OAHHS Hospital Voice Fall/Winter 2020

20 » A magazine for and about Oregon Community Hospitals. Not only has COVID-19 boosted the stature and role of telehealth, the virus has also sharpened the focus on an issue that’s long been simmering in the hospital world: value-based payment or care. Essentially a form of reimbursement that links payment for care to the quality of care and the efficiency of providers, value-based care has been discussed as an alternative to the traditional fee-for-service model for years. Rebecca Tiel, director of public policy for OAHHS, said the discussion around value- based care has been underway in Oregon for nearly a decade, but it’s never really come to the surface. COVID-19, however, has changed that. “It’s really put a spotlight on the antiquated payment system of a fee-for-service model based on volume,” Tiel said. What pushed the discussion to the forefront was the fact that, during COVID-19, people haven’t been coming into hospitals the way they did before. If people aren’t coming in and needing services, then hospitals aren’t able to generate revenue. In April alone, Oregon hospitals were losing about $13 million every day. “That really exposes these facilities because their operational costs are not going away just because people are not showing up,” Tiel said. “There is inertia for payers and providers to come together and talk about other ideas.” At this point, talk is all it might be. But Tiel said there is a decent chance that value-based care could see some movement, particularly with public payers like Medicaid and Medicare. Those might be good places to begin testing the waters and seeing what works well—and what doesn’t. Tiel also said the focus could slip back from value-based care models when the country controls the pandemic, but she said there’s still likely to be a push away from fee-for-service. “I anticipate we’ll still go in this direction,” she said, “but you just never know.” HOW COVID-19 COULD CHANGE THE WAY HOSPITALS ARE PAID HHS relaxed rules with a waiver, allowing more providers to offer telehealth to more patients from more facilities. They added 135 services, including emergency department visits, initial patient and nursing facility visits and discharge day management services that could be delivered via tele- health. Additionally, Oregon's Department of Consumer and Business Services directed commercial health insur- ance plans to cover telehealth services at the same rates as in- person ones. Platforms that had before not been permitted for telehealth, such as Zoom and Facetime, were now allowed, at least during the pandemic. The result? Nationally, while tele- health accounted for just 0.1 percent of Medicare primary care visits in February, by April it was more than 43 percent. In Oregon, telehealth made up 46 percent of total visits in April. “With regulations being lessened, it really opened it up,” said Michelle Gardner, clinic director at Wallowa Memorial Medical Clinic in Enter- prise, which is affiliated with Wallowa Memorial Hospital (WMH). She said prior to the pandemic, the clinic had not been able to offer much telehealth, but since the waiver patients have received virtual office visits, physical therapy, and some other services. Despite a few bumps over reimbursement at the start of the pandemic, Gardner said the expanded telehealth services have been going well. Joe Wanner, Chief Financial Officer for WMH, said the hospital hasn’t expanded its telehealth offerings markedly, but it has been offering