SummaryThe impact of COVID-19 goes beyond the disease and produces additional strain on the healthcare system, including managing patients and meeting cost and quality drivers.
Hyper focus on the pandemic may impact provider participation in value-based care arrangements and potentially diminish the value of reporting in the future. This domino effect could result in poor patient outcomes.
Delaying Elective Procedures and Routine Care Will Impact Patients
As of March 18, 2020, the CMS recommended clinicians prioritize care for COVID patients by delaying elective procedures, postponing routine and preventive care visits, and reducing administrative burden on clinicians so they could focus on high-priority needs related to COVID-19. While reducing contact between providers and patients is critical to slowing the spread of the virus, these actions will impact long-term patient outcomes, including quality of life and functional status. Patients with underlying/comorbid conditions—such as diabetes, obesity, and high blood pressure—may delay their routine care to avoid overburdening the healthcare system and risking exposure to a virus for which they are at particularly high risk for severe complications or death.
If underlying medical conditions are not being addressed, patients may require provision of additional services or acute interventions (e.g., amputation, bypass surgery) on an already taxed system. Caregivers may be required to manage more care at home during this time, adding burden on these individuals. Lack of data collection on patient-focused measures puts more onus on the patient to interact with the health system and their physician to be transparent about their needs, including when non-emergent procedural needs becomes urgent.
Anecdotal evidence and a recently released study from Cigna also indicate that patients with more acute health-related concerns (e.g., chest pain, appendicitis) in the time of COVID-19 are not using the healthcare system, further exacerbating their conditions. Data compiled by cities and counties also demonstrate a dramatic increase in people dying at home, suggesting many people are ignoring life-threatening signs and symptoms due to fears of contracting COVID-19.
Lack of Performance Feedback to Clinicians May Impact Outcomes
One of the current accountability mechanisms encouraging providers to meet standards of care is quality reporting. The Merit-Based Incentive Payment System (MIPS), for example, is a clinician-level Medicare reporting program in which almost 900,000 US clinicians participated in 2018. Under MIPS, providers are required to select 6 measures to report on (from 200+ options); recent Physician Compare data indicates frequently reported measures focus on preventive services such routine screenings, vaccinations, care planning, and medication reconciliation.
As part of COVID-19 relief efforts, the CMS has either delayed or made health system and provider reporting optional through the end of June 2020. Though reducing burden on the healthcare industry is a critical component to combating the epidemic, a lack of performance feedback to providers may potentially create unintended consequences.
Less Focus on Value-Based Care Could Alter System Performance
The CMS stated its intention to prorate any losses incurred by Medicare Accountable Care Organizations (ACOs) in 2020 for the duration of the pandemic (e.g., if the emergency lasts for 6 months, annual losses would be halved). Existing value-based payment arrangements do not address how a public health emergency like COVID-19 could affect quality or cost provisions written into the payment methodology. While many health systems made infrastructure investments in 2019 to yield greater shared savings, they will likely see greater financial losses as a result of CMS flexibilities to the program and the health systems inability to meet quality and cost requirements during COVID-19.
The CMS, the Innovation Center, and health systems have spent significant resources implementing models to promote value-based care especially for programs like the Medicare Shared Savings Program (MSSP). Although the CMS encourages MSSP ACOs to maintain participation in the program, concerns loom regarding program withdrawals as a result of COVID-19 impacts on cost and quality, the main pillars of the MSSP program. While value-based payment arrangements may not be top of mind for health systems right now, the downstream financial impact will be clear in 2021 when payments are typically distributed. Acknowledging the effect payment arrangements have on health system performance will be pivotal for future contracting considerations.
Clinical challenges associated with treating patients in models like the Oncology Care Model will also impact expenditure patterns for providers due to care disruption associated with COVID-19 (e.g., lack of care coordination, patient navigation, delays in therapy, reduced access to infusion sites). Providers participating in these types of models will have challenges navigating their financial future in addition to ensuring their patients are receiving the care they need in a timely manner.
Care Delivery After COVID Will Require a Shift in Focus
- Routine Care: Is Telemedicine the Solution? As providers and patients continue to navigate necessary care versus care that can be delayed, virtual care has played a significant role. Larger practices with resources have the privilege of investing in telemedicine capabilities, where small community practices may still be trailing in these investments. Evaluating the advances telemedicine visits will be critical in an era where the future of virtual physician visits may become more mainstream.
- Quality Reporting and Performance: Does Measurement Actually Offer Improvements in Care? The CMS’s intent to delay quality reporting to reduce administrative burden in the current environment is done with good intention. However, members of the clinical community may question the value of quality reporting if no consequences occur as a result of reduced reporting during this time.
- Participation in Value-Based Payment Arrangements: Will Providers Continue to Participate in Value-Based Care Arrangements? Large-scale disruptions resulting from COVID-19 are reshaping provider and health systems’ consideration to participate in value-based care contracts. Key attributes of value-based care center on health, experience, and cost. These pillars will continue to be relevant in a post-COVID environment.
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