physician in medical mask, cap, cloves and gown

Long-lasting impacts of the COVID-19 pandemic on the health care system

Hospital closures, workforce burnout and displaced health professionals are issues the United States health care system may face in the aftermath
April 20, 2020

Hospitals and private practices closing, reduced hours, furloughs and layoffs of physicians, nurses and hospital staff seem unimaginable as the world struggles with the COVID-19 pandemic. However, this is happening across the United States and is leaving many to wonder how it will affect the future of health care.

What is the cause?

Becker’s Hospital CFO Report reported that more than 120 hospitals across the country have furloughed workers, and the number is growing every day. According to Bita Kash, PhD, MBA, FACHE, professor at the Texas A&M School of Public Health and joint associate professor in the Department of Internal Medicine at the Texas A&M College of Medicine, there are a number of contributing factors.

First, hospitals and clinics are experiencing a reduction of in-person clinic visits due to social distancing. But the major factor affecting their bottom line is the halt on elective procedures and surgeries in order to prepare for COVID-19 patient loads. Surgeries have been reduced by approximately 50 percent nationwide.

“Hospital revenues from elective procedures and surgeries are historically higher than revenue from the emergency rooms and intensive care units,” Kash said. “On average, hospitals are losing $3,000 per COVID-19 patient due to length of stay and resource intensity. Even with the government hospital stimulus fund to increase reimbursement for COVID-19 admissions, hospitals are expected to still lose over $1,000 per COVID-19 patient.”

Effects on health care professionals

To support a surge in COVID-19 patients, some physicians and nurses that have been furloughed or released are being redeployed to emergency departments. But this poses many issues as well.

“Physicians and nurses who have not been trained or practiced emergency medicine and intensive care in years are now being deployed to COVID-19 units. This can bring up issues regarding malpractice and scope of practice concerns combined with personal protection equipment shortages, adding to the risk these physicians and nurses take to take care of COVID-19 patients,” Kash said.

Most primary care and specialist physicians are adopting telehealth as a substitute for in-person clinic visits during this pandemic. Although a great alternative that allows patients to have continuity of care, the payment reimbursement rate for telehealth is lower than in-person visits and has been a source of uncertainty during early adoption as more insurance companies started to cover telemedicine visits during the month of March. In addition, the learning curve for telehealth technologies can be an issue for both patients and physicians. In fact, many physicians are reporting that they are spending considerable time providing technical support to telehealth patients before the actual medical visit can commence.

Medical residents finishing their training by June 2020 may also face difficulty finding work this year, Kash stated. As many hospital systems and private practice physician groups are having hiring freezes and focusing solely on COVID-19 needs, many new specialty trained physicians will have, and are having, a difficult time finding jobs. With incoming residents poised to replace outgoing residents, these newly trained specialty physicians may be left in limbo until COVID-19 is over and potentially for months after the health care systems recover and start hiring physicians again.

Aftermath

As recovery from the pandemic begins, Kash believes the two major issues the health care system will face are health workforce shortages and even more rural hospital closures.

“Many nurses and physicians are experiencing heightened levels of burnout due to the COVID-19 experience and many of them are expected to retire early or look for alternative work settings after all this is over,” she said.

The nation was experiencing a physician storage long before COVID-19, but experts predict it will get even worse once the pandemic is over, adding strain on an already taxed workforce.

The biggest financial impact of the pandemic will likely be felt by the rural hospitals systems, which have already been closing at devasting rates over the last decade. Kash says government intervention with a stimulus package for a rural hospital will be the only way to save this important safety net for rural communities. The closure of rural hospitals will create an ever-growing disparities crisis in rural areas across the county, leaving millions of Americans without immediate access to health care.

Reopening

As state governors craft plans to reopen the economy, with Texas allowing surgical procedures to resume at the end of April, how will this affect the health care system?

Kash believes there is likely to be several periods of states opening and closing due to community spread of the virus until a vaccine is produced.

“We can’t assume that the upcoming openings are permanent ‘back to normal’ policies,” she said. “These will be very cautious openings and can change as predictive modeling of the spread of the virus and death rates are directly influenced by social distancing behaviors and closures.

“The only weapon we do have against this virus right now is social distancing, which is comparable to hiding from the enemy as the short-term strategy,” she added.

If there is a silver lining to this experience it’s that there are lessons to be learned.

“My hope is that our experiences during this pandemic will trigger thoughtful planning towards the ‘new normal,’” Kash said. “This includes an improved public health infrastructure, a sufficient stockpile of PPE, an appreciation for science as part of decision making and overall greater investments in the health of all Americans.”

— Dee Dee Grays

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