MADISON, NJ – APRIL 10: A sign in the window of a Coldwell Banker Real Estate Branch which is closed … [+]
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Against the backdrop of the health crisis caused by the coronavirus and the ensuing economic crisis triggered by efforts to contain the spread of it, could there be a silver lining? It may seem strange to contemplate anything good coming out of the devastation brought about by an unseen enemy that leaves serious illness, death, and mass anxiety in its wake. Clearly, a free-falling economy characterized by massive unemployment only adds to the anxiety and sense of hopelessness for all too many Americans, who find themselves isolated and facing an uncertain future through no fault of their own.
This is clearly a wake-up call for the nation. We have been unbalanced in our short-sightedness and willingness to pursue quarter- to- quarter profits at the expense of longer-term sustainability. We have worshipped at the altar of outsourcing to foreign countries in order to improve margins at the expense of undermining national security — jeopardizing our supply of essential medicines and critical medical supplies. We focused on the profits of breakthrough new therapies at the expense of investment in vaccines and critical population health measures. We have failed to plan to protect our nation in the face of a real health emergency. And the coronavirus has shown us in neon lights the error of these actions.
So, what exactly, is the good news?
In healthcare, bureaucratic rules have stymied innovation, and interest groups have committed themselves to maintaining a status quo that is often inefficient and fails to deliver better health outcomes at lower total cost of care. The crisis has changed some of this. Recognition that bureaucratic rigidity is the enemy of innovation, there has been widespread media coverage of FDA’s decision to allow anti-malaria drugs to treat COVID-19 patients, a relaxing of its rules. With the outbreak of COVID-19 the Centers for Medicare and Medicaid Services (CMS) gave states more flexibility in administering Medicaid programs, suspending preauthorization requirements and allowing Medicaid beneficiaries to seek care in alternative settings, even if those settings aren’t specifically licensed by Medicaid. CMS has also increased the availability of telehealth by paying for it in lieu of in-person physician visits, and loosened HIPAA regulatory exposure at the same time. Staying home reduces risk of infection; and if you’re not well, keeps others in waiting rooms and emergency departments safe. Obtaining consultation via phone –even for pregnant women — has decided advantages. It is clearly more convenient, and studies done by the Mayo Clinic years ago have shown it’s safe and preferred over traditional office visits by patients who have experienced it.
Beyond enabling telehealth across a wide range of situations, states have also enabled licensed clinicians to practice across state lines, and New York State in particular, has put doctors and nurses who have not yet graduated to work on the front lines of fighting coronavirus. Industrial masks have been put to good use in healthcare, even though prior regulation prohibited such use in healthcare delivery. Necessity is certainly the mother of invention — and bureaucracy is its nemesis.
Are these efforts just going to be a relaxing of rules in the face of a crisis, or do they point to a more efficient and effective way to deliver healthcare in this country?
It’s certainly legitimate to short-cut regulations during times of crisis that would otherwise limit the efficiency of the system exactly at a time when maximal efficiency is required. Some regulations have a basis in public safety. Interstate truckers, for example, need to keep a log and can’t drive for more than 11 hours at a shot. This is a concession to public safety. But if a crisis arose that required every trucker to haul as much as he or she could as fast as possible for as long as possible, we’d probably waive that regulation — until the crisis was over. And then, in the name of public safety, we’d probably reinstate it. On the other hand, some regulations are the result of lobbying by stakeholders who want to erect barriers to entry and safeguard their turf. So, it is with regulations that require clinicians to be licensed in the state where they would practice — even when they’re practicing telehealth. By ensuring adequate payment for telehealth and removing unnecessary restrictions in its use, we’re likely to see more telehealth and greater efficiency. We might even see greater adherence to medical advice! It’s absurd to imagine that patient/consumers would prefer going back to a time when they have to take time off from work to see a physician, transport themselves to the doctor’s office, wait in a waiting room with coughing strangers — all to get 5-7 minutes with their physician if what they need can be delivered telephonically. This genie’s out of the bottle, and it’s unlikely going back.
Now that we have waived some of these pointless barriers to a free market and discovered that the world doesn’t end as a result, perhaps it will be more difficult to re-build them when the crisis has subsided. And that would be a good thing.