Leadership Challenges The impact COVID-19 may have on value-based care, accountable care organizations, and telehealth
nยบ8 - Summer 2020
Will Value-Based Care Stall? Kenneth Persaud talks to RISE about the impact of COVID-19
Legal analysis finds CMS has authority to modify risk adjustment calculation for MA plans before June bid submission
Supreme Court ruling: Feds owe ACA insurers billions for risk corridor payments
What you need to know about risk adjustment changes outlined in the 2021 Payment Notice for ACA marketplace
Medicare Trust Fund is set to run out in 2026, but that doesn’t account for COVID-19
OIG report: CMS must take more action to address opioid misuse among Medicare Part D beneficiaries
Coronavirus fuels explosive growth in telehealth and concern about fraud
COVID-19 crisis leads to more CMS waiver and policy changes 2021 bid process: MA advocacy group urges CMS to issue guidance to help stabilize market in the wake of COVID-19 CMS clarifies actual dates of special enrollment period due to COVID-19 CMS: Special enrollment period available to those affected by COVID-19 pandemic in a FEMA declared disaster area Medicaid providers at the end of the line for federal COVID funding Medicare Advantage news roundup
7 tips to tackle stress and create resiliency amid COVID-19 Health insurers prosper as COVID-19 deflates demand for elective treatments
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CMS issues official guidance on diagnoses from telehealth services for risk adjustment: What you need to know CMS releases 2021 Medicare Advantage and Part D rates COVID-19 update: NCQA announces new HEDIS and CAHPS reporting policies CMS announces changes to 2021- and 2022-Star ratings data calculations in response to COVID-19
CMS halts RADV audits due to COVID-19 concerns Medicare telehealth: CMS further expands services in the wake of COVID-19
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COVID-19 PUTS LEADERSHIP TO THE TEST Earlier this month I had the pleasure of moderating a panel discussion during the RISE virtual event, COVID-19: The Catalyst to Widespread Telehealth. The online seminar examined the current regulatory landscape of telehealth, including changing guidelines, operational challenges, coding practices and billing protocols, and best practices. The information was timely and important. But what struck me most were the words of
If you want folks to follow, you truly have to lead ”
panelist Amy Nguyen Howell, M.D., chief medical officer of America’s Physician Groups, who noted at the end of the program that the most successful organizations had leaders who quickly pivoted to telehealth. They motivated and inspired their entire teams, developing and deploying a telehealth strategy. These leaders helped make everyone comfortable with telehealth, a particular platform, and led the entire team so patients could access the technology quickly. “If you want folks to follow, you truly have to lead,” she said. Panelist Leanne Nadeau, director of clinical services, Episource, agreed, stating it takes leaders to work together with a multi-faced team toward a common goal. “There needs to be a sense of calm leadership that we are all in this together,” she said. It is easy to be a leader when operations are going well. But the true test of leadership occurs during a crisis when there is no playbook and the path forward is unclear. It requires someone who can respond quickly and honestly, someone who listens well and communicates effectively, someone who will take actions to course correct when mistakes are made. It also requires someone who can see short-term and long-term opportunities for organizational change, innovation, and system improvements. Leaders who have these skills will pass the test and guide their organizations to emerge from COVID-19 stronger than before and better prepared for the next public health emergency. I am looking forward to hearing these success stories in the months ahead.
Ana Handshuh, CHC
RISE Executive Advisory Board Member Principal CAT5 Strategies Click to see other articles
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WILL VALUE-BASED CARE STALL? Kenneth Persaud, M.D., CEO of Visualize Health, a Sharecare Company, and a member of the RISE Association Advisory Executive Committee, talks to RISE about the impact COVID-19 may have on value-based care, accountable care organizations, and telehealth.
The COVID-19 pandemic has not only threatened the health of millions of people across the globe and the economy. There is another potential victim: Valuebased care.
