Lessons to Learn from COVID-19

It’s a different healthcare world today than it was even just a few years ago.

The COVID pandemic is going to be studied for years to come. Psychologists will need a long time to try to figure out how people could be convinced that a vaccine, dispensed from a multi-dose vial through a tiny needle, could possibly contain a tracking chip in each dose.

Supply-chain professionals will be using the shortages that occurred at the onset of the pandemic to determine how to be better prepared when the next crisis hits. And the medical professionals will have an abundance of data to study.

Many are also interested in studying the collateral effects of the near-complete breakdown of our medical care system, and we are starting to see the data on what many of us feared: the delayed diagnosis of potentially curable diseases. Data published in February from a single hospital shows the stage at presentation of patients with breast cancer, before and during COVID. The percentage of patients presenting with later-stage cancer increased significantly. They did not look into the causes, but one can presume that many missed their yearly mammograms, and some likely had delayed evaluation of palpable abnormalities. As time goes by, I expect similar data for other cancers. Please encourage your patients, family, and friends to get their screening tests they delayed during the pandemic.

Moving on, I believe I have discussed Condition Code 44 versus self-denial in the past, but I got into another online discussion about it recently. Yes, doing a Condition Code 44 change to outpatient is difficult, with lots of moving parts and a short time frame – and simply marking a case for post-discharge self-denial and rebill is a heck of a lot easier, but whose decision is it as to which should be preferred? Well, in this case, it was a unilateral decision by the utilization review (UR) team to not do 44s. The physician advisor didn’t want to be bothered, and the UR staff had too many other tasks.

But what if the finance team was asked to provide input? Which would they choose, the option that allows them to prepare and submit one outpatient Part B claim and get paid in a few weeks, or the one that requires three claims to be produced and delays payment for a couple of months? Do we want to tell a patient in person that their status has changed and they probably owe less money and be available to answer questions, or should we wait and send them a letter where they have to decipher all the technical jargon about Part A and B and inpatient or outpatient and have to call the hospital to get answers? Now, maybe your facility chooses the self-denial route. That’s fine, as long as it was an informed decision weighing the costs and benefits of each method, and all involved parties have had an opportunity to provide input.

Finally, I am sure everyone heard about the Vanderbilt nurse found guilty of criminally negligent homicide. This unjust verdict will have a pronounced chilling effect all through our hospitals, with providers of all types thinking twice about reporting errors, as this nurse promptly did.

As if the harassment many healthcare workers faced during COVID wasn’t enough, now this verdict exposes all of us to criminal charges for systemic errors. I suspect many would have a different answer now than in 2019 if asked if they would recommend a family member go into healthcare. 

Programming Note: Listen to Dr. Hirsch every Monday as he makes his Monday rounds on Monitor Mondays, 10 Eastern, and sponsored by R1 RCM.


Ronald Hirsch, MD, FACP, CHCQM, CHRI

Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).

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