A Post COVID-19 United States – What is Happening to Healthcare?
There isn’t one person we know who is not stunned by the catastrophic events and incalculable economic harm from the COVID-19 pandemic here in the U.S. and throughout the world. For years, we have praised the strength and resilience of our healthcare sector, and the economic stability that it brought by virtue of it representing 18% of the nation’s Gross Domestic Product – one of the largest individual sectors of the U.S. economy. Healthcare has maintained its upward trend in growth through some of the worst economic recessions in the last 50 years and has remained a steady employer with employment numbers increasing year-on-year. Sadly, not this time, as over 1.4 million healthcare professionals have either been furloughed or lost their positions as of June 2020. Even though many people are beginning to return to work, there are still a stunning number of those facing dismal prospects today, as the economic damage is forcing hospital bankruptcies and physician practices to permanently close.
Healthcare is changing, is being forced to change and what appeared to be relatively minor flaws on the surface, have proven to be major faults that, in just a few months, have nearly brought the behemoth healthcare delivery system to a near complete halt. For these faults to be repaired the U.S. healthcare system must change dramatically in several areas. The very fact that many regulations have been suspended, speaks to the fact that there have been problems all along and that we have merely become accustomed to our “work arounds” instead of fixing the underlying problems. The critical shortfalls in the U.S. healthcare system must be addressed and addressed NOW!
Healthcare in the United States is a very complex industry, made even more so by the plethora of federal and state regulations; therefore, no single solution or “silver bullet” can put the industry back on its feet. Although many problems have been brought to light by this pandemic, we find many centered around two general categories: first, what we will refer to as Structural Failures, and second is Technology Failures or more specifically Universal Data Access. The problems in these categories have existed for many years in the healthcare industry, and like a lumbering giant, the industry has continued to plod along stepping over, around or simply ignoring the issues until the pandemic brought progress to a halt! Now, these issues must be faced, and healthcare must transition.
We have witnessed huge providers of care seek out technology solutions, and stumble to adapt or even work around technology issues once they get them. We have also been watching technology companies with solutions, looking at the problems and bringing their best to providers only to find their technology was a ‘square peg in a round hole.’ These two groups have been working around each other and this circular process must end.
For several years, we had been planning these transitions taking place; however, we did not expect to see them occurring in such an accelerated time frame. The healthcare industry is not one that embraces change quickly or easily, yet the pandemic has clearly jolted the foundations of this giant; changes that we expected, even discussed taking 10 years, are now happening in 10 quarters or 2.5 years.
In the following paragraphs, we want to hit two key categories that we believe require material change and transformation.
Structural Failures – Patient Care and Capacity
- Lack of patient-centered care. In the ’70s and ‘80s, the focus shifted from the patient to the provider, who has been forced to be more consumed with trying to maintain a positive revenue stream due to increasing regulatory burdens and escalating costs than with patient-centered care. This has forced many providers into a ‘pack ‘em in and run ‘em through’ mentality in which the patients encounter with a provider is, at best, brief. This high-demand process wears on the physician and staff resulting in high-stress levels and lower patient satisfaction due to reduced quality of care.
- Provider payment models are left over from the 1960s. The antiquated “encounter-based” or “Fee-for-Service” model, much like a tollbooth on the highway, is further contributing to a lack of patient-centered care. Adherence to this payment model is driving providers to demand that Telehealth “encounters” be reimbursed at the same rate as an in-office visit. The cost of operation, between an in-office encounter with the overhead attendant of the office, does not compare to the much lower cost of a telehealth encounter; yet, the pandemic and ongoing concerns of the virus are choking the throughput in the offices, and they’re reducing the capacity substantially in those offices resulting in a revenue stream that makes the individual physicians’ practice less financially solvent.
