An Unexpected Opportunity Presented by the COVID-19 Pandemic
Resetting the Health Care Utilization Rate in the United States:
In 2018, the United States spent 16.9 percent of our gross domestic product or $10,600 per capita on health care. Our nearest competitor, Switzerland, spent $7300 per capita. For 2019, U.S. spending is estimated to have been $3.6 trillion.. Globally, we have the highest rate of health care utilization, easily outpacing any other country on the planet.
Health care costs have come into sharp focus as the nation figures out the best responses to COVID-19. No one knows how many people have been exposed to the virus, making it almost impossible to estimate accurately how many people may need acute care, how many may die, and how much it may cost.
Right now, a major focus has been keeping the existing system from being overwhelmed. As one lifesaving measure, a few governors have asked hospitals to put off any elective surgery until the crisis subsides. This request comes from concerns about public health rather than economics because surgery-related costs are difficult to estimate because of the ancillary expenses. Costs related to ambulatory surgery were estimated at $36B in 2018 and expected rise to $40B by 2020. Overall hospital costs were nearly $1.1 trillion in 2017.
The ratio of emergency-to-elective surgery in the U.S. is, using data gathered between 2006 and 2016, 9.4 to 1 with 8.59 percent classified as urgent and 91.4 percent as elective. Combining with overall costs in the U.S., on the latter between $519.5B to $523.5B is spent annually.
That’s a big number, making unnecessary surgery and overutilization of surgical services a substantial source of wasteful health care spending. 2,016 doctors were surveyed from an AMA database, to determine the magnitude of overtreatment in the U.S. Of those surveyed, 64.7 percent of physicians believed 15-30 percent of medical care was unnecessary. In his book Health in the 21st Century: Will Doctors Survive? Dr. Francisco Contreras puts the percentage of unnecessary surgeries at 29 percent.
It matters, not least because, as we all now know, Chinese authorities alerted the World Health Organization on December 31, 2019 to an outbreak of a novel strain of coronavirus causing severe illness. As of April 3, 2020, 1,095,208 COVID-19 cases have been documented worldwide with more mild cases likely undiagnosed. The virus has killed to date more than 58,000 people. The primary mode of transmission from person to person is the exchange of respiratory droplets. Social distancing and proper hand hygiene are recommended for everyone while health care workers protect themselves additionally with masks and gloves during all patient encounters. At the time of this writing, non-essential workers have been encouraged to stay home at least until mid-April, perhaps longer to slow the spread and “flatten the curve.”
The elective surgery moratorium could continue well into the year. Patients advised of the need for non-urgent surgery may wait for weeks, perhaps months to get it. This pause creates an opportunity to study the necessity of these elective surgeries, re-determine risks, and lower surgical care utilization rates.
Not only is this a good idea, it may be vital to getting the U.S. health care system and the economy back up to the point they are fully functional – and the importance of technology in this effort cannot be understated. The SurgiQuality platform, which I helped develop, is one way to reduce unnecessary surgeries and re-evaluate risk by connecting surgical patients to best-in-class surgeons operating in a cost-efficient environment.
In our system, patients needing surgery are connected to a personalized concierge who helps upload medical records and imaging to a HIPAA-compliant cloud. Through the SurgiConnect app, surgical specialists throughout America are notified of cases within their area expertise and interest. The can then review the records, validate the necessity of the procedure, and enter experience -- number of cases performed, success rates and complication rates – for patients to consider. Surgeons and facilities may also enter “all in” bids performing procedure as well as recommendations of alternative therapies and suggestions as to whether it’s needed at all.
Making multi-specialty opinions available through these technology platforms offer patients less invasive options and a potential for less morbidity while helping providers prioritize care. Surgical specialists can indicate their areas of interest within their specialty when they sign-up. Surgical patient records are connected to surgeons based on these areas of interest. Surgeons in different specialties could then offer opinions on the same case, giving patients greater choice. For example, a patient with a cancerous colonic polyp is presented to both general surgeons as well as gastroenterologists. The former may recommend a colonic resection, the latter a much less invasive colonoscopy with micro-excision, with considerably less morbidity and faster return-to-work time.
This information exchange allows patients to choose surgeons based on cost, location, quality, and convenience. And, by allowing the medial review process to suggest alternatives, the system may bend down the cost curve by producing a reduction in the number of unnecessary surgeries performed int eh future.
If the dourest projections about COVID-19 are right, hospitals, and surgery centers, and patients could use the system to prioritize beyond typical triage efforts what should be done first and why in critical cases and elective care. If technology tools like SurgiConnect reduce the possibility a future pandemic like the one we are now experiencing to overwhelm the health care infrastructure, doesn’t it make sense to deploy them now?
The post-COVID-19 period will cause us to re-evaluate the necessity of surgeries and associated risks in elective surgery. The SurgiQuality platform and those like them will be an important tool for achieving those goals.
Sanjay Prasad MD FACS is a practicing surgeon for nearly 30 years and Founder of SurgiPrice, Inc., SurgiQuality and SurgiConnect. Dr. Prasad is an Assistant Professor at the George Washington University Hospital, Washington DC.
