COVID-19: Did the healthcare system let down providers fighting on the front line?

Editor’s note: This episode of the MGMA Insights podcast continues a series focused on COVID-19 and its effects on healthcare professionals and their patients. Keep up with the latest updates by visiting the MGMA COVID-19 Recovery Center Center.

Author Robert Pearl, MD, former chief executive officer of The Permanente Medical Group, doesn't mince words in reflecting on the situation for healthcare providers and medical practice staff amid the COVID-19 pandemic.

“I'm very much connected with the individuals on the front line, and they feel like they're in war,” Pearl said. “A­nd they feel as though they have not been protected the way they should have been.”

Reflecting on his work today and his 2017 book, Mistreated: Why We Think We’re Getting Good Health Care and Why We're Usually Wrong, Pearl emphasized early in the conversation that the crisis facing healthcare workers today is a symptom of long-lingering issues with how the industry has been shaped over decades.

"Despite every piece of objective data, what we see is that Americans still believe we have the best [healthcare] system — without any evidence," Pearl said, noting the fragmented nature of reimbursement in the shifting space between fee-for-service and value-based care, as well as the technological challenges that today's providers face, such as the continued reliance on fax machines in healthcare to share vital information.

A need for leadership

But above all else, Pearl points to a need for leadership in healthcare to confront the COVID-19 pandemic. “One of the challenges you see [with COVID-19] is the complete lack of leadership, coordination, collaboration and cooperation that would be essential for us as a country to overcome this massive viral threat.”

That's not to suggest that actual providers aren’t doing “a remarkable job under some of the most difficult circumstances that exist,” Pearl noted, all while navigating broken supply chains for essential tools in the fight against COVID-19, such as personal protective equipment (PPE).

“When a virus comes along, it is crucial that we actually prevent infection,” Pearl said. “The way you avoid viral infections is vaccination,” but given how new this coronavirus is, developing a vaccine in short order is unlikely. “It’s not going to happen in a week or two.”

Pearl noted that the United States missed the opportunity for containment “because we underestimated the severity … we didn’t have the testing requirement,” Pearl said. “We missed that window. … All you can do is slow down the progress.”

Pearl noted that the insistence on social distancing isn’t to prevent infection, but rather to prevent the speed of transmission of infection in hopes to not overwhelm healthcare providers and limited supplies of beds, ventilators and other crucial care elements. If Americans can socially distance and isolate appropriately, “we can save many, many lives,” Pearl said.

The need for medical groups to evolve in the response is also vital. Pearl noted he heard about one large system that was still performing cosmetic surgeries and other elective procedures this week. That those masks and supplies are being used for cosmetic surgeries and not for doctors and nurses fighting COVID-19 was another sign, Pearl said of a “broken system.”

“The people who feel as though they are taking the brunt of it are the people who have dedicated their lives to taking care of patients: the doctors, the nurses, the respiratory therapists,” Pearl noted. “They feel like they are under siege, and I think, as a nation we need to do a better job of supporting them.”

To that end, Pearl encouraged more integrated care between physician offices and hospital settings. “When care is integrated and people work together, they can come up with better solutions,” he said.

Some of those solutions involved increased use of telehealth services. While leading Permanente, Pearl noted a typical month had about 10,000 virtual visits — today, the rate is closer to 5,000 a day for patients who are having symptoms consistent with coronavirus. “I think that’s going to be a game-changer.”

Better education

Another key element to helping patients understand how to make this time easier on practices. Pearl said more should be done to educate the public so that they understand what the world is facing in this pandemic — especially young people who may not be taking the same precautions as individuals who have comorbid conditions and are at higher risk if they are exposed. The general public needs to understand that COVID-19 won’t simply disappear in a week or two.

"I'm amazed every morning when I read about people who look at the escalating number of individuals who have died or have the disease, and they're surprised that it's gotten higher," Pearl said. "A virus of this type grows exponentially. ... This virus doubles every three days. … We’re talking about massive numbers."

“Our minds don't have the ability, intuitively, to understand exponential growth. We think about either arithmetic growth or we think maybe about geometric growth, but exponential growth, we're not able to do,” Pearl said. “I think that people have underestimated how long this is going to take, and more importantly, when the spikes happen, how bad they're going to be. They're not going to be twice as bad or three times as bad. They're going to be 100 times worse or even more simply because that's the nature of exponential growth. It's biology, and it's mathematics. It's not opinion nor pessimism.”

Pearl opened MGMA20 | The Operations Conference Online with a keynote session titled, “The Future of American Healthcare: Four Pillars for Transformation.” To sign up for Pearl’s monthly newsletter, learn more about his book or browse his latest content, visit robertpearlmd.com. 

Other highlights from Pearl’s interview: 

• (6:00) “We lag, based upon the Commonwealth Fund, in every aspect of healthcare outcomes as a nation except how much we spend, where we lap everyone else, spending $11,000 per patient. … Everyone else is half of what we spend with better outcomes. And what I see is despite every piece of objective data, what we see is that Americans still believe we have the best system without any evidence that’s there.” 
• (7:14) "With the Stanford Graduate School of Business, I always taught my first class by asking the students: How do doctors send the most vital medical information from one office to another? … I explain, it’s the fax machine. And do you know what they say? ‘What’s a fax machine?’”
• (13:25) “All you can do is slow down the progress. We don’t do social distancing in order to prevent infection. We do it to prevent the speed of transmission of infection … If we can do that, we can save many, many lives.”
• (24:32) “I think the third [myth] and the one that really concerns me the most is there’s still this notion that ‘Oh my gosh, it’ll just take a couple more weeks and everything’s going to be under control.’ I’m amazed every morning when I read about people who look at the escalating number of individuals who have died or have the disease, and they’re surprised that it’s gotten higher. A virus of this type grows exponentially.”
• (31:23) “I think [telehealth’s] going to be a game changer. I think when it’s all done, patients are going to demand to continue to get the care, the convenience, the access through telehealth that otherwise they would have had to come to the physician’s office.”

Additional resources in this series:

• COVID-19 Update: An action plan for medical practices and healthcare professionals
• COVID-19: How one of Northern California’s largest health systems is responding to the crisis
• COVID-19: What healthcare leaders need to know about telehealth and the CMS policy changes
• COVID-19: Flattening the curve for America's elderly patients through quarantine and isolation

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MGMA Insights is presented by Decklan McGee, Rob Ketcham and Daniel Williams.

Thanks to Biome, Midmark and Solutionreach for sponsoring this episode. 

• To learn about how the Biome solution, powered by artificial and augmented intelligence, can improve your cardiovascular service line’s performance today, visit biome.io/solutions. 
• For more on how Midmark is transforming healthcare delivery through their real-time locating system, visit midmarkRTLS.com. You can also click here to check out Midmark’s recent on-demand webinar titled “Outpatient Design: Using Data to Improve Patient Access and Satisfaction,” which is eligible for ACMPE, ACHE and CEU credits. 
• To explore how Solutionreach can help improve your organization’s healthcare communication, visit srhealth.com. You can also click here to register for Solutionreach’s upcoming MGMA seminar titled “Taking Patient Text Messaging to the Next Level with A.I. and Other Tech,” which is eligible for ACMPE, ACHE and CEU credits.