The coronavirus pandemic has changed the world dramatically. Since late February, healthcare organizations have been largely in crisis mode – adapting to new testing and treatment demands and strategies – all while struggling to stay afloat emotionally, physically, and financially during these difficult times.
- They’re dealing with supply chain challenges.
- They’re adopting telehealth or accelerating their existing use of virtual health services.
- They’re dealing with financial uncertainties due to either their focus on COVID-19 or due to the destruction of demand for non-COVID related services.
- They’re navigating the harsh reality of a reimbursement system based on volume.
And there are many other changes caused by the pandemic and the response to the pandemic that are not yet known or fully understood.
And now, our school systems are struggling to safely re-open and bring some semblance of normality back to families and children. And as autumn rapidly approaches, addressing concerns about the potential impact from kids returning to school and the fall flu season are topics of discussion among many people.So what’s changed and what’s remained the same? What have healthcare leaders – particularly those serving in clinical and public health roles – observed and learned over the past months? What challenges, issues, and opportunities should they be focusing on? Is there a yin-yang opportunity available?
To help answer these questions, the HealthCare Executive Group hosted an informal discussion with three physician executives. This post, the first in a series of three, shares some highlights and some details from that discussion.
Look for the remaining posts over the coming weeks and be sure to subscribe to our newsletter for more information on potential value to healthcare leaders and change-makers.
Listen to the entire recording here
Physician Leader Panelists
Long-time HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, currently a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by Dr. Johanna Vidal-Phelan, MD and Dr. Jason Woo, MD.
|Dr. David Diloreto, MD||Dr. Johanna Vidal-Phelan||Dr. Jason Woo, MD|
Dr. Johanna Vidal-Phelan, MD (Dr. Johanna) is Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA.
Dr. Jason Woo, MD (Dr. Jason) is a practicing board-certified obstetrician/gynecologist and a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service. Dr. Woo is a consultant at the Arbinger Institute.
In addition, HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provide HCEG perspectives. For more on the background and expertise of these participant leaders, see their bios here.
Live, Interactive Follow-On Chat and Q & A – October 13th
For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physicians, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.
The physician panelists will provide additional insight on what’s changed and what’s remained the same under COVID-19 with more on what expect this fall and going into 2021.
Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.
Ferris Taylor welcomed everyone, offered a short summary of the goals of the informal discussion and passed the microphone (virtually of course) to Dr. Diloreto to kick off the discussion by sharing some information and insight collected over the last six months.
“Supply chain issues this spring and the PPE and pharmaceutical shortages have presented new challenges, issues, and opportunities to analytics companies; re-doing their algorithms to account for co-covered impact factors.
Results of market demand forecasting and essentially what we’re seeing is a lot of what we have been virtual health. we’ve been we’ve probably compressed the trend for adoption of virtual health by five to seven years and now people are figuring out well that was bootstrapping and video conferencing with families but how do we really get the provider workflows adjusted so that this is meaningful and a productive way to deliver care.”
Impact Factors Affecting Utilization of Services
“The other thing we’re looking at that’s interesting is how the impact factors are affecting utilization of services. Early on we saw folks just avoiding the emergency room even staying home with symptoms of stroke and myocardial infarction. The high acuity services have returned but low acuity services have not, and we don’t believe they ever will.
These are things that basically probably shouldn’t have been in the emergency room to start with and folks are finding ways to deal with it. High acuity conditions like TAVR (Transcutaneous Aortic Valve Replacement) procedures and neurosurgical procedures are actually coming back really strong. People almost at full comparing the first six months of 2019 the first six months of 2020 basically the same utilization rates.
What’s interesting are more elective procedures including things like PE tubes in children – which have only come back to about 40 %. And so one of the issues there is could be a combination of factors. In the social distancing that was happening in the spring maybe there was less UTI and eye infections. On the other hand, families that we know are avoiding preventive services. There may be children with chronic ear infections not getting detected now. There are things that may play out long term that we have to figure out. So there’s a variable return of on the provider side of certain services.”
Dr. David went on to share more about:
Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
- They have to balance the treatment of COVID positive patients and non-COVID positive patients in the pandemic. And we watch those surges in places like Tampa and Los Angeles and Houston last month. And actually the provider community is getting a lot better at being able to balance that care. We know more about early intervention with certain treatments. There’s less folks going on onto ventilators and obviously we’re protecting the most vulnerable people in the elderly and institutions much better.
- On the other hand, the impacts financially both from demand destruction as well as increased costs are huge. We’re seeing provider groups, hospitals and health systems really having to deal now with not only the near-term financial recovery but also some very significant economic issues. We’re looking at unemployment rates in Florida right now and in Orlando where there’s high rates of people employed in tourism and entry-level service jobs unemployment rate of about 20%.
Returning to School & Addressing Disadvantaged Populations
- Should I send my children to school? What should I look for? Am I at risk? How will they (children) interact with aunts and uncles and grandparents? Is it really safe? And if they don’t go to school, what does that mean?
