The COVID-19 public health emergency has left a lasting impression on the healthcare industry. Sustained fissures in the infrastructure of the healthcare system are impacting care-seekers, as unprecedented respiratory disease surges overwhelm emergency rooms. The pandemic itself continues to contribute to emerging healthcare problems for Americans, while also highlighting other flaws in the healthcare system.
Joint Viral Surges Increasing Number of Hospitalizations
A joint surge in respiratory infections, including RSV, influenza , and COVID-19, have increased the cumulative hospitalization rate to the highest it has been in a decade (1). CDC health data notes 1,600,000 flu illnesses, 13,000 hospitalizations, and 730 deaths (with at least 2 pediatric deaths) from the flu this season (1). Data tracking from the US Department of Health & Human Services offers the conservative estimate that, nationally, 78% of inpatient and 74% of intensive care unit beds are currently in use (2). The healthcare industry will have to reevaluate their inpatient care plans as Americans seek treatment in a flu season with multiple illness cycles.
Non-investment in Acute Pediatric Care Due to Stretched Budgets
A study distributed by the American Hospital Association estimates that more than half of hospitals are expected to have negative margins in 2022 relative to a pre-pandemic baseline (3). This suggests billions of dollars lost and an increased strain on the healthcare industry. With supply, labor, and drug expenses rising, the ability for patients to access care in some areas is profoundly impacted by the ability of hospitals to break even as businesses, especially smaller hospitals.
The recent surge in infections necessitating hospitalization also exposes a lack of acute pediatric care. A growing subset of rural care seekers have to travel to receive specialized attention as “hospital provision of acute care decreased” between 2008 and 2016 (4).
Nationwide, there is a wave of pediatric units closing. Henrico Doctors’ Hospital in Richmond, VA announced the closure of its pediatric unit to “focus on our care teams’ efforts on the increased demand for adult inpatient medical and surgical care.” Ascension St. John Medical Center in Tulsa, OK shuttered its general pediatric and PICU units to “invest $27M to expand adult ICU capacity”. Hospital costs for providing specialized pediatric care is higher than general care for insured adults (5). The long-standing effects of closures still remain to be seen. However, reports from pediatric physicians alleging that they’ve already reached capacity prior to peak flu season are hinting at the downstream effects of closures.
Telehealth Capabilities
Impermanent or a lack of access to telehealth is also emerging as a healthcare problem for Americans. To preempt the amount of people who seek in-person care, many hospitals emphasized telehealth during the COVID-19 pandemic– can this be an effective strategy going forward? A McKinsey study found that virtual care is accessible but reliant upon hospital investment and utilization. Developing a robust telehealth network remains difficult and slow-moving. Policymakers urged the prioritization of virtual visits during the peak of the pandemic and expanded telehealth provisions until 2023. At the end of this period, “absent any changes, most Medicare beneficiaries will lose access to telehealth services unless they live in rural areas or enroll in Medicare Advantage,” and many of those who have been utilizing virtual services will no longer have that option (6). Historic staff shortages still prevent many from receiving timely and consistent virtual appointments. Telehealth may be a path forward, but the industry currently lacks the resources, policy adjustments, and capacity to implement it as standard practice.
The concurrent surges of the flu, RSV, and COVID expose the underlying problem of reduced hospital capacity, especially for pediatric patients. Tight budgets, the cost of keeping pediatric care units and specialty departments open, staff shortages, and limited telehealth infrastructure are limiting many Americans’ ability to receive care. As America progresses into the new reality of the long-tailed effects of the COVID-19 pandemic, how it handles the emerging healthcare problems exposed by and related to COVID-19 will have large impacts on the health of Americans.
References
- CDC. Weekly U.S. Influenza Surveillance Report. https://www.cdc.gov/flu/weekly/index.htm#ILINet. Updated Nov. 4, 2022.
- HHS Protect Public Data Hub. Hospital Utilization. https://public-data-hub-dhhs.hub.arcgis.com/pages/Hospital%20Utilization. Updated Nov. 10, 2022.
- Kaufman, Hall & Associates, LLC. The Current State of Hospital Finances: Fall 2022 Update. American Hospital Association September 2022. https://www.aha.org/system/files/media/file/2022/09/The-Current-State-of-Hospital-Finances-Fall-2022-Update-KaufmanHall.pdf
- Michelson K, Hudgins J, Lyons T, Monuteaux M, Bachur R, Finkelstein J. Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016. Pediatrics January 2020; 145 (1): e20192203. 10.1542/peds.2019-2203. https://publications.aap.org/pediatrics/article/145/1/e20192203/36973/Trends-in-Capability-of-Hospitals-to-Provide
- Colvin J, Hall M, Berry J, et al. Financial Loss for Inpatient Care of Medicaid-Insured Children. JAMA Pediatrics. 2016;170(11):1055–1062. doi:10.1001/jamapediatrics.2016.1639. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2551924
- Harris J, Bhatnagar S, Newell B, et al. The Future of Telehealth After COVID-19: New Opportunities and Challenges. Bipartisan Policy Center. Oct. 11, 2022. https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2022/09/BPC-The-Future-of-Telehealth-After-COVID-19-October-2022.pdf