It is a massive understatement to say the coronavirus pandemic impacted healthcare in many ways in 2020—and while perhaps detrimental for the most part, there were some silver linings. (We will talk about both.)
It has affected public views of frontline healthcare staff, provider career prospects, provider compensation, staffing needs, and hospital revenue. It also significantly influenced telehealth's growth and altered the course of some residents' medical education, clinical practice, and much more.
With help from Mike Frye, MD, Senior Vice President, Group Medical Officer, SCP Health, we examine a cross-section of COVID and non-COVID issues, and share perspectives about the virus's lasting effects on healthcare.
1. Respect for Frontline Healthcare Staff
One silver lining of the pandemic is how the public now views healthcare workers, particularly frontline staff. The term "heroes" has been often and aptly applied.
"This pandemic has thrust frontline clinicians into the spotlight," Dr. Frye says. "I don't know if 'respect' is the right word, but there is more of an outpouring of recognition that these frontline clinical teams have been putting their lives and families at risk in dealing with the challenges accompanying COVID-19."
This video from UChicago Medicine illustrates the point very well. What's said regarding its staff has been echoed on behalf of healthcare workers in hospitals across the country.
It's not only the public that has heralded the courage of providers but also the healthcare industry. Here's one example: SCP Health's Enterprise Chief Medical Officer, Dr. Randy Pilgrim, reflecting on the pandemic's effects and the resilience of clinical staff during the crisis, said, "Those of you that ran into the burning building when everyone else was running out ... I am just incredibly humbled and thankful for what you have done and how you have done it."
2. Provider Health & Career Prospects
The pandemic has had a decidedly detrimental effect on how clinicians view their careers, a malady that, according to Dr. Frye, has affected emergency department providers most adversely.
"From an administrative standpoint, watching the mental health effects [the pandemic has had] on ER docs, it's pushing careers to the brink," he said. "'I don't think I can do this anymore' is a common refrain. It's taking years off of the careers of a lot of the physicians and clinicians involved in the coronavirus response."
He amplified his statement by saying the effect has not only been relegated to the providers’ work life but also home life. "Doctors are thinking, 'I'm dealing with all this at work, and my home life is in turmoil because I need to quarantine.'"
Closely aligned with the previous point is that due to the material decrease in patient volume, especially early on, hospital clinical staff have been laid off and left to find jobs where they could.
"It's flipped the supply and demand curve that usually favors physicians and clinical staff," Dr. Frye says. "It's much harder than normal to find a job now."
As the pandemic rages on, it does appear Americans are becoming more comfortable seeking care now, which means a slight uptick in patient volume. Still, some amount of ED volume will likely never return, and that fact will further compound the issues of providers’ career stability.
According to Healthgrades' latest COVID-19 Patient Confidence Study, published February 18, 2021, 72 percent of respondents said they'd feel comfortable going to their primary care physician tomorrow (up from 40 percent in April 2020); 69 percent said they'd feel comfortable visiting a specialist (up from 38 percent in April 2020), and 63 percent said they'd be willing to visit urgent care (up from 32 percent in April 2020).
Of particular interest, 54 percent of respondents said they'd feel comfortable having an elective procedure at a hospital.
3. Clinician Compensation and Hospital Revenue
Two more pieces of the COVID puzzle, according to Dr. Frye, include physician compensation and hospital revenue.
A May 2020 Medical Group Management Association survey revealed that 82 percent of healthcare leaders had seen their provider compensation affected by Covid-19.
Physician income has dropped in some areas by as much as 20-40 percent due to reduced patient volume, a mathematical equation that Dr. Frye says equates to a potential "financial disaster" for some.
But lower physician incomes have been an ongoing battle that predates the pandemic.
"Physician compensation has been under heavy attack for five or six years from commercial insurance payors," he states. "It's been a relative out and out war on decreasing reimbursement pre-COVID. Physicians have been reimbursed less and less by insurance payers year over year for the past several years."
On the facility side, the situation has also been quite difficult, due to lower patient volume and elective procedures—a bottom-line revenue driver— being put on hold in the beginning of the pandemic. Governmental financial assistance has been helpful for many hospitals, but it is still a struggle to survive sustainably.
4. Resident Life and Medical Education
If there is one area strongly affected by the pandemic, it's resident life and education.
