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CMS Provides Relief for Quality Reporting Amid COVID-19 Crisis

On March 22, 2020, the Centers for Medicare and Medicaid Services (CMS) offered some relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs – including the 1.2 million clinicians in the Quality Payment Program and those fighting coronavirus (COVID-19). This unprecedented action by CMS has been applauded by the American Medical Association as practitioners focus on treating COVID-19 patients as their top priority. CMS is working to reduce bureaucratic efforts that create barriers for health care professionals who are prioritizing patient care over paperwork.

While state Medicaid programs and commercial health plan quality programs have not yet provided guidance on their own quality programs, it is expected that some or all will follow suit and ease reporting requirements as well. Some key highlights of the CMS announcement include an update to the data submission deadlines for April and May 2020 to make them optional for providers now. More importantly, data reflecting services provided between the dates of January 1, 2020 through June 30, 2020 will not be used in CMS’ calculations for Medicare quality reporting and value-based purchasing programs1. This will allow providers more time to focus on direct patient care during these difficult times. While CMS has only issued guidance on data for the first part of 2020, it is plausible the entire calendar year of 2020 may be included should the COVID-19 virus impacts continue as projected.

Hospitals and practitioners in the field are adjusting their workflows and standard operating procedures to be more creative to meet the needs of COVID-19 demands. Elective procedures are being put on hold and there is an increasing focus on utilizing telemedicine to expand virtual capacity and reduce risks of exposure to COVID-19 for patients in numerous markets. Newer platforms and models that leverage home based electronic health records (EHR) and care management platforms are enabling more caregiver engagement to a large number of at-risk patients now effectively sheltered at home. As the health care industry works to respond rapidly to these new realities, quality programs, reporting, care models and patient engagement strategies will need to adapt in order to succeed in this temporary, remote care focused way of life.

It remains unclear how long the effects of the COVID-19 outbreak will be felt and what impacts it will have on long-term outcomes of health care particularly around preventative medicine. As many well check-ups and other routine appointments have been cancelled for patients around the country, a backlog of specialist visits and primary care appointments is expected to arise over the coming months. Providers will be challenged with meeting the requirements of each of their various quality programs and more changes and flexibility across the board will be expected.

Now more than ever, it is important for providers and payors to band together to provide new models of care, adjust workflows for care management and become creative with care delivery, access and financial reimbursement mechanisms to be responsive to the evolving and emerging unprecedented changes facing providers. Quality of care measures and programs will need to be modified to reflect this and CMS’ announcement to provide relief on quality reporting is merely the first step in what will be the new health care environment post-COVID-19.

COPE Health Solutions is working closely with our providers, payors and technology partners as we explore how best to support the critical, front-line services in facing the health care community. For more information, please contact Carla D’Angelo, Vice President at cdangelo@copehealthsolutions.com or 213-514-4823 or Evan King, Principal & COO at eking@copehealthsolutions.com or 213-663-3075.

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