RDI Healthcare COVID-19

Post COVID-19 Healthcare Forecast

Pre-COVID-19 healthcare forecasts for 2020 predicted continued regulatory changes to our healthcare that included modifications in prescription drug policies, expansion of Medicaid services, and increased debate of the Affordable Care Act. The Spring 2020 COVID-19 outbreak changed many of these priorities and will continue to do so for some time.

So what predictions can healthcare see for the remainder of 2020?

Increase in Healthcare Waivers

As COVID-19 outbreaks continue, we will see an increase in waivers regarding payments, policies, and payment codes.  The CMS “Coronavirus Waivers and Flexibilities” web page lists in excess of twenty-five waived items implemented over the last six months.  Additionally, forty States have requested and received blanket waivers for specific Medicare, Medicaid, CHIP, and/or HIPAA requirements.

  • Commercial insurance carriers have implemented temporary waivers ranging from lowered or no co-pays, to reduced premium payments.
  • Expanded services such as telehealth are being marketed by many carriers as well.
  • Temporary exemptions are intended to make coding and billing for COVID patients easier at present.

What the future is for these exemptions as the pandemic rescinds will be of interest to all providers and facilities.

Additional Public & Private Partnerships

While not a new concept, these partnerships have accelerated during the recent outbreak.

Programs of note include

  • United Healthcare partnering in research and data mining
  • Health and Human Services (HHS) increasing testing footprints with health systems
  • Food and Drug Administration (FDA) increasing healthcare production by aligning with private sector resources.

Should these partnerships continue to be politically and financially profitable in information gathering, outcome analysis, and serving the public need, we could predict continued relationships past their present phases.

Change in Patient Interactions

Many agree that changes in testing and professional reimbursements during the COVID-19 outbreak are related to two areas:

  1. Changes in inpatient volumes
  2. Changes in patient interaction and testing methods

Phone or Telemedicine Vs In-office

Changes in patient volumes and method of interaction (phone or telemedicine vs in-office) has led to many outpatient entities seeing a 30% to 40% decrease in direct visit volumes. A recent Medical Group Management Association (MGMA) publication cited volume declines as high as 60%.

In comparison, telemedicine visits accounted for approximately 15% of all visits in 2019 according to several sources. With the addition of COVID-19 in 2020, volumes have increased to as high as 70%.  Audio-only or voice interactions have also seen a double-digit increase in volumes.

Questions are outstanding on if these volumes will continue as virus changes occur.  While patient satisfaction for these revised visit sessions are generally high, the hesitancy of some age groups to be part of virtual provider interactions are an illustration of issues that will determine telemedicine’s ultimate impact and disposition.

Future Forecast of Healthcare

To forecast what’s upcoming for healthcare entities post-COVID, much information needs to be considered:  The effect of waived policies, changes in reimbursement levels, patient acceptance of telemedicine options are all up for review and measurement.

As an example, providers can presently opt-out of the Medicare Merit-based Incentive Payment Program (MIPS) for hardship reasons related to COVID-19 without penalty.  Thus, how does this waiver change future outcome results and reporting?  Financial impacts for all parties?  Additional considerations?

Yet to be determined is the impact of increased lobbying efforts by the healthcare industry and patient advocacy groups on Congress and Government entities on patient care, oversight, and reimbursement issues.

Congressional action, individual State initiatives, and funding of present programs (some programs are presently active but not funded or operating with exhausted funds) could have leveraging effects on present and pending next steps.

Many issues remain to be measured and considered before a final or additional direction can be firmly predicted. Of first importance is the health and well-being of all affected by COVID-19.  Past that, policies and direction are in flux and are awaiting finalization past present steps on many COVID-19 issues.

For more information about healthcare operations & strategy, contact us today!

Charles Hutchings
Director of Healthcare Operations & Strategy