This post is a resource for publicly available COVID-19 updates for Colorado family doctors.
The Small Business Administration has posted instructions for applying to a disaster relief forgivable loan. More details here.
A series of ECHO talks focusing on COVID-19 are being held every Monday, Wednesday, and Friday from 7 am to 8 am. Register for the talks here. The series is a partnership between CAFP, the University of Colorado School of Medicine, and the University of Colorado School of Pharmacy and Pharmacy.
- Executive Orders and other government directives.
- PPE updates
- Public health responses
- Medicare resources
- Telehealth guidelines
- Advocacy and practice resources
- Life resources
- Other state responses
- Other demographics
- Innovative solutions
Executive Orders and other policy directives:
Recently, HHS released a breakdown of added CARES Act funding that has been distributed to healthcare providers and organizations via provider relief funds in each federal Congressional district (5/15/20). The linked analysis indicates that each Colorado county has received:
|District||# of Entities||Total Funding|
This data is somewhat limited, as it may reflect where the central office of certain facilities and group practices are located as opposed to the end location of the funding. But it still gives an idea of some of the dollars coming into the healthcare provider community in Colorado.
The latest updates on Colorado’s pandemic response, the Safer At Home policy, as well as updates on testing capacity have been issued by the governor’s office. Read here. (4/29/20)
CDPHE has issued a new Public Health Order allowing for the limited resumption of voluntary and elective surgeries and procedures. Read the order here. (4/27/20)
Governor Polis has published a slide deck explaining the plan to start a limited phase-out of the stay-at-home order. It has detailed information about what will be possible and what won’t be. (4/23/20)
The City of Denver will extend its stay-at-home order to May 8. (4/23/20)
Colorado has issued an amendment to the public health order for long-term care facilities, which requires submitting a response and prevention plan by May 1. More details here. (4/21/20)
Governor Polis issued a new executive order (4/18/10) that requires essential workers to wear face masks. The list of essential workers includes healthcare workers, grocery store workers, staff at congregate care facilities, and the folks who are still going to work each day to protect our food supply, roads, public health
HHS has announced that $30 billion of the $100 billion for healthcare providers was issued on Friday, April 10 2020. Practices will receive their payment beginning today based on their Medicare 2019 reimbursements. This applies to physicians in a group practice and solo docs who bill Medicare. The press release shows how to estimate their payments.
CMS Approves Over $51 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week. More information is here. (4/9/20)
Governor Polis has extended the Stay-At-Home order to April 26, and created a website with free resources for ideas about how to adapt to the policy (4/9/20)
On March 27, the Coronavirus Aid, Relief and Economic Security (CARES) Act was signed into law. Read the AAFP summary of it here.
Governor Polis issued a statewide Stay at Home order, effective March 26, 2020 (CAFP wrote him a formal letter asking for this policy on Monday). This order also updates the Public Health Order from last week that closed non-essential businesses. See the governor’s presentation on why social distancing is so important here.
Please read the Frequently Asked Questions issued by the state.
The U.S. Department of Labor has posted an FAQ for the Families First Coronavirus Response Act (4/1/20).
The state has posted an updated resource guideline for those facing eviction, foreclosure, or non-payment of utility bills (4/2/20).
Energize Colorado has created a PPE marketplace with disinfectants/hand sanitizer, gloves and surgical masks for order. The buyers of the marketplace are limited to Colorado institutions and re-sellers may not purchase. The vendors to the marketplace go through a thorough vetting process to ensure that only quality product is available on the marketplace and the prices are as low as possible. (5/15/20)
For any healthcare professionals that are struggling with ongoing access to PPE, the state has procured two mask decontamination centers – one in Denver metro/Brighton area and the other in Western Colorado/Montrose. The process for accessing the systems for mask decontamination is shared below. (5/15/20)
- The Colorado Unified Coordination Center has received two Battelle Critical Care Decontamination Systems that clean and disinfect used N95 respirators for reuse. The first system is up and running at the Adams County Fairgrounds in the Exhibit Hall. The second will begin operating soon in Montrose. All health care personnel are eligible for the FREE N95 decontamination, including emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, dentists and dental hygienists, students and trainees, contractual staff not employed by the health care facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). To have masks decontaminated, organizations should:
- Fill out an enrollment form at battelle.org/decon for instructions and a special code;
- Place respirators in a shipping box labeled with the 3-digit code and a biohazard sticker (end-to-end shipping is available at no cost); and
- Ship the masks (or drop them off) to the site. They will clean the masks and return them.
