The health care landscape has drastically changed since the coronavirus pandemic arrived in the United States.
Doctors restructured office waiting rooms and now greet patients daring enough to keep regular visits wearing masks. Hospitals cut elective surgeries, limited visitors and scrambled to provide protection for workers. Tests and annual checkups have been postponed or converted to virtual visits.
Dr. George Sledge, professor and chief of the Division of Oncology at Stanford University Medical Center, said criteria to monitor patients have had to adapt.
"Many of our protocols got way too specific and way too impractical and (the pandemic) has allowed us to reset a lot of those," he said.
Precautions impacting the way most Americans access basic health care are expected to last. Without a vaccine – not expected even optimistically until sometime next year – the risk of transmitting the virus that causes COVID-19 remains high.
So what will the future of medicine look like as the U.S. adapts to the new pandemic landscape? Expect more remote doctor visits, tenuous hospital care in rural areas and increased preparedness.Telehealth and telemedicine
While telemedicine is technically nothing new to health care providers, experts say it has exploded since the pandemic began.
“For years, we’ve talked about the promise of telemedicine and its opportunities,” said Mark Holmes, professor at University of North Carolina Gillings School of Global Public Health. “But what the last two months has shown us is that it could really be a game changer.”
Dr. Lisa Yerian, chief improvement officer at the Cleveland Clinic, has seen the growth firsthand. Prior to COVID-19, the clinic had an average of 3,400 virtual visits per month. That number shot up to about 200,000 visits in April.
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The coronavirus pandemic has forced health care providers to iron out kinks in telemedicine, Holmes said. The Trump administration has broadened Medicare coverage and payment of virtual services as hospitals educate their patients and health care workers on how to use it.
“There was a time when many people were very reluctant to use virtual technologies,” Yerian said. “But more and more people are becoming more comfortable.”
Not everyone, however, can enjoy the convenience of virtual visits, Holmes said. Broadband in rural communities continues to be an obstacle.
“We still have a way to go,” he said.Rural hospitals closing
Rural hospitals have been teetering on the tight-wire of financial fragility for about a decade, said Michael Topchik, director of the Chartis Center for Rural Health.
The pandemic could be what sends them over.
A study conducted by the health care consulting firm revealed 453 rural hospitals – nearly 25% in the country – are vulnerable to closure.
“Things were bad and they’ve gotten way worse,” Topchik said. “One in three hospitals were operating in red. Now it’s almost one in two.”
Elective procedures largely put on hold since the pandemic make up the majority of business for rural hospitals. According to Topchik, 79% of rural hospital volume and revenue come from these procedures.
“That’s a crushing blow,” he said.
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Emergency room volume, another source of revenue for rural hospitals, has plunged. Florida hospital officials say emergency room visits in the state have dropped by almost 50% as patients delay or refuse care because they’re afraid of going to the hospital and getting infected with the virus.
While Topchik said rural hospitals are seeing COVID-19 patients, those patients not staying for long. Most of them are stabilized at these smaller hospitals and then transported to bigger ones with more resources. It's always been that way, he said.
Due to the loss of income, the Chartis study found, rural hospitals are operating at a median of 33 days cash on hand. Hospitals in 14 states are operating at zero to 19 days.
Rural hospitals have long relied on bipartisan support. The Rural Emergency Acute Care Hospital (REACH) Act and, more recently, the CARES Act, provided some relief to small health care providers. Additionally, the federal government decided this month to send $22 billion to rural hospitals and those hardest hit by COVID-19.
"Every available dollar possible should go to rural hospitals as it will be a much larger dollar in three to six months," said Jimmy Lewis, CEO of HomeTown Health, which represents rural hospitals in Georgia.
Topchik says more can be done. Reversing cuts made to federal spending and bad debt reimbursements and creating incentives, such as loan forgiveness programs to attract and retain rural doctors, could help.
"COVID may serve as the catalyst where there's a recognition that this system was so fragile and in such a state of decay that this is the time where we put our money where our mouth is," he said.Hospital preparedness: PPE, testing and tracking
Holmes said health care providers were not surprised by the coronavirus pandemic but were unprepared.
“There had been a lot of playbooks and forecasts that have seen this for years,” he said. “The issue is that it costs money to prepare.”
Holmes hopes the pandemic has taught society the value of preparedness and stockpiling personal protective equipment in case of any emergency, whether it’s a pandemic or a hurricane. He also underscored the need for a national data system that keeps track of daily cases instead of relying on individual states.
Dr. Lisa Carey, oncologist at the University of North Carolina Lineberger Comprehensive Cancer Center, highlighted the importance of testing in future pandemics.
“We’ve had four pandemics in the last 20 years and three of them (came from a) coronavirus,” Carey said. “These are lessons learned for not just this but future infections.
“And there will be others.”
Contributing: Jayne O’Donnell, USA TODAY; Associated Press. Follow Adrianna Rodriguez on Twitter:@AdriannaUSAT.