Coronavirus and Healthcare: How a Pandemic is Improving Our Healthcare System

[ValinMNG]

In the wake of a dramatic surge of COVID-19 cases in many cities across the country, our healthcare system is forced to favor efficiency over profit. Several barriers have been removed for providers that allow for improved patient care like the elimination of prohibitive licensing requirements and equitable reimbursement for telemedicine. Though these measures are highly advantageous in a world without COVID-19, our profit-driven healthcare system never facilitated their growth. This pandemic underscores the dire need for healthcare reform—and, just maybe, this pandemic will be the catalyst for long-term changes.

On the removal of restrictive healthcare licensure requirements:

I am a registered nurse with an active nursing license in Washington State but the law does not allow me to work as an RN in Missouri (where I live and go to school) until I submit an application and receive approval after a lengthy review process with the Missouri Licensing Board. I could be helping right now. I want to be helping right now.

State healthcare licensure is convoluted for the majority of healthcare professions. Individual state licensure requirements were initially enacted to protect the public from medical incompetence in the late 19th century. However, because healthcare programs are accredited by national bodies and, well, because healthcare education is evidence-based there is no obvious need to continue this way.

These unreasonable requirements often deter providers from obtaining licenses in multiple states and result in lost opportunities for providing healthcare. When we consider providers living along state lines (like in St. Louis, MO) or the relevance of telemedicine (which brings healthcare to those who cannot physically access it)—we realize the importance of removing licensing barriers.

The good news is, several states have temporarily loosened their licensing requirements to allow for healthcare providers to work across states. The most notable example of this is New York issuing an executive action to allow physicians, nurse practitioners, nurses, and physician assistants to practice in NY as long as they are in good standing in their respective states. The bad news is, several states (like Missouri) do not have any legislation allowing for outside providers to practice during the pandemic. If healthcare personnel in Missouri are no longer able to provide adequate care because they are overwhelmed with the volume of patients, people will perish at the behest of outdated legislation.

On the increased use of telemedicine:

COVID-19 has spurred a dramatic growth in telemedicine use for two reasons 1) doctors still provide care to patients for chronic diseases, pregnancy, and mental health—but requiring office visits put patients at additional risks and 2) to keep coronavirus patients who do not need hospital care at home to prevent the spread of the disease.

The benefits of telemedicine have long been understood: it is cost-efficient, easier to access than an in-person visit for patients, and frees up valuable appointment time for more complex issues that require an in-person visit.

So, why did only 22% of providers report using telehealth in 2018 though a majority believe it is beneficial for patients? Among the top reasons are low reimbursement and aforementioned interstate licensing constraints. Out of necessity, insurance providers, including Medicare, have begun to reimburse doctors for telehealth at similar rates to in-patient visits. Effective for services beginning March 6th and “lasting for the duration of the COVID-19 public health emergency,” the Coronavirus Preparedness and Response Supplemental Appropriations Act requires that Medicare reimburse providers (doctors, nurses, nurse practitioners, and physician assistants) at the same rate as they would in-person visits and covers most conditions. Other influential insurance companies, like Aetna, have adopted similar reimbursement practices.

Improvements are important, but at what cost?

It would be remiss to not acknowledge the uncertainties of the cost of such large changes. In allowing for out-of-state providers to practice, states lose a revenue source—but, during non-pandemic times, this could be recouped if the government creates a federal licensing board and distributes fees equitably to states based on amount of providers. For telehealth, Medicare long-resisted telehealth for fear of increasing patient visits and thus, swelling costs. However, the Veterans Health Administration has been able to reduce hospitalizations by 19% and costs per patient by $6500 by enrolling patients in telehealth.

These changes will work. These changes will save lives.

Coronavirus has enhanced healthcare in two major ways and we are at risk of losing these gains if there are not adequate policies put in place to protect them. It is time to leverage the improvements being made right now for the sake of our future health.

[OUxPhys, BSN, RN]

I will say it is amazing that during this time my hospital has spent money to turn all our rooms into negative pressure rooms, switched out monitors, put glass in the doors so we can look into the rooms, installed monitors outside the room so we can watch the patient's without going in. For all of this I am grateful as other hospitals across the country are not taking the same steps or making the same investments. However, once this thing is over I know it will be business as usual.

In regards to the licensure I know some states have reciprocity agreements and it isn't very hard to obtain a license in another state (as long as they have reciprocity agreement). But I do agree, to get a license in another state that doesn't have reciprocity with your home state can be a pain. That is one of the benefits of working that VA.....if you have license in one state and what to work in another it transfers over. I dont see why we can't have something like that in the future for all RN's.