If you need help on the procurement side, the state has asked that individual physicians contact their county emergency management offices. A list of those offices is available here.
See an official snapshot of the current state of PPE supplies and the state’s response here (4/2/20).
If you or your organization are experiencing a shortage or outage of personal protective equipment (masks, gloves, gowns, etc) to conduct essential or life saving functions during this crisis, please reach out to your local emergency manager or local public health department. These entities are connected to the state’s emergency operations center through their local/Tribal emergency operations center, and are the best contact for your request. Thank you for your work serving Coloradans during this difficult time.
- Information about your county emergency manager.
- Local public health department information.
- An alternative list of public health department information.
The state has begun to distribute materials from the Strategic National Stockpile. Details are here.
There is also a web resources for tracking down goggles for healthcare providers: https://www.gogglesfordocs.com/. Make sure to click on the Request Goggles link.
If providers and clinic staff are interested in supporting case and contact investigation efforts, they can apply here (5/21/20). TriCounty is also currently working on interviewing and processing applicants for this contact tracing work, which suggests that they are planning on developing their own contact tracing workforce.
Colorado is extending the enrollment period for Medicaid and the insurance exchange through April 30.
STRIDE Health Center has opened a drive-thru coronavirus test site in Aurora. (3/23/20)
Colorado Department of Regulatory Agencies posted an overview of Governor Polis’ executive order temporarily banning all elective and non-essential surgeries and procedures, affecting Medical, Dental and Veterinary licensees (3/20/20).
See also this FAQ by Colorado Medicaid about telehealth guidelines (3/23/20).
The University of Washington has posted a helpful list of phone triage and clinic workflows that might be relevant to Family Physicians (3/22/20)
- There is a public health order closing all bars, restaurants, theaters, gymnasiums and casinos in Colorado (3/19/20).
- There are updated guidelines on telemedicine. (3/18/20).
- Posted updated guidelines on how to isolate patients, and how to quarantine patients (3/18/20).
- CDPHE strongly advises residents and visitors to Eagle, Summit, Pitkin, and Gunnison counties to stay home and minimize social contact (3/15/20).
- CDPHE recommends that Colorado follow CDC guidance to cancel or postpone in-person events of 50 people or more (3/15/20).
- There is an alert for people who visited the Colorado Springs Bridge Center from late February to early March (3/14/20).
- Alert about Children’s Hospital: they are not testing for COVID-19 (3/13/20).
- The drive-up screening clinic has experienced high volume and will have limited availability (3/12/20).
- CDPHE will start free COVID-19 testing at the LOWRY FACILITY at 8100 E. Lowry Blvd in Denver. Patients will need a doctor’s order to get tested. See the updated response plan here (3/12/20).
- Interim Recommendations to Optimize the Supply of Personal Protective Equipment for Healthcare Personnel: COVID-19 Response (3/9/20)
- They have posted specimen collection best practices (3/2/20).
- Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting (3/1/20)
- Updated guidelines on COVID-19 testing are being posted regularly.
- Healthcare Personnel Preparedness Checklist for 2019-nCoV (1/29/20)
- Initial Assessment Form for LPHAs and Healthcare Providers (3/5/20)
The CDC is posting continuous updates to its own resource page. In particular, the situation summary is updated daily, along with updates to pathology, information for healthcare workers including safety guidelines, and guidance for people under investigation (PUI) (3/8/20) of exposure to the virus. Plus, keep track of their own Health Alert Network updates here.
- Information for Clinicians on Therapeutic Options for COVID-19 Patients (3/22/20)
- Guidance for Retirement Communities and Independent Living (3/20/20)
- Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings (3/14/20)
- Evaluating and Reporting Persons Under Investigation (PUI) (3/9/20)
- Strategies for Optimizing the Supply of N95 Respirators (2/29/20)
- Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (undated; updated continuously)
- CMS has posted a new set of blanket waivers that are applicable to the COVID-19 crisis. (4/30/20)
- Medicare announced today it is paying telephone visit codes at the same rate as office visit E/M, retroactive to March 1. More details here (4/30/20).
