A doctor talks to a patient during a telehealth visit in Canton, Ga., June 18.
Photo: Robin Rayne/Zuma PressMany states face Covid epidemics that are proving hard to quell. America will have to deal with Covid as a significant threat for perhaps six more months, until a vaccine is ready. It’s a short period in our long history. But so far we haven’t been able to muster the collective will to control the spread.
The resulting epidemics put more than businesses at risk. If spread continues, school districts will be hard pressed to open in the fall. Also at risk is important health care that people put off during the shutdowns.
For a short time, we need to define a new normal for restaurants, offices and even health care. Florida, Texas and elsewhere are revealing what happens with a fast return to business as usual. Even as the virus surged, many hospitals were resuming elective procedures at 90% of the usual rate. Telehealth visits fell sharply as states reopened.
The focus on restoring elective services is understandable. Providers absorbed major economic hardships during the shutdown. Physicians and hospitals are paid based on procedures, so returning to volume is critical to financial viability and preserving jobs. “Elective” procedures are often vital for a patient’s health.
But as the virus spreads, the focus on restoring elective services creates problems, too. For one, there is a finite pool of testing resources in each state, and it isn’t vast. Since Covid screening before elective procedures relies on the same testing resources, it reduces tests available for handling outbreaks and symptomatic patients.
In the Austin suburbs, for example, it’s possible to get a colonoscopy or a plastic-surgery procedure with little waiting, including a timely Covid test to confirm you’re negative. In East Austin it may take several days for patients who think they have Covid to get tested, then several more days to receive the result—a critical delay. The positivity rate on tests done in that area has exceeded 15%, indicating not enough people are being screened.
Similarly, physicians in states with epidemics are telling symptomatic patients not to come into the office, but to try to get tested for Covid elsewhere. Patients have no alternative but to go to the emergency room if their conditions worsen while they wait for test results. Telehealth should continue to be maximized for routine services to limit face-to-face interactions. More Covid testing needs to be channeled to people in vulnerable communities.
For reopening to succeed against a relentless virus, we need more help from the health-care industry. This doesn’t mean stopping all elective services. But for the coming months, helping to contain the pandemic is likely a higher priority than some marginal elective procedures, such as MRIs and surgery for back or joint pain that can be managed with physical therapy at home.
Health insurers have taken steps to help providers make this shift. Besides expanding coverage for telehealth, Medicare has established higher payments for collecting a Covid test sample, including remote video guidance, and performing a test. But managing symptomatic and at-risk patients still pays less than performing a Covid test on an asymptomatic patient who needs an elective procedure.
Insurers should do more. There’s evidence that patients are more likely to isolate and provide timely help with identifying contacts when their doctors counsel them about their Covid tests. Health insurers should reimburse for counseling time, not only for ordering the test.
For another, insurers should increase support for innovation in medical practice. Practice-management companies and networked practices are using electronic data to identify patients at particular risk for Covid and provide quick access to Covid disease-management services, so that their patients with Covid symptoms can get tested quickly and receive care in isolation. Penn Health and Advocate Aurora Health have set up programs at home for patients with serious health needs, such as chemotherapy administration and intensive rehabilitation after acute care.
These reforms are possible because the physician groups and hospitals are being paid differently by insurers—in part based on a direct payment for whatever their patients need, including help with Covid management. To keep doctors accountable, the payments take some account of results. These providers haven’t been hit so hard by the volume reduction, and they have more flexibility to meet the shifting needs of their patients.
A bipartisan group of former Medicare leaders, including one of us, has proposed ways to expand this approach, to reduce the tension providers face between helping to contain the pandemic and remaining financially viable. But the viral fires are burning uncontrolled. Trying to reopen without a clear plan for containment isn’t sustainable.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute and was commissioner of the Food and Drug Administration, 2017-19. Dr. McClellan is the director of the Duke-Margolis Center for Health Policy at Duke University and was FDA commissioner, 2002-04. They are board members and advisers for several health-care companies.
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