The U.S. healthcare system has been a hot topic for decades. Along with the tension and infamous pushback from the medical-industrial complex, the ongoing bipartisan debate of who gets what and how much seems to never come to an agreement. But since the pandemic, the country has seen several drastic shifts in the healthcare system including telehealth inclusion, doctors declining Medicare, and overworked hospitals closing down non-emergency services.
The question is, will these changes stick around, like the long overdue Affordable Care Act? Some healthcare professionals attest to the power of COVID-19 being what this country needed to force urgent and sudden shifts in our healthcare system.
What healthcare changes are here to stay?
Gail Wilensky, a health economist who ran the Medicare and Medicaid programs for President George H.W. Bush in the early 1990s, believes that “healthcare is never going back to the way it was before.”
Everyone benefits from telehealth for all
Though telehealth, also known as telemedicine, is not a new concept, it has become much more prevalent since the pandemic has kept older adults housebound. Medical professionals have used telehealth to treat patients in rural or remote settings since the late 1980s, but COVID-19 has forced the healthcare system to utilize this virtual tool to reach those who cannot go to the doctor in-person.
Today’s advanced technology has made virtual doctor visits much easier, but obstacles have arisen, such as licensing. The issue lies in determining how a doctor in one state can legally treat a patient in a state where the doctor is not licensed.
Payment is also something debated. The question lies in the difference in the reimbursement rate of a virtual doctor’s visit and an in-person visit. Will making it easier for doctors and other medical professionals to use telehealth encourage unnecessary care, thus driving up the nation’s $3.6 trillion health tab even more?
Even still, the seriousness of the pandemic has made these issues less pertinent. Because of the demand, most healthcare providers who are able, are providing telemedicine. According to the results of a new survey from Gallup, the number of patients reporting “virtual” medical visits more than doubled, from 12 percent to 27 percent, from late March to mid-May, alone.
There are many perks to telehealth, such as: you can see a healthcare professional from the comfort of your home, you do not need to have assistance of a loved one to take you to the doctor, there are no hassles like dealing with parking, nor do you have to take off as much time from work to go to the doctor.
Doctors and other practitioners seem to have mixed feelings about telehealth. It can be harder to examine a patient over video and some services just can’t be done via a digital connection. On the other hand, with telehealth doctors can make time for more patients in a single work day and need less staff support to conduct virtual visits.
Of course, telemedicine is not right for everyone. Some patients, particularly the oldest seniors, lack the technological skills needed to connect. In addition, if you need more extensive medical attention, telehealth might not be right for you. Either way, those who can utilize telehealth create more time and space for others to go into the doctor or hospital in-person.
The number of primary care doctors dwindle
Another trend that has been exposed is the nation’s dwindling supply of primary care doctors. This deficiency of primary care doctors has created a boom in current medical students choosing to specialize in primary care.
“I’ve been trying to raise the alarm about the kind of perilous future of primary care,” said Farzad Mostashari, a top Health and Human Services Department official in the Obama administration. Mostashari runs Aledade, which helps primary care doctors make the transition from fee-for-service medicine to new payment models.
The American Academy of Family Physicians (AAFP) reports that 70 percent of primary care physicians are reporting declines in patient volume of 50 percent or more since March, and 40 percent have laid off or furloughed staff. The AAFP and other primary care and insurance groups have come together in asking the HHS for financial aid.
“This is absolutely essential to effectively treat patients today and to maintain their ongoing operations until we overcome this public health emergency,” the groups wrote.
One way to aid primary care doctors is to adjust payment methods. Medicare beneficiaries have been turned away by their primary care physicians due to the difficulty with payment. Many alternative payment options have been suggested, but ultimately, the move from fee-for-service to capitation (value-based care) has unfolded gradually and was championed in the Affordable Care Act.
Some healthcare experts argue the urgent need for a plan to be in place in preparation for the pandemic’s next wave. They predict that the coronavirus pandemic could finally mark the beginning of the end for doctors who still charge for each service individually.
Mostashari, who spends his time helping doctors make the transition, said, “In times like these, it would make more sense for primary care doctors to have “a steady monthly revenue stream, and [the doctor] can decide the best way to deliver that care. Unlimited texts, phone calls, video calls. The goal is to give you satisfactory outcomes and a great patient experience.”
Still, many physicians, particularly those in solo or small private practices, worry about the potential financial risk of the possibility of getting paid less if they don’t meet certain benchmarks that the doctors may not be able to directly control.
But with many practices now ground to a halt, or just starting to reopen, those physicians who get paid per patient rather than per service are in a much better position to stay afloat. The new payment method may gain traction as doctors consider what the future holds.
Hospitals may continue to decline
The pandemic also might lead to less emphasis on hospital-based care. What does this mean exactly?
While hospitals in many parts of the country have obviously been full of very sick COVID-19 patients, they have closed down other non-emergency services to preserve supplies and resources to fight the pandemic. People with other ailments have avoided doctors offices and hospitals even when services were available, for fear of catching the virus.
Many experts predict that care won’t just snap back if the emergency of the pandemic wanes. Dr. Mark Smith, former president of the California Health Care Foundation, said, “It is as if a switch has been flipped. Overnight it seems we’ve gone from high-touch to no-touch.”
It is not looking promising for hospitals who have spent millions trying to attract patients to their labor-and-delivery units, orthopedic centers, and other parts of the facility that once generated lots of income. Even more concerning is that hospitals’ ability to weather the current financial shock varies across the board. Hospitals in rural and underserved areas, where access to healthcare is scarce already, are the facilities that would struggle most.
Will healthcare continue to struggle to adapt?
Not all these changes will necessarily be good for the health system or society. Financial pressures have the potential to end up driving more consolidation than fear of the pandemic’s continuation or return, which could push up prices as large groups of hospitals and doctors gain more bargaining clout.
One thing is for sure, and it is the changes within the healthcare system are outpacing the ones in all of American history.
Wilensky put it this way, “When you’re forced to find different ways of doing things and you find out they are easier and more efficient, it’s going to be hard to go back to the old way.”
