COVID-19 has altered the answer to that question forever, making a case that it is actually both. This pandemic has caused changes in just about every aspect of life. Through a government lens, it has pushed states to ask and define what is “essential”. There has also been a challenge identifying to what extent, the federal government is responsible for assistance during a pandemic. On a social level, COVID-19 has exposed what and who our society values systematically. Examples of this are displayed through policy like the Coronavirus Aid, Relief, and Economic Security (CARES) Act, where larger corporate restaurant chains like Shake Shack and Ruth’s Chris Steakhouse, have received small business funds through the Paycheck Protection Program (PPP). Even the Los Angeles Lakers were awarded 4.6 million dollars that other ‘Mom & Pop’ businesses missed out on, as reported by NBC News.
From an economic standpoint, it has left nearly 30 million people in the United States filing for unemployment benefits, in considerably the greatest financial threat to the United States since the Great Depression. Logistically, it has impacted the world’s supply chain and travel capabilities drastically. From an ethical view, some hospitals have had to choose which patients to treat based on age, and previous conditions, due to a limited number of ventilators and even bed space. A report from USA TODAY Network states within hospitals, COVID-19 coded patients generate more revenue especially if they’re on Medicare. Sen. Scott Jensen, R-Minn., a physician in Minnesota, believes this is “Because if it’s straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000,” he added to the report “But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”
With the barrage of global information coming from all avenues of media, stifling through the facts can be draining. Currently, statistics show the United States has over 60,000 deaths from the pandemic, but even these deaths are being questioned due to robust coding and death certificate procedures instituted by The Centers for Disease Control and Prevention (CDC). An individual who tests positive for COVID-19 or was known to have been in contact with someone who tested positive for COVID-19, and dies – can be considered a COVID death, even if it was not the primary cause of death. In addition, and to cause even more confusion, testing has been a huge issue of the pandemic, with many believing the overall number of COVID-19 cases have been undercounted based on limitations in the number of tests available.
Although there is uncertainty at this time, there are positives coming from this situation. Many people are working remotely and making the best of the situation. Many are reconnecting with spouses and children, enjoying genuine time together for the first time in years. Video conferences are at an all-time high, and there seems to be a technological shift. Happening. Student loans and mortgage payments have been temporarily suspended for those that qualify. Americans are receiving “stimulus” funds averaging $1200 or more. The efficiencies gained by eliminating red tape of regulatory roadblocks will be thoughtfully considered prior to go back to the “old way” of doing things. Health and wellness right now are a priority for everyone. This global emergency also presents an opportunity for policy change and organizational development at all levels.
Some believe the reason for our inability to carry out a response to COVID-19 is our misunderstanding of the nature of health care. Our health care system is reactive and relies on bottom lines. It is a topic that has been talked about countless times and is rearing its head once again. Many outside the healthcare bubble are shocked that there are layoffs and furloughs happening to thousands of hospital workers across the nation. Yes, even Doctors. There is an assumption that hospitals are busier with the pandemic going on, but this is the reality only for areas considered hotspots or with packed intensive care units. With elective surgeries essentially banned during this time of quarantine, hospitals are empty and losing millions each month. This is because surgical procedures account for often more than half of the revenue of hospitals. According to Randy Tomlin, CEO of MobileSmith Health, for a hospital with $600 million annual revenue, 60 cents of every hospital revenue dollar is generated through surgeries, with another 30 percent coming from the Emergency Department.
As COVID-19 morphs into a fight about rights, we must also reevaluate the focus of the Community Benefit Formula for non-profit hospitals. Although hospitals can be 501-C3 Corporations, they are still motivated to not lose money. Hospitals receive tax exemption as part of their non-profit status, and in return, they provide “Community Benefit.” We need to redirect the focus of the Community Benefit to outside of the walls of the hospital. Hospitals often justify their Community Benefit by focusing on financial shortfalls relating to providing services to Medicaid members and Medical Education. The focus of much of this justification stays within the walls of the hospital and is tied to services “after” a person is already sick.
We have the opportunity to further transition our “sick care” reactive system, to a proactive “health system” that focuses on overall population health. Hospitals must play a leadership role in working with government at all levels, to ensure we are prepared for similar types of catastrophic events, and that our healthcare workers have the Personal Protective Equipment (PPE) needed. As leaders in our communities, we must do our part to educate and inform one another based on credible information. I personally want to thank all my colleagues, friends, and family that work in healthcare for their commitment and work during these times on the frontlines.
Mario Jones, MPPA 19
References
Treating the Reactive Culture in Healthcare” August 10, 2017, By Qventus, Becker’s Hospital Review
“Losing Revenue from Surgery, Ed Operations? There’s an App for that” August 8th, 2019 By Randy Tomlin, Becker’s Health IT
“US coronavirus death toll surpasses 60,000”, April 29, 2020, By Morgan Winsor and Emily Shapiro, ABC News
COVID-19 Alert No. 2 , March 24, 2020, National Vital Statistics System, CDC
“More Than 26 Million Americans File for Unemployment Amid Coronavirus Outbreak” April 23, 2020, By Andrew Soergel, U.S. News & World Report
“Fact check: Hospitals Get Paid More if Patients Listed as COVID-19, on Ventilators” April 24, 2020, By Michelle Rogers, USA TODAY
“U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge” March 21, 2020, By Sacha Pfeiffer, NPR
“What’s Essential? Confusion Clouds Workers, Employers” April 1, 2020, By Elaine S. Povich, PEW
Special Bulletin; Senate Passes the Coronavirus Aid, Relief, and Economic Security (CARES) Act, American Hospital Association (AHA)
“L.A. Lakers received $4.6 million from federal loan program – but returned it” April 27, 2020, By Ahiza Garcia-Hodges and Stephanie Ruhle, NBC
