FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

Quality & Safety | FAH Policy Blog Team

New Episode: The Impact of COVID-19 on Value-Based Reporting with Dr. Ken Sands

The COVID-19 pandemic has changed health care in unimaginable ways and some of the true effects are still unfolding. One issue to watch is the way COVID-19 will ultimately impact Medicare hospital quality reporting and value-based purchasing programs – something that is critical for patient decisions and the evaluation of care provided at every hospital in the nation.

Dr. Ken Sands, Chief Epidemiologist at HCA Healthcare, started the conversation on Hospitals In Focus by discussing what his system learned by treating more than 120,000 COVID-19 positive patients so far.

“We discovered that we had greater capability than we may have thought in order to adopt and adapt to new information. Also that our workforce was very committed and also very agile in being able to meet the needs of patients and the larger organization,” said Dr. Sands.

But as case  numbers continue to drop, Dr. Sand explained how the pandemic could impact hospital quality measurement and payment programs for years to come.

“I think we have a year of special cause variation that is going to be very hard to disentangle and understand the options and investigate what those factors are. We need to find some way to understand that period of time – the period of time with COVID population – separately and discount that. We know that future years still have the potential to include the period of time of 2020 and I would say that, even now, thankfully, the COVID numbers are significantly down, but our hospitals are far from back to baseline or normal.”

The key Medicare programs in question are as follows: Inpatient hospital value-based purchasing, hospital readmissions reduction, hospital-acquired conditions, and inpatient quality reporting.

These programs have three main goals: transparency of data on quality and efficiency of hospital care for patients, continuous improvement in care, and accountability for care provided.

Each of them had its own set of issues even before the pandemic struck – but COVID threw a real wrench into the gears.

Early in the pandemic, there was a shutdown of most elective procedures, which led to a major change in the patient mix at many hospitals – and was further complicated as COVID surged and dominated patient services.

Additionally, CMS delayed or even stopped the collection of quality data. While this helped hospitals focus on COVID response and special COVID reporting of cases, ICU capacity, and deaths, the reporting changes and case variations from the virus have skewed results in much of the data.

This brings up real questions about whether the quality data collected during the public health emergency is reflective of the true quality of care patients can expect to receive in the post COVID world.

FAH President and CEO Chip Kahn co-authored a blog on HealthAffairs.org entitled – COVID-19 Will Upend Hospital Reporting And Value-Based Programs For Years To Come – that outlines these issues and discusses ways that they can be blunted through regulation.

Dr. Sands talked about possible actions that CMS can take.

“I think that there’s a number of techniques that they could assess. One could be to deemphasize a certain period of time in, in how they do calculations or deemphasize certain measures –  so that is one approach, an underweighting. I think that they could use the data that they have to further try and understand that the relationship between care of COVID patients and some of these performance metrics and create a more level playing field. But that will be a fairly significant endeavor to try and understand that impact. The choices are to either attempt to better understand the way that COVID impacts these measures or say we can’t achieve that understanding. And therefore, we have to at least underweight those for that period of time – if it cannot be entirely ignored.”

While the full toll of COVID-19 on hospitals and health systems is yet to be understood it is important to do our best to understand the specific impact on data to ensure we do not mislead patients with invalid information, nor incorrectly penalize hospitals for delivering care during a inconceivable period of duress.