Is the Future Now?

One of the biggest questions surrounding the SARS-CoV-2 pandemic is whether we will ever go back to normal. Personally, I don’t think we will, but I also don’t think that’s as bad a thing as many people fear it might be. Why? Because as awful as most aspects of this pandemic have been, it has successfully sped up our learning curve. It has also highlighted which parts of our healthcare system have solid foundations…and which parts desperately need improvement.

Most surveys about who gets COVID19 (the actual disease) have suggested that the COPD population is actually under-represented in the number of cases. That is, fewer people with COPD have shown up needing treatment for COVID19 than previous population studies would predict. That also means we need to consider why that might be. Is it because people with COPD have a lot of experience avoiding infection? Because they’re the same group that was probably staying mostly at home even before they were mandated? Because they were wearing masks before it was cool?

The answer is probably all of the above, and more. For example, traditionally, in order to get a “rapid response kit” (something like an antibiotic & steroid to help limit an early-stage exacerbation), most of the time practices would require people to come into the office, be evaluated, and then get the orders written. However, in many areas with stay-home orders, offices turned to telehealth to keep patients safe. By calling or video-chatting with a clinician, a basic evaluation could be done and orders sent in. This seems to have worked pretty well for the past 3 or so months, so why would we want to go back? Similarly, loosened restrictions on collaboration & supervision have allowed easier access to safe medication prescriptions, including bronchodilators. Who does it help to now remove such access?

The answers to these questions are, “we wouldn’t” and, “no one.” Fortunately, there has been some support for not going back, at least for telehealth. No less than the head of the Centers for Medicare & Medicaid Services, Seema Verma, has stated support for continued telehealth access. However, there are still many unanswered questions about everything from reimbursement to what makes a provider eligible. Further, the statement itself doesn’t address other fundamental inequities & inefficiencies.

The coronavirus crisis has put many of the fundamental flaws of what is often called the “greatest healthcare system in the world” on full display. Although polls tell us there’s not much appetite for wholesale changes in healthcare, is this not a unique opportunity to build something better? Are we going to miss our shot? Or can we make our voices loud enough to insist on not going back?

Navigator Nation, tell me your thoughts!

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