We’ve also seen organizations like American Kidney Fund fund at-home dialysis for patients to comply with social distancing and remain at home to avoid disease spread – and they filled their spots within a single business day! Organizations are also releasing best practices on how to get one’s treatment while also staying safe – every little bit of this helps.
NAACOS even wrote a letter to CMS to call for adjustment to value-based payments to ensure that clinicians and ACOs were not negatively impacted by COVID-19.2 While CMS is considering these adjustments, how can ACOs be more proactive and help their clinicians that may be negatively impacted?
Fill out the form to access our special report that helps with scenario planning and understanding the potential impact of COVID-19 on your organization.
Implications for ACOs
NAACOS has estimated that the potential cost to Medicare of the COVID-19 epidemic over the next 12 months could range from $38.5 billion to $115.4 billion.3 Although CMS has invoked the MSSP extreme and uncontrollable circumstances policy in their March 30th Interim Final Rule, it doesn’t mean that ACOs are off the hook.4 This regulation will help – it states that CMS will mitigate the amount of shared losses an ACO must pay back to CMS as it relates to beneficiaries in areas impacted by the diseases (during the time of the pandemic). However, it does nothing to prevent ACOs from being forced to take on more risk in 2021 nor does it make adjustments to the benchmark or expenditures for higher than typical spending associated with these global events.4
Farzad Mostashari believes that MSSPs are prepared for COVID-19 in the way the Pathways to Success program was designed.5 He believes it protects primary care practices from most cost increases due to the outbreak. Since the Pathways program is set up so that ACOs need to perform better than the regional and national cost trends, the assumption is that everyone’s performance will rise, thereby raising the benchmark. While that will almost certainly be the case, we need our ACOs to help curb that increase as much as possible by being proactive and by reaching out to their patients that need it the most.
It’s important to note that telehealth can be provided to all patients, new and established, COVID-19 positive or negative and that the cost-sharing will be waived accordingly.6 Regardless of the stage in their value-based care journey, every ACO can do something to help their cause. In our previously released “Call To Action”, we profile several different priorities or actions that need to be taken, including “Opening up more public data”. While we at CareJourney only have a small role to play, we are doing our best to abide and are opening up additional data for you to access. By navigating to our analysis, users will be able to use the dashboard to better understand what the pandemic could cost their ACOs as it relates to Inpatient costs. We have released this so that ACOs can better understand the impact if they don’t act now. We recommend that all organizations consider the following four actions:
- Determine the potential impact
- Evaluate your vulnerable population
- Proactively reach out to your vulnerable populations
- Utilize your best practices
Determine the potential impact by leveraging public data to estimate the impact to your bottom line. Accounting for some assumptions from a Fair Health Article, we can assume a 20, 40, or 60% incidence rate, 50% of your affected population will seek treatment, and of that, 15% will need an Inpatient stay.6 These numbers will allow you to do various scenario planning exercises to take the next step and realize there is plenty that you can do.