By EWA MATUSZEWSKI
Will healthcare be forever changed in a post-COVID-19 world? Hopefully yes and hopefully no. We must of course hang on to what is good about our healthcare system. Primary care physicians and nurse practitioners affirming the care model of the patient-centered medical home. Fearless leaders such as Dr. Kimberly Farrow, CEO of Central City Integrated Health, and Dr. Anthony Clarke of Health Centers of Detroit, who toiled away in the heart of the city, the epicenter of Michigan’s pandemic, to treat, comfort, educate and encourage our state’s neediest patients. In the meantime, minutes and hours away, family medicine physicians, internal medicine docs, pediatricians and other Michigan providers also cared for their patients, some introducing makeshift telehealth, others treating, if not COVID-19 symptoms, then the anxiety and depression they spawned. And that will be a healthcare change.
There will be a new COVID-19 post-traumatic stress disorder experienced by healthcare workers, first responders and grocery store clerks. Primary care providers and behavioral health specialists must be prepared. These same professionals must plan to support and care for each other, as well as colleagues who engaged in the war against COVID-19 with varying degrees of battlefield exposure. From the front lines to federally qualified health centers to private practice, all were there in spirit if not physically. It will take a toll.
What else must change? Inventory. Before the pandemic, it wasn’t just hospitals that did not have the proper supplies. Primary care physicians also need to inventory and stock supplies such as protective gear like gowns, masks and gloves. One month’s supply is not adequate; a six-month supply should be a minimum. Along with protective gear must come new training modalities on a variety of topics, including basic information on how to properly put on and remove personal protective equipment.
Also needed? Advanced alternative payment models. As COVID-19 testing and treatment was taking place, immunizations, well-child exams, annual wellness exams, follow-ups and other visits were cancelled at many practices. Because there are obvious business aspects of running a practice, we cannot expect physicians to close down their entire practices without remuneration. While not often discussed, medical practices can and do file for bankruptcy, after all they are small businesses. Thankfully, the CARES Act includes physician practices, but payment models must now include funding for healthcare teams, integrated behavioral health services and palliative care.
Now to revisit telehealth, after taking it on as a relative novelty in last month’s column. For those who implemented temporary telehealth options through Facebook Live or Google Duo, good for you! Necessity is the mother of invention. One change guaranteed to happen post-pandemic is the widespread adoption and use of HIPAA-compliant tools. Not only are there affordable and easy to use options, telehealth will become an expectation of patients—who will “doctor shop” if their own PCP is wedded to traditional in-person visits. Those won’t go away; they are invaluable. But telehealth is no longer futuristic. It is now. And rightly so.
Patients and physicians will need to adapt to new a new form of care that will be ambidextrous: facile in both in person and virtual care. Some exams will require a traditional treatment approach while others will embrace the listen, hear, see and assess on-the-screen approach. Both will be valued—and reimbursed.