The System Responds
While patient behavior has undergone a significant change, our health system has been struggling to keep pace, adapt and return to some semblance of normalcy. Even as states have begun to reopen, few expect the demand for non-COVID health services to resume pre-pandemic levels anytime soon. As of this writing, the virus continues to spread across the country, keeping healthcare system executives and regulators unbalanced and wary about any rapid resumption of traditional operations.
Nevertheless, physicians and hospitals are working to convince potential patients that it is safe to return to the clinic, as they may experience significant health consequences unrelated to the virus if they continue to forego necessary care. To serve these patients, hospitals already experiencing unprecedented financial strain are investing in costly safety protocols, including purchasing additional PPE for healthcare workers, managing waiting rooms at lower capacity, and increasing testing for COVID-19.
Telehealth and remote monitoring have also stepped in to fill this gap in care. Both have experienced tremendous growth throughout the pandemic, yet neither has counterbalanced the drops in in-person visits, particularly in terms of revenue. The AHA estimates that US nonfederal hospitals are expected to lose around $161.4 billion in revenue between March and June 2020 from cancelled elective and non-elective surgeries, outpatient treatment and reduced urgent care rates. Facilities are already being forced to close, reduce services they can offer or take other extraordinary measures to stay afloat.
The urgent care sector has also seen extraordinary volatility. Patient volumes declined by nearly 80 percent at the start of the pandemic but have now increased in some regions to levels higher than what they would normally be in the summer months, when respiratory illness, which drives a significant amount of urgent care volume, is relatively low. This spike has been driven predominantly by patients seeking COVID-19 tests. An important question that urgent care operators are considering is whether these lower-margin testing services ultimately replace other services their traditional patients sought, leaving a busier but less profitable industry.
As the virus continues to spread across the US, not only will the healthcare sector continue evolving and adapting, but so will patient behavior. Many patients will continue to view the risk of contracting coronavirus at a clinic as greater than the risk of their chronic illness or pain remaining unaddressed.
A Delicate Balance
This evidence raises important questions to which we’ll be learning the answers in the months and years to come. What were the consequences of these delayed diagnoses and foregone treatments? Which types of individuals and patients suffered the worst outcomes, and which avoided any negative consequences as a result of their reduced interaction with our healthcare system? What types of care once considered essential by patients and physicians will now be seen as optional?
Dr. Jauhau suggests that perhaps without access to doctors, people appear to be taking more responsibility for their own health, noting that a “vast majority of patients seem to have fared better than what most doctors expected.” This is an optimistic view, but perhaps the long-term data will support it, at least in certain circumstances.
One certainty is that this extraordinary moment in history will generate a trove of health outcomes data upon which public health experts and policymakers can base future plans. It’s critical that they do so. This experiment comes at a terribly high price, and it would be a shame if we didn’t learn from it.
Raul Damas is a Partner in Brunswick’s New York office, and leads the firm’s US healthcare practice. Additional reporting by Pauline Blondiaux, an Account Researcher in New York.
Illustration: Edmon de Haro