Hospitals work on thin margins that are easily threatened by revenue disruptions, making preparing for future crises all the more difficult. This is compounded by lower reimbursement rates from the government and consumer health insurance plans for certain services and populations.
Gibbs noted that reimbursement for services for individuals who are on Medicaid or otherwise in need are too low to allow for adequate care, especially if services need to be ramped up.
Health systems that regularly treat a more affluent patient base have plenty of resources to help them weather tough times, but finances will remain shaky for safety-net facilities that rely on public health reimbursement, he added.
Questions remain on how to create excess capacity for future crises.
“During this major surge, we shut down all our operating rooms and even transformed our hallways to accommodate COVID patients, but we can’t always do that,” Dowling said.
It’s not clear whether it’s feasible for health systems to build beds, staff them and leave them empty until another crisis hits.
“Who’s going to finance that?” Dowling asked, though he noted that President Joe Biden’s commitment to upgrading infrastructure might help.
One way hospitals took in revenue last year as patients stayed home was through the use of telemedicine. But reimbursement rates for virtual care are not yet on par with those for in-person services, so some doctors opt not to use it.
Telehealth visits surged to over 7,000 calls per day during the height of the pandemic for NYU Langone, Widawsky noted. It has since mellowed to about 600 per day.
“It is not going anywhere and will be a mainstay of how we deliver health,” he said. But, he added, the reimbursement issues have to be ironed out to make the tool truly beneficial for physicians.
Despite the lack of parity, though, health systems cannot drag their feet on integrating telehealth into their care models, Dowling said.
“We can’t afford to sit around and say, ‘We can’t do this’ simply because reimbursement has not caught up,” he said. “We all know telehealth is the future.”
As health systems beef up their readiness for the next crisis, however, the work to improve their operations will never be truly done.
“Even if we think we’re doing great, there will be 20 things we can be doing better,” Widawsky said.