Duke Margolis Center for Health Policy, Families USA, United States of Care Send Letter to Hill Asking for Key Health Reforms in Next COVID-19 Legislative Package

The COVID-19 pandemic has sent shockwaves throughout our health care system, forcing health care providers to rearrange staffing, modify facilities, rely heavily on telehealth and community-based care, and reimagine the best way to support patients – all while facing significant and persistent revenue shortfalls. Physician practices have seen declines of up to 50% in service volume and hospitals are projected to lose at least $323 billion in 2020.

This is a problem largely created by a health care system that is propped up by a fee-for-service (FFS) payment model which specifically rewards volume over value when it comes to patient care. In the midst of this national crisis, provider organizations are finding that FFS offers no backstop when utilization drops, forcing many practices to close their doors and preventing families from being able to access critical health care services. And meanwhile there is no payment for keeping a community in good health.

These system failures also expose an important opportunity: While not immune to all pandemic complications, providers and systems who participate in value-based payment arrangements such as alternative payment models (APMs), have been more financially stable, more adaptable, and more responsive to evolving patient needs. They were better positioned to adapt to dramatic changes in patient volume, and quickly responded with innovative care coordination, patient engagement tools such as phone apps and 24/7 help lines, robust data analysis, and infrastructure supporting telehealth, remote monitoring, and home and community-based care.

In short, APM providers have been able to quickly implement an effective pandemic response, while FFS providers have had to rely on outdated rules and dramatic payment changes in order to move forward with obvious and necessary reforms.

The health, safety, and economy of our country is dependent on a viable health system throughout this crisis and beyond. It is critical that we ensure health care providers have sufficient resources and flexibility to meet evolving patient needs through the remainder of the health emergency and long into the future.

We urge Congress to include the following recommendations in the next COVID-19 relief and stimulus legislation:

• Enact a COVID-19 Health Care Relief, Response, and Resilience Program.
• Expand Telehealth Coverage.
• Expand Site-Neutral Payments.
• Enhance Data and Transparency on Quality and Cost of Care.