The COVID-19 pandemic has disrupted nearly every aspect of healthcare, from worker protections to hospital capacity systems to supply chain management.
But the sheer overwhelming nature of the crisis has caused some other important storylines to receive less attention than they would in a pre-pandemic world.
Some movement is occurring despite the threat of the novel coronavirus, like regulatory efforts to increase transparency around consumer costs for services, a fight still ongoing in the courts. Legislative efforts like those to ban surprise medical bills, however, have significantly slowed despite patients still receiving them and bipartisan agreement a fix is necessary.
Others have been pushed along by COVID-19. Many smaller ripples of change that were underway, such as migration to telehealth and increases in home health services, have found a catalyst in the pandemic, experts say.
"I think the pandemic really sped up a lot of stuff that was going to happen anyway," said Rick Gundling, vice president of the Healthcare Financial Management Association.
As the pandemic rages on in the U.S., here's a look at issues flying somewhat under the radar.
Price transparency going strong
While HHS and CMS have delayed many initiatives and rules due to the pandemic, regulators seem to be going full steam ahead on the bid to mandate hospitals post prices for certain services.
The fight is still wrapped up in a court battle, though a three-judge panel seemed skeptical of industry arguments against the effort last week. The requirement is currently set to go into effect Jan. 1.
CMS recently posted a new website outlining the requirements and giving more information — plus a complaint hotline — to patients. Also, President Donald Trump last month issued an executive order telling CMS it should state whether a hospital is in compliance with the guidelines on its Hospital Compare website.
These actions suggest the agency isn't backing down on its timelines.
Bryan Niehaus, vice president at consultancy Advis, said the readiness among providers "is going to be as diverse as our healthcare landscape," but most he's talked to plan to try to be fully compliant.
"I've heard rumors that organizations may decide to take daily fines and see if something changes as there's possible turnover in the administration, but from what we're hearing everybody is working to get compliant by Jan. 1," he said.
CMS has admitted in the past, however, that it has little leverage to enforce its rule. No further advancements in that area have been shown.
An agency spokesperson said earlier this month that CMS has the authority to judge compliance by monitoring hospitals websites in addition to evaluating complaints.
"Should CMS conclude a hospital is noncompliant with one or more of the requirements to make public standard charges, CMS may assess a monetary penalty after providing a warning notice to the hospital, or after requesting a corrective action plan from the hospital if its noncompliance constitutes a material violation of one or more requirements," the spokesperson said.
If the hospital doesn't comply with a corrective action plan, CMS may impose a penalty of up to $300 a day, and publicize that fact on its website.
When asked whether the agency has a plan to do regular audits of hospital websites, the spokesperson said "CMS may self-initiate the audit of a hospital's website."
Niehaus said the rule could also prompt systems to look at their chargemasters and consider how the public will react. "Trying to identify any outliers or any charge structures that should be renegotiated ahead of Jan. 1, I think, is one of the higher pressures that some of these systems are looking at trying to get in place while they've lost valuable time during the pandemic in spring and throughout summer."
Gundling agreed that CMS doesn't seem likely to back down, nor will patient advocates. "We can debate the intricacies of whether that rule is the right rule or it's the right precedent, but certainly transparency is not going away," he said.
Companies rush to go public
A drought of digital health IPOs abruptly ended over the past 12 months with a flood of companies announcing plans to trade on the stock exchange. That comes among record digital health investment that has followed the realization that telehealth is likely to have a permanent place in routine care even after the pandemic.
Some IPOs were last year, mostly in the medtech space. They included chronic care management platform Livongo, analytics company Health Catalyst, software-as-a-service firm Phreesia and software vendor Change Healthcare.
But in recent weeks and months, virtual care and other tech-forward companies have gotten on board.
SOC Telemed, formerly Specialists on Call, announced a blank check deal to go public in late July. The acute care telemedicine company was valued at about $720 million.
