In response to COVID-19, many health care regulations on telehealth, licensing, supply, and testing processes have been eased. These changes have been good for patients, doctors, and everyone in the system and need to be made permanent – and lessons need to be learned from them. Coupled with the right policies, this effect could be leveraged to reduce complexities and costs in our healthcare system and help patients with much-needed access to providers through a less contorted delivery system.
As patients and doctors confronted the pandemic, many practices joined the telehealth movement. While telehealth was something that many were aware of, overall market usage was low. This is in large part because of complex systems of reimbursement. However, in response to the pandemic, the federal government eased restrictions on reimbursement for telehealth and there was an immediate response. Doctors could receive reimbursement, patients could stay at home, and healthcare was able to be delivered.
And as states experienced surges of patients and doctors working longer hours – licensing restrictions initially held back replacements. As soon as this was fixed at the state level, providers were able to both flow into surge areas as well as see patients for telehealth visits, easing demand on different portions of the overall system. Patients had access, and doctors weren’t overworked – that meant better healthcare for all.
Instead of COVID-19 tests being sent to a government lab, private labs were able to take over and greatly increase the efficiency of processing the test. An efficiency with widespread desirable consequences for all involved by just reducing the regulatory maze of complexity.
Furthermore, many states eased their Certificate of Need (CON) laws in response to COVID-19. CON laws restrict the number of hospital beds as well as ambulatory surgery center operating rooms in a given area. Easing these restrictions created more supply for COVID-19 surges, but also opened up supply and competition for other services as well.
Lastly, Operation Warp Speed has shown what is possible when the government, even partially, gets out of the way of drug development. Instead of a vaccine taking five years to be developed and work its way through the system we are looking at one year. This is a win for both the recipients and sellers of vaccines. Hopefully, opponents of fast vaccines may reconsider their position as they begin to understand that many capable legal channels exist to protect against mischief.
But more needs to be done.
Years ago, a threshold was reached in health care where it evolved to a self-perpetuating ecosystem spinning out of control. The system now has a life of its own that defends against attempts to simplify. Whether solutions come from policymakers or health care stakeholders, they all have to fight against strong antibodies that target change.
In health care, the patient is increasingly the payer. In segments of health care where the patient is the payer, access is almost immediate, prices are low, and quality is high. Whether it is like the cosmetic services bundled payment model or the increasingly widespread Surgery Center of Oklahoma Direct Payment model.
Congress needs to look at how the market is already innovating and attempt to incentivize more of these changes, while also looking at other government regulations and ask how they too affect the system.
Healthcare in the U.S. is second to none, but the system has been drowned in complexity for decades. The government keeps getting bigger, the private sector keeps integrating, and patients are being left out in the cold. This doesn’t need to be the case. It is actually not sustainable. A fork in the road was realized with the government response to the COVID-19 crisis. If this opportunity is yet again squandered, we may just continue down the wrong way to a dead end with a painful impact.
Dr. Sherif M. Khattab is a board-certified plastic surgeon in Torrance, California, and has been in practice for more than 20 years.
