How does a COVID-19 United States Healthcare System Rebuild?
We received a great deal of comments on part one of this series, and we are pleased by the support on the framing of the problem.
We have been predicting a quantum leap in healthcare for quite a while; although, we have been disappointed by its slow speed. We believe that healthcare cost and quality were going in different directions. In this blog, we have noted many times that we can only reduce cost by first improving the quality. We also note the fee-for-service model will not survive this generation. The “Black Swan”1 we discuss in healthcare, as a result of COVID-19, is the most amazing manifestation of the problem in our lifetime.
Below is a collection of headlines over the past few days, beyond the Bloomberg article we quoted in the opening of the series:
Financial Times – How coronavirus broke America’s healthcare system
Stat News – When the Covid-19 pandemic is over, health care must not return to business as usual
Vox Media – Coronavirus is exposing all of the weaknesses in the US health system
Primary care practices could close in a matter of ‘weeks not months’ without financial support
Doctors face pay cuts, furloughs and supply shortages as coronavirus pushes primary care to the brink
Covid-19 is battering independent physician practices. They need help now
Beaumont Health and Summa Health call off deal
How Poor Payer Reimbursements are Affecting Practices During the COVID-19 Pandemic
Doctors and clinics who care for the poor have waited months for coronavirus stimulus cash. Here’s why it’s taking so long for them to get the money they need to stay open
UW Medicine to furlough 4,000 union employees
Over the last 30 years, I have been in nearly every segment of healthcare delivery in the use of key technologies; however, my interest, respect and passion has been for those physicians in the front lines – family practice and primary care physicians. They account for less than 10% of all healthcare expenditures, yet they are the backbone of the healthcare delivery system by providing over 50% of office visits with each one representing a point of care to an individual in our population.
These physicians have the lowest fee-for-service reimbursements; therefore, they receive the lowest pay scales (with pediatricians at the lowest), with the heaviest workload and must maintain an office and staff on top of all the other overheads. Consequently, they do not have the extra capacity to build up their own resiliency and financials. What is the end result? Many forecasts are saying that the attrition of our frontline community-based care providers could reach as high as 20%, forcing them to close their doors and never re-open again.
In addition to the attrition of providers, there have been reports of many consumers that have been delaying care, and we suspect that delayed care is not temporary. We believe, as the experts are predicting, that delayed care will having an increasingly negative impact on the quality of life and life expectancy for millions in our community, as well as add materially to the overall cost of healthcare. Health conditions of many of these people will deteriorate beyond the capacity of the primary care physician; thus, require treatment by a specialist or even hospitalization. We wonder how many have already delayed treatment of serious dermatology issues, colonoscopies, pap smears, mammograms, cancer and diabetic checkups and even heart conditions?
There’s no question the specialist impact is going to continue to be huge in the healthcare industry. We have seen the entrance of many private equity investors acquiring and restructuring the highest specialist over the last 10 years. Some of those may find the current environment too difficult to transverse and will make a difficult, if not unseemly exit.
I also expect the failure of dozens of hospitals in the United States (if not more) even after the federal, state and sometimes local community’s help financially. Many will survive on what is considered elective care or more appropriately, procedures that can be scheduled and not an emergency. A typical community hospital has inpatient and outpatient surgery, plus one or more joint ventures with physicians, for things such as heart catheterization and stress test labs, colonoscopy/endoscopy centers, and at least one out-patient surgery center. All have been adversely impacted and are likely to continue to be impacted for the foreseeable future.
We are expecting to see discounts on procedures, new ways to bundle care and other types of financing options to bring the patients back into the hospital over the next few months and years. I expect to see “get XYZ procedure done, deferred payment and zero interest until 2022” or “have this procedure done and be credited with XYZ reward miles.”
Many people believe we will rebound quickly from this true “Black Swan” event for healthcare; however, from my view I would not make that bet. The bet that I would make however, is that the future of healthcare is both “high-tech / high touch,” that “technology-infused healthcare” we have been talking about in these blogs for years will finally emerge. We also see a complicated set of problems that are interrelated. In turn, this will require more than a “single shot solution” rather than what is really needed, and that is a much more comprehensive and holistic approach that COVID-19 has created the opportunity to address. We as a society/government/business have tried for 30 years to tweak the system and it has not worked – time to roll up the sleeves and do some major overhaul.
One of the best examples of attempted “tweaks” to the healthcare system is the Electronic Healthcare Record (EHR) that has emerged as a standalone industry. At the global scale, we have spent well over $100 billion USD in EHRs over the last decade, and we have not improved the quality of care, reduced cost or empowered the consumer. Instead, we have created one of the single largest contributors to physician burnout today along with rampant provider operating costs.
In our view, the EHR is equivalent to a digital electronics control system in today’s advanced cars. It is not the engine, transmission, differential or tires in your car, however, it can make them all work better, just as the electrical system in your car can make your car run better. The best digital control system in the world cannot make up for the shortfall of a bad transmission or a flat tire; however, the opposite is also true, that a great engine and drivetrain can be tuned optimally for today’s advanced cars without the technology, the computers and the complex digital systems. The same is possible by integrating both the technology of healthcare with the service of healthcare; it must be done optimally.
We expect to see value-based care, remote monitoring, telemedicine and modernized medical facilities lead to the “renaissance” that we envision as the emergence of a new type of event that analogous in its own way to the “Gray Rhino” and the “Black Swan.” More about that in our next blog.
-Noel J. Guillama, President