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COVID-19: Elective Surgeries, Quality Programs, Targeted Inspections

The Centers for Medicare & Medicaid Services (CMS) on March 18 recommended providers delay all elective surgeries and nonessential medical, surgical, and dental procedures during the COVID-19 pandemic.

This recommendation aims to preserve personal protective equipment (PPE), beds, and ventilators; free up health care workers to care for patients with greatest need; and limit exposure to the virus. The recommendations use a tiered framework to classify procedures by factors including acuity of the procedure and health of the patient, as well as availability of beds, staff, and PPE. CMS recommends providers postpone procedures in tiers 1 and 2; however, decisions remain the responsibility of local health care delivery systems, including state and local health officials.

CMS Grants Quality Reporting Exceptions

The agency on March 22 announced it will grant reporting requirement exceptions and extensions for Medicare quality reporting program participants.

For Quality Payment Program Merit-based Incentive Payment System (MIPS) and Medicare Shared Savings Program accountable care organizations, CMS extended the 2019 data reporting deadline from March 31 to April 30, 2020. MIPS-eligible clinicians who have not submitted 2019 data by April 30 will qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will receive a neutral payment adjustment for the 2021 payment year. The agency is exploring relief options for 2020.

For hospital quality reporting programs, CMS deemed optional data submission for Oct. 1–Dec. 31, 2019. The agency will not count data from Jan. 1–June 30, 2020, for performance and payment programs. For the Hospital-Acquired Condition Reduction and Hospital Value-based Purchasing programs, the agency will use data from Jan. 1–March 31, 2020,  if submitted, to score programs, but submission is not required.

CMS Further Targets Facility Inspections

The agency announced a new focused inspection process after a recent nursing home inspection in Kirkland, Wash., the epicenter of the COVID-19 outbreak in that state. Under the focused survey process, during the next few weeks, CMS will only prioritize and conduct these types of federal inspections:

  • those related to complaints and facility-reported incidents that are triaged at the Immediate Jeopardy level;
  • targeted infection control inspections of providers identified through CMS collaboration with the Centers for Disease Control and Prevention, using a streamlined targeted review checklist; and
  • self-assessments by providers and suppliers of their infection control plans, using the same checklist.

CMS notes that this new process is not intended to be punitive, but rather to respond to urgent issues while ensuring providers are compliant with federal health and safety standards.

New Telehealth Toolkit

The agency on March 20 released two digital telehealth toolkits to inform providers about virtual care, vendor options, launching a telehealth program, documenting visits, and offering temporary services during the COVID-19 pandemic.

One toolkit focuses on general providers; the other is tailored to providers caring for patients with end-stage renal disease.

Joint Commission Suspends Surveys

Effective March 16, The Joint Commission is suspending all regular surveying, with the exception of surveys in high-risk situations. Accreditation will automatically be extended when organizations go past their due date with no effect on Medicare payment.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Emily Schweich is a senior communications associate for America's Essential Hospitals.

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