COVID-19 may pose an unprecedented challenge to our system of care, but it’s certainly not the first crisis our nation has encountered. What wisdom can we take from our responses to past catastrophic events as we confront this new threat?
Looking back at 9/11 and the Great Recession, we can find lessons that apply to today’s situation as we seek new solutions. The particulars may be different, but leaders emerged from these situations clinging to two common themes: 1) focus on what you can control; 2) prioritize and execute.
As we collectively face this extraordinary health emergency, here are 10 approaches for health system executives to think about that reflect those themes while incorporating what we’ve already learned from this evolving global pandemic:
- Deploy telehealth. Establish a comprehensive plan to address screening and testing needs, and expect to go live in the next few days. Even if your organization doesn’t have an existing telehealth platform in place, there are stand-alone COVID-19 use case platforms that are being made available for coronavirus screening. Short of a comprehensive telehealth platform, consider other means of increasing capacity for the community while minimizing face-to-face contact between patients and providers, including chat bots and phone screening.
- Ask health plans to increase current rates for the short term. Rates could be increased by, say, 5% for a one-year period, after which they would return to the contracted levels. Cancellations in elective procedures during the crisis will drive hospital margins down while health plans will realize a windfall.
- Request capital and/or operating grants from health plans. Providers should quantify the additional expense to the delivery system as a result of the coronavirus and ask for an operating grant. Providers should identify capital needs and request capital grants tied to the outbreak. Payers may argue that those dollars are not included in the medical loss ratio, so it may be better to seek a contract rate increase.
- Seek short-term out-of-network contracts. Hospitals may want to enter into short-term contracts with payers for whom they’re currently out of network so patients aren’t stuck with out-of-network cost sharing and issues with getting authorizations.
- Alleviate concerns of employed physicians. The cancellation of elective cases, reductions in clinic visits for routine visits, and care of COVID-19 patients will have a profound effect on provider compensation, as the vast majority are compensated through productivity-driven or revenue-less-expense models. Providers may also be at risk of being penalized for nonattainment of payer incentives related to value-based care withholds and quality. Employed physicians may need a WRVU holiday or other type of economic safety net to keep them stable in the short to medium term.
- Work with distressed aligned physician practices. Similar hardships for independent practices could result in a new wave of consolidation. Practices that may have resisted employment (or alignment) overtures in the past may now be willing to listen or actively seek assistance.
- Prioritize the importance of charge capture/management. Initiate billing flags or other types of charge management structures to identify and organize COVID-19–related cases. In this new paradigm, it will be essential to clearly document the care given, supplies used, and situations driving care decisions in order quantify the impact of this event as reimbursement is determined.
- Implement solutions for bed management and expansion. What is the right number of beds—both at tertiary facilities and across the system? What options exist for increasing capacity (e.g., converting existing hospital space, utilizing tents or MASH-type units, reopening closed facilities, repurposing nonacute care facilities, using hotels for recovery units)? How can the number of isolation (negative pressure) spaces be increased quickly?
- Utilize ASCs to service qualified urgent surgeries. An ASC’s ability to provide all types of urgent surgical care will vary based on access to staffing and surgical equipment, along with other factors. While CDC guidelines normally restrict ASCs to performing elective surgeries at this time, ASCs are still able to service “urgent cases,” which are those that cannot be delayed for six to eight weeks as provided in guidance from ASCA and ACS. Ongoing discussions are occurring on a national level with ASCA about ASCs taking on addition types of urgent cases (e.g., fractures [excluding hip fractures], laparoscopic cholecystectomies, appendectomies, and select spine and other orthopedic surgery) from hospitals, which would enable them to accommodate patients who may suffer if their care is delayed due to hospital cancellations. There are also efforts at the national level to look at ASCs as potential sites that could offer infusions so cancer patients can minimize exposure risk by avoiding hospital infusion therapy sites. Further, some organizations are exploring the potential to use their ASC for OB services in an effort to get L&D services out of the hospital to free up capacity, all of which would be subject to ASCs receiving approval on the 1135 waiver.
- Learn from your network. The state of Washington is developing “crisis standards of care” related to how ventilators will be rationed if hospitals are overwhelmed with COVID-19 patients. Many of our colleagues in states like Washington who have been hit hard have a head start in developing standards of care that they are willing to share. Your network and other sources can provide valuable information on the lessons they are learning and how those learnings can help you respond more quickly and effectively.
Published March 24, 2020