Patient Reported Outcomes and Impact of COVID-19

A significant indicator for quality of healthcare is how a patient personally reports the outcomes from the care received. These reports are Patient Reported Outcomes (PROs). Many studies have shown that PROs improve the quality of healthcare. PROs are important, not just because hospitals need Medicare reimbursement, but because they show whether healthcare is improving patients' lives. PROs are also important because they are increasingly used to determine the amount of Medicare reimbursement that clinicians receive. Starting with the calendar year 2020, the system for calculating compliance with MIPS improvement activities has changed. Healthcare organizations opting to use PROs as one of their required improvement activities must now demonstrate that at least 50% of their physicians are having their patients complete PROs. As a result, if these organizations cannot show that a sufficient number of their providers are participating in the collection of PROs, their score in the improvement activities category of MIPS will decrease. This in turn could affect the level of reimbursement to the applicable physician billing group. Despite the value in PROs data, challenges exist with data quality and its usefulness between different healthcare institutions. Researchers have identified a few risks in data quality. There is no agreed upon structure for documenting PROs across all institutions, which can make the analysis and interoperability of PROs data difficult, if not at times impossible (Black et al., 2016). Another issue with PROs is whether they are a good representation of the quality of healthcare received from a large variety of patients. Patients may give varying opinions on the care they receive, despite receiving similar care. Furthermore, some studies have found issues with implementing PROs. It is important that healthcare organizations research how best to implement PROs to get the most value from outcomes reported by patients. Challenges with implementing the collection of PROs is especially clear in light of the recent COVID-19 pandemic. The COVID-19 pandemic in early 2020 has impacted the MIPS Program, specifically the PROs program. In order to support hospitals through this pandemic, CMS has updated their policy on MIPS activities. Healthcare institutions no longer are required to submit their quality improvement numbers for the MIPS program for 2019. Regardless of a hospital's performance, the hospital will still receive at least a neutral payment adjustment during payment year 2021, even if no data is submitted. However, this change does not alter the fact that usage of PROs are still an important indicator and they are a tool to measure the quality of care. It is important to continue to quantify PROs usage and understand recent changes due to the COVID-19 pandemic. At one academic healthcare organization, the COVID-19 pandemic had an additional impact on PROs usage. Elective surgeries and procedures were postponed leading to fewer encounters when PROs data would be collected. In addition, the World Health Organization (WHO) reported that SARS-CoV-2 can spread on surfaces (WHO, 2020). Therefore, to reduce hospital acquired infections, iPads can no longer be used by patients to collect PROs. iPad removal is likely to lead to even further reductions in the completion of PROs. Therefore, the purpose of this project includes two objectives: a) to assess the use of PROs among patients at one academic healthcare organization prior to and during the COVID-19 pandemic; b) to identify potential strategies and their cost and benefits to maintain and improve PROs reporting. These findings will inform recommendations for continued adequate documentation of PROs.