Schwabe’s recently published report, “State of Healthcare in the Pacific Northwest,” offers reason for optimism. It notes that over 40% of the healthcare workers in Oregon and Washington who responded to the firm’s survey believe that their institutions are better prepared for the next pandemic. These healthcare leaders, physicians, nurses, and other professionals point to the new policies and practices they have adopted, the personal protective equipment and pharmaceutical supply chains they have bolstered, and the remote healthcare technologies they have optimized.
But not everyone is so sanguine. In an article titled “I Worry We’re Making the Same Mistakes Again,” which was published in The New York Times on March 19, 2023, Bill Gates lamented, “The world hasn’t done as much to get ready for the next pandemic as I’d hoped.”
Mr. Gates is in a good position to make judgments about our state of pandemic preparedness. Since 2020, the Bill and Melinda Gates Foundation has spent over $2 billion combatting the spread of COVID-19 worldwide. Epidemiologists, public health experts, physicians, and biotechnologists from the Gates Foundation were on the front lines of the pandemic response, providing funding, expertise, tools, and logistical support to ensure that COVID-19 testing and treatment was effective and accessible to all. One of the key lessons Mr. Gates and his colleagues took away from their harrowing experiences is, “We need a fire department for pandemics.”
The analogy of a fire department works on several levels. First, it suggests that pandemic first responders must be professionals. Certainly, volunteers can help with the heavy lifting that any wide-scale pandemic necessitates. But the work of coming up with tailored attack plans and containment strategies must be done by experts who are specifically trained (and paid) to prepare for and respond to the disasters that might be lurking around the next corner.
Second, the fire department analogy counsels that regular drills are an essential part of any comprehensive training regimen. Just as firefighters would not charge into burning homes without first having participated in simulations in a controlled environment, healthcare professionals should not be asked to charge into the rooms of potentially infected patients without first having practiced donning and doffing their PPE or administering the tests used to check for disease. Practice might not always make perfect, but it almost certainly makes for better outcomes than the alternative.
Third, the fire department analogy cautions against complacency. The healthcare industry cannot afford to assume that COVID-19 is the last, or even the worst, pandemic the world is likely to experience. Future pandemics will occur; the only uncertainties are when, where, and how. It is therefore critical for healthcare providers to remain vigilant. They must think about not only the steps they will take to ensure they can effectively test, treat, and accommodate future pandemic patients, but also the steps they will take to protect themselves and their colleagues from the physical and emotional toll of heading into the breach.
A key challenge is deciding how to budget and plan for future pandemics when current exigencies are so pressing. This dilemma forces healthcare leaders to ponder two difficult questions: (1) How much money and time should be invested in pandemic planning? (2) Which pandemic-related investments are likely to provide the biggest bang for the buck? There are no clear answers to these questions, but some helpful data points and promising theories are now emerging.
The National Academy of Sciences estimated in August 2021 that the probability of a pandemic as serious as COVID-19 occurring in any year is about 2%. This estimate might be used as a starting point for making budgetary decisions. For example, a chief financial officer could use as a placeholder the amount derived by taking the cost of operating the health system during pandemic times, minus the cost of operating the health system during non-pandemic times, multiplied by 2%. Whether or not this calculation produces the right number is almost beside the point. More important is that healthcare leaders spend time thinking about the costs of responding to future pandemics, and embed pandemic planning dollars and hours into both their short- and long-term budgets.
As for the question of which pandemic investments pay the biggest dividends, studies suggest a few possibilities may be worth considering. One is redesigning or building new facilities to maximize flexibility. Upgrades to airflow systems, installations of outlets for electric and gas mounts, and expansions to accommodate large equipment like ventilators can allow regular hospital rooms to be repurposed as intensive care or isolation rooms should the need arise.
Another viable candidate for investment is telemedicine infrastructure, including, specifically, hospital-at-home capabilities. Previously, there was uncertainty about whether providers would receive payment for hospital-at-home services rendered after the public health emergency ended. But this concern was allayed by a 2022 omnibus spending bill that ensured Medicare reimbursement for such programs would remain available until, at the earliest, December 31, 2024. Hospitals can now invest with confidence in hospital-at-home initiatives, which combine virtual visits with providers through telemedicine technologies with in-person visits by trained nurses and other professionals to enable qualifying patients to receive inpatient-level care in the comfort and safety of their homes.
One more essential target for pandemic-related investments is staff wellness. A study published by the Institute for Progress suggests that the pandemic may end up costing the United States as much as $6.3 trillion in “mental health losses,” including expenses related to the treatment of skyrocketing anxiety, depression, and eating pathologies. The healthcare industry bore more than its fair share of these costs. Not only did overwhelmed physicians, nurses, and other healthcare professionals exhibit symptoms of burnout; they also left the profession in droves. The result was an unsustainable and forced reliance of healthcare institutions on temporary staffing resources.
Forward-looking organizations are now redoubling their efforts to create environments where physicians, nurses, and other staff want to work. They are hiring chief wellness officers, bolstering employee assistance programs, cross-training employees to work and provide relief in multiple areas, and convening robust staff wellness committees. They are also challenging historical assumptions about where and how their employees need to spend their workdays. The result is not only a proliferation of remote workers but also the establishment of a more contented and resilient workforce.
As importantly, the result is a healthcare industry that is better prepared to respond to the next three-alarm public health emergency.
This article summarizes aspects of the law. It does not constitute legal advice, nor does it create an attorney-client relationship. For legal advice for your situation, you should contact an attorney.
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