(Bloomberg Opinion) -- So many ordinary activities have been put on hold in the time of coronavirus, but one stands out as an especially punishing loss: People have sharply curtailed their non-Covid health care — not just easily postponed checkups, but also tumor removals, diabetes tests, prenatal visits, kidney transplants, vaccines, even emergency care after heart attacks. Since early March, in-person doctor visits have fallen about 60% in the U.S. Cancer screenings have dropped 86% to 94%. And until recently many hospitals were turning away all patients except those with Covid-19, often by order of state officials.
Epidemiologists assume that the pause in non-Covid health care accounts for an as-yet-unmeasured share of the tens of thousands of “excess deaths” that have happened in the past couple of months in the U.S. This is a danger in any epidemic; during the Ebola outbreak in West Africa in 2014-16, increased deaths from measles, malaria, AIDS and tuberculosis ultimately exceeded deaths from Ebola.
In the current situation, it’s unlikely that indirect mortality will ever outpace deaths from Covid-19 itself. But the pause in medicine is an urgent public health challenge in its own right. Telehealth has helped fill the gap for many patients who need advice, evaluations and prescriptions more than hands-on care, but it can do only so much. Meeting the need will require combined efforts by doctors, health insurers, hospitals, and state and federal governments. Their goal must be to recommence health care carefully and gradually enough to avoid making the Covid-19 outbreak itself any worse, or exposing people with existing conditions to a virus that’s especially threatening to them.
The medical profession has every incentive to move as quickly as possible, as doctors and hospitals are taking an enormous financial hit. With income from day-to-day health care and non-emergency surgery on hold, many independent doctor offices face a stark choice between closing and selling out to a larger medical enterprise. From mid-February to mid-March, some 43,000 U.S. health-care workers were laid off. Even the biggest, most secure hospitals are suffering. Stanford Hospital is temporarily cutting all employees’ pay by 20%. The Mayo Clinic, anticipating a $3 billion loss in revenue this year, is also imposing pay cuts.
For already struggling rural hospitals, the loss of income from elective surgery and non-Covid care stands to be disastrous. Yet the pandemic has demonstrated how essential it is to keep rural hospitals in business. As Covid-19 case numbers rise in more rural states, the need will grow ever more obvious.
The trouble is, medical offices and hospitals are among the most difficult businesses to reopen in a pandemic environment in which testing and contact tracing are still not up to speed. Hospitals shouldn’t even begin to consider treating non-Covid patients, the Centers for Medicare and Medicaid Services has warned, until they ensure they have the capacity — including masks, ventilators, other supplies as well as personnel — to respond to any new coronavirus surge, and until they are able to fully isolate Covid and non-Covid patients (and their care providers) from each other.
In restarting elective surgery, in particular, practitioners and hospitals have agreed on strict rules: It shouldn’t happen until the hospital has seen a sustained decline in the Covid-19 rate for two weeks, and until all patients and hospital workers can be quickly tested for the coronavirus. Even then, it will be essential to prioritize the most medically necessary and time-sensitive procedures.
Federal support through the various coronavirus bailout bills will help hospitals make progress. Future federal money should come with the condition that staff be retained. And funds should be set aside for rural hospitals. Rural states can help, too, by finally expanding access to Medicaid under the Affordable Care Act — as 14 of them have yet to do.
Governors can help hospitals by helping communicate to an understandably wary public when it’s safe to return to their doctors and hospitals.
Private health insurers have actually saved money thus far in the coronavirus crisis because of the falloff in routine medical care. Some are trying to help doctors, clinics and hospitals stay in business by guaranteeing loans or providing interest-free loans. Blue Shield of California is also helping some of its providers switch from their standard fee-for-service payment model, which has caused their income to plummet with the arrival of Covid-19, to monthly per-patient payments. Many doctors who manage to keep their practices afloat during the pandemic may find it makes sense to move to such flat fees for giving patients all the care they need — as through Medicare’s successful Shared Savings Program. Then their income would not decline when patients can be treated only via phone or video calls.
In this and perhaps in many other ways, Covid-19 will change U.S. health care. When the next crisis strikes, one hopes the system will be better prepared. For now, though, the most urgent job is to return, with caution, to medicine as usual.
Editorials are written by the Bloomberg Opinion editorial board.
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