Even the most vocal critic of the American health care system cannot watch coverage of the current Covid-19 crisis without appreciating the heroism of each caregiver and patient fighting its most-severe consequences. Hospitals are being built in parks and convention centres, new approaches to sterilizing personal protective equipment (PPE) for reuse are being implemented, and new protocols for placing multiple patients on a single ventilator have been developed. Most dramatically, caregivers have routinely become the only people who can hold the hand of a sick or dying patient since family members are forced to remain separate from their loved ones at their time of greatest need.
By admiting the immediacy of this crisis, it is important to begin to consider the less-urgent-but-still-critical question of what the American health care system might look like once the current rush has passed. Particularly, what can the system learn from the existential challenges it faces due to the spread of Covid-19? A few broad lessons are already emerging.
Medicine is medicine, no matter how and where it’s practiced.
Since the crisis has unfolded, we have seen health care being delivered in locations that were previously reserved for other uses. Parks have become field hospitals. Parking lots have become diagnostic testing centres. The Army Corps of Engineers has even developed plans to convert hotels and dormitories into hospitals.
When parking lots, parks and hotels will undoubtedly return to their prior uses after this crisis passes, there are several changes that have the potential to alter the ongoing and routine practice of medicine.
As concerns over the spread of Covid-19 in the United States grew during March, several arcane regulations that have long constrained American health care showed signs of easing. Most notably, the Centres for Medicare & Medicaid Services (CMS), which had previously limited the ability of providers to be paid for telemedicine services, increased its coverage of such services. As always they do, many private insurers followed CMS’ lead. For supporting and to shore up this growth the physician workforce in regions hit particularly hard by the virus both state and federal governments are relaxing one of health care’s most different restrictions: the requirement that physicians have a separate license for each state in which they practice.
These moves have provided a boost to pure-play telemedicine companies such as Teladoc Health, which reported an increase of 50% in its visit volume during the week ended March 13 and it has been found stock price increase by almost 43% during the week starting March 16. In addition, these regulatory changes, and along with the need for social distancing, may finally provide the impetus to encourage traditional providers — hospital- and office-based physicians who have historically relied on in-person visits — to give telemedicine a try.
During this crisis, many major health care systems had begun to develop telemedicine services, and some, including Intermountain Healthcare in Utah, have been quite active in this regard. That said, nationwide use of telemedicine had been limited. The chief innovation officer of Boston Children’s Hospital, John Brownstein noted that his institution was doing more telemedicine visits during any given day in late March that it had during the entire previous year.
The hesitancy of many providers to embrace telemedicine in the past has been due to restrictions on reimbursement for those services and concern that its expansion would jeopardize for theeven continuation and quality of their relationships with existing patients, who might turn to new sources of online treatment.
For the health care system truly to embrace the potential for change, physicians and hospitals must get to the point where they realize that telemedicine is not an inferior substitute by a face-to-face act but rather simply a different technology to use in delivering it. Their experiences during the pandemic could bring about this change. The other question is whether they will be reimbursed fairly for it after the pandemic is over. At this point, CMS has only committed to relaxing restrictions on telemedicine reimbursement “for the duration of the Covid-19 Public Health Emergency.” Whether such a change becomes lasting canmostly depend on how existing providers embrace this new model during this period of increased use due to necessity.
Due to this onset of the crisis, health care providers were experiencing high and increasing levels of burnout. A key driver of this trend has been the need for physicians to manage a host of non-clinical issues related to their patients’ so-called “social determinants of health” — factors like a lack of literacy, transportation, housing, and food security that interfere with the ability of patients to lead healthy lives and follow protocols for treating their medical conditions. According to recent study in the Journal of the American Board of Family Medicine found that physicians who perceived that their clinic had a high capacity to address the social needs of patients — typically with the availability of non-physician providers — had significantly lower levels of physician burnout.
Due to thecrisis of Covid-19 has created a surge in demand for health care simultaneously due to spikes in hospitalization and diagnostic testing while threatening to reduce clinical capacity as health care workers contract the virus themselves. And as the families of hospitalized patients are unable to visit their loved ones in the hospital, the role of each caregiver is expanding, this increased mismatch between the provider and patient needs capacity highlights one of the most pervasive inadequacies of the U.S. health care system.Hospitals are being built in parks and convention centres, new approaches to sterilizing personal protective equipment (PPE) for reuse are being implemented, and new protocols for placing multiple patients on a single ventilator have been developed. Most dramatically, caregivers have routinely become the only people who can hold the hand of a sick or dying patient since family members are forced to remain separate from their loved ones at their time of greatest need.During this crisis, many major health care systems had begun to develop telemedicine services, and some, including Intermountain Healthcare in Utah, have been quite active in this regard. That said, nationwide use of telemedicine had been limited. The chief innovation officer of Boston Children’s Hospital, John Brownstein noted that his institution was doing more telemedicine visits during any given day in late March that it had during the entire previous year.
