Impact of COVID-19 on Oregons health care providers Oregon Health - - PowerPoint PPT Presentation

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Impact of COVID-19 on Oregons health care providers Oregon Health - - PowerPoint PPT Presentation

May 18, 2023 226 likes •660 views

Impact of COVID-19 on Oregons health care providers Oregon Health Policy Board Informational Session September 2020 1 Today 1. Overview 2. Initial impact of COVID-19 3. Ongoing impact 4. Reflections 5. Financial support strategies 6.

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Impact of COVID-19 on Oregon’s health care providers

Oregon Health Policy Board Informational Session September 2020

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Today

  • 1. Overview
  • 2. Initial impact of COVID-19
  • 3. Ongoing impact
  • 4. Reflections
  • 5. Financial support strategies
  • 6. Ongoing monitoring
  • 7. Q&A

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Today

  • 1. Overview
  • 2. Initial impact of COVID-19
  • 3. Ongoing impact
  • 4. Reflections
  • 5. Financial support strategies
  • 6. Ongoing monitoring
  • 7. Q&A

This is an information session, not an

  • fficial Oregon Health Policy Board

meeting. Please type questions into the chat box, and we’ll discuss at the end. Submit public comment to OHPB: HealthPolicyBoard.Info@state.or.us

Reminder

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  • 1. Overview

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COVID-19 has had a major impact

  • n Oregon’s

health care system and providers

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Fewer patient visits Lost revenue Laid off / furloughed staff Office closures Stress and burnout New ways of providing care

COVID-19 has had a major impact

  • n Oregon’s

health care system and providers

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The Short-Term Provider Financial Sustainability (STFS) Workgroup

Convened in early May to

  • Monitor state and federal financial supports
  • Coordinate across programs and agencies
  • Identify additional financial supports for providers
  • Support communications to providers about resources

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  • 2. Initial Impact of COVID-19

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Outpatient utilization plummeted ~60% by early April

https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits Sources: Ateeva Mehrotra, Michael Chernew, David Linetsky, Hilary Hatch,and David Cutler, “The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges,” The Commonwealth Fund and Phreesia. Data from from Phreesia’s clients, which include more than 1,600 provider organizations representing more than 50,000 providers across all 50 states. 9

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The drop in outpatient visits varied by provider type

https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits

  • 30%
  • 46%
  • 47%
  • 51%
  • 55%
  • 61%
  • 62%
  • 63%
  • 63%
  • 66%
  • 73%
  • 79%

Behavioral Health OB/GYN Oncology Primary Care Allergy/Immunology Cardiology Pediatrics Urology Pulmonology Surgery Dermatology Opthalmology

Percent change in visits from baseline, by early April

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Oregon providers also experienced this drop

Percent of Oregon Primary Care Practices reporting…

a decline in patient volume >50% decline in patient volume

81.9% 96.9% 89.8% 70.4% 62.2% 54.6%

April 10-13 April 17-20 April 24-27 May 1-4 May 8-11 May 15-18

https://www.ohsu.edu/oregon-rural-practice-based-research-network/hot-topics 11

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Percent of Oregon dental practices’ status, by week

https://www.ada.org/en/science-research/health-policy-institute/covid-19-dentists-economic-impact/survey-results

63.9% 82.9% 81.7% 86.3% 85.5% 25.6% 10.0% 15.9% 11.8% 11.8% 7.5% 3.6% 23-Mar 6-Apr 20-Apr 4-May 18-May

  • pen and business as usual
  • pen but lower patient volume than usual

closed by seeing emergency patients only closed and not seeing any patients

Initially, 98% of practices were closed By May 4th, two-thirds of practices were open, but most were seeing lower patient volume than usual

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Drops in utilization resulted in decreased revenue for providers

Healthcare Professionals and the Impact of COVID-19: A comparative study of revenue and utilization. FAIR Health. June 2020.

