As most of us remain homebound facing a virus that is unprecedented in our lifetime, we are beginning to understand that returning to normal will not be returning to the lifestyle we were living before COVID-19. The transformation that we will experience in our lifestyles will impact our healthcare system. Americans have taken for granted that the system would be there to protect us when we needed it. It cost our society nearly 20% of the Gross Domestic Product to maintain the current system and we have naturally assumed it is the best in the world and will have our back. However, today we are disillusioned as we see the daily statistics on COVID-19. We hear the pleas for Personal Protection Equipment (PPE) and for ventilators to save lives and not put our heroes in this battle against a virus at greater risk. Our expectations of the ability of the healthcare system to cope with our healthcare problems has been substantially eroded, despite the extraordinary performance of the doctors, nurses, and emergency personnel throughout this crisis.
The reality is that the structure of our delivery system is antiquated and designed for the 20th century, not the 21st century. We have continued to build huge hospital facilities filled with med/surg. beds. This type of growth no longer reflect how inpatient healthcare is delivered. We have maintained ratios of intensive care units to Med/Surg. beds that no longer reflect the type of patient that is regularly being admitted to most of our hospitals. The patients that are determined to require inpatient care are, more frequently than not, more compromised and have significant co-morbidities that require intensive treatment modalities. As a result, these patients, by and large, should be in the ICU, because they actually require critical care instead of in a general Med/Surg bed.
The turnaround time on surgeries, both elective and non-elective, that used to feed patients to the med/surge wards, has been accelerated geometrically; and surgical patients are being discharged very rapidly. The ability of the healthcare system to manage these individuals at home has improved dramatically. Enhanced technology now allows telemedicine visits with doctors and monitoring equipment can continuously monitor an individual’s vital signs. The need for patients to remain in a hospital’s general ward has substantially diminished. Programs such as Transition Care Management and Chronic Care Management can provide ongoing patient supervision, coordination, and stability without incurring the heavy costs of a hospital stay. All of these changes should lead us to rethink the whole hospital and healthcare delivery process.
While discussions of future epidemic and pandemic crises response and our lack of preparedness needs to be discussed, as does the current financial models’ lack of sustainability under crises, we can all agree hospital systems needs to preserve life and preserve their capacity to financially deliver the services required. So then, how do we change the system to operate efficiently and cost-effectively during normal times and yet have the capacity to maximize resources in the best interest of society during exceptional circumstances such as COVID-19? The answer to this dilemma is playing out real time during our present crisis. We need to rethink and rebuild our healthcare infrastructure and utilize our technology to refocus efforts on transitions in care from the ICU to home monitoring when critical care is unnecessary.
There would need to be a multi-pronged approach. Much has been written about the emergence of “micro-Hospitals” and that is one part of the solution. Another part of this solution is the need to reconfigure our larger hospitals to reflect that if a patient needs to be in the hospital, the likelihood is that it is due to an increase in severity of disease or injury. In “The Healthcare Conundrum” I wrote about the difference between illness and diseases. In this context, the disease is defined as a very serious diagnosis that must be treated immediately. An illness, on the other hand, results after the disease state has been controlled. In that situation, many very serious diseases become chronic illnesses with significant life expectancies.
In this new world of healthcare delivery that will emerge out of our experience with the COVID-19 pandemic, the healthcare supply chain is going to be critically important as the world faces more unique virus-disease states. We will need to be prepared and continually up-grade the quality of our equipment preparedness. The normal delivery of non-critical healthcare will continue to move significantly from inpatient to outpatient settings utilizing all of the improving communications technologies that are emerging. Hospitals will need to reorder their ratios of intensive care capacity medical surgical capacity. There will be a need for a dramatic increase in ICU capacity, and we need to train our medical professionals to reflect the changing ratio for those who provide services within the hospital.
The consolidation that is occurring in healthcare systems, if handled correctly, can result in Centers of Excellence within each of the systems without the need for continuing duplication and dilution of quality. This should lead to a reduction in the construction of healthcare facilities that are being built and equipped for a healthcare delivery process that no longer is needed. The American healthcare system has to become more agile and capable of adjusting to the dramatic advances in healthcare research, the development of new proven technology and expanding outpatient capabilities. We have already proven, with the Army Corp of Engineers that we can build critical space when needed during a crisis. We have proof that the system can be developed that reflects the current realities in both normal times and extraordinary times, however the reality of what “normal” looks like versus what we are building for do not correlate.
The ultimate question will be – Will we seize the moment of this horrible crisis to reposition our healthcare system to serve us in times of normal healthcare demands yet be agile enough in personnel, facilities and equipment for the future?