- Hospital preparedness. Our fixed capacity is nowhere near enough for a major pandemic, and the lack of scalability of in-patient care management is nearly non-existent. Technology can offer means to effectively manage patient care from a distance and reduce the burden on hospitals for all but critically ill patients. Planning for the “hospital surge” that occurs during a health crisis must be re-thought, re-planned and include a better use of technology to a more robust “technology-infused healthcare.” How will hospitals adapt to less throughput and amortize their huge physical plant investments? How do we combine on-site care with distant care as we shift from encounter-based care to a more wellness management or “value-based” care payment model?
Technology Failures – Universal Data Access
The pivotal issue in Universal Data Access is the electronic health record (EHR) systems. After nearly 10 years and more than USD $100B invested, we still do not have digital patient medical records that are universally and seamlessly exchanged between different systems, or better yet, one universal medical record that follows the patient. This greatly inhibits the usefulness of patient medical records to only the provider who has that record, unless other providers for that patient operate on the same EHR system.
- Data consolidation. Despite the EHRs, patient records are nearly as inaccessible between different providers as if the records were still in paper filing systems, and there is no ability to consolidate patient records to provide a complete patient history. The EHR “experiment” has failed to provide better patient care, improved patient-centeredness, communication (patient to doctor or doctor to doctor), reduced cost by creating greater efficiency, in fact just the opposite has happened in many ways. The pandemic has proven these failures, and now with the threat of so many providers closing their offices permanently, their patients face both the challenge of replacing a provider and the concern for how their records can be migrated to a potentially different EHR, all without a loss of irreplaceable information and knowledge of the patient.
- Telehealth (Telemedicine). The use of existing technologies, such as Telehealth, are crucial to full provider utilization and patient-centered care. However, in order for Telehealth to be of equal value, both the patient and physician, to an in-person encounter, there must be knowledge of the patient or access to the patient’s medical records and history – as well as their current vitals (blood pressure, heart rate, temperature, respirations, etc.) to make a meaningful and informed care diagnosis. The pandemic has resulted in the suspension of several laws, some of which prohibited the practice of medicine across state lines, which has resulted in a virtual explosion in the use of Telehealth. Even if these laws remain suspended or changed going forward, the full utilization of Telehealth will require, at bare minimum, the ability to connect with a patient’s medical record – something that is not universally possible today.
- Impact of IoT. There remains systemic deficiencies in the use of proven technologies, such as IoT (Internet of Things), i.e. wearable device data that can provide the ability to care for a patient remote from the provider, to provide scalability in beds in hospitals ICUs and ‘Step-down’ units, as well as providing real-time data to a provider on a Telehealth interaction.
The United States depends on a healthcare infrastructure that is comprised nationally of a total of 5,686 hospitals and 914,613 beds. In addition, there are nearly 1,000,000 doctors (MDs and DOs) that serve both in the hospital and in private practice. These numbers were ‘pre-COVID’ and it is expected that due to provider attrition and bankruptcies of hospitals, these numbers should be reduced by upward of 10% to in some areas, even 20%.
Losses in community-based care has an impact on all segments of the population, from infants and children to adults and the elder population. Attrition of primary care providers is a looming crisis in the healthcare delivery model – a model that needs a major transformation, quickly.
As you have read, the failures in Structural and Technology are impossible to separate today, and the industry looking forward must deal with that. Today, post-COVID-19, we are more convinced than ever that “technology-infused healthcare,” including elements such as Internet of Things (IoT) / wearable device technology and remote patient care, telemedicine, robotics and Artificial Intelligence (AI) are required, at the appropriate touchpoints, to ensure that a comprehensive healthcare-driven application of technology occurs. All of these can provide care to nearly every demographic in our population from youth to the growing number of Baby Boomers exiting the workforce and “at risk” seniors in a quality and cost-effective way, as well as aid in preparing for the next pandemic. The numbers strongly suggest that in the next 10 to 20 years, healthcare will be the main business in the United States, as well as the remainder of the developing world, and in the U.S. we believe it could easily rise to consume 25% of GDP, or more, as we extend life expectancy and optimistically, quality of life.