By sheer necessity, the Covid-19 pandemic has united health care systems around the common purpose of accelerating advances to help patients that might otherwise have taken years to develop. This has taken cutting through layers of bureaucracy stemming from misguided policies, ingrained industry practices, and outdated conventions that too often tied the hands of patients and clinicians.
Such advances, some of which I saw firsthand at University Hospitals in Cleveland, where I serve as the chief clinical transformation officer, should be built on during this crisis and after it has passed.
One solution we devised to remotely monitor patients’ vital signs was the use of a new mobile sensor taped around a patient’s finger and connected to the cloud via a smartphone. It made it possible to keep a close watch on patients who were well enough to be sent home but still needed observation, thereby freeing up more hospital beds for those who needed in-hospital care.
But there was a small hitch: The Centers for Medicare and Medicaid Services’ monitoring program was designed for chronic care, not acute care, and required patients to be monitored for 14 days before CMS would pay monitoring. Most Covid-19 patients needed monitoring for just four to eight days.
Understanding this shift, CMS revised its requirement to two days, paving the way for our hospital to be paid for using this technology.
This patient-centered technology is 10 to 20 times less expensive than keeping a patient in the hospital, and the collaboration with CMS and the Food and Drug Administration enables us to quickly deploy it for many patients, which creates capacity to treat more patients in the hospital who are seriously ill, and is ultimately saving lives.
During the pandemic, more than 400 restrictions have been removed by CMS, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Department of Homeland Security, and state health agencies.
- CMS expanded access to telehealth by allowing Medicare to pay clinicians for telemedicine visits with patients who were in their homes. This allows Medicare patients to participate in telemedicine without leaving their homes and streamlines remote patient for at-home patients. Many commercial insurers followed suit and broadened their telemedicine policies.
- The FDA and the CDC loosened restrictions on university labs and private companies developing new tests for Covid-19. This contributed to the rapid development of diagnostic tests and has helped our country scale the number of daily tests that can be performed.
- CMS relaxed rules that prevented doctors and nurses from practicing across state lines. This allowed health care professionals to help in hard-hit areas without having to jump through hoops to do so.
- CMS granted nurse practitioners the authority to order home health care and devise care plans without physician oversight. It also removed a requirement that patients need to be home bound to qualify for home care. This allowed more people to access home care and avoid being admitted to a skilled nursing facility, where a substantial number of Covid-19 deaths have occurred.
Loosening these and other rules has been essential for the explosion of rapid innovation and learning that is saving countless lives.
A shift in mindset
It would be a mistake to think we can always generalize based on the response to a specific crisis. But there are several lessons to be learned from multiple aspects of the current situation.
The process must serve people. The early days of our country’s chaotic response to this crisis made clear that we were being forced to navigate a labyrinth of bureaucratic rules that were preventing a coordinated response from taking hold. As the pandemic progressed, waiving some of these rules fostered a more team-based approach, to medicine, empowering providers to do what they were trained to do.
Covid-19 showed the types of breakthrough progress that are possible when we create a process that serves people. Rather than a one-size-fits-all response for how to flatten the curve, key principles such as social distancing, testing, conserving personal protective equipment, and canceling elective surgeries were promulgated, and states and regions within states had flexibility to implement these principles to best serve their citizens.
Of course, some wise rules and regulations are necessary. But we must have the humility to recognize that a rules-based approach intended to stop bad things from happening also prevents countless good things from happening. We should work to establish principles or guidelines that set boundaries while being flexible for health care providers.
Trust and believe in people. One of the most insidious problems in health care is that so many problems are accepted as inevitable: Harm from errors. High costs. Opacity. Red tape. Although these can seem to be facts of life, the spirit of innovation we have seen during Covid-19 shows they are anything but.
When people are empowered around a common purpose, they can do amazing things. Not surprisingly, what we’ve found is that experts on the ground who are dealing with the challenges are often much better placed to know what needs to be done than faraway planners who are not on the scene.
To carry on in this spirit requires more than a shift in policy. It requires a shift in mindset — from limitation and suspicion and rigid hierarchy to belief in people and cooperation.
Progress is interdisciplinary. Covid-19 has shown that solving problems in health care requires input from patients, clinicians, communities, business leaders, policymakers, and more. Rather than these groups treating each other as the opposition, we need to engage across disciplines to scale solutions that work.
For instance, we are seeing tests, treatments, and potential vaccines for Covid-19 developing at lightning speed. This is possible because organizations in the public, private, and social sectors are working toward a common purpose. Tackling other complex challenges — from improving hospital safety to treating cancer and Alzheimer’s — is going to require similar cooperation.
The Covid-19 crisis made visible the gaps in how health care is organized and delivered in the U.S. Barriers that have made our nation’s health care industry fragmented and often-times inefficient left us unprepared when the pandemic began.
As we return to something resembling normalcy in the months and years ahead, we need to figure out how to keep this spirit of invention and collaboration alive. Not only is this essential in preparing for future pandemics, but also in transforming health care to focus squarely on serving patients and empowering providers to help them.
Peter Pronovost is a critical care physician and chief clinical transformation officer at University Hospitals in Cleveland.