NAACOS, along with nine other health care organizations, have urged federal lawmakers to shield participants in ACOs and other value-based payment models from financial penalties because of costs incurred responding to the pandemic (see related story page 6). Because ACOs are judged against their spending from previous years, NAACOS said they could spend well more than their predetermined spending targets in 2020 as they see spikes in hospitalizations and prolonged intensive care stays of their ACO patients because of COVID-19.
medical practices and could wipe out any savings that providers who participate in ACOs have made, says Kenneth Persaud, M.D., CEO of Visualize Health, a Sharecare Company, and a member of the RISE Association Advisory Executive Committee (pictured above). Also, in danger: the strides ACOs have made in value-based care for the nearly 12 million beneficiaries enrolled in the Medicare Shared Savings Program (MSSP) program.
Indeed, more than half of health care organizations that participate in the risk-based Medicare Accountable Care Organization program may drop out of the program to avoid payment of massive financial losses to cover the cost of the deadly coronavirus outbreak according to a new survey from The Many of the 580+ ACOs have generated National Association of Accountable savings to achieve improved quality and Care Organizations (NAACOS). The outbreak has completely upended reduced costs. But even in cases in which 4
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ACOs are below the threshold to receive shared savings payments, Persaud said that physicians in those organizations have invested dollars and practice resources toward improving the health of their patients and they do not view it as a failure if the ACO leads to high-quality grades for their patients. “That’s a win for the practice and communities they serve,” he said, adding that practices want to continue in a program transitioning to a value-based model even if they are not receiving payments.
and be held financially accountable for losses. “Some ACOs are thinking whether it financially makes sense to join a new ACO program in 2021. Most have been sidelined so unless CMS provides relief in the form of a financial carve out for catastrophic COVID-19 related costs in those geographies with high numbers of cases, I don’t see how physicians can move forward,” he said.
To avoid losing ground and the number of ACO’s moving forward into 2021 and beyond, Persaud hopes the Centers for Managing medical practices during Medicare & Medicaid Services (CMS) will COVID-19 provide announcements of relief soon, so But COVID-19 has placed a tremendous the programs will not be penalized for amount of stress on practices that aim outcomes of COVID-19 that they cannot to keep patients out of the hospital. control. Medicare beneficiaries are the highest Telehealth offers a lifeline postrisk demographic for poor outcomes in COVID-19 the event they come down with COVID-19. To reduce the risk of spreading the virus, Persaud said that he is encouraged, practices have had to cancel as much as however, that CMS has expanded 95 percent of their visits to avoid patients telehealth benefits on an emergency coming to the office. The revenue losses basis due to the outbreak. “This was a and volume reductions couldn’t come at a phenomenal announcement and we are supporting our practices to adopt these worse time, he said. visits which enable them to manage their “At a practice level, they are trying to patient during the pandemic and will help manage through the crisis but have fixed practice emerge post-crisis,” he said. overhead costs. We’ve seen as much as a 40 to 50 percent reduction in staffing Telehealth, he said, may be the silver lining and that translates directly into ACO for health care delivery in the future and business. All elective procedures have may allow providers to reach patients who been canceled to avoid treating patients may not have sought out care in the past. in the inpatient environment. It’s been Most of the population has smart phones and are tech savvy. Social distancing devastating for practices,” he said. has led many seniors to learn how to In order to make payroll and keep video chat with their grandchildren. All providers employed, practices may have these factors will help patients be more to rethink their business model and cut comfortable with telehealth visits, even fixed costs to perform data analytics as after the country relaxes social distancing well as staff that provide care coordination and people start to go back to work in services. offices. The problem is compounded because this is the last year of the MSSP and as of January 1, 2021, all ACOs will have to take on some element of downside risk
Until now, insurance companies have not typically paid for these types of visits. The approval from Medicare to allow practices to interact via telemedicine with
their patients during social distancing is a huge development. The problem is not a lot of companies provide secure technology to allow providers to have a meaningful exchange with patients via video and photographs. “It’s absolutely critical that we start to leverage new capabilities and technologies and help practices emerge in the post-Covid, post-shut down period,” he said. Editor’s note: For more information on the latest CMS developments, visit the CMS Newsroom. The site contains notices about changes to telehealth, MSSP ACOs, Medicare Advantage payment rates, Medicare Advantage billing guidance, and summaries of recent actions.
