At the Helm

10 takeaways: Covid-19 has shaken up health policy. What happens next?

by Christopher Kerns and Amanda Berra

To help navigate developments in the Covid-19 pandemic, we have compiled a list of  key takeaways for the week, consolidated from our webinar on May 14. This time, we focused on policy, and welcomed expert cohosts Mara Mcdermott and Rachel Stauffer from McDermott+Consulting. Join us Thursday, May 21, for our next update on where things stand.

Covid-19 weekly webinar: What health care leaders need to know

1. On a plateau—with no clear way down

At least 82,355 Americans have died from the effects of Covid-19 as of May 13. Daily death rates in the United States appear to be slowly trending down—but not in the steep way that characterized the front end of the curve. Many (not all) states' Covid-19 positivity rates have declined.

Tremendous economic and social pressure has led many states to begin lifting distancing requirements, causing experts to increase projected death rates. Experts, policymakers, and the public continue to debate how to move forward.

2. Testing rates rise nationwide, but remain far short of demand

Testing capacity has been a key focus of reopening discussions. The latest data show testing rate increased last week when compared with the week prior for the majority of states. The positivity rate (the percentage of patients testing positive for Covid-19) also fell in all but four states. However, test supply is still falling well short of demand—and the United States will need to improve capacity and testing accuracy to move forward. The latest entrant into the market is a new antigen test, increasing the diversity of testing options.

3. For health care leaders with policy questions, start with the public health emergency—which dictates how long our regulatory 'new normal' will last

Health care leaders charting new strategies for their organizations are increasingly asking questions about regulatory and political agendas across 2020 and 2021.  Leaders need clarity on issues ranging from the future of reimbursement, to changes to Medicare risk and value-based payment programs, and the outlook for the 2020 election.

In particular, leaders are focused on the fact that CMS has issued several temporary holds on regulation and reporting requirements during Covid-19. These changes have significantly altered the "rules of the road" for health care providers and payers—notably, dropping barriers that had formerly inhibited widespread use of telemedicine. 

In answer to the question "how long will this ‘new normal' persist," experts from McDermott+Consulting explained that the timeline revolves around how long a "public health emergency" (PHE) remains in place, as it must be renewed every 90 days. The current (third) PHE will last until end of July and will likely be renewed through September. Beyond that point, no one can predict.

4. A complete reset to pre-Covid-19 regulatory conditions is unlikely  

The entire health care industry has responded to regulatory changes by investing resources and evolving the delivery system to drastically scale up digital health capabilities. It makes sense for regulators to come to a future regulatory middle ground that would preserve beneficial changes—as long as those changes do not inadvertently greenlight fraud and abuse. 

5. Legislators—not just CMS—will determine whether de-regulation persists

McDermott+Consulting experts pointed out that CMS alone does not control whether, or to what extent, regulatory changes made during the PHE can persist. CMS could extend some policies through its own regulations; others would require congressional action in order to grant CMS the relevant authority. For example, CMS can increase payment or add services to the telehealth coding list. However, some limitations around which providers can bill, and how, are statutory and would need to be addressed via legislation.   

6. More health care industry relief possibilities on the horizon

Federal and state relief packages—including the provider relief fund, accelerated payments (essentially a loan program), and favorable Medicare reimbursement changes—have considerably helped many providers, while falling short of the needs of others.  

Providers who perceive they were not sufficiently well supported by initial relief packages, such as post-acute providers and physicians, may receive some additional forms of help in coming weeks.  

Among providers, repayment terms for advanced Medicare payments are an area of particular concern. While changes that would completely forgive loans appear to be a bridge too far, repayment terms may well be changed to reduce provider burden—for example, extending recoupment date, reducing the interest rate on un-repaid funds.     

In addition, Democrats in particular are pushing for additional public health investments, such as major contract tracing initiatives.

7. CMS is working responsively with providers on risk and value-based payment programs

The Covid-19 crisis has raised a wide range of questions and challenges for providers participating in risk and value-based programs, McDermott+Consulting notes:

  • Most notably, industry leaders and observers have been debating what effect the Covid-19 crisis will have on providers with a large portion of at-risk revenue. There is a chance that some will be less financially impacted from Covid-19; meanwhile providers in hard-hit areas, with high hospitalization rates, could be responsible for higher than anticipated costs. These uncertainties are contributing to anxiety among providers, many of whom are looking to stay the course on their journey toward value-based payment.

  • The agency appears to be working through ways to protect organizations from downside losses if the PHE continues. On the other side of the coin, there is uncertainty about what will happen if some providers, particularly those less affected by Covid-19, experience "too much" savings.

  • ACOs that shelved plans to apply to the Medicare Shared Savings Program should note that CMS could open a mid-year opportunity; it has occasionally done this in the past.

  • CMS is also actively looking at solutions for organizations worried about accurately capturing and addressing risks in their patient population. As an example of flexibility on these issues, CMS has begun allowing diagnoses from audio-video visits; however, they have not gone as far as to allow diagnosis collection from audio-only calls. As with telehealth deregulation, the issue for CMS is to balance providers' legitimate concerns, along with patient access challenges, against the need to protect the program against fraud and abuse.

8. Politically speaking, the Covid-19 crisis is being woven into talking points on either side of the existing divide

McDermott+Consulting experts posited that both parties will continue to weave the pandemic and its impact into their larger talking points and platforms.  Generally speaking, Republicans will put the pandemic into the context of their larger economic platform; Democrats will continue their focus on health care by putting the spotlight on preparedness, investment in science, research development, buttressing the ACA, and expanding access and coverage.  Expect to see Democrats using the pandemic in arguments for a Medicaid buy in or lowering Medicare age eligibility.

In the near term, the political divide will dictate stance on relief packages.  Democrats will continue pushing for sweeping support for the health care industry; Republicans will argue for a wait-and-see approach, measuring the effectiveness of the last package, watching what happens as some people back return to work and the effect of those factors on the economy before passing more packages.  

9. Now is the time for health care leaders to talk to their representatives  

On all of the issues outlined above, the McDermott+Consulting experts emphasized repeatedly that CMS, state, and federal representatives all have doors open to hear industry feedback—making now the essential time for health care leaders to make their voices heard. Health care organization leaders should weigh in now on issues including:

  • Telemedicine-related deregulation: Which changes should persist, what benefits are being accrued, what concerns still need to be addressed;

  • Unmet needs for financial relief: Including the case for more favorable loan forgiveness and relief packages; 

  • Flexibility on Medicare Advantage risk adjustment methodology; and

  • Additional input on upcoming value-based programs—since some, such as Primary Care Plus, may experience delayed launches, creating more time for health care stakeholders to help shape those programs.

10. Health care leaders: Don't overlook compliance and documentation

As health care leaders look for additional support and, in many cases, deregulation, they should equally ensure their own houses are in order by dialing up focus on compliance and documentation. CMS is looking to ensure that latitude it is given is not abused; and legislators who are approving relief packages will be looking to ensure that those dollars are well spent. 

Slide deck: Politics, regulation, and legislation—health policy in the post-Covid-19 era

In this week's webinar we focused on policy, and welcomed expert cohosts Mara Mcdermott and Rachel Stauffer from McDermott+Consulting.

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