By EWA MATUSZEWSKI
With the President’s Emergency Declaration – Public Health Emergency related to COVID-19 slated to end on May 11, I have some observations to share on this and other matters that somehow feel related. My first observation is that I don’t want to see telehealth and its many benefits languish should government support ebb.
The pandemic didn’t launch telehealth, it was re-introduced after a years-long wobbly start where payers didn’t want to reimburse for it so providers didn’t want to offer it. Suddenly, in the early desperate days of the pandemic, telehealth was the rage, with unsecured channels like Facetime or Google Meet serving as makeshift portals for frightened patients and frazzled physicians needing to make a connection. As COVID-19 raged on, behavioral health took center stage as a telehealth beneficiary. The toll of chronic illness – its cost in lives lost, isolation, disconnected friends and family, and ultimately cultural and societal cracks that created a dark cloud over the country – manifested in a behavioral health crisis that was long brewing but could no longer be contained.
While I’ve been vocal about the shortcomings of virtual healthcare for both physical and behavioral health (chiefly the absence of physical touch and interpretation of body language), I still remain a strong proponent of its benefits regarding access to care and continuity of care. For millennials and Gen Z patients, virtual health options have been particularly critical both in behavioral health crises and for physical health. For parents of newborns, babies and toddlers, the ability to speak with a reassuring licensed health care professional about wellness, scary symptoms or simply the at-times-overwhelming responsibility of being a newer parent has been a godsend for pediatricians and their patients. For these examples and so many others, I believe it’s imperative that we continue to use and advocate for the unique role that virtual health has come to play in overall healthcare – yet, I do fear that payers will pull back.
Some other observations as various key players in the medical community announce devastating financial losses post-pandemic, while other powerhouse players newer to direct healthcare experience potential profit bonanzas. Prior to the pandemic, hospital stays were generally short – sometimes too short. Then, for nearly two years, only the sickest patients were admitted to the hospital. And many stayed a very long time. The trajectory was from ICU to step-down unit to a regular floor to a post-acute care facility. Cha-ching. All the while, there was insufficient clinical personnel available to care for patients – and premiums were paid to fund the gap.
In the meantime, behemoth retailers and retail pharmacies lured by the financial promise of serving consumers by purchasing physician practices were further emboldened in the pandemic era to meaningfully expand from in-store advanced first-aid clinics to the holy grail of reimbursement: primary care. Not just any primary care, though, with all patients/all payers and preventative and well care services from birth to middle age to death; rather, selective primary care for the Medicare-covered 65-and-older set, with more expensive, reimbursable healthcare needs.
Recent deals include Walgreen’s joint venture with CityMD and CVS Health’s acquisition of Oak Street Health. Amazon is in on the primary care fun, too, with its February announcement to purchase the One Medical group of primary care clinics. While Wall Street primary care clinics focused on the Medicare population may serve as a community center of sorts based on their convivial waiting rooms, they are chiseling away at primary care that is relationship-based, not age-based.
A final observation? Amid these frustrations, we cannot lose hope for the future of primary care. While embattled primary care physicians (and also the specialists to whom they refer patients) may be tempted to give up their independent practices to corporate healthcare, such a move is not inevitable. Large employer groups and payers should reward independent primary care physicians for their commitment to entrepreneurship and willingness to transform and learn new approaches to providing quality care, while providing patient-centered, community-focused care to all.