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 Welcome to this week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Well, we have some, a special request here, the programming team at this weekend Health.

It would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months. This is in direct response to, uh, comments we're hearing on the show, as well as comments I'm hearing in my consulting practice. Uh, before you drop me an email, I. I need solutions that have successful client stories.

I receive about 10 emails a week from companies that wanna highlight their product on the show. And my first question is always put me in touch with a reference client. And, uh, amazingly about 90% of those requests fall away, which I find really interesting. Um, we wanna see what kinda response we get from you guys and then we will, uh, determine how we're going to.

You know, get this integrated into our programming and get it out there. So, uh, you know, send in your responses, bill at this week in health it.com. Love to hear from you. Love to hear what you guys are doing. That is showing hard dollar savings, uh, real money savings for healthcare. Uh, this episode and every episode since we started the C Ovid 19 series has been sponsored by Sirius Healthcare.

Uh, they reached out to me to see how we might partner during this time. . And that's how we've been able to produce daily shows. Uh, and, you know, it's just a special thanks to Sirius for supporting the show's efforts during the crisis. Now onto today's show, this morning we're joined by Marie, our Mari, I, I keep getting that wrong, VP of public policy for Chime.

And Andrew Tomlinson, director of Federal Affairs for Chime as well. Uh, good morning and welcome, welcome back to the show. Good morning. Thanks. Thanks for having us. Yeah, I'm looking forward to the conversation. Uh, if I was being a wise guy, I guess I would start with, uh, so what's new? Uh, you know, over the last 60 days there's so much coming outta Washington that you guys have been incredibly, incredibly busy.

We're gonna try to, in, uh, 25 minutes or less. Talk about all the things that are coming out of, of, of Washington these days. Um, you know, let's, let's start with, gosh, there's so much money flowing around. Let's start with, uh, the Caress Act and, uh, you know, how, how health systems are receiving funding, uh, during this covid time.

Um, talk a little bit about the CARES Act. Obviously we're, we're on the other side of this roughly a hundred billion ish for hospitals. Um, what's the, you know, how are people viewing this? Was it enough? Is there more on the way? What's the sentiment around, uh, distribution as well? I. Yeah, I think it's a little bit of a mixed bag.

And, um, there's, uh, you know, I know that from our perspective, our members, for example, have been applying for, uh, some of the FCC money with, um, they have a new pot of money they've established, and Andrew can go in a little bit more detail, but that's been one of the pieces that we focus on pretty heavily because it establishes money for connected care.

So, Andrew, do you wanna elaborate a little bit? Yeah, I mean, I think one of the big pieces that came out of that CARES Act was some of the support for telehealth and the FCC Connected Care pilot program was already in the works before the pandemic hit, but the C Ovid 19 telehealth program is the new program that came out of the CARES Act.

It's 200 million in funding to help providers set up and recoup funding that's gone into expansion of those telehealth services that've been able to give to their patients that don't feel comfortable or aren't able to make it into. It's the hospital. I mean, it's one of the big discussions you've seen, at least in the last few weeks has been that care needs to continue even in the face of the pandemic.

And telehealth is a huge piece of allowing that care to have, to be able to have that care available to patients, allow patients to be able to continue to see their provider. I. So they've just announced their seventh round of funding about 50 million has been earmarked so far. The program remains open throughout the rest of the public health emergency, and then they're gonna continue to award or really earmark because it's a, it's a reimbursable program until that 200 million has been expended.

Yeah. So we, we talked a, we talked a bunch about this on the show. 200 millions available. It's really wide open. It's. What you can get funded as long as it's providing, you know, care in some way through a, through a digital means. And, and you're saying about 50 million of that 200 million's, uh, been snatched up?

Um, are, are, are health systems making the move on this? 'cause that, that sounds a little low to me. I mean, given. Given how broad it is and how much money's available. You know, there's been some discussion on the hill. Uh, the chairman, Aja PA testified last week there was a discussion about how little's actually been invoiced.

The way that the program functions is that the providers submit a list of what they wanna have reimbursed underneath the program. The FCC approves whatever parts of that . Plan from them, they're gonna be able to cover, and then they provide a certified invoice back to the SEC. It sounds like a low amount of funding, but I think the key is that, you know, we're only partway through this pandemic and the hotspots seem to continue to shift.

I know that was a concern upfront was, is this program gonna be viable for potentially another fall resurgence or different areas that need to have wider access to telehealth? So yeah, it is, it is a low amount of funding. You know, we haven't heard from any of our members or anybody that we've talked to that there's ever been anything other than the ability to implement their telehealth systems.

