Behind the Mask

About time, transforming the delivery system

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For a Chief Medical Officer of a large hospital based in the US, the COVID-19 crisis has been a driving force in accelerating some key changes in the medical delivery system; leading to urgent re-examination of those practices. But unexpected consequences have also caused drawbacks in other critical areas.

Something he’s seen acknowledged at an institutional level is the need for revamping the delivery system at its core.

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For many years, our delivery system has put a lot of thought into how we transform it from one in which every patient is a revenue center, to one in which every patient is a cost center. In other words, how do we move from the ‘eat-what-you-kill’ mentality to surviving on a fixed income and delivering high-quality care?

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In an industry as large as the medical field, change is hard-fought and slow-moving. As witnessed across many sectors, the rapid shift in how we work day-to-day since the start of the pandemic was a wakeup call for him and his colleagues.

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“The COVID-19 crisis presented a stark relief of our failure
to transform our delivery system into a patient-centered one.”

In some respects, this was a welcomed catalyst – the need for quick adaptation allowed for updated training and the process of how healthcare staff work with patients was completely redesigned.

There was rapid training of nursing and physician staff to do telephonic advanced care planning. The training extended to nursing homes, residential care facilities, and was expanded to include independent physicians in the larger medical community. Physicians not only filled a critical void in our knowledge of patients’ goals and preferences but could also generate revenue from doing so.

Another noticeable change was that as patients took more care when visiting their doctors, the downstream impact of the pandemic was less revenue on all sides. This forced a large-scale change reassessment of which staff positions were most valuable to keep on with limited funds.

“For as long as I can remember, we’ve talked about the high administrative overhead in medicine. From billers and coders, to medical directors and all the people that don’t see patients that add to the total cost of care. The COVID crisis caused us to reach a tipping point in which we said we can no longer support the huge infrastructure that we’ve developed. We didn’t lay off any clinical staff, but unfortunately, we laid off hundreds and probably close to one thousand administrative staff. It took this crisis for us to finally realize that we could not justify the overhead these people created.”

While the loss of these administrative voices was a long time coming in many eyes, this effort also impacted the progress he was hoping to see take place when it came to the core operation of the delivery system as a whole.

“Some of the primary voices leading that effort have been silenced because of the downsizing implemented by the system to ensure financial stability… purging the system of people who have been courageous enough to speak the truth to waste, mismanagement and overuse of healthcare services; visionaries who have sought to transform care yet had been hindered in their efforts. “

This has shifted his hope from real, substantive change to concern over what this means in the long-term for the ability of the US medical system to evolve at all.

“I believe that what we have seen is the emergence of a culture of fear rather than a culture of courage, collaboration, compassion, and curiosity. Fear of losing one’s job not only because of the financial straits of the delivery system, but also for speaking the truth, for calling out inconsistencies, for putting patients over profit, and for putting staff and patient safety over volumes.”

The functionality of US medicine is a topic of heavy discussion for patients, HCPs, and government, especially in the time of COVID-19 and with the upcoming presidential election. The COVID pandemic presents an opportunity for meaningful change, and it will be up to administrators and doctors to seize it or lose it. This CMO sees opportunity, and danger, ahead as we begin the hard work of assimilating the new technology into day to day medical practice. He hopes we make good choices.

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