Making plans when ambiguity reigns

Note: This article is not intended as legal or regulatory advice.

Questions and concerns about how stimulus funds are being distributed – and spent – are growing, changing with each new announcement from the government.

How do hospitals keep up with a situation that seemingly evolves by the hour, especially when the situation isn’t just the medical realities of an evolving viral pandemic but also the response to it?

We recently talked to Martie Ross, Office Managing Principal in the Kansas City office of PYA to break down some of the opportunities and nuances in the various stimulus funds coming online – and the situation evolved even in the 24 hours following our conversation after HHS began distributing some of the funds. Ross and her PYA colleagues have dissected some of the requirements around those funds here, but even now ambiguity remains. With all the confusion, frustration and scrutiny, what are some general considerations for providers to ensure that they stem the bleeding now and take advantage of opportunities to position themselves for the future.


  • No matter where you are in the COVID-19 cycle, begin planning now for post-COVID-19 operations
  • Consider cementing any changes made to how you deliver care; e.g., telehealth and outpatient services
  • Keep records of everything so you’re prepared to answer questions later
  • Don’t just focus on federal funds for recovery

Plan now for re-opening the shop

There’s probably nothing scarier than having an idle medical community because you’ve got high-end specialists who have been shut down and frustrated in that circumstance. But now, as hard as it is to get your mind around it, is the time to do some planning.

Plan for what does happen when they let us come back online. You have a huge backlog that’s growing every day. Ask, ‘How are we going to titrate and which procedures go first, which are the most critical?’ That decision needs to be made locally. No one should be dictating that. It’s the medical staff working with administration to talk through the restart.”

(Permanently?) shift to alternative models of care

No one wants to go to the doctor’s office now. You have to figure out how to provide those services via telehealth. It’s going to take a lot of patient outreach, especially with older patients. They’re going to be challenged by it.

CMS has been great in relaxing the rules and providing reimbursement. Fingers crossed the commercial payers will follow suit. So, figure out either how to do audio/visual appointments, which are true telehealth visits reimbursed the same rate as a face-to-face visit for Medicare purposes, or just telephone visits. There is lower reimbursement available for phone consults, but at least it’s something to cover the time in those circumstances.”

Take good notes

It’s going to get dicey when relief funds start showing up that are not specifically tied to a program. What happens when you open your bank account and there’s $2 million that CMS deposited? How will you be accountable for those? If I was a provider, I would be prepared to tell the story of how that money was spent to maintain access to care.

Every health care provider has a lot of needs – infrastructure needs, staffing needs. Having the dollars available now presents a great deal of temptation. But I think that money should be viewed as access to care. Certainly, it means the response to COVID-19 and doing what what’s necessary in terms of making testing available, paying staff hazard pay if appropriate. That will be your front line usage of those dollars.

But it’s also going to be using those dollars to provide access to normal care. So, investments in telehealth, investments in outpatient programs and the like. Let’s not get a black eye with any allegations that funds were misappropriated, and that means you need to be prepared to tell your story.

Add seats around the table

Right now, compliance officers should be saying, ‘I’m here to document our story. If any questions are raised after the fact about what we did, we’ll have the contemporaneous notes that tell us how we got here.’

It’s a brand-new world for most compliance officers to become the storyteller. But they need to be in the room so they know what the story is. That’s going to be the only vehicle by which you’re going to be able to answer any charges in the future that something was misappropriated.

Partner with the community

When it comes to charity care, we can expect some of the dollars out of the “Marshall Fund” to cover the costs of recovered care for uninsured individuals.

Another component is private philanthropy. We have a lot of incredibly effective healthcare foundations in the United States that are the bandages for providers – as providers have needs, foundations can quickly respond.

Most foundations have obligations to pay out roughly 5 percent of their corpus to meet IRS obligations, and most foundations right now are saying ‘to hell with that, we’re going to spend as much of our dollars as we need to right now.’ There are great stories in city after city of what they’re doing financially. They’re so close to the local community, they can plug money in where it’s needed far more effectively than CMS can.

So, healthcare providers should be looking for opportunities to partner with local philanthropy.

David Shifrin