- CMS has issued new guidance for opening up facilities based on the federal “Opening Up America” plan. (4/19/20)
- CMS is applying MIPS extreme and uncontrollable circumstances policy in response to COVID-19 and reopening applications (4/3/20)
- CMS has released new guidance on nursing homes and long-term care facilities (4/2/20)
- Medicare is expanding Telehealth to include audio-only E/M visits (4/1/20)
- CMS announced a new wave of regulatory guidance and policy waivers in response to the COVID-19 pandemic (3/30/20)
- CMS posted a set of Blanket Waivers in response to the COVID-19 Pandemic. (3/30/20)
- There is a new fact sheet on the accelerated and advanced payments program for providers and suppliers during the pandemic (3/28/20)
- Read a related memo from CMS here (3/28/20)
- Read the AAFP’s summary of this accelerated payments program here (3/30/20)
- QPP Coalition documents on CMS reforms, and a COVID-19 Response Fact Sheet, are current as of 3/26/20
- CMS has announced relief for clinicians, providers, hospitals and facilities participating in Quality Reporting Programs in response to COVID-19 (3/22/20)
- CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19 including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements. A copy of the FAQs can be found here (3/23/20).
- CMS has updated its guidance on Medicare Fee-For-Service and is advising practices to limit or eliminate adult elective procedures (3/18/20).
- CMS has expanded telehealth benefits for Medicare beneficiaries.Read more on the fact sheet as well as the frequently asked questions (3/17/20).
- CMS has updated its guidance to providers about COVID-19. The full list can be seen here (3/12/20).
- The FCC is releasing funding for non-profit and government-operated clinics that are providing telehealth services to their patients. More details are here. (4/13/20)
- CMS released a toolkit for long-term care in nursing homes. (3/27/20)
- AAFP has posted an index of billing codes for providing telehealth (3/27/20)
- Aledade has created a resource guide for incorporating telehealth into your practice. They also have a resource page with additional guidelines. (3/26/20)
- FMS and CMS are hosting a webinar on Friday, March 27 at 12:00 PM MST, about integrating telehealth into your virtual private practice. Please see the flyer and distribute accordingly. If there is a continued demand they will host additional webinars. (3/24/20)
- The Healthcare Policy and Financing department is updating the ACC page regularly with telemedicine updates. (3/18/20)
- CMS released a toolkit for telehealth for general practitioners (3/18/20).
- The Colorado Department of Health Policy and Financing has posted guidelines about appropriate venues and services for conducting telemedicine (3/18/20).
- AAFP has a detailed telehealth resource page.
- The AMA has posted several documents about telemedicine that are worth reading (3/17/20.
- Chart of telemedicine laws in all 50 states
- AMA Quick Guide to Telemedicine in Practice
- AMA Guidance for Ethical Practice in Telemedicine
- American Telemedicine Association Practice Guidelines
- American Health Information Management Association Telemedicine Toolkit
- Also of relevance is this Telemedicine Quick Set-up Guide in Response to COVID-19 National Emergency, developed by Drs. Sylvia Romm, Adam Maghrabi, Tisha Rowe, Aditi Joshi.
Advocacy and Practice Resources:
- The latest letter from AAFP President Gary LeRoy, MD, is a must-read. Many of those resources have been posted to the rest of this resource guide. (6/4/20)
- The AAFP recently released contact tracing guidance to outline the basics and the role family medicine practices play in the process. (6/3/20)
- The AAFP recently released practice reopening guidance has good resources for how physicians can evaluate the path back to normal operation. (6/3/20)
- The latest survey (Series 5) of family medicine clinics within Colorado has been released by SNOCAP (6/3/20).
- The latest survey (Series 8) of family medicine clinics by the Larry Green Center has been posted. (5/6/20)
- The latest survey of family medicine clinics by the Larry Green Center has been posted. A worrying finding is that 66% of the respondents say less than half of their work is reimbursable. (5/1/20)
- AAFP President Gary LeRoy, MD has written a letter to family physicians about reopening the economy, additional relief, and physician rell-being. Read here. (4/30/20)
- AAFP President Gary LeRoy, MD has written a letter to family physicians about additional financial relief, reopening resources and a new HHS telehealth website for COVID-19 relief. Read here. (4/23/20)
- The Green Center and the Primary Care Collaborative have released the 6th series of the their national survey. Review the summary and results here. (4/23/20)
- Ariadne Labs has posted a set of toolkits for Serious Illness Care during the pandemic. Primary care providers can provide Advanced Care Planning via telehealth during the crisis (4/18/20).
- AAFP are hosting weekly town halls each Wednesday at 7 pm CDT. Details here.
- The Primary Care Collaborative has posted the first four weeks of data for its primary care survey. The weekly results are available here.
