One year ago today, I was in an airport on the east coast heading home after finishing a business trip, delightfully unaware that that would be the last time I would be out of Southern California for, well, a year. And counting. There have been 11 months of varying states of lockdown and tumult to our business and industry to look back on. With an end is finally on the horizon, it seemed a good time to reflect on a few things that have been relevant to us.
Elective services kind of are
There’s enough data published now about the impact of hospitals shutting down elective, preventative, and other procedures in the first and second waves of the pandemic to start making some observations. Surveys indicate that somewhere between ⅓ – ½ of patients postponed or chose to completely forgo care, with corresponding drops in revenue for hospitals and providers. The longer-term impact here is something to watch: how many of these services have merely seen a time shift in demand, and how many are experiencing permanent demand destruction? Considering that only 11% of patients who delayed or skipped care reported that their conditions worsened because of it, that may foretell a long road out for organizations depending on the revenue generated by such services. It’s not particularly surprising that hospitals in a number of states quickly reopened (and vowed to stay open) for elective procedures, though to what extent politics, short-term financial interests, and long-term viability played into those decisions is hard to say.
More recent data shows these trends continuing into 2021. By nearly every metric: margins, discharges, patient days, OR minutes, and more, hospitals and health systems are in worse shape than they were a year ago. Anyone hoping that things will go “back to normal” is setting themselves up for disappointment. Organizations relying on elective services will continue to face significant headwinds, and need to plan and equip accordingly.
Telemedicine works, except when it doesn’t
300+%. Teladoc’s 2020Q2 visit numbers were more than 3 times higher than the same period a year earlier. Perhaps no healthcare sector, digital or otherwise, benefited from the pandemic as much as telemedicine. Telemedicine –like VR and the Cleveland Browns– has never managed to live up to its promise and break through, but COVID-19 and some unprecedented help from CMS finally made it happen. Maybe. Telemedicine volume skyrocketed early in the pandemic, but then plateaued and has since been on a consistent decline. Tellingly, Teledoc has softened their outlook for 2021.
That mirrors what I’ve seen at wound care programs. Wound care, I think, is a microcosm of the promises and the pitfalls of telemedicine: good for assessments but challenging for treatment, and often misaligned with the current incentives for many of the parties involved. While telemedicine visits are still considerably higher than pre-pandemic levels, there’s little evidence that a fundamental shift in consumer behavior has taken place. For many programs or service lines, telemedicine is not a death knell, but is a threat on the margins and should be accounted for.
Heck, the Browns even won a playoff game this year.
Your quiver has more arrows than you might think
“Do what you can, with what you have, where you are” is one of my favorite quotes (it’s commonly, though [to my dismay] apparently falsely, attributed to Teddy Roosevelt). When systems, services, and institutions we normally relied on either didn’t show up, were no longer relevant, or even failed, the ability of individuals to find and make something work was truly inspiring.
We have a small little niche here that is, in the grand scheme of things, far less important than others, and we won’t pretend otherwise. Still, for programs that suddenly found themselves unable to fire one of their most reliable arrows –direct, in-person outreach– it didn’t take them long to adjust and adapt. By focusing on virtual visits, phone calls, and emails, often as part of a larger campaign, business managers and outreach coordinators were able to engage with their referral base in meaningful ways. Those efforts helped restore volumes and keep programs afloat. Equally important, it helped in developing strategies that can be employed even after the pandemic is over.
The strong get stronger
There was a time last year when I thought (or maybe just hoped) that the pandemic would be an egalitarian black swan event; something that affects us all and brings out the best of us as we’re all in it together! Didn’t last. Disparities in the pandemic’s impact manifested everywhere with a common theme: the big, strong, rich, powerful got bigger, stronger, richer, more powerful. A great equalizer Covid was not.
A survey conducted by The Physicians Foundation to measure the impact of COVID-19 put forth some stark numbers: in a survey of physicians conducted in July 2020, 8% of respondents — representing an estimated 16,000 practices — had to close. 76% of those closures were private practices. Already on the decline nationwide, many of them simply did not have the ability to withstand the strains (economic or otherwise) that hospital groups, academic facilities, or larger medical groups were able to ride out.
No surprise: most practices report a negative financial impact from the pandemic, with 72% of surveyed physicians experiencing a reduction in income and 82% experiencing a reduction in volume. The PPP proved successful as well, with the majority of practices that applied for and received a loan able to remain open. With limited government intervention on the horizon, practices will need to do all they can to restore volumes, lest they close or find themselves gobbled up by a larger organization. Increased consolidation in the marketplace as the strong get stronger only makes it harder.
More than ever, being flexible is an imperative
It’s kind of incredible how much and how fast some places were able to change. My kids’ school switched to distance learning in March 2020 in less than a week. I, like the rest of my coworkers, took my laptop home with me one day and…kept working.
While most companies found a way to deal with the pandemic (because what was the alternative?) the best ones found a way to turn it into an advantage. Tech companies like Twitter and Facebook quickly adopted permanent work from home policies even though they hadn’t planned on doing so for a number of years. Sure, the move will benefit their employees, but the companies will benefit as well. Not every company can do what they do, and they’ll turn WFH/WFA into a competitive advantage because of it.
As we (hopefully!) get to the end of the pandemic, the focus shifts to long-term reopening. A lot of discussion surrounding reopening offices implies getting back to how things used to be. That’s natural, and many people are working in ways that don’t benefit their personalities or their job functions. But looking back to February 2020 isn’t realistic for many, and probably shouldn’t be a goal for most. More change will come, and the companies that can adapt to the market and the environment while sustaining their culture will be the most successful.
Don’t use Bossware though. Things are dystopian enough already. We’re all better than that.
Sources and further reading:
- https://www.healthaffairs.org/do/10.1377/hblog20201006.263687/full/
- https://khn.org/news/nearly-half-of-americans-delayed-medical-care-due-to-pandemic/
- https://www.healthcaredive.com/news/one-third-of-us-adults-postponed-care-during-pandemic-reports/595102/
- https://www.urban.org/research/publication/delayed-and-forgone-health-care-nonelderly-adults-during-covid-19-pandemic
- https://www.healthcaredive.com/news/covid-19-spurs-tripling-in-teladoc-visits-to-28m-full-year-outlook-hiked/582546/
- https://www.statnews.com/2020/09/01/telehealth-visits-decline-covid19-hospitals/
- https://www.ehrn.org/articles/telehealth-fad-or-the-future/
- https://physiciansfoundation.org/wp-content/uploads/2020/08/20-1278-Merritt-Hawkins-2020-Physicians-Foundation-Survey.6.pdf