A July 2020 SCP Health post said:
"Since the first case of COVID-19 was reported in Washington state back in January, medical residents have found themselves in unique and, sometimes, conflicting circumstances. They are doctors on the one hand and trainees on the other, forced to develop their skills while treating patients with a respiratory illness about which little is known."
Of all the areas of a resident life affected by the virus, education may have been impacted the most, the post said:
"Students have been pulled from clinical rotations or sent home from physical classrooms to learn virtually; residents are moving from their specialty to assist in other clinical areas; elective surgeries are being canceled, so surgeons in training don't have access to the clinical experience they need to learn life-saving skills; and the curriculum has to be manipulated to fit the new virtual learning environment because residents can no longer gather in discussion groups, grand rounds, or other in-person formats to receive didactic education."
5. Advances in Telehealth
Telehealth (and its cohort telemedicine) has moved forward at light speed due to the crisis, and for good reason, Dr. Frye says.
"With all the other pressures, financial and otherwise, telehealth presents opportunities for patients and practices alike. Virtual health aptly expands patient access by providing quick, affordable care for many conditions and concerns. Additionally, if you can take a clinician and put them in a single site where they can cover multiple geographic areas, it expands options for clinicians and significantly reduces cost, especially for the smaller facilities," he says. "Now and into the future, it will be critical to leverage telemedicine to most efficiently deliver the high-quality medical care that patients need.”
SCP Health practices what we preach; we have telehospitalists available on a 24/7 basis to help hospitals achieve more efficient provider scheduling and save costs, and we use our telehealth capabilities to deliver post-discharge follow up, post-acute care visits, surge and triage support, and much more.
6. Use of Nurse Practitioners, Physician Assistants as Leads
Another one of the pandemic's silver linings may be seen in the accelerated use of nurse practitioners and physician assistants as leads.
"Smaller facilities are finding it difficult to support the costs of a physician 24 hours a day due to the financial pressures," Dr. Frye says. "They are looking more and more at solution sets that involve an NP or PA or in some cases risk closing their doors."
He added that it's common to have NPs and PAs work with physicians, but more and more states are increasing their scope of practice and are allowing them to work solo with off-site physician back-up.
"We are looking at this area closely with an emphasis on how to do it while also maintaining or even increasing quality," he says. "There is a lot of pressure on the timeline, especially with COVID-19, to find viable ways to keep smaller town rural community hospital doors open, and the NP/PA solution is one that is working well in the right setting."
7. Healthcare Innovation
Despite the upheaval caused by the coronavirus pandemic, troublesome times have set a course for innovation.
Popular Science says that pharmaceutical companies have pivoted to fast-track vaccine development. Biotechnology labs have become "laser-focused" on developing accurate testing devices, including an “easy-to-use, fast, reliable, and extremely cheap test for COVID-19” and a reusable N95 mask prototype.
On the telehealth front, clinical-grade diagnostic units as small as a coffee cup give physicians real-time access to data from ten examination tools, including a stethoscope, otoscope, ophthalmoscope, and dermatoscope, as well as a thermometer, pulse oximeter, and ECG sensor.
The device is pending FDA clearance and should be available once cleared, Popular Science says.
8. Changes in Healthcare Not Stemming from the Pandemic
While 2020 will likely always be known as the year of COVID-19, not every change in healthcare in the past year has stemmed from the pandemic. Natural disasters—an unprecedented hurricane season, western wildfires, and, most recently, historic winter storms—have proven to be catalysts, giving rise to a greater focus on disaster management.
"Population health and disaster management have moved more to the forefront ," Dr. Frye says. "These terms are becoming much more common in the clinician vernacular."
Looking Back to Look Ahead
As we slowly begin to move forward into a world where COVID-19 will hopefully have less of an impact, it's helpful to look back in order to see what we’ve learned and what the future might hold.
Like many clinical leaders, Dr. Frye sees both warning signs and hopeful notes for the future of healthcare.
He reflected, "The political environment drives so much of what is going on. Combined with the frequent and constant news cycles, it feels like fear and unrest is the message being put forward. It's hard to see where that ends. I hope we get back to more normal human interaction but fear we won't—at least not for some time." The good news is that people will always need health care, patients always appreciate a kind and caring experience, and despite the challenges, committed and skilled professionals will certainly find a way forward.
If you’re interested in hearing more about how SCP Health is helping hospitals and health systems overcome pandemic challenges and prepare for a brighter future, email us to start a conversation.