Before COVID-19 hit the U.S., health systems were already facing a mountain of challenges: personnel shortages, provider burnout, increased risk and compliance responsibilities, revenue shortages and a need for top-line growth and bottom-line efficiencies.
In the days, weeks, and months that have followed COVID-19, health systems’ began to feel the sharp pain from unprecedented revenue loss, personnel burnout and shortages, and stretched operational capacity.
With the focus so acutely on operationalizing the electronic health record (EHR) for years, many providers found their technology was not adequate in managing the coming challenges presented by COVID-19. With the need to rapidly deploy virtual care strategies amidst the pandemic, healthcare operations in early 2020 have relied heavily on telemedicine and remote patient monitoring to address revenue, burnout, and capacity issues.
An Unprecedented Revenue Crisis
Health systems are facing an unprecedented revenue crisis. In anticipation of the surge in COVID-19 cases, hospitals took proactive actions to cancel revenue-driving services, such as elective procedures and surgeries and inpatient visits, including those for treatment and management of chronic conditions. Hospitals began to furlough staff, move administration and other non-clinical roles to work from home, and quickly restructured to allow virtual visits to replace in-person visits.
Hospitals are reporting losses between $80M and $800M per month. New York academic medical centers have stated losses up to $450M a month since the start of COVID-19 due to sharply rising personnel costs with “dramatic losses in revenue.” As hospitals continue to lose millions of dollars, they are spending more money on personal protective equipment (PPE) such as masks, face shields, gloves, and gowns to protect their staff from the surge of COVID-19 patients.
All of these investments were in anticipation of increased hospitalizations of COVID-19 patients – meaning revenue plummeted while expenses skyrocketed. Federal funding from CARES Act and the FCC have helped offset costs, but providers say it is not enough. As a result of revenue losses, the industry expects more furloughs and layoffs of hospital staff – from nurses to I.T.
We still have not reached peak revenue loss for providers. For PCG (primary care groups), independent physician practices, hospitals, and health systems, the worst is, unfortunately, yet to come.
Stretched Capacity
Long before COVID-19, many emergency departments struggled with overcrowding, long wait times, difficulty triaging patients, growing visits from uninsured patients, and being the de-facto service providers as patients left PCPs. The biggest problem plaguing emergency departments is the lack of beds and a lack of doctors, nurses, and medical equipment needed to care for each admitted patient.
A recent analysis found that the U.S. has fewer hospital beds with practicing physicians per capita than many similarly large and wealthy countries. Additionally, the U.S. lags in hospital beds per capita, with 2.8 hospital beds for every 1,000 people.
Right now, hospitals are facing an enormous capacity problem. The demand for patient beds is growing faster than the number of beds available. Patients in hard-hit areas are stuck in the waiting room or on stretchers in hallways until a bed becomes available. In many cases, doctors and nurses have to decide in a matter of minutes who is sick enough to receive urgent care (and receive a bed/medical equipment) and who can either continue to wait or return home until their symptoms worsen. The nature of the Coronavirus has made those initial determinations difficult. A patient with symptoms that might not appear severe at first can rapidly deteriorate if they are not given the proper medical attention.
Personnel Issues: Shortage and Burnout
Capacity issues are compounded by a lack of doctors, nurses, and medical equipment needed to care for patients. And, while these problems existed before, COVID-19 has created a constant state of chaos within hospitals – increasing stress, burnout, medical errors, or worse, leaving patients to worsen or decompose in the clinical care setting.
Helen Ouyang, an E.R. physician in New York City, wrote an article describing what it is like to work in a hospital during COVID-19. “A couple of hours into my shift, one of the nurses comes to me. She falls apart, tears streaming down her inflamed, marked cheeks. She sobs out words of anger and frustration and sadness. The morning, on top of the last several days, has crushed her. I want to hug her, but I can’t. Shortly after that, someone asks, “Doctor, is it OK to take the patient to the morgue?” The other physician on duty and I look at each other. The morgue? Who just died? Apparently, a patient who was waiting for an inpatient bed, whose family had decided against extreme resuscitative measures, had died, without us even knowing.”
During this crisis, hospital staff has been forced to make great sacrifices within a field that requires constant, daily sacrifice. Many hospitals have required physicians and nurses to extend their shifts without protective gear or resources. Hospital staff have had to work through sickness, struggles, and trauma. Many of them have had to quarantine or separate themselves from their families. Hospital staff has been asked to take on roles and responsibilities outside their training or education. They have worked as professionals amongst constant anxiety, personal fear for their safety, and saddest of all, some died after contracting the virus, many in the line of duty.
Before COVID-19, a broad-based study that assessed U.S. physicians using the Maslach Burnout Inventory (MBI) showed that 54.4% of all physicians combined reported experiencing at least one symptom of burnout. During the pandemic, nurses and other healthcare professionals have quit. Hospitals were short-staffed before COVID-19, with excessive burnout, COVID-19 could leave hospitals even more short-staffed than before.
The Solution and Future State
As the ratio of patients to clinicians increases, the quality of care can diminish. Virtual care is a critical way to solve the deficit and to ensure quality improves while meeting increased compliance requirements and patient needs.
Hospitals and health systems can address capacity issues by moving inpatient care to the home, especially for those who are managing an acute or chronic condition. When combined with virtual check-ins, remote patient monitoring (RPM) can replace many of the current inpatient visits related to adjusting and managing treatments. Because those with chronic conditions are at an increased risk of getting severely sick, the need to monitor these individuals is critical during this time. Through virtual care services like RPM, providers can get a holistic and comprehensive picture of a person’s health and a deeper understanding of how their health has evolved.
With CMS reimbursement available for RPM, providers can use CPT Code 99457 to bill for remote physiologic monitoring treatment management services and 99453 for patient education and set-up. These two codes allow for quick deployment and scaling of remote monitoring programs by providing the financial structure for physicians and qualified healthcare professionals to be reimbursed for their time spent on patient care using connected devices and remote monitoring technology.
Hospitals can deploy physicians on telehealth visits, which are currently billed at the same rate as in-person care while deploying nurses on RPM services, which can generate $12k per patient per year in revenue.
Validic Impact is a remote monitoring platform that enables seamless management of remote care programs within existing clinical workflows and systems. The solution has proven to reduce the cost and clinical burden that lifestyle-driven chronic health conditions place on people, providers, and caregivers by enabling early diagnosis and prevention, and proactive, personalized care management.
Through an RPM program using Validic Impact, both patients and clinicians reported that as a result of the program, there was better care delivery and communication. The program allowed both parties to save time in communications and traditional in-person visits. Specifically, average call times for nurses were reduced from 15 minutes to 5 and a half minutes.
Additionally, 92 percent of physicians said the program helped them make better clinical decisions – based on ‘accurate, timely data from synced devices,’ and 88 percent said the program saved them time by ‘eliminating manual tasks.’ The remote monitoring program saved $500K – $1M on interface development and integration costs needed to support patient health data in Epic flowsheets.
At the end of the day, patients are relying on access to healthcare to survive. Through canceled appointments, fear of in-office visits, and the mental and physical health effects of being quarantined, they need support now more than ever, and they need our healthcare system to be well equipped to do so.
As demonstrated over these last few months and with continued support from regulatory bodies like the Centers for Medicare and Medicaid Services (CMS), healthcare providers will no longer be able to afford not having these solutions in place for disaster recovery, pandemic response, and business continuity plans. Virtual care is here to stay. Thankfully, these solutions offer support to address many of the critical challenges healthcare providers and patients face today.
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