In order to make payroll and keep providers employed, practices may have to rethink their business model ” Click to see other articles
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COVID-19 may force more than half of ACOs to drop out of Medicare Shared Savings Program A new survey by The National Association of Accountable Care Organizations (NAACOS) finds that 56 percent of health care organizations in the riskbased Medicare ACO program may drop out of the program because of fear they will have to pay massive losses as the result of the COVID-19 pandemic. NAACOS surveyed the ACO community in an online poll between April 3 and April 8 sent to all participants of the 2020 Medicare Shared Savings Program and Next Generation ACO Model, including NAACOS members and nonmembers. There were 304 responses from 226 ACOs across the country. The Medicare Shared Savings Program, the largest value-based payment model in Medicare, fully launched in 2012 and rewards ACOs for lowering spending and improving outcomes for patients. The program saved $3.5 billion from 2013 to 6
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2017 and in 2020 almost 20 percent of Medicare beneficiaries were part of an ACO. But these ACOs didn’t bargain for a global pandemic when they signed up for the program. NAACOS estimates the coronavirus outbreak could cost Medicare between $38.5 billion and $115.4 billion over the next year. Providers have had to cancel routine, in-office visits for chronic care management, delayed elective procedures, and have diverted quality control staff to handle COVID-19 response elsewhere.
Key findings from the survey As a result of the swings in unpredictability and spikes in expensive hospitalizations, when asked how likely it was they would leave the Medicare Shared Savings Program in response to concerns about having to potentially repay losses for 2020 affected by COVID-19, the survey found:
• 21 percent of at-risk ACOs said they were “very likely” to leave the Medicare ACO program • 14 percent said they were “likely” • 21 percent said they were “somewhat likely” to leave
When ACOs made a commitment to assume risk, they didn’t expect they’d be handling the risk of a global pandemic” The survey also found that:
• Almost 80 percent of ACOs were “very concerned” about their ACO performance this year • A quarter of survey respondents expect spending to increase by more than 10 percent as a result of the pandemic • Nearly a quarter expected spending to increase between 5 and 10 percent • Only 10 percent expect spending to remain the same or fall because of the pandemic • 37 percent of respondents weren’t sure about their spending, which the NAACOS said illustrates the great uncertainty they face
said Clif Gaus, Sc.D., NAACOS president and CEO, in an announcement about the survey. “Rather than be forced to pay enormous losses resulting from the pandemic, these groups of providers may sadly quit the program, which they can do without penalty by May 31. Medicare’s decade-long effort to change how we pay for health care to better reward quality and outcomes may be lost unless Washington acts quickly to throw these providers a lifeline.”
In March NAACOS joined nine other leading health care organizations to ask the Centers for Medicare & Medicaid Services (CMS) to hold harmless providers who participated in alternative payment models from performance-related penalties for 2020. But CMS has not yet adequately mitigated the costs and NAACOS: ACOs need protections disruptions of the pandemic, according “When ACOs made a commitment to to Gaus, and the Medicare program will assume risk, they didn’t expect they’d be suffer as a result. handling the risk of a global pandemic,”
“ACOs are telling us that they will leave the program unless there is protection from the losses of the pandemic, and it would be a tragedy for millions of Medicare beneficiaries to lose the access to care coordination and quality improvement that ACOs offer,” he said, noting that ACOS have established initiatives like care management at home, telemedicine, integrated home health, and an understanding and use of waivers that have helped the U.S. health system respond to the outbreak. “While that work has helped our health system pivot in their COVID responses, the financial strain and external forces may be too much to survive this pandemic,” he said.
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NEW NAME NEW VIRTUAL FORMAT SAME AMAZING CONTENT The annual event, formerly known as RISE Nashville, will now stream live on June 29-30 with pre-conference workshops on Friday, June 26. Designed to be highly interactive and hosted on a state-of-the art digital platform, RISE National 2020 will deliver the same high-quality content and engagement opportunities that attendees have come to expect from RISE live events. Here’s a look at what you can expect at this year’s mega-conference for professionals of all levels in the Medicare Advantage and Affordable Care Act market.
PRESENTATIONS FROM CMS & OIG Monday, the first day of the main conference, will also feature policy updates from the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG). At 10:30 a.m., OIG presenters will discuss the findings and recommendations of work conducted by OIG’s Office of valuation and Inspections on the financial impact of chart reviews on risk scores in Medicare Advantage. Speakers will include Megan H. Tinker, senior advisor for legal affairs; Jacqualine Reid, social science research analyst; and San Le, social science research analyst for evaluation and inspections.