There may be a lag in the approval process that they're still waiting on, but none of them have seemed to indicate that's been an inhibition for them. So the Cares Act might be old news. What's, what are we, what are we looking for? You know, we saw the Heroes Act got, uh, put forward and that from, you know, different sides looking at this, that might be DOA, uh, but what's, what's next?

What, what is the next conversation we're gonna have around potentially, uh, more, uh, funding being made available to hospitals and health systems? Yeah, I mean, I think that there is gonna be a discussion about the PPP. Um, there's not at all consensus right now, um, with lawmakers on the hill. And so I think that they're pretty far apart right now.

I don't think we're gonna see any movement really until the end of June. So they're in their respective camps. It's become fairly partisan. Um, but I think the PPE will have to be addressed again. As well as some other pieces. It, you know, it's, I think there's gonna be a fight for whether or not this turns into like another kitchen sink sort of thing where like, or like the proverbial Christmas tree and um, there are some concerns about like how much has been spent so far and there's some need for oversight for the monies that have already been issued.

So I think those are things that are weighing on lawmaker's minds. You know, it's, it's interesting. I think people would expect that all we're gonna talk about is covid, but there is so much going on. 21st Century Cures Act, uh, information blocking, uh, you guys actually put together, uh, I was looking at your, uh, Washington briefing that you send out.

Uh, put together a great information blocking cheat sheet. Uh, it has a great, uh, table in there. Actor definition of the OC rule changes from the proposed rule, uh, penalties and, and clarifications on the rule. Uh, I recommend it to anybody who's, who's responsible for making this a reality. Uh, it really is great work.

Where, where are we? Where are we at right now? Uh, with regard to the information blocking in 21st Century Cures, the pandemic has really taken center stage, and so these rules are so seismic that we consider them to be, um, a barometer of what's to come for the next decade, but. Because everything, you know, has been turned upside down with the, with the Covid crisis that some of our folks are just now starting to emerge and pay attention to this.

So, um, I'm sure Andy was about to fill you in on some of the activities that we're I. Um, that we've got going on in addition to our cheat sheets. Yeah, I think, you know Mari's, right? We are still in the middle of this pandemic and CMS and ONC and the finalization of those rules did give some leeway, you know, a few delays on some of those requirements and deadlines within those rules.

But we're still looking at November 2nd is gonna be the, the enforcement deadline for these information blocking requirements. Even though right now the only outlined enforcement activity has been through the office of the Inspector General. And their rule that outlines how the, the health information exchanges, health information networks and the vendors are gonna face civil monetary penalties.

Everyone is going to be required to comply with those information blocking rules when it comes to November. Wow. Uh, so people shouldn't expect that date to get pushed back at all. We haven't heard anything. I mean, you know, I'm always hesitant to say never, but, you know, there hasn't been any indications at this point, and that is what's within the rule.

So that would require changes to the, the final rule itself to be able to, to extend that deadline out. So it's in, so it's interesting. Everything, you know, everything sort of has been turned on its head as it should be, uh, to address the pandemic. Um, but some of this stuff is, is still moving forward.

With all those other initiatives that were sort of, had momentum, had, uh, a lot of work going on, uh, I mean, do do they really take a significant back burner or do they continue sort of, um, with, without the spotlight that they would normally get given the, uh. The, the pandemic? I think it's a little bit of both.

I mean, COVID has been fairly distracting and it, I think it also depends on which member you are. Um, some of our members are experiencing layoffs and furloughs, which obviously means that there's fewer people to do the same amount of work. It's not as if, you know, the information blocking policies or the cyber criminals are, you know, taking a break.

They're, they're not. So this is all has to move forward. Um, I think, you know, the healthcare system can only absorb so much change at once. So as we've said, some of our, we're just starting to emerge and start educating our members on information blocking after, you know, after several months of like, usually we would've done this much sooner.

And in fact, Andrew held an excellent webinar yesterday, and for those of you who missed it, we're happy. Get folks the link with, um, o um, ONC, and we're gonna do a four part series in June. So right around the corner that's gonna break down each information blocking exception in quite a detailed manner, and it will be accompanied by, um, we have a 25 page summary for.

As we try to break it down in as much a plain English as possible. So we're gonna have to start rolling this out, but I it back to your original question. I think it depends on who you are and what situation you're in. You might be peaking right now, in which case it's all hands on deck, right? We heard from some of our members, they had just, um, put aside, um, you know, lifts on technology.

