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May 6, 2020
Enduring Financial Toxicity in Health-Care Systems By Brianna Hoffner, MSN, ANP-BC, AOCNP®
Oncology health-care practitioners generally experience professional immunity to the turbulence of financial markets. After all, people get sick in times of prosperity or poverty; therefore, the demand for health-care services remains
somewhat constant. Historically, there was less worry about massive pay cuts, job losses, or furloughs than in non–health care professions. Certainly, we have felt the effects of economic downswings in less significant (but still
challenging) manifestations such as mandates for no overtime approvals, cuts to the budgets supporting professional education and development, or years in which employers did not issue raises.
Impact on Health-Care Providers and Medical Practices
However, COVID-19 has shaken confidence in the stability of health-care positions such as oncology advanced practitioners. Health-care systems are experiencing unprecedented financial stressors as they take on the costs of converting beds,
buying equipment, rapidly implementing virtual health-care protocols, and more. These changes come at a time when revenue from other sources, such as elective surgeries and routine medical visits, is down.
A recent survey from the Medical Group Management Association (MGMA) demonstrated that 97% of medical practices (of all sizes and specialties) experienced a negative financial impact directly or indirectly related to COVID-19 (
Medical Group Management Association, 2020). Patient volumes are down an average of 60%, with a corresponding 55% decrease in revenue. Certainly, such losses are felt more profoundly in small, private health-care practices.
At the same time, access to health care is becoming ubiquitously financially unattainable. More than 30 million people have applied for unemployment, and more than 25% of those with private insurance have an insurance policy with
a deductible of $2,000 or more (Cutler, 2020; Long, 2020).
Telehealth Services
As previously reported in the APSHO Advance and elsewhere, the use of telehealth services has skyrocketed in this pandemic. From 2005
to 2017, only one out of every 150 medical office visits and one in every 5,000 to 10,000 specialist visits were conducted via telemedicine (Barnett, Ray, Souza, & Mehrotra, 2018).
Then, in response to the COVID-19 crisis, the federal government temporarily lifted many of the telehealth restrictions in March, spurring a rapid uptake in utilization. Teladoc, the largest US virtual-care provider, is now reporting
over 100,000 appointments weekly (Cahan, 2020).
However, only 20% of states require payment parity for telehealth and thus, reimbursement rates for telehealth average 20% to 50% lower than in-person visits (Cahan, 2020). As practices pay subscription fees for standard telehealth platforms and absorb the financial losses from decreased patient volumes, they concurrently may experience significantly lower reimbursement rates for the patients seen virtually.
Implementing Changes in Response to COVID-19
As COVID-19 cases continue to surge in US cities across the country, hospitals are rapidly adapting with the implementation of additional ICU beds and additional personal protective equipment (PPE). The cost of converting a regular floor
bed into an ICU bed is approximately $45,000, plus costs of training additional critical care providers (Neighmond, 2020).
Furthermore, with the increasing demand, the cost for PPE has skyrocketed; more than a 1,000% increase in cost can be seen in some cases (Diaz, Sands, Alesi, 2020). This situation has been exasperated by bidding wars between states, health-care systems, and even the federal government (Subramanian, 2020).
Patients who are waiting for COVID-19 testing results must be presumed positive until proven otherwise for the safety of staff, and this requires that all health-care workers use PPE while interacting with these patients. Thus, delays in testing times and access to testing are further stressing health-care finances. While the hope is that such acute costs lessen as the curve flattens, the next phase of response to the virus will bring with it additional expenditures. If and when effective treatments and a vaccine are available for COVID-19, health systems and insurers will be called upon to pay for these services for tens of millions of patients and beneficiaries (
Gruber & Sommers, 2020).
Shared Goals
Taken together, this sample of COVID-19–induced financial stressors paints a worrisome picture for health care. But, the parallel reality of advanced practitioners on the front lines, working tirelessly to continue caring for oncology
patients is crucial. In the words of neurologist and medical ethicist Dr. Kaarkuzhali Krishnamurthy, “At a time when health care systems are calling on doctors and nurses to do more, this is not the time to be making it more difficult
to do that” (Bebinger, 2020). As with any divergence, the best path forward is likely that of shared
understanding and empathy. Oncology advanced practitioners, with all health-care providers, must take the time to understand the stressors our administrative colleagues in health care face, while concurrently continuing to give voice
to our needs and experiences as oncology APs. We have a shared goal of providing the best possible care to those in need during an unprecedented pandemic experience.
References
Barnett, M. L., Ray, K. N., Souza, J., & Mehrotra, A. (2018). Trends in telemedicine use in a large commercially insured population, 2005-2017. JAMA, 320(20), 2147–2149. https://doi.org/10.1001/jama.2018.12354
Bebinger, M. (2020). Furloughs, retirement cuts and less pay hit Mass. Doctors and nurses as COVID-19 spreads. WBUR. Retrieved from https://www.wbur.org/commonhealth/2020/03/27/doctors-nurses-mass-coronavirus-infections-pay-benefits
Cahan, E. (2020). Why telehealth can’t significantly flatten the coronavirus curve—yet. Techcrunch. Retrieved from https://techcrunch.com/2020/04/04/why-telehealth-cant-significantly-flatten-the-coronavirus-curve-yet/
Cutler, D. (2020). How will COVID-19 affect the health care economy? JAMA Health Forum. Retrieved from https://jamanetwork.com/channels/health-forum/fullarticle/2764547
Diaz, D., Sands, G., & Alesi, C. (2020) Protective equipment costs increase over 1,000% amid competition and surge in demand. CNN. Retrieved from https://www.cnn.com/2020/04/16/politics/ppe-price-costs-rising-economy-personal-protective-equipment/index.html
Gruber, J., & Sommers, B. D. (2020). Paying for Medicaid - State budgets and the case for expansion in the time of coronavirus. NEJM.
https://doi.org/10.1056/NEJMp2007124
Long, H. (2020). U.S. now has 22 million unemployed, wiping out a decade of job gains. The Washington Post. Retrieved from https://www.washingtonpost.com/business/2020/04/16/unemployment-claims-coronavirus/
Medical Group Management Association. (2020). COVID-19 financial impact on medical practices. Retrieved from https://www.mgma.com/getattachment/9b8be0c2-0744-41bf-864f-04007d6adbd2/2004-G09621D-COVID-Financial-Impact-One-Pager-8-5x11-MW-2.pdf.aspx?lang=en-US&ext=.pdf
Neighmond, P. (2020). Growing costs and shrinking revenues squeeze hospitals as they brace for coronavirus. NPR. Retrieved from https://www.npr.org/sections/health-shots/2020/04/06/828108255/growing-costs-and-shrinking-revenues-squeeze-hospitals-as-they-brace-for-coronav
Subramanian, C. (2020). How a frantic trek to a McDonald’s parking lot shows the scramble states face for coronavirus supplies. USA Today. Retrieved from https://www.usatoday.com/story/news/politics/2020/04/18/coronavirus-creates-ppe-bidding-war-states-like-illinois-new-york/5144652002/
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