- The impact in disadvantaged communities has been huge and it plays out in interesting ways not just in urban centers but was really interesting as we watched the surges in Los Angeles, Tampa and Houston as they came down the nearby rural areas particularly where you had either migrant workers and low-income workers in fields they were getting infected at very high rates. That’s probably sort of the fits and starts with this that we’re going to have throughout this pandemic until there’s widespread use of vaccines, herd immunity and more effective therapies
Dr. Johanna was asked: What are you advising your patients on when they ask you: “Is it safe to send someone to school? As both a Practicing pediatrician and a parent of two school aged children, Johanna shared:
“So that’s a very important question and each family will have a different solution. I think that the first thing I have to tell parents and including myself as a parent is to empower the parent to make the decision. And there’s no wrong or right decision. You need to do what’s right for your family. And so, in partnership with the school district where your children are, I’m going to think about different things that had happened in the last 10 years for families and children. This has been one of those aspects that had created a lot of anxiety for families including myself. And I think a topic of importance to discuss is in regard to the home environment.
Most of the kids in the state of Pennsylvania are not having the opportunity to return to school full-time – so not five days. They’re doing a hybrid model or fully online. What is the impact for a working family that has to figure out how to come up with new solutions in regard to the care of the children during the days that they are not in school?”
Impacts to Minorities & Underserved Populations
“And the financial hardship that that may represent to a family. I’ve seen families make very challenging decisions where one of the parents is no longer working. So that parent can help with the children in the home environment for schooling. And other families are sending their children though they don’t want to, or they don’t feel comfortable because they have to go to work. I’ve seen a really dramatic impact in Latinos and minorities. As you know, Latino families/minorities families are mainly in the service industry – many of us. So what happens is that the level of exposure to COVID-19 is higher – disproportionately impacting African Americans and Latinos.
So you think about families and the impact in children and what that means to them is significant. It is a very challenging question. Parents ask me all the time in the pediatric practice and I respond with the answer: What is it that is important to you as a family? What is it that you can provide or not for your children education? And then we have a frank discussion about what the family will need to do.”
Uncertainty in Testing & Understanding Prevalence
Dr. Jason followed on with:
“I think, coming from the public health perspective particularly the FDA background, there’s just so much uncertainty in the testing and understanding incidents prevalence and what the outcome of an infection is. It’s so critical to be non-judgmental of what – as you pointed out Johanna – each family has to figure out what’s best for them.
As we’re providing services, part of the challenge is to be aware of the individuality that has to be accounted for each of the patients or each of the patients coming or families coming into the healthcare system and trying to figure out what’s right for them.”
A Perfect Petri “Diamond Princess” Dish – Wasted
“I think the one thing I kicked myself is, at the beginning of all this, I was so certain that we would have such good data from the date of the Diamond Princess. There were 3000 patients, they’ve been isolated, they’re dropping CDC resources in there, they’re doing sampling and we’re going to have so much information. And then after two weeks and nothing’s coming out. I had completely missed out.
We talk about the public health system being underfunded but I never expected us to be so poorly informed in terms of the data of the natural course of the infection, of infectivity, of how quickly it spreads and how it spreads. And so now with the plethora of different testing and the different way things are being approved by the FDA, I think it’s challenging because it’s just not the kind of data or standards that we would have had when we did Ebola, when we did Zika.
I wouldn’t say it’s for lack of knowing how to deal (with it), it’s just the challenge of not having a sort of a standard upfront approach prepared to go up front. And I don’t say politics. I don’t want to point fingers at all in this.”
Ferris mentioned reading about a poll asking physicians when physicians are expecting to be “on top of or ahead of COVID-19.” Ferris related that 50% of physician respondents are expecting that we won’t be on top or ahead of COVID until June of 2021.
Dr. David shared some other insight from his organization:
“Our projections are that we’ll be dealing with a pandemic situation probably into the fourth quarter of next year (2021) simply because the production and distribution of effective vaccines – and of course the early trials are encouraging – but it’s still a monumental undertaking. And also, we still don’t know the issues about long-term effectiveness (of any vaccine). There’s still a lot of volatility around that.”
“It seems like 2020 has been a decade. We’re finally in August and so in addition to dealing with an ongoing pandemic, we’ll have seasonal viruses and seasonal respiratory infections starting to come into play. Tell us a little bit about how you think it’ll affect frontline practices particularly with respect to testing strategies and recommendations for families.”
Dr. Jason countered:
“The question is: what do states do at this point in terms of making requirements that some of the school-age kids must meet to even participate?
I think New York already came out with the mandatory testing; I think California also as well. There’s certainly been a lot of confusion. There are factors that – as you point out – variables that if kids aren’t in school how does that affect exposure rates that we’re not going to project the uncertainty as a provider. I think that you’re presented with where folks are coming in is certainly so dependent upon where our testing capabilities are. And how much better knowledge we have. And how quickly folks can respond to that. And that’s why it’s very difficult.
It gets back to the uncertainty of how quickly these conditions continue to evolve and to what extent we’re able to get better information. There seems to be a lot of people working very hard at it but there’s just so much variation in the testing and so I think it’s going to be particularly hard for providers to make that (decision) but there’s just still a lot of uncertainty about what those actual prevalence rates are going to be with the different conditions.
I’d also ask, if kids aren’t in school, how does that affect the general trend of seasonal viruses?”
Part 2 Coming Soon – More COVID-19 Insight from Physician Executives
In the next post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:
- COVID-10 Vaccines & Importance of Fall Flu Shots
- Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations
- Vaccinations for Underserved Populations – Messaging is Key
- The Change to Telehealth: New Opportunities for Providers to Connect with Patients
- Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust
Live, Interactive Follow-On Chat and Q & A – October 13th
For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.
The physician panelists will provide additional insight on what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.
Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!