That's how a 2021 report from the U.S. Department of Health and Human Services Office of the Inspector General described how hospitals operated during the first year of the COVID-19 pandemic. During those early months, hospitals were stretched to the brink as they dealt with “significant challenges related to health care delivery, staffing, vaccination efforts, supplies and financial stability," the report found.
It's no wonder. The coronavirus upended just about every facet of American life, and its impact on hospitals will last for years to come. But it also helped accelerate some positive trends, like expanding access to telemedicine for those who would otherwise struggle to access care.
Here’s how the pandemic has changed the way hospitals operate — and what we might expect to see down the line.
During the early days of the pandemic, we turned to remote medicine out of necessity. Looking forward, telehealth has the potential to play a much larger role in our healthcare system. A recent analysis of nearly 900 hospitals and more than 19,000 clinics by the Kaiser Family Foundation and Epic Research found that while telemedicine use has fallen from its peak in 2020, it now accounts for a much larger share of healthcare outpatient visits than it did prior to the pandemic.
The report suggests that telehealth services could improve access to medical care for several groups of people, including older Americans managing chronic conditions and people in rural areas with limited access to healthcare providers. The ability to receive necessary care at home, rather than having to travel to a hospital or clinic, could be life-changing.
While the pandemic has helped expand access to care for some, it has limited that access for others. Caitlin Donovan, spokesperson for the National Patient Advocate Foundation, describes a worrying trend. “People [have had] to delay their care for longer” during COVID-19 surges, she says, oftentimes because hospitals lacked the capacity to treat them.
Sometimes there simply aren’t enough beds, or enough surgeons. As providers struggled to cope with the ongoing emergency, many reduced the number of elective surgeries they provided or paused these surgeries all together. Donovan notes that there’s a difference between the medical meaning of “elective surgery” and the way most people think about the term, adding that many people learned the difference in real time over the last two years. The gist? Elective surgery doesn’t mean optional surgery. “Elective surgery can still be for cancer,” she says, “it just means it’s not an emergency.”
Constraints caused by COVID-related disruptions in income or savings have also contributed to healthcare delays. “There are a lot of folks that might be in a situation where they're hesitant because of the financial burden,” says Patricia Kelmar, the healthcare campaigns director at US PIRG, a public interest advocacy group. These people may have debt from previous care related to COVID-19, Kelmar says, or they may have lost their insurance or used up their savings.
A poll conducted last fall by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that one in five American families had delayed care for serious illnesses in the previous few months, and three-quarters of those unable to access care experienced negative health consequences as a result.
Whatever the reason, delaying necessary healthcare often exacerbates the problem and can lead to more complications and costs down the line, both for hospitals and for patients.
A lesser-known consequence of the pandemic has been consolidation — hospitals buying up smaller doctors’ offices and weaker competitors.
The industry was already trending this way, according to testimony from Martin Gaynor, a professor of economics and public policy at Carnegie Mellon University, at a congressional hearing last May. There have been more than 450 hospital mergers in the last decade, according to Gaynor.
But more recently, an influx of federal pandemic relief money to large hospital chains (allowing them to scoop up competitors) has experts concerned about the acceleration of this trend. Some worry that more consolidation will ultimately hurt not only patients but doctors, insurance companies and employers, too, by raising healthcare costs.
“When you have less competition,” Kelmar says, “prices go up.”