The nation’s hospitals [including Vermont’s] suffered grievously during the pandemic as its services were shut down, but the patients that fill their beds and line up for their scheduled visits apparently did not suffer, raising questions about whether the health care system we’ve built is necessary.
The question was most recently raised in an New York Times op-ed by cardiologist and author Dr. Sandeep Jauhar. He noted that in a recent survey only one in 10 respondents said their health, or the health of a family member was an issue during the shut-down. The rest said their health remained about the same.
The article was not an attempt to suggest that nine out of 10 patients were hypochondriacs and didn’t need care, it did raise the question as to how much of the care our hospitals provide is actually needed and what the cost of that unnecessary care might be.
It’s not a comfortable question to address in any circumstance, but almost impossible to do so when times are good. Lots of jobs hang in the balance.It takes a crisis like what we are experiencing to make us rethink what is necessary and what isn’t.
It’s that crisis that forced the University of Vermont Health Network to announce this week that 900 of its doctors would no longer be able to accrue vacation time and would no longer have an employer match to their retirement benefits. More than 500 of their employees have been furloughed or had the hours cut back.
The plan is for the cutbacks to be temporary, but there isn’t any way of knowing what the future demand for services will be. The same cost-cutting exercise has been put in place at Northwestern Medical Center, as well as the other hospitals in Vermont. It’s hard to know where the bottom is, harder still to predict how patients will respond, and at what level.
Mr. Jauhar framed it this way: “If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. If so, this has implications for how we should reopen our health care system. Doctors and hospitals will want to ramp up care to make up for lost revenue. But this will not serve our patients’ needs.
“The start-up should begin with a renewed commitment to promoting beneficial care and eliminating unnecessary care. Most doctors recognize the importance of this distinction, even if we don’t always act on it. In a survey a few years ago, two-thirds of doctors in the United States admitted that between 15 percent and 30 percent of health care is probably unnecessary.”
We knew in advance of Covid-19 that our health care system was too expensive, that it was not sustainable as organized and promoted, and that it was wasteful. This understanding came not just from outside the health care system, but from the inside as well. That’s why, in Vermont, we elected to step away from the fee-for-service model of health care that Dr. Jauhar critiques. It’s the fee-for-service model that pushes more services/treatments upon the patient.
If the Covid-19 shutdown shows us that patients don’t need the amount of treatment being pushed upon them, then that should be the opportunity we need to rethink the opportunities before us. Not only could it cost us less, it could, as Dr. Jauhar argues, be better for the patients.
by Emerson Lynn