COVID-19 Impact: Three permanent changes to the healthcare landscape

06.18.20 Cassie Schmalzl

Editor’s note: While the full impact of this pandemic will not be summable for years to come, we know the coronavirus has made an indelible mark on our nation’s healthcare system. Moxe implementation specialist, Cassie Schmalz, recently attended an HFMA virtual conference on the impact of Covid-19. Here is her take on a few permanent changes in healthcare and their future impact.

Three predictions as to how COVID-19 will impact the future of Healthcare

The Covid-19 pandemic has affected everyone in some form. While all Americans have felt an impact, so has every industry segment of the economy. But few industries will experience the long-term effects of this unprecedented period longer and more impactfully than our healthcare industry. The pandemic will have both devastating and revolutionizing lasting impacts on the healthcare industry. This article will explore the lasting impacts on telemedicine, rural and independent practice healthcare, and supply chain.

Prediction 1: Your checkup goes long distance

Telemedicine visits are here to stay. The technology to perform consults and general office visits virtually has been around for a while, but telemedicine failed to gain a foothold primarily due to coverage. Medicare, along with many private insurers, provided limited coverage or no coverage at all for telemedicine visits.

In the face of this unprecedented public health emergency, access has finally changed. Forcing Medicare members to travel to a clinic or hospital for routine care would put a high-risk patient population more at risk. CMS rolled out new payment regulation for telehealth visits, and many private insurers followed. While the new CMS guidelines are temporary in nature and could be rolled back after the public health emergency, mounting political pressure for more accessible and affordable care will make that difficult. Making telemedicine a widely available platform for patient care will result in reduced costs for patients.

Outcome: Telemedicine has the power to revolutionize emergency care in rural areas and access to mental healthcare offerings, breaking down geographic barriers to care in areas of severe shortages of providers.

The problem of limited emergency room access in remote areas of rural America is not new. For decades, healthcare leaders have grappled to find a solution without adequate resources to open Emergency Care facilities and staff them with physicians. Transport by helicopter to regionally located Emergency facilities has helped, but helicopter resources are limited and usually reserved for the most critical patients. Telemedicine utilizing live video streams and remote physician monitoring is an innovative and cost-friendly solution. They are able to assess the patient and provide precise, step by step instructions to the nursing staff onsite. As a result of telemedicine utilization and success during the pandemic, expect to see more remote emergency care facilities established in rural areas.

The need for more access to mental healthcare is strong. 1 in 5 adults in America experience a mental illness and 60% of those adults did not receive mental health services in the previous year. Telemedicine is an innovative solution to increase accessibility to mental healthcare providers. Unlike emergency care, mental healthcare often does not require an in-person physical examination. Therefore the patient could receive the same care remotely. The technology enabling telemedicine is not new. The barrier to wide utilization of telemedicine care for mental health has always been reimbursement from insurance payers. CMS regulations allowing reimbursement have changed the game and mounting political pressure for more accessible and affordable care will make rolling back the payment changes challenging.

Prediction 2: Accessibility in rural communities is at a crossroads

Covid-19 has been financially devastating to the most vulnerable hospitals and health systems. Another reality facing America’s healthcare system is a significant cash shortage. In the wake of the pandemic, health systems across the country canceled elective procedures. Prior to Covid-19 an elective procedure was known in the medical billing world as a procedure likely not covered by insurance but likely would be self-pay. “Cosmetic procedures and plastic surgery” is not what elective procedures mean in this context. A better term would be “postponable procedures.” If a procedure could be postponed—even procedures as important as heart surgery or cancer treatment—It was canceled or rescheduled. Health systems rely on these outpatient procedures for revenue. The loss of incoming cash flow hits hard for rural hospitals. “Rural hospitals especially depend on outpatient services for much of their revenue- about three-quarters of it on average… Before Covid-19 reached the US, one in four rural hospitals was already vulnerable to closure”. (source:https://www.vox.com/the-highlight/2020/4/15/21211905/coronavirus-covid-19-pandemic-medical-health-care-hospitals) Some experts believe when public health restrictions are lifted, outpatient providers will be met with pent-up demand. Unfortunately for the most vulnerable critical access hospitals, it may be too little, too late.

Outcome: Smaller independent practices with less cash on hand will likely seek acquisition or pursue forming partnerships to keep their doors open. Unfortunately, the decrease in revenue has been financially devastating to many providers. For some, furloughs and PPP loans aren’t enough to keep them solvent and they will have to shut their doors. To help fill accessibility voids, larger health systems will likely open more cost-friendly emergency care facilities staffed by remote physicians, as described earlier in this article. Even with increased usage of telemedicine, accessibility problems will be exacerbated. The closure of independent specialty practices will lead to an increased burden on patients, who will be forced to travel farther for specialty care or take on higher costs to be seen out of network.

Prediction 3: Supply Chain includes contingency plan

The shortage of PPE, ventilators and beds in the hardest hit areas comes as no surprise to supply chain experts. The healthcare industry’s supply chain has not been as refined and optimized as other industries like automobile manufacturing and grocery stores. Primarily, there have been more important problems to focus on. Improving the quality of healthcare provided, implementing EHRs, addressing population health through chronic condition care management, and advancing treatment options for the most ill patients have been prioritized higher by exec teams over optimizing the supply chain. It also wasn’t as imperative as the other initiatives; providers had the supplies they needed when they needed them- until now. Covid-19 has thrust America’s healthcare industry’s weakness into the spotlight. Redundancy programs will emerge to create a solution to share resources among geographic locations, shifting supplies, and equipment to the areas in the country that need them the most.

Outcome: For the first time ever, health systems are accepting materials that are “good enough.” For example, healthcare providers are utilizing PPE designed for the construction industry because it meets the minimum necessary requirements. Expanding the range of acceptable PPE products allows for more versatility and suppliers. Additionally, supply chain planning for surge capacity will become standard. Instead of the status quo approach of planning which includes “what do we have on hand” and “what do we have coming,” leaders will now additionally plan for “what will we need for surge capacity and what suppliers will we use?”The result will be an optimized supply chain with versatile equipment, built in redundancies, and better prepared for surge capacity.

It’s unclear if and how regulatory governance will impact supply chain planning in healthcare moving forward. Some health systems faced a severe shortage of PPE during the pandemic, while others weren’t as affected. To put this in perspective, here’s a personal anecdote. Both my sister and mother are inpatient RNs in northeast Wisconsin. They work for different health systems. Their hospitals are located within 35 miles of each other. The hospital where my sister is employed required inpatient nurses not directly involved in care of a Covid-19 patient to re-wear the same surgical mask for one week. In contrast, my mother’s hospital provided each RN with a N-95 mask.  How could two health systems in the same geographic area have such a different level of supplies available? One reason: There are no regulations providing guidance on surplus inventory. Governance regulating required PPE surplus supplies in case of a pandemic could help improve the safety of healthcare workers in the future.

What’s next

Covid-19 has changed America’s healthcare industry forever. Telemedicine availability will provide more care options, helping mental health providers reach patients in need. Unfortunately, some rural hospitals will need to close their doors, leaving vulnerable communities in need and increasing commute times for care. The healthcare supply chain will be optimized, resulting in a more versatile supply chain better preparing America’s healthcare systems for surge capacity treatment. Led by the fearless physicians, nurses and support staff, America’s healthcare industry will prevail and will be in an improved position for the next public health emergency.

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