Many Medicare payment initiatives aim to link reimbursement to value. Value includes the cost and quality of care. However, measuring the quality of care during a pandemic is problematic. In addition, most CMS value-based procurement programs, such as the hospital value-based procurement program (VBP), the hospital readmission reduction program, HRRP) and the hospital-acquired condition reduction program (HAC) all look at retrospective data to assess quality. From the graph below (courtesy of u Salzberg and Khan broke into the Health Affairs blog) it can be seen that quality impacts during COVID-19 will influence Medicare reimbursement to providers through 2024 for most programs and in some cases until 2025.
There were a number of problems with the data during COVID-19.
- Data reporting quality. CMS recognized consent and tried to attenuate the measurement of the quality of the signal weight for many health care providers. While this is a prudent and prudent approach in the midst of a pandemic, it also means that data quality may be worse than in other years. For example, a decline in quality could be observed during the COVID-19 years, not because of poor quality, but rather only because of quality ratios.
- Dealing with COVID-19. Clearly, before 2020 there were no quality measures related to the quality of COVID care. Thus, even if a hospital provided high COVID-19 care, they would not get credit for it in existing value-based purchasing systems as there were no measures to quantify this quality dimension. In addition, there have been new hospital challenges and other providers have had to deal with additional costs for personal protective equipment (PPE) and infection control protocols.
- Capacity limitations. With so much effort used to treat COVID-19, there was less space and staff available to treat other patients with other diseases.
- Mixture of cases during COVID-19. During the pandemics of the pandemic, many people did their best to avoid going to the hospital. Thus, most of the people who went to the hospital during COVID-19 were those who had no other choice. Thus, it can be expected that the acuity of patients who are not COVID admitted to hospitals during the pandemic will be more severe than normal.
- Mixture of cases after COVID-19. The mix of patient cases after COVID-19 may also be more severe. Some people may be reluctant to receive preventive or maintenance care during the pandemic; others may have undergone the necessary surgeries. Thus, patients after the pandemic may also present with more acuity due to decisions to delay necessary care.
In short, data on the quality of care during the pandemic are unlikely to be comparable to previous or subsequent years. These problems pose a challenge to payers to make a fair refund, while continuing to reward high-value care. Salzberg and Khan he concludes by saying:
While the full impact of COVID-19 on hospitals and health systems is yet to be understood, understand the specific impact and predict effects on the data it can help direct analysis, ensure that we do not mislead patients with invalid data, nor incorrectly penalize hospitals for providing care during a period of coercion for which we cannot know the extent of the impact.