During his time at the Centers for Disease Control and Prevention, Farzad Mostashari, M.D., investigated infectious disease outbreaks. Mostashari also spent a chunk of his career creating policy in Washington, D.C., including as the National Coordinator for Health IT.
Combined, the background in epidemiology and policy has afforded him a unique viewpoint into the current COVID-19 pandemic.
He was one of five healthcare experts, including former FDA chief Scott Gottlieb, who penned a proposed plan to build a national COVID-19 surveillance system. In that recently published paper, issued by the Duke-Margolis Center for Health Policy, Mostashari, Gottlieb and other leaders argued that a system to effectively track and trace COVID-19 is a prerequisite for gradually reopening the economy.
"I think as we’re talking about multi-billion dollar bailouts for every industry, the best stimulus to help control the outbreak is to make sure practices can do what they want to do to care for and treat patients," Mostashari said.
He is now closer to the frontlines of healthcare running Aledade, the company co-founded in 2014 to help independent physician practices transition to value-based models. With more than 500 independent practices in Aledade's network, Mostashari talks to practice leaders around the country about the impact of the pandemic.
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I was able to catch up with Mostashari recently to talk about the current health crisis, how it's impacting physician practices and the Trump administration's recent guidelines to reopen the country.
FierceHealthcare: How will the COVID-19 pandemic impact the future of independent physician practices?
Farzad Mostashari, M.D.: This shows that you can’t count on fee-for-service. If the only way you as a physician makes money is by having someone physically come to your office for a patient visit and you spend 10 minutes with that patient so you can bill for it, and that is literally the only revenue you have, then it turns out that is taking on risk, putting all your chips on fee-for-service. Our practices are going to be getting another kind of revenue and they have us to help them navigate through this. Our practices will be getting significant funding from these value-based care programs that don’t rely on face-to-face visits.
Another way to think about it is, fee-for-service is requiring a $100 billion bailout as organizations are going broke because there are no fee-for-service payments. Value-based care programs don't need a bailout at all, they are fine. As COVID costs go up and hospital utilization does down, with value-based programs, the key is to just be better than your neighbors. Our practices will decidedly be in a better position than their neighbors.
FH: The White House Coroanavirus Task Force announced on April 16 guidelines for states and cities to begin reopening the economy using a phased-in approach. What is your take on those guidelines?
FM: I think a lot of these things that we talked about in our plan were in there. Things like needing to ensure adequate testing, contact tracing, syndromic surveillance, and serological testing. As always, it's about execution. Importantly, if we’re going to get larger and larger numbers of people who have COVID diagnosed and then sent into isolation and ramp up contact tracing, primary care needs to be at the top line of that. Who will be doing most of the testing? You don’t want people flooding into the ER.
Again, it shows why, more than ever, we need primary care to be prepared, to have protection with PPE (personal protective equipment) and masks and we need primary care to be there in those communities to serve them.
FH: When do you think things will get back to normal?
FM: We won't get to back to normal until there is widespread inoculation with a vaccine. We can have a phased approach to gradually loosening the restrictions as we ramp up surveillance and contact tracing. If the numbers start to go up again, then we will have to respond. It’s not a light switch that you turn on or off, it's more like a dimmer switch or a dial that you adjust.
FH: What do you look forward to when the stay-at-home restrictions begin to relax?
FM: We need to start getting chronic disease patients back into primary care. I'm super worried about all the seniors and vulnerable patients, those patients with heart disease, lung disease, and kidney disease who are toughing it out at home right now and are too afraid to go into the doctors’ offices. All the conditions these patients had before COVID are still there. We need to get back to primary care where we can take care of patients with chronic diseases.
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Our practices are amazing and I'm so in awe of their service. They are taking care of patients in their parking lots, on porches, with tapped-on masks. There are heroes. My only advice to them is to take care of patients, take care of the staff but also take care of themselves too.
FH: Do you think the Department of Health and Human Services (HHS) should delay the recently released interoperability regulations? [Editor's Note: HHS announced Tuesday it would relax enforcement of the rules.]
FM: I think CMS (the Centers for Medicare and Medicaid Services) and ONC can provide some enforcement discretion on that. But I think, more than ever, we need to have information exchange in the age of COVID. If one of our practices’ patients has a fever and cough and goes to the ER, that practice should know about it.
Hurricane Katrina was a milestone in terms of helping us understand the need for EHRS (electronic health records) when waterlogged paper records were destroyed. COVID highlights the need for information to not only be electronic but for it to move.