Discussions about the US health policy have been suspended because the US is now putting all of its efforts into containing COVID-19. Before the virus outbreak the first thing on the agenda was the overall cost of health care in the US. But now, the most important issue that most people focus on is the price of COVID-19 testing.
There’s no doubt that we must organize our collective efforts in order to secure your community’s health. However, the issue of ballooning our health care costs still remains unresolved and will keep getting worse as we proceed to battle COVID-19.
We’re aware that the costs will be transferred over to a Coronavirus funding package as well as state-level emergency dollars. When we calculate the cost of COVID-19 by adding together the cost of testing and treatment, we get an expensive price tag. And this is only for when you walk into a clinic to be evaluated.
During the past few years, we have studied and tried to figure out a way to implement different programs which will keep non-urgent patients out of emergency departments and thus reduce costs. Programs like small pilot studies or expansion of Medicaid, yielded some results, generally in the reduction of unnecessary visits.
But no matter how far forward thinking we were and how many good ideas we come up with, no one could have ever pictured a scenario like this one or even prepare for it. As the virus spreads, we are not yet able to determine whether every person with a cough has contracted the disease or what type of treatment they need, if at all. In these uncertain times, the use of emergency departments will become inevitable which will sill result in a high price tag.
Unfortunately, we do not know the exact price of how much this will cost. But if the 2008 H1N1 influenza is any indicator, there were almost 500 thousand emergency visits. In 2009 there were over 1.2 million visits. Back in 2008, 87% of the emergency patients were treated and released while that number in 2009 was 90%.
With the increase of total emergency visits per year, we can also notice a high number of unnecessary emergency visits as well. For example, UnitedHealthcare put a price of over $2,000 on one emergency visits that could have been avoided and address in a less expensive way. When we multiply that cost, with the number of unnecessary visits we get a staggering figure of $1.5 billion. And if we assume that the COVID-19 year will be worse than the H1N1 year, we are looking at a much heftier price, where we add billions and billions of dollars.
With the proactive of social distancing and self-quarantine, there is a chance that the number of emergency visits due to COVID-19 will be smaller than the estimate, but at this moment we can’t tell for sure.
To assume that COVID-19 will result in more emergency department visits and that the majority of those visits will be unnecessary, is not reasonable and many cities, like New York issued alerts about this. Cities are asking Americans to stay home and self-isolate instead of heading to the ER and potentially jeopardize the care of other patients that might really need it.
We have to focus on the consequence of an ER overcrowding, not the cost. If we stretch (unnecessarily) the resources too thin, the health system won’t be able to help those in need. We’ve seen this in the scenarios in Italy and China.
It’s impulse to be evaluated and seen in an ER is understandable, especially if you feel some of the symptoms or you’re scared. According to some research, people tend to go to emergency departments rather than primary care setting because they are more accessible.
Experts already came up with a solution to use telemedicine to triage patients. Various telemedicine platforms have the necessary infrastructure to design and launch a system that will use evidence-based algorithms for triage.
If you suspect that you’re experiencing symptoms of COVID-19, you get to do an online assessment to determine whether or not you’re at risk for COVID-19. The assessment was developed using guidance from infections disease specialists from the CDC, WHO and local / state public health departments.
If the assessment determines that you’re at risk, the system will connect you with a medical professional who will then follow up with you via message, voice and video call.
While on the call, the healthcare provider will ask you questions in order to get additional information about your symptoms, concerns and of course recommend the best course of action. If necessary, they might even recommend you to local doctor to get diagnosed and tested.
If you are an individual with low risk for COVID-19, you will be redirected to a resource hub where the information is updated constantly and you can manage and monitor your symptoms from home.
Naturally, this self-quarantine at home system has limits. You won’t be able to test yourself for COVID-19 or get actual treatment yet, but nonetheless it is a powerful triage tool which will prevent patients not likely to contract the coronavirus, to storm the emergency room and jeopardize the care of other patients, who might really need it.
According to some companies, this type of medical service will cost roughly $50 which is a fraction of the actual cost of an emergency department visit (over $2000 per visit). When we apply this $50 bill to the scenario of H1N1 and those numbers, the cost is over $50 million.
Telemedicine visits for acute respiratory infection treatment are convenient and they are utilized by people that would normally not be able to travel and see a doctor in person. This means that we will need to do more in order to maximize telemedicine’s potential to bring down the costs and it also means that telemedicine will be able to compete with emergency departments regarding convenience and access.
Even though COVID-19 has caught us off-guard we do have the tools that will aid us in these situations. Government leaders now realize that telemedicine can play a key role in COVID-19 response and prevention.