In August, telehealth vendor Amwell filed its IPO with a $100 million backing from Google. Smaller vendor Hims & Hers also used a blank check deal to trade on the New York Stock exchange through a plan announced earlier this month.
Less tech-focused companies are also getting listed. That includes Medicare Advantage startup Clover Health and primary care chains Oak Street Health and One Medical (announced before the pandemic began in the U.S.)
|One Medical||Jan. 3||$1.7B|
|Oak Street Health||July 10||$5B|
|SOC Telemed||July 30||$720M|
|Hims & Hers||Oct. 1||$1.6B|
|Clover Health||Oct. 6||$3.7B|
Stephanie Davis, an analyst with SVB Leerink, said the surge in IPOs shows that the sector was poised for growth but needed a catalyst. That push came fast and furious in the form of the pandemic.
"The question has always been what would make people invest," she said.
Surprise billing efforts slow to crawl
Although the COVID-19 crisis has if anything highlighted the frustration of patients getting an unexpected bill from a provider they didn't realize was out-of-network, any momentum from last year toward a fix was effectively halted by the pandemic.
At the end of last year, lawmakers came close to a deal for legislation that would ban surprise medical bills, but industry influence scuttled an agreement as payers and providers remain deeply divided over potential methodology.
Some emergency legislation addressing the pandemic banned surprise bills for COVID-19 testing and treatment, although reports of the practice still surfaced. Including a more permanent fix was discussed, but only briefly.
More relief bills were expected after the Coronavirus Aid, Relief, and Economic Security Act passed in March, but gridlock in Congress that has intensified in the leadup to the November election has kept an agreement at bay.
Both presidential candidates say surprise billing is a focus for them, but neither has outlined how they would implement a ban. Despite the White House once backing a bill that included a rate-setting element favored by payers and loathed by providers, HHS has most recently said it emphasizes the need for legislation but will not state a preference for methodology.
Niehaus said he expects bipartisan legislative action eventually, but not likely before the end of the year.
Gundling, however, said he's hopeful providers and payers will step up to work together and solve the issues themselves. "I think the private sector is going to continue to move forward on it. I think patients and patient groups are going to continue to push on it," he said.
Preference for healthcare at home
As with telehealth more broadly, a pivot to providing more services in a patient's home isn't new, but the necessities of the pandemic and the associated stay-at-home orders supercharged the movement. Experts said that will continue as hospitals form new and more hybrid models of care delivery.
Oak Street, for example, serves an older population at high risk for severe COVID-19 symptoms, and realized it quickly had to adapt what had been a "very high-touch primary care model," Senior Medical Director Olaoluwa Fayanju said last week at HLTH.
The company surveyed members and found they did not want to travel outside their home, so Oak Street took vans that had been used to take patients to their clinics and started using them to deliver internet-connected tablets that people could use to complete a video visit. It also sent out remote monitoring tech like pulse oximeters and continuous glucose monitors. "Adoption was strong," Fayanju said.
Some big health systems are making moves in that direction as well.
Intermountain Healthcare in June announced a new service that provides hospital-level care in the home for certain conditions. It touted the move as a way to better understand how a patient lives their daily lives. Keeping a patient out of the hospital also helps with overhead costs.
Universal Health Services entered into a definitive agreement with Bayada in July to provide post-acute home care.
And CMS isn't standing in the way. It has proposed a rule that would permanently roll back restrictions lifted for the public health emergency, including remote patient monitoring. The agency is also considering a 2.6% increase in payment for home health providers, which would help spur adoption of the care model.
Gundling said health systems are starting to take a breath after the acute stress test of the pandemic. Now they can re-evaluate where their resources should be going.
"I think they're kind of looking at the whole of how they responded to the pandemic and learning from that what was needed and what wasn't, how resilient they were, and go from there," he said. "I think part of that is just understanding what the new normal is."
Correction: An earlier version of this article misspelled the name of Advis Vice President Bryan Niehaus