Congress’ COVID-19 relief package recognizes optometry’s physician role

Recognizing the importance of optometry's full inclusion in all federal health legislation and overcoming the constant efforts of medical interests to insert restrictive physician definition language—even at late stages of Capitol Hill deliberations—the AOA successfully ensured doctors of optometry are fully recognized as physicians in the nation's COVID-19 mobilization now underway.

The initial legislative response by Congress and President Donald Trump to the COVID-19 public health emergency and localized reports of community spread in the U.S. is a sweeping, $8.3 billion emergency aid package signed into law on March 6. The measure includes funding for lab tests, vaccine research and general outbreak response, including directives aimed at providing physicians with authority and reimbursement mechanisms through Medicare for remote and telehealth services to their patients.

"While COVID-19 is a novel virus, as primary eye health care physicians we know that we are a critical part of the public health solution to protecting our practices and patients," says Barbara L. Horn, O.D., AOA president. "Together with our affiliates, the AOA is acting quickly to provide our member doctors with the information and tools needed to support practices and quality care, and we'll continue to do so throughout the crisis. As a first step, I encourage colleagues to register for a special AOA webinar, which will include billing and coding specifics, and also to reach out at president@aoa.org with questions, comments and concerns."

Typically, Medicare restricts telehealth services, allowing only for reimbursement of telehealth services when provided in locations outside of metropolitan statistical areas and in Health Professional Shortage areas. However, the package gives Health and Human Services the power to suspend these rules, keeping Medicare beneficiaries—an age group particularly susceptible to the virus—at home. When Health and Human Services (HHS) issue guidance to implement the act, it will clarify how the act's waiver applies to particular Medicare-reimbursable telehealth services.

Throughout bill negotiations, the AOA worked to ensure doctors of optometry were recognized as physicians and included as qualified providers under the bill.

Doctors of optometry and their patients should be aware of current Medicare benefits that can help ensure patients receive care while helping to contain the spread of the disease. Since 2018, Medicare has paid for "virtual check-ins" for patients to connect with their doctor in lieu of an office visit. These check-in services are for patients with established physician relationships and are not related to a medical visit within the previous seven days and does not lead to a medical visit within the next 24 hours. The patient must verbally consent to services and it must be documented prior. The Medicare coinsurance and deductible apply to these services, the AOA notes.

Doctors of optometry can bill for these virtual check-in services furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010).

Medicare also pays for patients to communicate with their doctors without an office visit using online patient portals. These must be patient-initiated; however, practitioners may educate beneficiaries on the availability of these services prior to patient initiation. Communication may occur over a 7-day period, and services may be billed using CPT codes 99421-99423. The Medicare coinsurance and deductible also apply to these services.

For more information about billing for telehealth and virtual care services during the COVID-19 pandemic, visit the #AskAOA Webinar Series page.

Additionally, President Trump announced immediate efforts to help support U.S. businesses and workers harmed by the COVID-19 outbreak. During an Oval Office address on March 11, the president said the U.S. will give affected individuals, and small and mid-sized businesses, a 3-month tax holiday to fight the economic toll of COVID-19.

Effective immediately, the Small Business Administration will provide low-interest loans to companies in affected locales. An additional $50 billion for the SBA lending program will be requested of Congress, President Trump noted. The AOA continues to work with federal lawmakers to secure further assistance for AOA members, their practices, employees and patients.

Localized COVID-19 community spread

The congressionally directed telehealth allowances and emergency funding package come as the Centers for Disease Control and Prevention (CDC) note COVID-19 community spread could become more widespread nationwide. Already, COVID-19 is causing major disruptions in the Pacific Northwest and large municipalities, such as New Rochelle in New York, where containment zones and cancellations of "mass gatherings" are attempting to keep community spread at bay.

To date, the number of confirmed U.S. cases rose to over 1,000 in 36 states and Washington, D.C., with a total of 29 deaths. Globally, the World Health Organization (WHO) reports 113,700 confirmed cases and over 4,000 deaths across 109 countries. Still, most of those can be attributed to China with over 80,900 confirmed cases and over 3,100 deaths, as of March 10.

Easy spread of COVID-19 is attributed to a combination of a highly contagious virus (SARS-CoV-2) and a lack of immunity, noted Nancy Messonnier, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, in a March 10 briefing .

"Based on this, it's fair to say that as the trajectory of the outbreak continues, many people in the United States will at some point in time—either this year or next—be exposed to the virus and there's a good chance many will become sick," Dr. Messonnier said. "But again, based on what we know about this virus, we do not expect most people to develop serious illness."

Per Dr. Messonnier, the WHO mission to China reports nearly 80% of confirmed cases recovered with only mild illness while 15-20% developed serious illness. Only 2% of confirmed cases were among children, which starkly mirrors the COVID-19 reality.

"This seems to be a disease that affects adults and most seriously older adults," Dr. Messonnier said.

The CDC notes risk of serious illness or death resulting from COVID-19 starts increasing at age 60 and becomes particularly acute at age 80, as well as people with serious underlying health conditions (e.g., diabetes, heart or lung diseases). Hence, the Centers for Medicare & Medicaid Services (CMS) decision to relax telehealth requirements among beneficiaries during the outbreak.

Doctors of optometry nationwide report seeing appointment cancellation increases and patients expressing concern of COVID-19 spread. The AOA's advocacy may help doctors of optometry furnish necessary services without requiring this at-risk population to leave their residences. Additionally, the AOA is committed to providing doctors of optometry the latest guidance on COVID-19.

AOA provides COVID-19 guidance, launches resource page

AOA's Health Policy Institute (HPI) continues to closely monitor developments and actively participate in U.S. public health discussions to date regarding the COVID-19 response to keep optometry informed of the latest information. Doctors of optometry need not only to understand the risks and current public health situation related to COVID-19 but also have the latest clinical recommendations and guidance for informed patient care.

Throughout this outbreak, AOA HPI representatives have joined public health forums and briefings with officials from the White House, CDC and National Institutes of Health to relay and translate information into an evolving patient care guidance for optometry. This manifests in the AOA HPI statement, "Doctors of Optometry and COVID-19."

This guidance regularly evolves as more information becomes available and contains the most up-to-date information on COVID-19, public health guidance, U.S. situation report and infection control protocols that all optometric practices should actively employ, bearing in mind the ever-changing nature of this outbreak.

"At our practice, we see a range of patients, many in the high-risk population for COVID-19, and this is the topic that concerns most of them," says William T. Reynolds, O.D., AOA president-elect. "We have implemented the guidelines outlined in AOA HPI's paper and by the CDC and are having conversations with patients about proper hygiene, including handwashing. It is critical, as our patients primary eye health care physicians, that we provide sound and useful guidance and direction for patients as they navigate the misinformation and confusion this situation is creating."

Considering the seriousness and evolving nature of this outbreak, the AOA also launched a COVID-19 resource and information page where optometry can quickly locate the CDC guidance and recommendations doctors need. This resource page includes:

• The AOA HPI statement, "Doctors of Optometry and COVID-19."
• Relevant CDC guidance and links for health care providers, including a patient evaluation flow chart, information on nonpharmaceutical interventions, and checklists.
• Up-to-date WHO situation reports and highlights.
• Updates from the White House Coronavirus Task Force.

The AOA recommends that doctors of optometry be aware of the COVID-19 situation in their communities and be mindful of the commonly understood characteristics of this virus, as well as patient exposure risk and how optometric practices should respond.

For additional information on global COVID-19 response, visit the WHO coronavirus webpage.