Post-PHE Survival Guide for Dermatologists

The COVID-19 public health emergency (PHE) is officially over, marking the end of this pandemic.

COVID-19 upended everything about our lives personally and professionally. It changed how we went to school, shopped, and interacted with our patients and each other.

Many of us struggled to keep our doors open during the initial stages of the pandemic. We furloughed staff or let them go completely. We rearranged our waiting rooms and offices to reflect social distancing protocols. We established virtual check-in and check-out procedures. We learned how to evaluate and treat patients over video or phone without fear of HIPAA violations. We collaborated with our colleagues over Zoom or other video-conferencing portals.

And the PHE declaration provided flexibilities and exemptions that allowed us to care for our patients and helped to offset some of the financial losses associated with widespread closures. To help weather this storm, Congress established the Provider Relief Fund to compensate for the financial losses and other unanticipated costs during the pandemic.

Now, it is time to (officially) go back to pre-pandemic practices.

File for Your MIPS Exemption

The Merit-based Incentive Payment System (MIPS) Automatic Extreme and Uncontrollable Circumstances policy was applied to individual eligible clinicians who did not submit any data for the performance year 2021 due to the pandemic. This is no longer an automatic exemption.

What to do now: Apply and actively request reweighting of one or more MIPS performance categories due to the COVID-19 PHE. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025. The deadline to file will be January 2, 2024. Visit https://qpp.cms.gov/mips/exception-applications?py=2023

Know the New Telemedicine Road Rules

Telemedicine really came into its own during the initial stages of the pandemic. We were allowed to treat new and established patients via video or audio. The Office for Civil Rights (OCR) used discretion in enforcing fines for the “good faith use of telehealth.” In addition, the Centers for Medicare & Medicaid Services (CMS) temporarily modified the regulatory definition of direct supervision during the PHE, allowing for virtual supervision instead. The CMS also established pay parity for video and audio visits.

Thanks to the Consolidated Appropriations Act of 2023, some telehealth provisions will be in place until December 31, 2024, including:

• The ability to see Medicare beneficiaries in any geographic area via telehealth services as opposed to just beneficiaries in rural areas.
• Dermatologists may continue to provide telehealth services to new and established patients via audio-only and other remote technologies if state law permits.
• People with Medicare can stay in their homes for telehealth visits rather than traveling to a health care facility.

What to do: Stay informed and make sure to check your state’s licensure requirements.

Note: These flexibilities may not apply to private payers.

Revert to Pre-PHE Pregnancy Testing for Patients Taking Isotretinoin

During the pandemic, at-home pregnancy testing was permitted for patients taking isotretinoin to make sure they adhere to iPLEDGE. This flexibility ends when the PHE does.

What to do: Plan to go back to pre-pandemic requirements for pregnancy testing for patients taking isotretinoin.

For Further Reading

CMS. About Exception Applications PY 2023. Accessed May 8, 2023

https://qpp.cms.gov/content-management/node/2101

CMS. Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency. Accessed May 8, 2023 https://www.cms.gov/files/document/frequently-asked-questions-cms-waivers-flexibilities-and-end-covid-19-public-health-emergency.pdf

The White House. Bill Signed: H.R. 2617. Accessed May 8, 2023

https://www.whitehouse.gov/briefing-room/legislation/2022/12/29/bill-signed-h-r-2617/