How will other needed care be provided during the pandemic?

As our healthcare system and others around the world gear up to deal with the largest public health crisis of the past 100 years, an important question to consider is: How will other needed healthcare delivery occur during the pandemic?

This needed healthcare includes elective surgeries that may still be important to help an individual function or manage other healthcare conditions; primary care services like chronic disease management that patients must get to avoid having their conditions worsen or cause other health problems; and preventive care that may help reduce the possibility of getting Covid-19 or mitigate its severity once contracted.

Given the healthcare system’s current inability to properly address the pandemic, it is fair to wonder how much other important healthcare will be neglected during the outbreak, and what additional negative impact this will have on the health status of Americans.

Already, my family and I have received e-mails from our providers telling us that their offices are closing to all but emergency care, for periods that may last a while. We have been told by several that we may be able to conduct telehealth visits with them for certain issues.  It is difficult to understand how telehealth can be used quickly or in a high-quality manner for services like orthopedics, cardiology, or dermatology; or any care that requires lab work, imaging, procedures, or an actual physical examination.

Regarding virtual care, the reality is we are simply nowhere close to having the technology or expertise to do it right, regardless of payment being available. In addition, some healthcare professional still has to be involved in telehealth provision, so in a system with no capacity, it is hard to imagine telehealth making much short-term difference. 

There is no doubt that our health system must gear up first and foremost for the crisis at hand.  The need to keep people at home and away from public spaces is a short-term imperative to blunting COVID-19’s spread. But over the longer term, if we make patients significantly delay or cancel important care they require to stay healthy and function independently, or provide it in a low-quality way, we risk making the effects of this pandemic much worse.

Blood sugars and high blood pressure that cannot be monitored or controlled properly; unperformed surgical procedures that would enhance patients’ ability to care for themselves or others; mental health issues that will impact people’s ability to think and behave proactively with respect to staying healthy, and being able to work and earn a paycheck-left neglected, these realities will amplify how Covid-19 affects local populations and leave many more Americans in worse health once this pandemic is over.

There are no easy solutions to these problems. Nations have spent years underinvesting in primary care systems almost everywhere-Italy, the United Kingdom, and the United States, to name a few. Here in the U.S. we have encouraged an expensive, fragmented, and mostly hospital-based system of specialty care.

And because hospitals are having to care for the sickest COVID-19 patients, it is difficult to get other needed forms of care out to the places where many live and work. Many hospitals have to focus almost solely on COVID-19 patients, both because of the highly communicable aspects of the illness and their lack of capacity to do anything else while dealing with patient demand from the illness.

How soon they are able to get back to business as usual once the current crisis ends is an open question. It may not be easy for them. 

Even when we have enough COVID-19 tests available, we will have difficulty getting the tests out to individual patients, in part because there are many communities without enough care providers, and because many medical practices are closing for extended periods of time.

What is left of the primary care system in the U.S. will need to step up to handle a good chunk of this other needed care delivery once the current crisis eases. Bringing physicians and nurses out of retirement in local communities to work in primary care offices and urgent care centers is one needed step.

Moving whatever basic primary care we can to the virtual space, whether via phone or computer, is a second step. Making some primary and urgent care offices in local communities remain open 24 hours a day, with certain hours allocated for specific types of care delivery, and staffed accordingly, is a third step. Redesigning workflows in these offices to improve care efficiency is a fourth step. Providing added financial support to these offices, in the form of enhanced reimbursement, underlies it all. These steps may require many months to be implemented.  Still, when the time is right, we have to try.

The COVID-19 pandemic is like nothing we have seen in our lifetimes. We must do everything possible to lessen its potential destructiveness. That includes making sure we do not forget about the other important care patients require to stay healthy and function. If we do, we risk emerging from this crisis with a population and workforce much less able to contribute in making our society and economy strong again.

Timothy Hoff, Ph.D., is professor of management, healthcare systems, and health policy at Northeastern University in Boston;  a visiting associate fellow at the University of Oxford, and author of Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health.