Dramatic Drop in Patient Volumes is Symptom of Serious Dysfunction in Health Care

Like a very low tide, the Corona crisis is exposing deep crevices in our health care system. This is a rare moment to explore these fissures, and to consider what health care would look like if instead it was delivered as efficiently and effectively as possible.

A grim paradox of the Covid 19 crisis is the dramatic drop in patient volumes at the same time as health care has geared up to fight a deadly disease with no known treatment beyond supportive care. These drops in patient volumes have led to immediate and stunning layoffs in the health care sector that has been immune to previous economic pullbacks. Some of the volume drops were expected and planned, such as halting all elective surgeries, and delaying routine ambulatory visits during shelter in place orders. However this doesn’t explain reductions of up to 50% in emergency room visits, and 20–30% drops in inpatient admissions.

One explanation is that a chunk of health care in this country is more discretionary than we realized. Significant efficiencies can be achieved by meeting patient needs before they go to the ER, and the drop in admissions suggests there is a percent of patients who could be managed without being hospitalized. The devastating impact this has had on the bottom line of hospitals and health care providers points out how dependent they are on these excess services. Their volume-based incentives discourage use of more efficient delivery models such as adoption of telehealth, and digital solutions to improve coordination of care and transitions throughout the continuum of care.

There is one segment of the health care system that has benefited financially from these volume drops- the big health insurers. The irony of this windfall is that health plans have played such a tiny role in actually dealing with the Corona crisis. Health plans are paid to provide value-based care, receiving fixed amounts to provide care that emphasizes cost and quality.

But the quality scores of health plans don’t seem very important when it has been left to providers including medical offices and hospitals to figure out this crisis on their own, along with understaffed and long-ignored public health departments. Not surprisingly, we see confusion around issues such as screening and testing as providers and health departments try to sort out who does what. Meanwhile, the health plans have been superfluous in this crisis. We can argue specific re-opening strategies, but we can be confident that the steps needed to emerge from the Corona pandemic will depend on a strong, energized public health infrastructure working closely with the actual providers of health care, clinicians, emergency rooms, and hospitals. This is a recipe for success now and in the future as we tackle other pressing health care issues including population health approaches to addressing the social determinants of health.

Health care is at a tipping point, driven by the growth of value-based care, availability of digital solutions, and the emergence of population health. There will be immense opportunities for improved efficiencies in the near future. If history is any guide, this will lead to a few wealthy individuals and corporations realizing immense profits, while the rest of us remain little better off. We are seeing evidence of this already, with the aforementioned windfalls for health plans, the proliferation of telehealth companies threatening to further fragment health care, and with laboratories receiving billion-dollar deals to provide Covid testing disconnected from public health planning.

We can do better. As we spend trillions to sustain our economy, we should also invest in a public health system that will pay dividends in improved physical, emotional and economic health for generations to come. We can use this crisis to develop a vibrant integrated health care delivery system that serves patients, providers, and communities. Let’s work together to tip health care in the right direction.

Dr Zweifler is a family physician with decades of experience in medical director roles, patient care, medical education, and managed care, a part-time physician consultant with The Terry Group, and is the author of the e-books, “Tipping Health Care in the Right Direction” and “Pop Health”

He can be contacted at The Terry Group John.zweifler@terrygroup.com