They have had repurpose a security personnel all to address the pandemic and so. I think depending on where you are in the midst of this, you, you know, and again, I think more and more folks are coming out of it, but we're also looking forward to the possibility, and I don't mean looking forward in a good way, but to an emergence this fall.

And so we're sensitive here in, you know, to, in the China public policy shop, how will this affect our members and what kind of, you know, things do we need to advocate for so that they don't feel crushed by . The tsunami of regulations and requirements, even as the government is trying to lift some of these off their plate.

Yeah, it's interesting. We've, uh, been talking to, and we've been dropping an episode a day talking to a lot of different health systems, and one of the recurring themes is we've, we've gone from a, uh, from one crisis to another, we've gone from a pandemic to really a financial, uh, crisis for bunch of health systems in healthcare, furl.

Uh, and right now I think what we're experiencing at this, you know, late May timeframe is the reality of those financial, um, uh, situations is starting to hit. And there is gonna be this situation of doing more with less, um, you know, more, more projects with less. And so you talk about that, that burden. And, uh, it's gonna be interesting to see how health systems are gonna be able to, uh, address these things.

As well as there's a whole host of pandemic related projects that have sort of popped up. Um, you know, if you've already started building a tower, uh, you know, a couple hundred million, uh, to a billion dollar tower, that's still gonna continue to to progress. So there, there is gonna be this burden on, on, uh, healthcare systems moving forward.

Talk a little bit about, so, uh, let's see. Uh, president Trump issued a, a new executive order to remove regulatory barriers. Uh, can, can you talk about that a little bit? What, what is that about? You know, the executive order in itself is aimed economic recovery, right? We've just talked about some of the economic barriers to success that providers are gonna be facing, especially coming to the fall when they're gonna be seeing an influx of patients that are going to be.

And comfortable and willing to come back to the, the space and the, the, the executive order itself, while not specifically aimed at telehealth, has been mentioned specifically as one of those regulatory barriers that could be removed, is supposed to help these providers continue to have viable revenue streams ultimately, as the country continues to move throughout the pandemic.

So, you know, all of the CMS flexibilities that have been announced to date with a few exceptions here and there are all grounded in the understanding that they continue. Through the length of the public health emergency. So this executive order, uh, you know, it directs Secretary Azar at HHS to look at what different flexibilities they've provided.

You know, a majority of those being telehealth and seeing which ones should stay and continue. Throughout both of the CMS interim final rules are. Uh, one of 'em closes for con comment, I think on the 1st of June and the other one a little bit later. You know, they're already looking to find out what things people, and providers and groups like ours are looking at and, and things should remain in place, but this executive order opens up another avenue for them to continue, whether it's beyond the

Public health emergency, or, you know, into the future as a, as a permanent new program. So it doesn't necessarily guarantee anything happens immediately, but it does continue the press and the push to understand that some of these flexibilities that came about very quickly are good in the long haul, not.

Just during a public health emergency. So this week in health it, we're gonna be talking to health IT professionals across the board. How do they get their voice heard through Chime? So glad you asked that question. Um, there's so many different ways. We, uh, we actually put on pause, our weekly debrief, um, until I think about two weeks ago, we had put a pause on it just acknowledging that our members were very busy and we didn't wanna overload their inboxes, but we're back to publishing our debrief and.

It comes out now every Tuesday, and one of the ways that you can get involved is just respond to us and let us know if you wanna get engaged in a work group. And, uh, one of the work groups we actually have underway, and we still would welcome to hear from every me any member, and we're always open to doing, uh, one-on-one phone calls is we're doing a work group on, uh, virtual care.

And so we're trying to understand, get a pulse check on what it is that folks could maybe live without and what must they live with moving forward. Acknowledging, and I think some people don't totally understand that, um, that analogy about putting the toothpaste back in the tube, it's not the best analogy.

But, um, once the waiver is gone, um, which is tied to the public health emergency, then it actually does dry up. And so this is in a lot of ways this is a congressional play. There may be some . Limited flexibilities that HHS could unearth and we hope, we certainly hope that they do that, especially in light of what Andrew just discussed around the executive order.

But we're trying to go through and, and Andrew wrote a, um, a great letter to CMS responding to the rules that they publish on covid that address virtual care and picking apart. There's very discreet policies in there. That touch, um, different provider groups around virtual care. And so we need to go through those, like the audio piece, right?

