The Quality Payment Program (QPP) is slated to retrench slightly due to COVID-19, but take note of several big news items: You’ll find a new reporting scheme for MIPS Alternate Payment Models (APM), a smaller than-expected rise in the overall performance threshold and several telehealth innovations.

by: Roy Edroso 

The first half of 2020 was an extraordinary time for the United States. Quality leaders are beginning to assess how the COVID-19 pandemic response will affect the quality metrics of hospitals for months after the emergency subsides. What will those metrics look like?

They may not look great, and accreditors might be prompted to use a form of “compassionate surveying” when it comes to revelations of noncompliance during this period.

Even after the pandemic winds down, the experience is likely to leave a significant and lasting effect on quality metrics, says Lauren Patrick, founder and president of Healthmonix, a healthcare analytics company based in Malvern, PA.

There are several components to the effect on quality metrics, she says. First, what will the quality metrics show in terms of quality of care? Will quality, measured via the clinical quality measures that are reported, remain at the same level?

“Changes in the performance of clinical quality metrics may be affected in a variety of ways. Chronic care management and preventive care measures may suffer due to missed appointments, clinical transformations, and providers’ focus on immediate issues during the initial period,” Patrick says. “Focus on urgent care, first and foremost, may impact the focus on nonemergent care.”

Metric Effects Uncertain

Secondly, there will be two factors that contribute to a change in the metrics, Patrick says. Depending on how well the quality protocols and standards of care are embedded in a practice at the beginning of the pandemic, there may be a temporary or longer-term decrease in those numbers, she explains.

“A decrease may be due to high-priority urgent care needs that cause a lack of focus on the quality actions that are normally included. A decrease may also be temporarily seen by physicians who are transforming their clinical practices to accommodate new strategies and protocols so swiftly,” Patrick notes. “As physicians quickly move to telehealth or shift roles due to layoffs or urgent care needs, workflows may need to be redesigned to accommodate the changes and ensure that outcomes continue to be achieved and documented.”

Hospital quality leaders already strained by the COVID-19 pandemic welcomed the decision from the Centers for Medicare & Medicaid Services (CMS) to delay reporting deadlines for the Merit-Based Incentive Payment System (MIPS) and not require reporting or use data from the initial pandemic period for Medicare quality reporting and value-based purchasing programs for future payment years.

By Paula Hartman-Stein, Ph.D.

The first quality improvement system implemented by the Center for Medicare and Medicaid services (CMS) in 2007 was designed to improve healthcare quality and reward clinicians for their efforts. The newest iteration, the Merit-Based Incentive Payment System (MIPS), has similar goals but focuses on value not volume while saving money for CMS by making it more difficult for clinicians to obtain bonuses while raising penalties.