Even the most vocal critic of the American health care system cannot watch coverage of the current Covid-19 crisis without appreciating the heroism of each caregiver and patient fighting its most-severe consequences. Hospitals are being built in parks and convention centers, new approaches to sterilizing personal protective equipment (PPE) for reuse are being implemented, and new protocols for placing multiple patients on a single ventilator have been developed. Most dramatically, caregivers have routinely become the only people who can hold the hand of a sick or dying patient since family members are forced to remain separate from their loved ones at their time of greatest need.
Amidst the immediacy of this crisis, it is important to begin to consider the less-urgent-but-still-critical question of what the American health care system might look like once the current rush has passed. In particular, what can the system learn from the existential challenges it faces due to the spread of Covid-19? A few broad lessons are already emerging.
Medicine is medicine, no matter how and where it’s practiced.
As the crisis has unfolded, we have seen health care being delivered in locations that were previously reserved for other uses. Parks have become field hospitals. Parking lots have become diagnostic testing centers. The Army Corps of Engineers has even developed plans to convert hotels and dormitories into hospitals.
While parks, parking lots, and hotels will undoubtedly return to their prior uses after this crisis passes, there are several changes that have the potential to alter the ongoing and routine practice of medicine.
As concerns over the spread of Covid-19 in the United States grew during March, several arcane regulations that have long constrained American health care showed signs of easing. Most notably, the Centers for Medicare & Medicaid Services (CMS), which had previously limited the ability of providers to be paid for telemedicine services, increased its coverage of such services. As they often do, many private insurers followed CMS’ lead. To support this growth — and to shore up the physician workforce in regions hit particularly hard by the virus — both state and federal governments are relaxing one of health care’s most puzzling restrictions: the requirement that physicians have a separate license for each state in which they practice.
These moves have provided a boost to pure-play telemedicine companies such as Teladoc Health, which reported an increase of 50% in its visit volume during the week ended March 13 and saw its stock price increase by almost 43% during the week starting March 16. Most notably, however, these regulatory changes, along with the need for social distancing, may finally provide the impetus to encourage traditional providers — hospital- and office-based physicians who have historically relied on in-person visits — to give telemedicine a try.
Prior to this crisis, many major health care systems had begun to develop telemedicine services, and some, including Intermountain Healthcare in Utah, have been quite active in this regard. That said, nationwide use of telemedicine had been limited. John Brownstein, chief innovation officer of Boston Children’s Hospital, noted that his institution was doing more telemedicine visits during any given day in late March that it had during the entire previous year.
The hesitancy of many providers to embrace telemedicine in the past has been due to restrictions on reimbursement for those services and concern that its expansion would jeopardize the quality — and even continuation — of their relationships with existing patients, who might turn to new sources of online treatment.