The payment parody. So we'd love to hear from our members about what they think and I don't know if Andrew wants to add to that. Yeah, I mean, I think continuing to have the discussion around what's working, what's not, being able to get real world examples of how these flexibilities have helped patients that may have not had access beforehand or areas of the country, you know, before some of these flexibilities.

Who was able to actually access telehealth was very restricted to having to live in specific parts of the country. And that's been lifted. And, you know, not just being in a rural area, for instance, is a barrier to gaining in-person care. There's work, there's childcare, there's the ability to make it to your provider.

There's the ability to make it in an hour that makes sense for you and your family. So it's, it's gonna be really interesting as, as we continue, but we would love to hear more from . Whether it's patients or providers, how the flexibility has been helping them, and then that can help us continue to shape the conversations that we have with the administration in the hill.

So give us an idea of what it's gonna take for these things to become permanent. Within CMS. It's there, there, there has to be a, a funding, there has to be a law passed, there has to be funding passed for this. The executive order will run out at some point, in which case it will need a more permanent funding.

Will that be. As part of a budget process? Or will that be its own? Its own bill? What will that look like? I can take that one. I mean, I think you've seen it already. Some of it, some of those flexibilities can be included. In rulemaking, we saw that the Medicare Advantage rule that came out includes additional flexibilities, allowing different specialties to be included as telehealth under Medicare Advantage plans.

Some of it's gonna probably be a mix of rulemaking and guidance. It's kind of hard to know for, in for sure. What's, what's gonna, it's kind of feels as if it's like a chicken and the egg process at this point, which creates what, what begets what, whether, you know, additional funding is gonna be needed if telehealth continues.

Just because it's gonna be a new I. Regulatory stream, a new funding stream. But if we're not really sure how the future's gonna to pan out on where that request is gonna come from, is that initiated within Congress or the administration? Is it both? I mean, both would would really show and demonstrate that this is a needed flexibility that continues.

Absolutely. Um. Last question. Unique patient identifier. Any, any progress? Any where, where, where's that at? Um, you know, co covid takes center stage. Well, um, we just, we just I'll, I'll start and, uh, I'll let Andrew finish because we have a two part, um, you know, we're dealing with the lawmakers on Capitol Hill and they we're also dealing with the administration.

I'll take the Capitol Hill piece and . Give it to Andrew. Um, so right now we actually just sent out a member alert. So for all of our members listening, go look at your email. From, um, from our CEO, we are once again in the appropriation cycle. It, you know, this year started with the appropriation cycle being, uh, like really fast outta the gate because it's an election year, folks are trying to get things wrapped up, and then of course, covid hit.

Show a tort of force. So, um, that's one thing that we continue to repeatedly go after and it's, it's very hard and it doesn't necessarily have to be replaced with a number. Um, it just striking the language is what we're asking to do so that we can have an honest and more transparent conversation with the administration about what the possibilities could be.

And, and from the federal side of things, you know, part of while that ban is still in place. Last year there was the op. There was the, the language included in there for ONC to do a report looking at patient matching and patient identity as it relates to how it exists current day and any potential recommendations.

And so on Monday, part of that process will be public. There'll be a working session held by ONC in which our own CEO Russ Ranell will be speaking, talking about. The importance of a unique patient identifier and how that can help really strengthen the health system that we have and help keep patients safe as they're navigating their way through what is healthcare that they need to access.

So that's available on, on Monday, and there's links available on public for on the health it.gov for anybody that wants to be able to. . Listen in, but it's gonna be a key piece of the conversation that moves forward and what ONC is gonna end up recommending and, and discussing with Congress within this report.

I, I was just gonna add that, um, you know, in addition to our CEO, um, who's gonna be on as well as one of our members, Chuck Christian, representative Bill Foster, who sponsored the amendment to strike the ban on the house side last year, is also gonna be making some more, uh, some remarks as well. So hopefully folks will tune in for that.

Um, so thanks very much. Sorry to get that in. Yeah, no, absolutely. Uh, looking forward to that. Hey, thank you very much for your time today. And for the, uh, and for the update, there's so much going on. It's, it's really, uh, kind of, kind of amazing at this point. And, uh, if people haven't, uh, listened to the, uh, to the live session, we recorded a live session on telehealth.

That's available on YouTube. You guys can listen to that as well. Thanks again for coming on. I appreciate you too, and all the work that you guys are doing. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

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