More than two years after the pandemic started affecting U.S. health care, it looks like we’re past the worst. However, while the battle for ICU beds, the supply of personal protective equipment, and the closure of profitable elective surgeries may be a thing of the past, deeper problems have arisen that represent long-term challenges for the U.S. health system.
While the beginning of the end of the pandemic is a relief, the worst may be ahead. 2022 will be a defining year for the U.S. health system as they grapple with structural and systemic changes. Ignoring deeper issues as we leave the pandemic behind will perpetuate fragile healthcare environments and leave hospital systems unprepared for financial and patient care performance for years to come.
The pandemic challenge should not be viewed as a fundamental problem, but as a symptom of the fragility of the U.S. health system: mask shortages may be resolved, but supply chain vulnerabilities remain. Nurses’ overwork may be reduced, but chronic staffing shortages remain a problem.
The fact that symptoms go away doesn’t mean the underlying problem has gone away. The deeper issues that hospital systems must address in 2022 and beyond involve procurement, operations, labor, consumption and patient population confidence. Let’s take a deeper look at each one.
purchase
We will continue to see significant supply change challenges over the next few years. Initially, we encountered this with masks and gloves, but the long-term problems will manifest in items such as semiconductor chips, equipment that uses certain plastics, and the unreliable supply of many medical devices from overseas.
Some medical providers have declared a lack of equipment and equipment needed for uninterrupted patient care. Supply chain challenges also have cost consequences: Medical device manufacturers report that their costs will rise, and those price increases will be passed on to hospitals and suppliers. Regardless, the post-pandemic period is unlikely to offset these cost challenges with increased reimbursement or additional government relief packages.
Part of the problem, of course, is that we rely heavily on foreign supplies, and we have only recently recognized that medical supply procurement is a national security issue. Another part of the problem is that procurement policies at the health system level are too laissez-faire, often focusing on price rather than supply chain resilience. The U.S. health system excels at contracting down prices, but focusing on short-term cost savings can be costly in the long run: Single-vendor contracts are common in the health system, but are also structural weaknesses when it comes to compensating for supply chain shortages.
To address healthcare procurement challenges, health systems should revisit their procurement policies and supplier relationships, focusing on “segmenting market share” rather than developing reliance on a single supplier. The elasticity of supply flows should be considered and in some cases domestic suppliers should be preferred over (cheaper) foreign suppliers.
Operation
During the pandemic, some hospitals have seen positive financial results thanks to the government’s rescue package. However, when elective surgery is shut down, many hospitals lose their single most profitable line of service, which under normal circumstances makes it possible to operate less profitable lines. As a result, costs have risen and revenues have fallen — an unfortunate combination that has left many health systems with negative operating margins for months on end.
The lesson for health systems is that over-reliance on certain profit centers can serve predictable, stable demand well, but large fluctuations in demand (such as the need for elective surgery and high demand for ICU capacity) may be eliminated entirely This situation.
Health systems need to develop a different operational setup to accommodate fluctuating demand, for example, allowing for simultaneous pandemic-related ICU admissions on the one hand and continuing services for cardiology and orthopaedic patients on the other. From a financial and patient care perspective, it cannot be one or the other.
Staffing
Staffing has become a big issue during the pandemic. Even before the pandemic, health systems had downsized staff to cut costs, so much so that nurses and technicians were overworked. This has been exacerbated by the pandemic due to the high number of patients in the ICU and the number of healthcare workers who have had to leave the hospital for weeks or months because of their own infection. This symptom has now largely disappeared with lower hospitalization rates and ICU capacity pressure, but the underlying problem remains.
The shortage of hospital staff is already a huge challenge we will face in the coming years. Health systems lacking nurses have experienced reduced surgeries, leading to lower hospital profitability and lower provider profits. As if that wasn’t bad enough, understaffed hospitals rely on mobile nurses to fill their vacancies—much more expensive than hired nurses, sometimes as much as $85 an hour.
Healthcare staffing issues need to be addressed nationwide. But the personal hygiene system can also “stop the bleeding” by ensuring fair pay and focusing on job satisfaction rather than how many hours employees can squeeze in.
consume
The single-use mentality of healthcare is still a problem: when we keep throwing them away, we run out quickly. In healthcare, we traditionally believe that throwing things away after a single use improves patient safety. But there are some forms of reuse—including single-use equipment reprocessing and instrument repair—that are perfectly safe. However, manufacturers continue to turn reusable devices into disposables and claim to have a monopoly on instrument repair. This imposes huge costs on hospitals.
In addition, consumer procurement of medical equipment and instruments is still largely driven by clinicians’ preference for expensive new and advanced equipment and devices. The pandemic has taught us that excellence in healthcare is less important than adequacy of healthcare when there are no ventilators available within a 300-mile radius. Health systems must address this issue and better balance clinical considerations with financial considerations and the sustainability of health care delivery.
Clinician-driven purchasing needs to give way to more balanced purchasing decisions to ensure more financially sustainable operations and more adaptive patient care capabilities. Health systems should view equipment and equipment reuse as a means to increase supply chain resilience and reduce costs.
With enough pressure from the U.S. health system, manufacturers are willing to help hospitals secure supplies by developing reuse solutions. Reuse technology is very advanced in the US, so the question is more about willingness than practicality.
patient group confidence
Profitable surgeries have not only declined during the pandemic because hospitals have stopped offering elective surgeries. In fact, for most of the pandemic, the volume of surgeries declined as patients didn’t want to go to the hospital. This has led to pent-up demand – which means many patients are getting sicker. The healthcare system will endeavour to provide appropriate care to patients who are exacerbated by delays in treatment.
There’s a fundamental challenge here that we haven’t addressed enough: the pandemic has severely reduced people’s trust in the healthcare system and its ability to provide them with care. The decline in trust is a product of the health system’s apparent failure to keep up with the pandemic, as well as the general skepticism and lack of confidence in scientific treatments that eventually characterize the post-pandemic patient mindset. This is a serious challenge when conducting studies at the scale of patient populations – a challenge that can lead to higher healthcare costs and lower life expectancy.
Health systems must work with patients and care delivery networks from primary care physicians to nursing home staff to rebuild confidence in the hospital environment. It will become important to study the service line patient experience to help educate and adjust expectations. Patients don’t go to the hospital just because they’re sick; they go there because they trust the hospital’s ability and compassion to provide the best possible care.
These are huge challenges, and it needs to be clear that the health system cannot meet them without changing how payers allocate insurance funds and how lawmakers regulate health care. However, health systems don’t have the luxury of waiting for governments or until the pandemic is completely over: the longer they wait, the deeper the hole. Health systems need to “fly the plane while it’s being built” and start addressing these challenges immediately.
Upixa, Getty Images
