June 29, 2020
When my first letter was distributed, our country was in the midst of the COVID-19 pandemic. That was April 6th, and none of us were performing elective surgeries. Since then, we have experienced a return to some sense of normalcy, only to see a resurgence of COVID-19 in certain “hotspots.” For example, last Thursday, Texas Governor Greg Abbott issued an Executive Order suspending all elective surgeries in those counties that contain the cities of Dallas, Austin, Houston and San Antonio. It appears that, as experts have warned, COVID-19 may be with us until we either achieve herd immunity or a vaccine is available. Hopefully, these bans on elective surgery will be short-lived and sporadic.
The federal government has taken advantage of the recent lull in COVID-19 cases to refocus on its pre- COVID-19 programs. On June 22nd, the Centers for Medicare & Medicaid Services (CMS) called for a renewed national commitment to value-based care based on Medicare claims data. The data includes the total number of reported COVID-19 cases and hospitalizations among Medicare beneficiaries from January 1 to May 16, 2020, broken down by state, race/ethnicity, age, gender, dual eligibility for Medicare and Medicaid, and urban/rural locations. These findings bolster previous findings by the Centers for Disease Control and Prevention (CDC) that older Americans, those with chronic health conditions, and members of minority groups are at highest risk for COVID-19. The data highlights deep disparities in infection rates and hospitalizations (look out for a new advocacy podcast episode on this topic airing tomorrow, June 30th). For example, Blacks had the highest hospitalization rate among racial/ethnic groups, with 465 per 100,000. Hispanics had 258, Asians had 187, and Whites had 123. CMS Administrator Seema Verma wrote that the fee-for-service system has clearly not been able to respond to this pandemic; hence, the need for a move to value-based care is more urgent today than ever before. Thus, it is clear that value-based medicine and alternative payment models are here to stay.
As we have detailed in previous letters, the federal government has created additional flexibility for many quality programs for the duration of the public health emergency. They include the CMS Hospital-Acquired Condition (HAC) Reduction Programs, the Bundled Payments for Care Improvement (BPCI) Initiative Advanced Model and the Comprehensive Care for Joint Replacement (CJR) Model.
Continuing on this theme, this week CMS announced that clinicians can opt out completely or partially from the 2020 Merit-based Incentive Payment System (MIPS) program. To opt out, the surgeon must complete a hardship exemption application by December 31, 2021, indicating that it is due to the COVID-19 public health emergency. This is a welcome relief from the MIPS reporting burden.
This Saturday is July 4th, the day we celebrate our nation’s birth. Although our country is far from perfect, I truly believe that, despite our current situation, we are fortunate to be living here at this time in history. Because of the holiday weekend, the next letter you receive from me will be on July 13th.
Have a safe and relaxing Independence Day!
Joseph A. Bosco, III, MD, FAAOS
AAOS President