COVID-19 has had a tremendous impact worldwide. As a result, nationally, the government has come out with several policy changes in response to the coronavirus pandemic. I wanted to review these healthcare policy changes and discuss their impacts to healthcare organizations.
Telehealth Services During Certain Emergency Periods Act of 2020: Medicare’s geographical restrictions on telehealth are waived while the country is in a public health emergency. This enables providers to use telehealth in urban and rural areas. Medicare beneficiaries can now consult their physician from home.
- The Office for Civil Rights (OCR) stated it will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the pandemic.
- CMS temporarily waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state for the purposes of Medicare and Medicaid providers. However, if a physician is providing telehealth services for non-CMS patients, these requirements may still apply. To date, only 8 states have waived requirements: Arizona, California, Florida, Louisiana, Mississippi, North Carolina, Tennessee, and Washington.
Many healthcare organizations have canceled elective procedures as a result of the pandemic. This has created a significant decrease in revenue. Many of these organizations are small businesses, and they realize they can’t afford to continue to pay their staff, which certainly contributes to the unemployment numbers. However, some of these organizations are supplementing their income through telehealth services. This service has become hugely valuable to patients because they can continue to receive care from their provider, and potentially decreases the number of patients overcrowding the emergency rooms. Nonetheless, challenges still remain:
- Not every insurance company will provide reimbursement for telehealth services
- Not every patient is comfortable with using technology, arguably, the patients that need it the most. For example, providing telehealth services to patients in a nursing home would be a perfect use of telehealth services. We can keep grandma, a high-risk patient, from having to go to the hospital for a UTI. However, how many elderly patients are technologically savvy enough to participate in telehealth services?
- State-by-state regulations differ on who can render telehealth services for non-CMS patients. Arguably, this will leave many patients in remote areas without a viable telehealth option.
AMA releases a new Current Procedural Terminology (CPT) code set: 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. This code will be used with the goal of increasing the healthcare system’s ability to track, allocate, and maximize resources.
Value-based organizations can use claims to identity high-risk cohorts for resource allocation. Subsequently, these organizations can conduct a retrospective analysis on the impact of these initiatives. Salient Healthcare has partnered with Cura Health Management and Care Continuity to develop an “out of the box” solution for managing patient outreach to at-risk populations during this time of unprecedented stress on our nation’s healthcare system. This solution delivers customized workflows to ensure outreach and monitoring of patients who are at elevated risk should they contract COVID-19 as well as those who are at risk of admission due to ongoing chronic conditions and/ or utilization history.
Quality Reporting Deadlines: Centers for Medicare & Medicaid Services (CMS) announced exceptions from reporting requirements and extensions, impacting over 1.2 million clinicians in the Quality Payment Program. The Quality Payment Program – Merit-based Incentive Payment System (MIPS) 2019 data submission deadline was extended from March 31, 2020, to April 30, 2020. The Medicare Shared Savings Program Accountable Care Organizations (ACOs) will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year. For more information, visit: https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting
Impact to ACOs: While the quality reporting deadlines have been extended, ACOs may face significant impacts to their shared savings. Specifically, COVID-19 will have a significant impact on financial expenditures, performance scores, patient attribution, and risk adjustment. If policy isn’t changed, ACO will experience performance-related penalties for the 2020 performance year, particularly those in two-sided risk models. NAACOS is requesting for CMS, House, and Senate leaders to provide support and policy changes to address expected spending spikes. On March 30, CMS issued an interim final rule with comment period that triggers the extreme and uncontrollable circumstances policy from 2017 to allow for an adjustment to the amount of shared losses for an ACO under the Medicare Shared Savings Program to be applied for the 2020 performance year. According to CMS, “for PY 2020 financial reconciliation, we will reduce the amount of an ACO’s shared losses by an amount determined by multiplying the shared losses by the percentage of the total months in the performance year affected by an extreme and uncontrollable circumstance, and the percentage of the ACO’s assigned beneficiaries who reside in an area affected by an extreme and uncontrollable circumstance.” 
Even with these policy changes, will COVID-19 have an impact on how many organizations will think twice before enrolling in a downside risk model in years to come?
Coronavirus Aid, Relief, and Economic Security (CARES) Act: In late March, the president signed the CARE Act, the largest stimulus bill in US history, with $2 trillion in stimulus. Many independent healthcare providers have been significantly impacted by COVID-19, having to terminate or furlough their employees due to a significant loss in revenue. Healthcare organizations will specifically benefit from this stimulus, leaving healthcare providers unemployed at a time when we need them most. $100 billion is available to eligible healthcare providers through emergency low-interest loans for healthcare-related expenses or lost revenues associated with COVID-19. Without this support, independent healthcare providers would go out of business, which would lead to mass consolidation and less competition. Additional financial support is available to the hospital through a series of Medicare reimbursements. A more comprehensive summary is available here: https://www.mcdermottplus.com/insights/cares-act-summary-covid-19/.
In response to the pandemic, the government has certainly
issued many regulations to help provide support to healthcare providers and
healthcare organizations. While these current measures are certainly helpful, I
find that additional policy changes will need to be made to minimize the impact