How COVID-19 has changed hospital care

“Survival mode.”

This is how a 2021 report from the Office of the Inspector General of the U.S. Department of Health and Human Services described how hospitals operated during the first year of the COVID-19 pandemic. In those early months, hospitals were pushed to the brink as they faced “significant challenges related to health care delivery, staffing, immunization efforts, supplies and stability. financial,” according to the report.

No wonder. The coronavirus has upended just about every facet of American life, and its impact on hospitals will last for years. But it has also helped accelerate some positive trends, like expanding access to telemedicine for those who would otherwise struggle to access care.

Here’s how the pandemic has changed how hospitals operate — and what we might expect to see down the line.

Telemedecine

At the start of the pandemic, we turned to remote medicine out of necessity. In the future, telehealth has the potential to play a much larger role in our healthcare system. A recent analysis of nearly 900 hospitals and more than 19,000 clinics by the Kaiser Family Foundation and Epic Research found that while telemedicine use has fallen since its peak in 2020, it now accounts for a much larger share of outpatient health care visits than before the pandemic.

The report suggests that telehealth services could improve access to medical care for several groups of people, including older Americans managing chronic illnesses and people in rural areas with limited access to health care providers. The ability to receive needed care at home, rather than having to travel to a hospital or clinic, could be life changing.

Deferred care

While the pandemic has helped expand access to care for some, it has limited that access for others. Caitlin Donovan, spokesperson for the National Patient Advocate Foundation, describes a disturbing trend. “People [have had] to delay their care any longer” during COVID-19 surges, she says, often because hospitals lacked the capacity to treat them.

Sometimes there just aren’t enough beds or enough surgeons. As providers struggled to cope with the ongoing emergency, many reduced the number of elective surgeries they provided or halted those surgeries all together. Donovan notes that there is a difference between the medical meaning of “elective surgery” and how most people think of the term, adding that many people have learned the difference in real time over the past two years. The essential? Elective surgery does not mean elective surgery. “Elective surgery can still be for cancer,” she says, “it just means it’s not an emergency.”

Stresses caused by COVID-related income or savings disruptions have also contributed to healthcare delays. “There are a lot of people who might be in a situation where they’re hesitating because of the financial burden,” says Patricia Kelmar, director of healthcare campaigns at US PIRG, a public interest advocacy group. These people may have previous care debts related to COVID-19, Kelmar says, or they may have lost insurance or exhausted their savings.

A poll last fall by NPR, the Robert Wood Johnson Foundation and the Harvard TH Chan School of Public Health found that one in five American families had delayed care for serious illnesses in the previous months, and all three quarters of those who did not have access to care suffered negative health consequences.

Whatever the reason, delaying needed healthcare often exacerbates the problem and can lead to more complications and costs down the line for both hospitals and patients.

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Consolidation

A lesser-known consequence of the pandemic has been consolidation — hospitals buying up smaller medical practices and weaker competitors.

The industry was already following this trend, according to testimony from Martin Gaynor, a professor of economics and public policy at Carnegie Mellon University, during a congressional hearing last May. There have been more than 450 hospital mergers over the past decade, according to Gaynor.

But more recently, an influx of federal pandemic relief money to large hospital chains (allowing them to claw back competitors) has experts worried that this trend is accelerating. Some fear that further consolidation will hurt not only patients, but also doctors, insurance companies and employers, by increasing health care costs.

“When you have less competition,” says Kelmar, “prices go up.”

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