It's maddening for everyone involved.
"There's understandable frustration among the provider community about the amount of burden that they've had to bear in the last 10, 15 years without seeming to improve care," said Dr. David Lansky, former CEO of the Pacific Business Group on Health, now a senior advisor to the organization.
Though many experts worry that the pandemic will slow down HHS' steps toward reform, even though several quality-related issues have come to light because of the outbreak.
"What's needed is national leadership," Lansky said. "Now is not the time to capitulate."
HHS has already laid some groundwork for quality reporting revisions. The agency quietly released its National Health Quality Roadmap in May, almost a year after President Donald Trump ordered HHS to create a Quality Summit to align quality and reporting requirements.
HHS plans to move forward with the programs outlined in the roadmap, although some project timelines will be pushed back, the agency said in an email.
Providers have been rocked by equipment and supply shortages and breakdowns in infection control processes throughout the pandemic. It's shown that the healthcare industry doesn't collect and publicly report enough data about safety measures related to preparedness and infection control, said Leah Binder, president and CEO of The Leapfrog Group, an organization representing employers and other purchasers of healthcare calling for improved safety and quality in hospitals.
Nursing homes, critical access hospitals and other facility types should gather and report that data on an ongoing basis so public officials and healthcare leaders can identify vulnerabilities in the healthcare system, experts said. The Trump administration began focusing on infection control reporting for nursing homes in March, but it was too late to prevent a surge of infections in nursing homes.
"We have to have a reckoning around patient safety and worker safety," Binder said.
And while the dramatic expansions of telehealth and scopes of practice show that the healthcare industry can change rapidly with enough leadership and commitment from government, it's given rise to new quality issues.
The steep decline in in-person office visits and corresponding growth in telehealth services has reduced clinicians' ability to gather information from patients about how they're managing their depression, partly because providers are less able to administer screening tests.
That's adding to existing problems around the delivery and evaluation of behavioral healthcare.
"From my perspective overseeing the Medicaid program, we're really not creating the intensity of focus around behavioral health quality, evidence-based protocol and outcomes," said Mary Mayhew, secretary of the Florida Agency for Health Care Administration.
Telehealth has also changed who seeks care, which means certain groups of people might have less access to care than they did before the pandemic. Patients that are older or with low socioeconomic status might not be comfortable with virtual care or lack the resources necessary to get it. That could lead to poorer outcomes down the line if people delay needed care or are unable to manage chronic diseases like diabetes.
It's also hard to see how HHS and CMS can return to the status quo after the public health emergency ends, Wadhera said. The federal government has many programs that link payment to quality measures, but there's mounting evidence that it "hasn't really worked." He said that it wouldn't make sense to go back to financially penalizing health systems based on their performance shortly after bailing them out.
According to Wadhera, the federal government should get rid of quality reporting programs if the evidence suggests they haven't worked. It should also rigorously evaluate the effects of the few programs that appear promising and develop more creative and innovative approaches to motivate clinicians and health systems to improve care.
Focusing on well-validated, meaningful measures developed in collaboration with frontline clinicians would help reduce so-called provider burden and ensure clinician buy-in, Wadhera said. Most quality measures and reporting programs are designed in a top-down fashion, which can curb provider support.
Most experts agree that more alignment of quality measures would be beneficial, but some fear HHS is overly concerned about provider burden. HHS cites "parsimony" as one of its goals for federal quality measures, but experts say the primary goal should be to get useful information, not to streamline reporting.
"We want to make sure that in the spirit of streamlining, that as a nation, we are not taking a step back from our focus on quality," Dr. Nancy Gin, chief quality officer for the Permanente Federation, the national leadership organization for the eight Permanente Medical Groups.
With a greater focus on evaluation, HHS could likely increase alignment and simplify reporting, which could improve quality and free up providers to devote more resources to patient care. There's been such an "insatiable appetite for this expansive approach to data collection" that it's caused policymakers and the industry to lose sight of their goal to understand the healthcare system better, Mayhew said.
"Too often, we make perfect the enemy of the good," she said.
The "basic principles" of quality measurement and reporting reform still make sense in a post-pandemic world, said Mark Hamelburg, senior vice president of federal programs for America's Health Insurance Plans.
Even before the pandemic, healthcare experts understood that quality measures and reporting requirements need to be better aligned among public and private payers and that data collection and reporting need to be better integrated into clinicians' workflow, said Dr. Shantanu Agrawal, president and CEO of the National Quality Forum.
But federal policymakers and the healthcare industry need to move forward with a sense of urgency now that COVID-19 has fully exposed that quality measures are downstream of fundamental weaknesses in the healthcare delivery system.
"If this is not a call to change, if this is not a call to resolve some of the foundational issues of healthcare, I don't know what that call would look like," Agrawal said.