3% 3%

  • 60%
  • 80%

3% 7%

  • 55%
  • 79%
  • 100%
  • 80%
  • 60%
  • 40%
  • 20%

0% 20%

Jan Feb March April

Percent change in commercial utilization and revenue (estimated allowed amounts) from 2019 to 2020 across all professional services.

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Estimates of lost revenue for Oregon providers

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Primary Care Behavioral Health

Expected Q2 2020 total revenue $227.7 - $243.9 million $87.9 - $94.6 million Estimated drop in revenue 50% 30% Estimated Q2 2020 $ loss $113.9 - $121.9 million $26.4 - $28.4 million

Data source: Oregon’s All Payer All Claims data, CY 2018. All revenue calculated using allowed amounts. Primary care providers identified using definitions from Oregon’s Primary Care Spending Report, applied to all carriers. Behavioral health providers identified using Actuarial Services

  • categorization. Total revenue adjusted for inflation using CPI-medical. Lower bound not adjusted, upper bound adjusted for 2019. Commercial

revenue adjusted to account for self-insured population (ERISA) not in APAC data: 6-12% depending on churn.

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Oregon hospitals reported over $600 million in operating losses in March and April, and a 41% reduction in inpatient revenue Over 50% of Oregon physicians report financial stress is at an all-time high 70% of Oregon respondents to a survey conducted by the National Council for Behavioral Health indicated they didn’t think they could survive past 3 months Income for Oregon health care interpreters dropped by about 75% on average

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  • 3. Ongoing Impact

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Nationally, by August 1, outpatient visits rebounded to about 90% of what they were in March

Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550 17

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18 Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550

In person visits All visits

Most of the rebound is in-person visits

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19 Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550

But the rebound varies by specialty

Dermatology Adult primary care Behavioral health Pediatrics

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20 Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550

And by insurance type

MEDICARE COMMERCIAL MEDICAID

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85.8% 92.9% 94.8% 67.8% 47.0% 19.0% 11.9% 6.6% 12.8% 1.2% 5.2% 7.1% 2.4% 3.2% 21.2% 30.8% 36.4% 20.8% 14.1% 9.6% 10.6% 2.6% 2.4% 2.4% 1.1% 8.5% 15.4% 29.1% 32.7% 38.0% 35.1% 31.8% 23.4% 3.6% 2.4% 1.1% 2.5% 6.9% 15.5% 34.7% 41.3% 42.6% 56.5% 68.8%

23-Mar 6-Apr 20-Apr 4-May 18-May 1-Jun 15-Jun 29-Jun 13-Jul 27-Jul 10-Aug

Oregon dental practices reporting their total collections as % of typical

American Dental Association, Health Policy Institute. Economic Impacts of COVID-19 on Dental Practices biweekly survey. Data for Oregon respondents.

<25% 25%-50% 51-75% 76-99%

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Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 11 (May 22-25)

Percent of Oregon primary care practices responding to how many weeks or months of financial reserves they have remaining

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Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 15 (June 26-29)

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Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 17 (July 24-27)

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Oregon primary care practice stress in late July compared to the first month of the pandemic

15.2% 13.0% 30.4% 19.6% 13.0% 8.7%

It seems worse - we are struggling It seems worse - but we are sadly now used to it It's the same - but over time, harder to bear It's the same - but over time, we've adjusted It's getting better Other

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Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 19 (August 21-24)

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60% 35% 70% 73% 100% 43% 18% 40% 28% 85%

food insecurity domestic violence housing insecurity struggle paying bills mental health concerns

Seen higher levels of Been more involved in assisting with

Percent of Oregon primary care practices reporting that they have

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  • 4. Reflections

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  • 5. Financial Support Strategies

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Congress appropriated $175 billion in Provider Relief Funds

https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html

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Provider Relief Fund allocations to date, in billions

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As of August 3rd ~$700M has been distributed to 3,235 Oregon providers from the CARES Act Provider Relief Fund

https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx

Hospitals and affiliates: $389.7M

37 recipients

Other Providers: $311M

3,198 recipients

Oregon E-Board has allocated $50M of state Coronavirus Relief Funds for grants to rural hospitals in addition to above.