[BSN-to-MSN, ADN, BSN, RN]

I do not think the healthcare is improving, virus or not.

[toomuchbaloney]

Public health labs suffered budget cuts prior to coronavirus

Maybe the improvements will be permanent.

Maybe not.

[lindac0525]

     I agree that telehealth has definitely impacted patient’s in positive ways during the coronavirus pandemic for multiple reasons. The number of patients going for in-patient visits to doctor offices has lessened during COVID-19 due to telehealth availability, thus decreasing the risk of spreading coronavirus. Virtual care and telehealth has improved patient health and costs of healthcare, has allowed surgeons to be less physically and mentally exhausted and has enhanced the overall access to healthcare (Mason, Dickson, McLemore & Perez, 2021). This is so important especially the past few months where a majority of people were out of work and laid off. Many of these people had health insurance through their jobs, which in the past few months of COVID-19 peaking, health insurance was extremely important. The transition to telehealth during these times was especially valuable in regards to costs. According to Yamamoto, “the average estimated cost of a telehealth visit is $40 to $50 per visit compared to the average estimated cost of $136 to $176 for in-person acute care” (Yamamoto, 2014). Yamamoto also states, “In Medicare, where telehealth visits are reimbursed at the same rate as in person care, savings would still be realized from replacing in person care with telehealth visits where appropriate. In fact, replacing in-person acute care services with telehealth visits reimbursed at the same rate as a doctor’s office visit could save the Medicare program an estimated $45/visit” (Yamamoto, 2014). 

    Rising healthcare costs and access to healthcare is a big healthcare problem in the United States. With COVID-19 rising and at its peak a few months ago, we have been beginning to see costs of healthcare change, some for the better some for the worse. Doctors have transitioned over to mainly telehealth for patient visits during the pandemic making the overall cost of healthcare decrease in those situations. There has also been situations in regards to elevated demand of a popular drug to help COVID-19 patients, where the price of this drug and the administration is extremely high.  The famous drug remdesivir for extremely ill COVID-19 patients, according to Marchione, is “$3,120 for patients with private insurance” (Marchione, 2020). Marchione states, “In 127 poor or middle-income countries, Gilead is allowing generic makers to supply the drug; two countries are doing that for around $600 per treatment course” (Marchione, 2020). This is a great example of some challenges that go along with trying to improve healthcare costs, specifically pharmacy cost of drugs. Treating patients with a drug that is in high demand all around the world will of course cause the price of the drug to skyrocket. There is also expectations of the consumer in the way that consumers have very little familiarity on value of the care that is delivered (Mason et al., 2021).  Their way of thinking is that "the more expensive the care is, the better care that patient will receive" (Mason et al., 2021). Challenges in improving healthcare costs has been present even before COVID-19.  There has been some reforms placed that assists in healthcare costs and access to healthcare. There has been site neutral payments put into effect where “reimbursement will be the same regardless of setting in which service is delivered” (Mason et al., 2021). This correlates with COVID-19 pandemic and telehealth services currently.  A well-known act, called the Affordable Care Act was also put into effect to assist rising healthcare costs including “bundle payments” and employer obligation to offer health insurance (Mason et al., 2021). At this current time I believe the affordable care act and site neutral payments have been advantageous. In my own personal experiences, during the coronavirus pandemic I was placed on furlough since I worked in an elective surgery outpatient setting. During that time, I was grateful that my job still offered health insurance where both the company and my coworkers and I continued to contribute the same amount (no more no less) even though we were not full time. As COVID-19 started to fall, doctor offices were opening back up and use of telehealth was decreasing.  I remember scheduling my first LASIK appointment and it was originally virtual through video chat. As weeks went by, the LASIK doctor office contacted me saying that the office was now open for in-person visits and consultations. I believe that in my situation, a virtual video chat would not have been beneficial for me because the doctor must measure and dilate my eye. However, for others who do not need physical direct care but instead overall education and assessment can benefit from telehealth in more ways than one as previously described (convenience, better health, decrease in costs and presently, continues to reduce the risk of spreading coronavirus). I recommend doctors continue using this option to see patients even though the wave of coronavirus has fallen. Not only has healthcare costs been greatly improved with telehealth but the access to healthcare has improved also.

Marchione, M. (2020). COVID-19 Treatment Remdesivir to Cost Private         Insurers $3,120. Retrieved from insurancejournal.com

Mason, D. J., Dickson, E. L., McLemore, M. R., & Perez, G. A. (2021). Policy     & politics in nursing and health care. St. Louis, MO: Elsevier.

Yamamoto, D. (2014). Assessment of the Feasibility and Cost of Replacing     In-Person Care with Acute Care Telehealth Services. Retrieved from   connectwithcare.org