Forward-looking policy suggestions to ease pressure on healthcare organizations
Allscripts has taken extensive steps to aid our clients during this time of COVID-19 crisis, and we have also witnessed and heard directly the immense challenges they face in delivering care and running their businesses right now. Everyone is doing their very best to move forward.
As we look to the next year and beyond, there are several steps that Allscripts recommends be taken by policy makers to mitigate the current pressure on healthcare organizations. This is important as it becomes increasingly clear that COVID-19 will be with us in some unmanaged form for at least the next 18-24 months, and even as we look to future catastrophic interruptions of society.
Following are several suggestions that I, as head of Government Affairs at Allscripts, believe would be helpful in alleviating concern, aiding business continuity for our clients, and enabling providers to focus on patients first:
- In many instances, our clients need to upgrade their EHR software to access the added functionality necessary to meet new regulatory requirements, such as the electronic prescribing of controlled substances (EPCS), Advanced Radiology Clinical Decision Support and Appropriate Use Criteria (AUC) rules. Accordingly, because many organizations have indicated they simply do not have the bandwidth to go through an update process right now, we have urged CMS to review upcoming program deadlines and implement an appropriate delay of each.
We also noted that while December may seem distant, any decisions regarding a delay of regulatory deadlines will only be useful if they are announced with sufficient time to make a difference. For example, alerting the industry on December 15 that there will be a delay in the EPCS January 1, 2021 deadline would have minimal impact. CMS should act swiftly when announcing delays to regulatory requirements.
- Thousands of provider organizations are currently experiencing dire fiscal challenges where they are unable to treat patients or are limited in doing so. Because Allscripts serves such a large number of independent physician practices and smaller hospitals across the country, we have heard many stories of practice closures, furloughs and layoffs, just when those clinical experts are most needed to treat patients recovering during the pandemic. The MGMA, AAFP and others have shared these statistics publicly.
Accordingly, we hope that HHS will broaden the categories of providers who can apply for assistive funds, as the limitations to date on eligibility (and basing payments only on those related revenue streams) has unfortunately mitigated the good that the program can do. News of funding allocated for grants has not reached everyone in this overwhelming time, particularly smaller providers who don’t have staff available to review the latest information from Congress and HHS. The 1135 waivers also hold great promise and have impressed us with the flexibility offered by CMS, but taking on a federal waiver application in the middle of a healthcare pandemic and corresponding fiscal crisis is daunting to all but the most sophisticated practices and hospitals. We urge CMS to simplify the process and make sure smaller provider organizations are aware of and equipped to take advantage of these opportunities.
- One bright spot in this pandemic has been a very clear use case – finally – for the widespread use of telehealth technologies. Allscripts has seen uptake of our telehealth solution grow exponentially, and I am hopeful that Congress, CMS and state Medicaid Directors will act to make as much of the flexibility and payment reform that has been temporarily enacted instead permanent.That said, we have also seen in stark relief the flaws in our nation’s primary care funding models. While we currently pay based on units of care and units of time in primary care, many have agreed for years that this doesn’t make sense where those clinicians and their teams are expected to care for patients in a more longitudinal, coordinated way than many other specialties. It is clear that primary care providers should instead be paid a prospective, risk-adjusted fee per patient for the population under their care. We have an opportunity – as Congress works on the next COVID-19 support legislation and as we look to a future when society has largely reintegrated – to implement innovative payment strategies that include an expectation of quality reporting from the clinicians while also offering a predictable revenue stream to doctors delivering family medicine, gynecology, pediatrics, internal medicine and other primary care services to patients. It could be a win-win-win for providers, patients and payers.
The COVID-19 pandemic has been earth shattering to virtually every segment of society, healthcare included in numerous ways. We hope that Congress and HHS will continue to act on both short- and long-term efforts that can help to mitigate the damage and even, potentially, make changes for the better as we look forward.