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1,094 Oregon providers received less than $1,000 to date from the Provider Relief Fund

Federal distributions as of August 3, 2020. 25 90 74 517 388 1124 644 317 67 17

<$10 $10-$50 $51-$100 $101-$500 $501-$1,000 $1,001 - $10,000 $10,001 - $100,000 $100,001 - $1 million $1-10 million >$10 million

3 providers received only $2!

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Many Oregon health care organizations received support from the Paycheck Protection Program

PPP Loan Amount # of OR recipients (all businesses) # of OR health care industry recipients Health care industry as % of OR recipients $5 - $10 million 54 10 18.5% $2 - $5 million 340 52 15.3% $1 - $2 million 654 62 9.5% $350,000 - $1 million 2,783 258 9.3% $150,000 - $350,000 5386 537 10.0% Total 9,217 919 10.0%

Source: Oregon summary of federal PPP data as of July 2020. More details https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx

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Source: Oregon summary of federal PPP data as of July 2020. More details https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx

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Source: Oregon summary of federal PPP data as of July 2020. More details https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx

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State level strategies

CCO 2019 Quality Pool – early distribution Medicaid FFS Provider Stability Program Rural Hospital Stabilization Program $25 million for behavioral health services

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CCO distribution of 2019 quality pool dollars

98% 71% 100% 98% 98% 100% 92% 98% 98% 98% 100% 87% 98% 89% 100%

Advanced Health AllCare Cascade Health Alliance Columbia Pacific Eastern Oregon Health Share Intercommunity Health Network Jackson County PacificSource - Central PacificSource - Gorge Primary Health Trillium Umpqua Health Alliance Willamette Valley Community Health Yamhill Community Care

Preliminary data: Percent of funds distributed to providers, and amount distributed. Reminder: CCO quality pool size is based on membership.

$ 2,417,768 $ 3,644,361 $ 2,158,805 $ 3,292,535 $ 6,145,938 $ 35,210,323 $ 6,021,905 $ 3,241,932 $ 5,819,764 $ 1,322,260 $ 1,091,029 $ 9,308,005 $ 2,946,752 $ 9,401,949 $ 2,886,386 https://www.oregon.gov/oha/FOD/Documents/QualityPool_Early_Release_Summary.pdf

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CCO distribution of 2019 quality pool dollars

On average 75% to physical health 6% to behavioral health 8% to oral health 10% to other

Advanced Health AllCare Cascade Health Alliance Columbia Pacific Eastern Oregon Health Share Intercommunity Health Network Jackson County PacificSource - Central PacificSource - Gorge Primary Health Trillium Umpqua Health Alliance Willamette Valley Community Health Yamhill Community Care

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Medicaid FFS Provider Stability Payments

Launched in August, program offers short-term loans for Medicaid FFS providers based on their average monthly FFS payments in 2019. Funds must be repaid. OHA has received one application (representing 6 providers) to date.

https://www.oregon.gov/oha/HSD/OHP/Announcements/Short- term%20Medicaid%20stability%20loans%20for%20providers%20with%20reduced%20business%20caused%20by%20COVID-19.pdf

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Rural Hospital Stabilization Program

In June, Oregon E-Board approved $50 million in federal Coronavirus Relief Funds for rural hospital stabilization grants. 20 rural hospitals applied and were funded in August.

https://development.oregon4biz.com/acton/rif/14786/s-0411-2008/-/l- 0007:9a/q-000c/showPreparedMessage?sid=TV2:srpqpBNip

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  • 6. Ongoing Monitoring

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We are publishing a monthly summary of the financial situation for Oregon providers

Available online at: https://www.oregon.gov/oha/FOD/Docum ents/STFS-Workgroup-Summary.pdf

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We are posting data summaries and other information as it becomes available

Available online at: https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx

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  • 7. Q&A

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