- The ABFM has issued a statement (3/30/20):
- “Our commitment is that no family physician will lose their ABFM certification because of the extraordinary patient care pressures associated with this pandemic. Additionally, if you are unable to participate in certification activities or Family Medicine Certification Longitudinal Assessment (FMCLA) in 2020 because of the demands of this pandemic, it will not jeopardize your certificate or your ability to continue your certification. We do not want ABFM requirements to play any role in the decisions you need to make to provide the best personal and public health response to this pandemic. Residents need not be worried about future consequences for their board certification in this regard. We will work with you.”
- The Colorado Physician Health Program has created a COVID-19 Care Line for any Colorado physician or physician assistant. The number is 720-810-9131 and more details are here. (3/30/20)
- OraLabs is making a new tranche of hand sanitizer available to frontline health care staff. (3/30/20)
- Clinic staff may fill out this critical personnel form, issued by the state, to ensure they can continue to work. (3/29/30
- AAFP has a Rapid Response Member Forum dedicated to COVID-19 (requires login).
- The Council of Medical Specialist Societies has written a statement urging the importance of continued social distancing measures. (3/27/20)
- AAFP President Gary LeRoy, MD, wrote a detailed letter giving a snapshot of the national response to COVID-19. (3/26/20)
- The AAFP wrote a letter to CMS Administrator Seema Verma requesting that CMS begin paying for telephone-only visits. For reference, I have attached a list of all telehealth, telemedicine, virtual visit and phone visit codes and G-codes. (3/26/20)
- The AAFP also wrote a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma requesting that they activate the Periodic Interim Payment (PIP) program and thus allow physicians to request advanced payments for services. This request is designed to assist practices in enhancing short-term cashflow. (3/26/20)
- The AAFP joined the AMA, ACP, ACS and MGMA in sending a letter to House and Senate leadership calling for increase support to physicians (3/20/20).
- AAFP Board meetings and travel have been canceled at least until May 31.
- AAFP have updated their Speak Out to urge Congress to take decisive action to make PPE more available to health responders. Their Speak Out tool is available for all family physicians to use (3/20/20).
- ACOG has posted a set of guidelines and a diagnosis algorithm to assist physicians in treating pregnant women suspected of COVID-19 (3/20/20).
- AAFP sent a letter to Vice President Mike Pence, laying out the results of a survey to all 134,600 members about their experiences with COVID-19. 10% of those members have reported COVID-19 in their practice (3/17/20).
- AAFP have added a Speak Out (3/13/20) urging Congress to improve the flow and quality of information to America’s frontline physicians and coordinate with them.
- AAFP have also called on health insurers and Congress (3/17/20) to provide better coverage of telehealth, virtual check-ins, and E-visits.
- Changes to the 2021 Family Medicine Residency Program Match. This pandemic is having dramatic effects on many educational systems, and medical schools and residency programs are especially impacted. There are significant changes to the 2021 family medicine residency program match process. The AAFP and the rest of the “family” of family medicine are working together to help students and residency programs navigate the unique challenges these changes present. AAFP recently issued a letter that highlights recommendations for students and programs. Medical students might want to consider joining the AAFP Student Community to connect with each other and get the latest updates on the Match.
- OnePoint HR has provided two resources on how the CARES Act will impact practice staffing: a Paycheck Protection Program and a Notice to Clients (4/1/20)
- Colorado Drug Card has released a simple diagnostic graphic helping to distinguish symptoms of COVID-19 from the common cold and infleunza.
- The Colorado Emergency Child Care Collaborative is ramping up a childcare support network for healthcare workers who need assistance watching their children while responding to the pandemic. The sign-up page is here.
- The Colorado Department of Labor and Employment offers a number of resources here (includes FAQs on paid sick leave and unemployment benefits for workers)
- Michael Best, a membership benefit partner, is also providing resources about how to approach COVID-19 response from a workforce perspective.
- MB Updated their Q&A for employers, taking account of CARES Act and PPP regulatory changes (4/9/20)
- A comprehensive tracker of COVID-19 initiatives at the federal and state level (3/24/20)
- More information on what employers need to know about the virus and its impact on business (3/23/20)
- There is a new Short-term COVID-19 Related Wage Replacement Benefits update from Pinnacol. Also read the email to Pinnacol agents for more insight.
- Employment Considerations for Responding to the Coronavirus
- The Coronavirus: Protecting Your Business from a Sick Supply Chain
- Higher Education Institutions Prepare for Coronavirus
- Coronavirus and Benefit Plan Offerings
- MBS Trade Alert – USTR Grants Exclusions for Medical Items Amid Coronavirus Outbreak
- Congress recently passed $8.3B in COVID-19 relief funding with a focus on undergirding public health response, expanding telehealth capacity under Medicare, and providing very low interest loans to small businesses.
