COVID-19 exposes gaps in the U.S. health care system

Before COVID-19, U.S. health care was being called out for unfair billing practicesopens in a new tab. Surprise billsopens in a new tab, confusing and excessive hospital chargemaster ratesopens in a new tab, balance billingopens in a new tab and overreliance on fee-for-serviceopens in a new tab had become familiar topics. While the COVID-19 pandemic has increased positive attitudes towards frontline health care workers, it has also intensified feelings of mistrustopens in a new tab towards a health care system perceived by many Americans as more concerned about profits than patients.  COVID-19 presents us with an opportunity to address these failures.

A studyopens in a new tab published in the Journal of the American Medical Association in June 2019 reported that more than one-third of hospitals in Virginia filed lawsuits against patients that did not pay their medical bills. Many were shocked to learn that hospitals, whose self-described mission is to provide care regardless of ability to payopens in a new tab, were actually bringing lawsuits against their most vulnerable patients. Dr. Marty Makaryopens in a new tab exposes some of the hospitals that sue vulnerable patients for unpaid medical bills in his 2019 book, The Price We Pay: What Broke American Health Care – and How to Fix Itopens in a new tab.

Since March 2020, hospitals have seen a decline in revenue,opens in a new tab mostly due to reductions in the elective procedures that comprise nearly half of their revenue. Revenue generated from outpatient and emergency department visits has also declined. Physician practices have suffered, since most of their income is still derived from fee-for-service payments for in-person visits. Does this mean that patients can continue to expect aggressive billing tactics from health care providers needing to make up a financial shortfall caused by COVID-19? Without changes to the current system, the answer is “yes.”

Attempts to contain the COVID-19 pandemic have exposed the gaps that exist within the U.S. health care system. Federal relief packages meant to cover COVID-19 testing and treatment for uninsured persons have not shielded patients from exorbitant billsopens in a new tab. Stay-at-home orders designed to protect the public from spreading and catching COVID-19, as well as fear of contracting the virus, have kept patients from getting the care they need to manage chronic medical and behavioral health conditionsopens in a new tab.

We have an opportunity to restructure an antiquated fee-for-service payment system for primary careopens in a new tab, eliminate surprise billsopens in a new tab for emergency department visits and surgical procedures, and create a more equitable pricing structure that aligns with Medicareopens in a new tab. Shortcomings of the U.S. health care system have become more pronounced since the arrival of COVID-19. The pandemic has shone a spotlight on those gaps and has reminded us that they cannot be ignored.

Steve Delaronde is manager of products for Population and Payment Solutions at 3M Health Information Systems.

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During a pandemic, information is gathered, studied, and published rapidly without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. We share our thoughts and expertise based on currently available information.