For those of us who are healthcare “insiders,” whose passions and livelihoods depend on and dig deeply into policies and decisions made in ever so slight nuances, we’ve been watching the new world of COVID-19 and pondering the same question: What will healthcare look like post COVID-19?

One area that I’ve been thinking about is the site neutral policy introduced in the OPPS final rule in January 2019.

The controversy surrounding the Medicare site neutral policy was alive and well before it was even hot off the press. The American Hospital Association and the Association of American Medical Colleges joined forces with others to quickly pounce and sue, claiming Medicare was overstepping its authority and  the decision, “directly undercut the clear intent of Congress to protect hospital outpatient departments…” Their lawsuit was a win for 2019, but the 2020 Final Rule included site neutral once again, and another lawsuit ensued at the beginning of this year.

But that was January 2020, a healthcare landscape that seems light years away from our current reality. Perhaps the focus moving forward for those of us in the outpatient services world isn’t about fairness or intent, or the ability for doctor-driven practices to survive, but will now be about patient safety. Do we want to live in a healthcare world where outpatient departments have to be within 250 yards of the hospital - or is it wise for some services to be a little bit farther away?

There are too many examples of off-site patient visit encouragement due to COVID-19 policies to name them all, but here are a few of note:

1. CMS is allowing hospitals to, “transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare.” The lines of off-site vs. onsite are quickly blurring as patient needs are understandably trumping policy. CMS is also allowing off-site testing sites, seemingly offering anything to increase the distance between infected vs. non-infected populations.
2. The American College of Cardiology COVID-19 Operational Considerations includes a provision to, “Consider moving necessary in-office visits to off-campus (non-hospital) sites.”
3. The CDC recommended in their “Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States” to “Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible” - another indication that efforts to increase the space between us are taking place.

Perhaps the subjective 250 yard rule for onsite payments will slowly seem irrelevant in a post-COVID-19 world and something like a wound care program down the street in a strip mall will seem safer for patients than a clinic on the 2nd floor of a hospital. It’s an even further shift away from the bring them in “heads in beds” model, to the get them out and spread model that has quickly changed the lives of Americans.

Of course I have biases in this discussion. I work for an organization that provides support for outpatient wound care services. But I’ve also seen the impact on hospitals since the site neutral decision, many of whom are in rural provider deserts, that have limited space to expand much needed community resources, and end up delaying service lines like wound care because of the site neutral restrictions. 

There’s no way to accurately predict the widespread changes that will occur in the coming years, but maybe site neutral will be one of the policies that gets dissected, reconsidered, and revised. Who knows? It might just result in something better for healthcare providers and institutions than our minds were open to even a few short months ago.