- Section 4216 is a Limitation on liability for volunteer health care professionals – it protects volunteer health care professionals practicing within the scope of their license, registration or certification, from liability under Federal or state law for any harm caused while providing health care services during the COVID-19 Public Health Emergency
- Families First Coronavirus Response Act (HR 6201) provides paid family leave and health plan coverage for COVID-related testing (including Medicare, Medicaid, CHP, Tricare).
- Here are the specific bill provisions that govern Emergency FMLA expansion, and the Emergency Paid Sick Leave Act.
- The provisions would also require that group health plans and health insurance issuers of group to cover FDA approved COVID-19 diagnostic testing products.
- Cost covered include the items and services furnished during a provider visit (office, telehealth, urgent care and emergency room) to the extent those items and services relate to the furnishing or administration of the testing product or the evaluation of the individual’s need for the testing product.
- The mandated coverage must be provided without “any cost sharing (including deductibles, copayments and coinsurance) requirements or prior authorization or other medical management requirements.”
- The requirement to cover COVID-19 testing costs starts from the date of enactment until the Secretary of HHS determines that the public health emergency has expired.
- Private and government lenders are also stepping up to provide business assistance. Small Business Administration resources can be found here.
- Headspace, a meditation app that can assist with mental health through breathing exercises, is offering its app for free to all healthcare providers. Use your National Provider Identifier (NPI) at this link.
- Be on the lookout for fraudulent COVID-19 scams targeting doctors.
Other State Responses:
Other states are making advocacy messages, consolidating treatment ideas, and other forms of adaptation that may be of interest to Family Physicians in Colorado. We are posting a few of them below:
- Washington State has issued a stay-at-home order (3/23/20)
- The Minnesota AFP has formally requested the state issue a stay-at-home order (3/23/20)
- The Oregon AFP has issued a formal letter requesting a stay-at-home order by the state (3/21/20)
- The Ohio Director of Public Health has issued a stay-at-home order for the state (3/22/20)
- The California AFP is pooling resources on a Google Form for people to send PPE to where it is most needed (3/20/20)
We will continue to catalogue CDPHE updates, CDC guidelines, and other news and research as it comes on this page as a centralized resource, and we will be posting regularly to our social media channels (Twitter and Facebook) with updates as well.
- United We Dream has health care information for undocumented communities here.
- COVID-19 Resources for Undocumented Communities has national and state-specific resources for undocumented communities, in English and Spanish (tabs are at the top).
- Front Range Mutual Aid is collecting information about those individuals who can give help, and those individuals who need help – and then connecting people between the groups. This is a grassroots effort to provide direct support, with resources in both English and Spanish, and is inclusive, but not only specific to, individuals and communities without papers.
- Here is a Health Care Resource Guide that Center for Health Progress put together in both Spanish and English to support people, particularly immigrants without documentation, to find health care in this moment. The list is evolving and they will continue to update it. If you are from a clinic with other information for them to include or change, please email Dana Kennedy at email@example.com.
- Transgender Legal Defense & Education Fund has created a resource page of Know Your Rights materials for transgender and non-binary people and also has information about court proceedings for name-change processes.
We are polling our members to see if any practices are coming up with innovative solutions to treat their patients while supplies and testing kits remain critically unavailable. There are reports that some practices are reusing disposable gear to conserve scarce supplies, so these solutions are important to share with each other. In order to In the interest of sparking addition discussion and brainstorming, those solutions will appear below.
- Nearly daily emails to patients giving clear information and instructions together with mental health tips and updates on changes in the practice to cut down on phone calls.
- Achieving a calm tone of taking it seriously but not panicking is important.
- Virtual visit / Telehealth screenings, with templates and question trees to establish need
- Creating an outside screening tent so that only patients with severe symptoms come inside
- Other forms of non-office triage — parking lot follow up visits, exterior respiratory tent, etc.
- Decreasing barriers to care by expanding access to telephone screenings
- Building homemade face masks
- Propping the main office doors open so they aren’t touched
- Removing Co-pays so patients don’t get close to clinic staff
- Using 1 mask all day, and sending used masks for re-processing
- Outreach to neighborhood social media groups about telehealth guidelines through Facebook, NextDoor, and others.
- Splitting into teams to limit the total number of staff potentially exposed to the virus
- Filling medications in-office to prevent a crowd gathering at the pharmacy
We will be updating this page continuously as more information comes in. Please stay safe.