ACP, other groups focus on effects of the pandemic

ACP has continued to advocate on issues related to the COVID-19 pandemic, including ensuring personal protective equipment (PPE) for all health care workers and financial survival of physician practices.

On March 31, the College compiled a summary of a recent interim final rule from CMS, with a focus on the aspects most likely to impact internists. Those include expansions in telehealth coverage, particularly the inclusion of telephone visits; advance payments to ameliorate cash flow problems in medical practices affected by the pandemic; and changes to quality payment programs. The College specifically praised the decision to reimburse telephone visits.

The College continues to advocate for direct support and appropriate regulatory relief for its members and their practices. ACP CEO Darilyn Moyer, MD, FACP, represented ACP in a March 18 virtual meeting of the White House COVID-19 Task Force with the Council of Medical Specialty Societies, the American Medical Association, and medical specialty society leaders. The meeting centered around the administration's efforts on the pandemic. Dr. Moyer took the opportunity to share the needs and concerns of internal medicine physicians.

The College recently released a statement in support of permitting physicians to bring their own PPE when these items are in short supply at their health care systems. The College continues to urge federal, state, and local authorities to ensure adequate supply and distribution of PPE for all health care workers. Its statement also called for physicians to be able to speak out in a professional manner regarding conditions at their workplaces related to the care of COVID-19 patients without retribution or disciplinary action. “Physicians may appropriately decide that going public (including to the news media and on social media) with their concerns is their professional responsibility, to achieve needed change for the health and safety of patients and clinicians, both within the health care facility and more broadly,” the statement said. The Joint Commission released a similar statement.

The College also issued a statement strongly condemning any and all harassment, violence, and discrimination based on an individual's race, ethnic origin, ancestry, or nationality, in response to reports of such discrimination against people of Asian descent, including clinicians.

ACP also recently offered a webinar for physicians with lessons learned from the inpatient and outpatient front lines of the COVID-19 pandemic in caring for our patients, colleagues, and ourselves, which is now available online.

Three Ideas and Opinions published by Annals of Internal Medicine on April 2 discuss the potential consequences of the COVID-19 pandemic on addiction care. One discusses the likelihood that the virus will have an outsized impact on persons who smoke or vape, use opioids, or have a substance use disorder, due to issues such as compromised lung function at baseline, less access to safe living conditions and needed medications, and increased risk of overdose due to stressors and lack of access to care. Another article listed needed system- and clinician- level responses to this problem, including expansions of telemedicine and mobile care and continued federal funding, noting that without such changes the authors are “gravely concerned that COVID-19 will increase already catastrophic opioid overdose rates.” The third article specifically discusses steps to maintain access to methadone and buprenorphine while limiting the risk of infection.

In response to shortages of hydroxychloroquine and chloroquine, an article published by Annals of Internal Medicine on March 31 offered guidance on treatment for patients with systemic lupus erythematosus and rheumatoid arthritis. These patients can be reassured that gaps in therapy of less than two weeks are not as problematic as longer ones, the article said. Halving doses may work well in some patients, but not all, it added.

Guidance on treating strokes during the pandemic was offered by two articles published by Stroke on April 1. The American Heart Association/American Stroke Association offered temporary emergency guidance to stroke centers while another article provided a suggested algorithm for stroke response, including key considerations such as screening, personal protective equipment, and crisis resource management.