMS).

“While we support the CPT coding revisions and revaluations of office and outpatient evaluation and management (E/M) services recommended by the AMA/Specialty Society RVS Update Committee [RUC], we strongly oppose the proposed budget neutrality reduction proffered by CMS for these and other physician fee schedule changes proposed for 2021,” said a letter sent Monday to CMS Administrator Seema Verma from 47 medical and health specialty groups including the American College of Surgeons, the American College of Radiology, and the American Academy of Ophthalmology. The groups represent 1.4 million providers, including physicians, social workers, and speech-language pathologists.

If adopted as proposed, the fee schedule would “reduce Medicare payment for services provided in patients’ homes, physician offices, non-physician practices, therapy clinics, skilled nursing facilities, hospitals and rehabilitation agencies — at a time when the spread of COVID‐19 remains unchecked,” the letter said.

The proposed fee schedule, which was announced in early August, includes “simplified coding and billing requirements for E/M visits [that] will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction,” CMS said. “As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.”

However, the proposed rule also lists (on p. 50375) the estimated impacts of the rule’s payment changes for each specialty, which includes losers as well as winners.

Three specialties fare the best: endocrinology, with a 17% increase; rheumatology, with a 16% increase; and hematology/oncology, with a 14% increase. At the bottom are nurse anesthetists and radiologists, both with an 11% decrease; chiropractors, with a 10% decrease; and interventional radiology, pathology, physical and occupational therapy, and cardiac surgery, all with a 9% decrease. Surgical specialties in general took some of the biggest hits, with cuts in every category ranging from 5% to 9%.

The proposed rule also lists the fee schedule’s final conversion factor — the amount that Medicare’s relative value units (RVUs) are multiplied by to arrive at a reimbursement for a particular service or procedure under Medicare’s fee-for-service system. Due to budget neutrality changes required by law, the proposed 2021 conversion factor is $32.26, a decrease of $3.83 from the 2020 conversion factor of $36.09, CMS said. Comments on the proposed rule were due by 5 p.m. on Monday.

American Medical Group Association (AMGA), which represents group practices, also weighed in on the proposed rule. “AMGA is concerned that the CMS proposed 2021 Physician Fee Schedule rule would inadvertently exacerbate the financial situation facing our membership that is a result of the ongoing novel coronavirus 2019 (COVID-19) pandemic,” the association said in a statement. “While appreciative of the effort to increase support for primary care services, the Physician Fee Schedule’s budget neutrality requirements effectively

Seattle Parks reopens playgrounds, fitness equipment, but kids will have to wait their turn


For more coverage, visit our complete coronavirus section here.

Good news for those with stir-crazy kids: Seattle Parks and Recreation is reopening 150 outdoor play areas to the public with new safety guidelines Tuesday.

The play areas closed in March when the novel coronavirus first hit the region as they were considered “high touch” areas that could easily spread the virus. But with new research showing that the virus is unlikely to spread through surfaces, the city’s parks have gotten the green light to reopen with new rules in place to limit transmission.


To keep swings, climbers and slides safe, play equipment will be limited to five or fewer children at any one time. In accordance with the statewide mask mandate, all children above the age of two will be required to wear a mask although there are some exceptions.



To maintain social distancing and occupancy requirements, the department is asking parents to visit parks at less busy times and only stay for 30 minutes or less to give others the opportunity to play. Green Lake, Seward, Magnuson, Discovery, Lincoln, Gas Works, Carkeek and Jefferson Park are some of the more popular play areas in the city and may be busier during weekends.


“We are all in this together, so kindly remind others of the guidelines and find a different activity if the play area gets too crowded,” Seattle Parks wrote in its blog. “We cannot allow play areas to be places where COVID-19 is spread, so we need folks to use these spaces safely.”

Cal Anderson’s playground will remain closed as the park has not officially reopened in the wake of summer protests.


Those who have canceled their gym membership in the past months are also in luck as outdoor fitness equipment at all Seattle parks reopened Tuesday. The equipment follows similar guidelines to play areas, including limiting use to five or fewer people at any one time and requiring masks.