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ALL-STAR KEYNOTE SPEAKERS Emmy-award winner John Quiñones will deliver a keynote presentation at 2 p.m. Monday, June 29, the first full day of the conference, that focuses on the importance of believing in one’s self, never giving up, and always doing the right thing. As the host and creator of What Would You Do?, the highly-rated, hidden camera ethical dilemma newsmagazine, Quiñones has become “the face of doing the right thing” to millions of fans. The following day Celebrity Chef Jeff Henderson will share his inspirational life story and lessons for success. Henderson is the star of the nationally syndicated series, Flip My Food with Chef Jeff, where he prepares healthier versions of favorite family and restaurant recipes. But before he discovered his passion for culinary arts, Henderson was a drug dealer and spent nearly a decade incarcerated in federal prison. He’ll tell his emotional story of how he overcame all odds at 9:05 a.m., Tuesday, June 30. Executive coach and celebrated artist, Allison Massari will follow with a presentation about the importance of compassionate care and how to transform lives through the art of person-centered care. Massari will provide a first-hand account of her own health care experience after she survived a devastating car accident that left her severely burned.
The CMS presentation will follow at 11:20 offer practical advice on how to make a.m. with Erin Sutton, deputy director presentations clear and compelling. for the Payment Policy and Financial Management Group, and Kelly Drury, Other half-day workshops include: director, division of risk adjustment • What Health Plans Should Be operations.
PRE-CONFERENCE WORKSHOPS Five full and half-day pre-conference workshops will take place on Friday, June 26: A full-day workshop for the Risk Adjustment Practitioner will be held from 8 a.m. to 4 p.m. The day will feature the essentials of and differences between Medicare Advantage, commercial, and Medicaid risk adjustment; understanding how risk scores are calculated, making sense of varying payment models, and tools for achieving data accuracy.
Seeing at the Crossroads of Better Data and Advanced Analytics: This workshop will focus on the future of EMR connectivity, provider engagement, and social determinants of health. • Taking your Medicare Advantage Program to the Next Level Arriving at the Intersection of Stars and Risk Adjustment: This workshop will guide you through the lessons learned and best practices for combining and streamlining processes related to Stars and Risk Adjustment. You will walk away with a game plan and actionable steps to apply in your organization.
The Advanced HCC Auditor is also a full-day workshop from 8 am. to 4 p.m. The class is designed for coders, finance, and analytics professionals and will go over regulatory compliance and how to optimize the accuracy of the information VIRTUAL NETWORKING WITH gathered and submitted at the practice PEERS & EXHIBITORS level. Our virtual platform will allow you to chat Brain Scientist Dr. John Medina, last in an open forum with other attendees year’s popular keynote speaker at RISE and send private messages within the Nashville, will lead a half-day workshop interface to build your network. Opt-in to on the brain science behind delivering share your contact information with other powerful and engaging presentations. attendees. He’ll
discuss
brain
processing
and Our virtual exhibit hall will allow you to
participate in one-on-one messaging with solutions providers, ask questions about technologies, and opt-in to share your contact information with sponsors. Video replay The technology also allows attendees to gain access to presentations for up to 90 days after the conference. That means you can re-watch sessions or catch-up on sessions you may have missed (no longer a need to choose between concurrent sessions). How it works Virtual conference participants will receive a link to the conference with additional details within two weeks of the event. Simply log-in prior to the opening remarks on day one, sit back and enjoy top-notch content and virtual networking from the comfort of your office. Our technical support team will be available to you before and during the conference to ensure you are set up and ready to go! Click here to learn more.
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UPCOMING VIRTUAL EVENTS
Navigating the Gnarly Challenges of HCC Coding: Episode 2 in a Series Thursday, June 18, 2020 1:30pm Eastern Time
June 15 - 16, 2020
September 9 - 11, 2020
June 26 - 30, 2020
Questions? Reach Out to Our Team
Ilene MacDonald Editorial Director imacdonald@risehealth.org
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