Looking Ahead to the New Year

No one would deny that 2020 was a hard year. But the coronavirus-plagued year proved that we are more resilient than we realize.

Will anyone be sorry to bid adieu to 2020?

It has been a hard year for practically everyone, largely because of the coronavirus pandemic, which at this writing has infected more than 15 million Americans, killing more than 287,000. Many of us were regularly forced to adapt to new situations. Healthcare providers began offering telehealth and virtual care services, or increasing those offerings; schools switched to online learning; office workers turned their kitchen tables into makeshift desks; and we all dealt with major disruptions to our personal lives. Meanwhile, healthcare became another political football during a divisive election.

While we don’t yet know what 2021 will hold, 2020 has proved we are more resilient than we realize, capable of adapting to whatever challenges the new year may bring. There are even some gifts we bring from 2020 into the new year.

Merriam-Webster defines resilience as “the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress” and “an ability to recover from or adjust easily to misfortune or change.” Although the stress of the pandemic has severely strained the body of healthcare, the industry has shown a remarkable ability to recover.

Healthcare’s ongoing efforts have been conducted on multiple fronts: logistical, technological, pharmaceutical, regulatory, communicational, educational—and, of course, human. As we move forward, compassion must be the foundation for all our efforts.

Ways We’ve Adapted

A Medecision blog post in July highlighted alternative solutions or workarounds that hospitals, manufacturers and the government had come up with to address various healthcare challenges. Those included technology-based developments such as the growth of virtual care, the use of artificial intelligence and 3D printing; optimizing the use of personal protective equipment (PPE); changes in patient flow and processes; and regulatory adjustments.

We continue to see advances in:

Virtual care. In a November blog post, we discussed four ways virtual healthcare can be used to expand access: allowing patients to visit with providers in real time without leaving their homes or offices; enabling healthcare providers and health plans’ care managers to build stronger relationships with patients; providing the ability to monitor patients remotely; and simplifying communication with patients.

Regulations. “We’re at a new level of crisis response with COVID-19 and CMS (the Centers for Medicare & Medicaid Services) is leveraging the latest innovations and technology to help healthcare systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” CMS Administrator Seema Verma said in a Nov. 25 news release announcing new regulatory flexibilities for telehealth and remote monitoring, as well as ambulatory surgery centers. “With new areas across the country experiencing significant challenges to the capacity of their healthcare systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond.”

The new flexibilities build on CMS’s Hospitals Without Walls program, which allows for care provision in settings outside hospitals. Other relaxations of regulations since the start of the coronavirus pandemic have included increasing support for virtual care as an essential weapon in the healthcare arsenal, and seeing that providers are adequately compensated for its use.

Supplies, logistics and protocol. Other hospital adaptations have included outfitting patient rooms with cameras and microphones to enable more remote monitoring; maintaining separate areas for COVID-19 and non-COVID patients; expanded testing, including rapid testing; new hygiene protocols; stocking up on PPE; buying extra ventilators, dialysis machines and other equipment; and training existing nurses to work in intensive care units.

Pharmaceuticals. The pharmaceuticals segment of the industry has been under extreme pressure to produce a coronavirus vaccine and treatments. Despite the unfortunate politicization of this process, we appear to be well on the way to shattering the previous record for fastest development of a vaccine: four years for the mumps vaccine.

The federal government’s Operation Warp Speed initiative “aims to start shipping vaccines within 24 hours of an emergency use approval from the Food and Drug Administration,” according to Modern Healthcare. In a November 30 interview with MSNBC, retired U.S. Army Lt. Gen. Paul Ostrowski—director of supply, production and distribution for Operation Warp Speed—said more than 300 million doses would be available to the public before June 2021. That’s enough to vaccinate a sizeable percentage of the population, although many will opt to forgo vaccination until its safety and efficacy have been proved.

As we welcome new medications and technologies, we must never lose sight of the human factor and the importance of trust. One example is smartphone contact-tracing technology. A service created by Google and Apple has the ability to identify other nearby devices using the service and notify those who have crossed paths with a user who later tests positive for COVID-19. The service appears as either a downloadable app or a setting, depending on the state and the device. The challenge, as reported by Modern Healthcare, is a Catch-22: People must buy into the system for it to work, but most are hesitant to buy into it until they know it works. Privacy concerns also could deter some people from using the technology.

Continuing Challenges

Dealing with the unknowns has been one of the hardest aspects of this public health crisis.

In an October story in the New England Journal of Medicine, David Blumenthal, M.D., M.P.P.; Elizabeth J. Fowler, Ph.D., J.D.; Melinda Abrams, M.S.; and Sara R. Collins, Ph.D., identified four intertwined healthcare crises spawned by the pandemic:

• Insurance coverage
• Deep financial losses for providers
• Substantial racial and ethnic disparities in the healthcare system
• A crisis in public health

Successful responses to these crises will likely require major reforms, in some cases confronting long-standing systemic issues and crafting new federal policies. Other challenges can be tackled on a more local level.

Delayed care. Many patients have been ignoring symptoms of conditions such as heart attack, stroke and diabetes and delaying essential care because of fears they will contract COVID-19 in the healthcare setting, Modern Healthcare reports. Such delays, in addition to having long-term implications for patients, can burden the healthcare system with avoidable costs.

Providers encourage patients to get the care they need. In many cases, this has involved reaching out with phone calls and video visits to assure them they will be protected during surgical procedures, vaccines and screenings. Large health systems have initiated marketing efforts such as “Don’t Die of Doubt,” a joint campaign of Connecticut-based Yale New Haven Health and the American Heart Association urging people to call 911 if experiencing heart attack or stroke symptoms. Others have used local media to spread the word about COVID-19 precautions.

Attrition. Anecdotal evidence collected by the American Hospital Association suggests many healthcare workers are retiring early or seeking jobs that don’t involve caring for hospitalized patients, out of fear of contracting the coronavirus or taking it home to their families. Those who stay at their jobs must deal with increased stress and, in many cases, heavier workloads.

Hospitals’ efforts to combat burnout and stress include visits from massage therapists, mental health support, childcare assistance, caregiver meals and help with transportation.

Whatever challenges 2021 throws at us, the fundamental skills and attributes that will help us succeed will be the ones that have always served us well: compassion, cooperation, innovation, open-mindedness and flexibility, as well as dissatisfaction with the status quo—and a willingness to challenge it in pursuit of something better.

 

For more perspectives on what the new year, and new presidential administration, may mean for healthcare, check out these insights:

• What a Biden-Harris Administration May Mean for the Future of Healthcare

• Top Priorities for President Biden: COVID-19, Then Everything Else