Ten years ago, the Affordable Care Act became law in order to reduce health care costs by encouraging doctors, hospitals, and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Formation of accountable care organizations (ACOs) in the Medicare program was a centerpiece of this approach. Results of a survey conducted in April 2020 by the National Association of ACOs (NAACOS) indicate that ACOs are highly concerned about the effects of COVID-19 on their organizations. Nearly 60% of respondents in risk-based models reported they are likely to quit the ACO program to avoid financial losses stemming from the pandemic, and 77% reported they are “very concerned” about the impact of COVID-19 on their ACO’s 2020 performance.
A likely driver for ACOs to exit the program is the uncertainty about costs, quality, and utilization for 2020. COVID-19 has upended normal utilization and care patterns, disrupting ACOs’ ability to employ successful population-health strategies and causing tremendous uncertainty about costs. Notable uncertainty exists on how the pandemic will affect other aspects of the ACO program, such as changes to acuity or risk scores, diminished opportunities to meet quality requirements related to preventive care, and which patients the ACO will be accountable for this year. This uncertainty was strongly noted by survey respondents in comments, with 65% reporting that the scope of the effects of COVID-19 will make it difficult for them to predict their ACO’s 2020 performance accurately.
Loosening By CMS Of Telehealth And Scope Of Practice Regulations
April 2020 marked a temporary suspension of certain regulations by the Centers for Medicare & Medicaid Services (CMS) to make it possible for providers, such as hospitals to have more flexibility in offering clinical services in response to the current pandemic. Physicians will be able to furnish care for patients across state lines using telehealth and online communication to coordinate with nurse practitioners at rural clinics without having to be physically present. The agency also is making it possible for nurse practitioners to perform some medical exams on Medicare patients at skilled nursing facilities. Other providers, such as occupational therapists will be allowed to offer as much care as their licenses will allow. An example is that these clinicians will be able to perform initial assessments on certain homebound patients, allowing these services to begin earlier.
U.S. Constitution’s Fourth Amendment And COVID-19 Digital Surveillance And Privacy
South Korea and Israel are examples of nations that have employed digital surveillance measures using cell phone location data, among other means, in an effort to track and limit the transmission of COVID-19. In the U.S., the federal government and some state and local governments reportedly have begun to gather geolocation data voluntarily provided by the mobile advertising industry to assess how individuals are continuing to move and congregate during the pandemic. This development has led to speculation about the potential in this country for more invasive, obligatory data collection and tracking practices emulating the measures taken in some other parts of the world. A legal sidebar issued by the Congressional Research Service (CRS) on April 16, 2020 provides an overview of the Constitution’s Fourth Amendment, along with certain relevant doctrines and exceptions before discussing how the relevant legal frameworks could apply to coronavirus-related government surveillance.
The Fourth Amendment protects against “unreasonable searches and seizures” and provides that “no Warrants shall issue, but upon probable cause,” among other things. The Supreme Court has recognized that the fundamental purpose of the Amendment “is to safeguard the privacy and security of individuals against arbitrary invasions by governmental officials.” The question of whether official action has run afoul of the Amendment’s dictates entails consideration of at least two distinct analytical components: (1) the existence of a search or seizure, and (2) the reasonableness of that search or seizure. Not only does the federal government play a central role in the provision and payment of health services, it has a duty to protect the inhabitants of the U.S. when their lives are threatened. What may need to be resolved at some future juncture is how extensive such protective efforts can be while continuing to adhere to provisions of the U.S Constitution.
More April 2020 TRENDS Articles
CALLING ALL CARS AND HEALTH DETECTIVES
Indicates the important role that epidemiologists play in explaining what is transpiring at key stages of COVID-19. Read more
PRESIDENT’S CORNER
ASAHP President Phyllis King discusses how with the thrust into the digitization of healthcare, the question for higher education is how fast can we understand, adapt, anticipate and project patient care needs and healthcare innovations to prepare our students and meet the needs of this new world? Read more
FAST CHANGING LEGISLATIVE ENVIRONMENT
Depicts efforts by the federal government to provide additional funding through Paycheck Program Protection legislation, along with an increasing concern that the U.S. is too dependent on other nations for supplying minerals used in the production of pharmaceuticals and medical devices. Read more
HEALTH REFORM DEVELOPMENTS
Points out how the existence of accountable care organizations (ACOs) is threatened by the current pandemic; describes COVID-19 surveillance activities in relation to the Fourth Amendment of the U.S. Constitution; and loosening by the Center for Medicare & Medicaid Services (CMS) of telehealth and scope of practice regulations. Read more
DEVELOPMENTS IN HIGHER EDUCATION
Describes a recent ASAHP webinar on clinical education; a statement of principles on academic credit; and whether regional higher education accreditation should go national. Read more
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Lifetime Prevalence Of Self-Reported Work-Related Health Problems Among U.S. Workers
National Health Expenditure Projections, 2019-2028
Skin-Interfaced Biosensors For Wireless Physiological Monitoring In Neonatal And Pediatric Intensive-Care Units
Bacterial Colonization Reprograms The Neonatal Gut Metabolome Read more
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
Brain Health Across The Lifespan
Leading In A Time Of Crisis: Corporate America And COVID-19
Confronting Rural America’s Health Care Crisis Read more
RACIAL DISPARITIES IN AUTOMATED SPEECH RECOGNITION SYSTEMS
Mentions how these tools do not work equally well for all subgroups of the population, with study results showing that all five ASR systems in an investigation exhibited substantial racial disparities, with an average word error rate (WER) of 0.35 for black speakers compared with 0.19 for white speakers. Read More
ESTABLISHING HIGH PERFORMING TEAMS: HEALTH CARE LESSONS
Refers to a study that shows while both Functional Change and Cultural Change processes were individually important for enhancing team-based health care, they were most effective when mobilized in tandem. Read more