The department also emphasized that play areas and fitness equipment are not regularly sanitized or cleaned and all users should wash or sanitize hands before and

Trump allies turn Covid diagnosis into a message of strength

His allies have tried to connect the president’s experience to the pain of millions of Americans affected by the deadly virus, but they haven’t used the experience to send a broader public-health message about a pandemic that has killed around 210,000 people in the U.S. They have instead presented, in a series of TV appearances and tweets, a testament to Trump’s resilience by asserting that he has overcome the disease.

He and his surrogates are now portraying the president as having personally vanquished the virus — and they continue to skirt any suggestion of his complicity in its spread while largely ignoring the dire signs of his condition.

Their defense is to push the president’s diagnosis almost as a boost to his qualifications. Piggybacking off the campaign’s criticisms of Joe Biden as a challenger relegated to his basement, Trump’s team has portrayed the president’s Covid case as an insight into the disease that the Democractic nominee could never have.

“He has experience as commander in chief. He has experience as a businessman,” a Trump campaign spokeswoman, Erin Perrine, said Monday on Fox News. “He has experience now of fighting the coronavirus as an individual. Those firsthand experiences, Joe Biden, he doesn’t have those.”

In a video to his supporters on Sunday, Trump said that he had “learned a lot about Covid.”

“I learned it by really going to school,” the president said. “This is the real school. This isn’t the let’s-read-the-book school. And I get it. And I understand it. And it’s a very interesting thing, and I’m going to be letting you know about it.”

But the approach hasn’t led the surge in public support that often follows a leader’s health crisis. His critics continue to question why he and his staff had continuously disregarded health officials’ advice on how to stop the spread of the disease. The recent burst in cases in the White House, they point out, was probably tied to a number of in-person events where allies of the president rubbed elbows in tight quarters while not wearing masks.

Even after his diagnosis, the president continued to act in ways that put his staff in danger of contagion. In a brief foray outside the hospital on Sunday, he greeted supporters from an armored, sealed SUV — potentially putting Secret Service agents in direct contact with the virus. It was a move meant to shore up support, but led to a frenzy of condemnation.

Trump’s camp has made it clear that the president’s stint in the hospital — he was discharged on Monday evening — wasn’t changing their approach to the virus. The campaign snubbed the use of plexiglass separators at the upcoming vice presidential debate, and upon arriving at the White House, Trump removed his mask for a photo op even though he’s likely still contagious.

If anything, it has become a talking point to boost the president as capable of meeting any challenge at the cost of minimizing the virus’ risks.

“We’re not going to

Expert looks at how COVID-19 problems can turn into lifelong chronic diseases

Once a patient is finished fighting COVID-19, their battle might not be over, as some effects could linger and even be worse than the virus itself.

Long-haulers are starting to realize the long-term effects are no joke. The effects could stay with a person for months, years or possibly the rest of a person’s life.

A long-hauler and an expert who studies the new part of the coronavirus fight spoke with sister station KOCO about the lingering effects.

“It’s important to know COVID is not an all or nothing, you die or you’re fine. There’s a whole lot in the middle ground that could impact lives for a very long time,” said Eliza Chakravarty, with the Oklahoma Medical Research Foundation.


That’s what Brad Benefield, of Moore, Oklahoma, is now realizing.

“I feel like I have the energy to go do stuff and then, whenever I start, it’s like, ‘Oh no. You don’t have the energy,’” Benefield said.

He tested positive for COVID-19 in March.

“Started feeling a little tickle in my throat at night,” Benefield said. “Like, you have this virus and people are dying from it.”

He said symptoms and panic immediately set in. Benefield recovered from active COVID-19 months ago, but now he’s seeing something else and is becoming a coronavirus long-hauler.

Chakravarty said COVID-19 long-haulers can have lung issues, brain fog, shortness of breath, inflammation of the heart – all affecting younger, healthy people.

“Interspersed in a lot of cells where they’re inflamed so they’re not functioning properly, so the heart is not beating as well as it should,” she said. “People running 7 miles a day now are struggling going down the driveway, so it can really take you out from the knees.”

Chakravarty added that these problems can turn into lifelong chronic diseases.

“Just because you don’t die from COVID doesn’t mean that you’re OK,” she said. “There’s no telling what it’s done long term. It’s scary.”

The virus is too new to know for sure how many patients will become long-haulers, but OMRF officials said a study in Europe showed that 43% of COVID-19 patients had shortness of breath months after the virus ran its course.

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