Health care is falling through the cracks this election year
This op-ed is part of The Hill’s “How to Fix America” series exploring solutions to some of America’s most pressing problems.
The issues raised during this election year — the economy, abortion, border security and childcare — are important to many of us. One issue, however, is mysteriously absent so far: health care.
As a hospital consultant with more than two decades of experience, I can say with certainty that despite the best efforts of our nation’s heroic clinicians, our health care delivery system is not prepared for the next pandemic.
COVID-19 has only exacerbated problems that were years in the making: hospital and emergency department overcrowding; increased medical error and patient mortality, shrinking hospital margins, clinician burnout and nursing shortages.
Patients are suffering and hospitals are closing down because of these issues. A new analysis reveals that 703 rural U.S hospitals are at risk of closure due to financial problems. For outpatient clinics, the primary care physician shortages are the biggest challenge, leading to dangerously long wait times for an appointment.
In 2023, the U.S. spent $4.8 trillion on health care, up from $4.5 trillion the year before. Up to 33 percent of that spending can be considered wasteful or avoidable. A recent survey projects that the cost of medical care benefits in the U.S. will increase about 8.9 percent in 2024.
In 2023, Medicare alone cost $839 billion — about 14 percent of total federal government spending — and Medicare spending is projected to rise from 3.1 percent of GDP to 5.4 percent by 2053, with hospital expenses accounting for nearly 40 percent of spending.
Clearly, we cannot afford to maintain the status quo.
So, what are our options?
Daily hospital bed occupancy varies widely with high peaks and low troughs. Counterintuitively, the main cause of this variability in bed occupancy is not unpredictable patient arrival to the Emergency Department, but rather scheduled patient admissions for planned surgeries. A recent New York statewide study showed that the daily number of emergency hospital admissions fluctuates considerably less than the number of daily scheduled surgeries.
Typical hospitals allocate more than 50 percent of their budgets to staffing, even now, with the current nursing shortages. Hospitals staff to the average level of anticipated patient demand, as nobody can afford staffing above that level. Peaks in admissions above this average level of staffing have been proven to cause overcrowding, nurse shortages, medical errors, patient mortality and readmissions. As long as these manmade peaks above hospitals’ staffing levels exist, the aforementioned consequences will continue, no matter what else a hospital does.
The mismanagement between demand and capacity is exemplified by the tragic story of 15-year-old Lewis Blackman, who died after a successful surgery when a lack of beds on the surgical unit caused him to be admitted to a unit with staff unfamiliar with his post-surgical needs. We don’t know how many more stories like this take place today in overcrowded hospitals.
Every hospital and outpatient clinic that has smoothed these manmade peaks in bed occupancy or in arrivals to outpatient clinics has saved lives and millions of dollars. Here are just a few examples:
- Cincinnati Children’s streamlined their surgical schedule and increased their margins by $137 million annually while significantly reducing emergency department wait times and nursing stress. Between the 6,000 acute care hospitals in the U.S. of different sizes, even if each of them saves only one-tenth of this amount, it would save us $78 billion each year.
- University Health Network (whose Toronto General Hospital is ranked No. 1 in Canada and No. 3 worldwide) was able to significantly increase the number of surgeries while reducing waiting for emergent, urgent and transplant surgeries — a life-and finance-saving intervention.
By addressing something as mundane as variability in scheduling in its Operating Room Department, the Ottawa Hospital in Canada completely eliminated over 600 annual surgical cancellations and postponements, saving $9 million and 40 lives annually. An incredible 24,000 lives could be saved annually if every U.S. hospital were to save just 10 percent of the number of lives that the Ottawa Hospital has.
- The Mayo Clinic (Fla.), applying the same methodology, reduced turnover among operating room nurses by 43 percent, while experiencing a multimillion margin improvement.
- Although 90 percent of its patients live within 200 percent of the national poverty level, the Federally Qualified Health Center, St. Thomas (a safety net clinic during Hurricane Katrina), addressed the variability in its patient demand. In doing so, it moved from the red ink to a multimillion dollar positive margin while providing access to care on the level of concierge care for its historically underinsured population.
If each U.S. hospital could avoid building just one single additional bed to accommodate artificial peaks in scheduled patient demand, that would save $9 to $18 billion annually in capital costs alone.
If implemented nationwide, this methodology would save $200 billion annually, which would be a reduction in 4 percent-5 percent of the overall U.S. annual health care cost or 25 percent of Medicare cost alone.
Today, we can state with certainty that our health care delivery is inadequate even without a new pandemic. Unless it changes, another pandemic is highly likely to overwhelm our entire health care delivery system. Unless scheduled patient demand is smoothed, we will again face the unpalatable choice between treating infected patients and those who need surgeries.
As our COVID-era experience demonstrated, this led to a significant deterioration in patient health and a substantial increase in avoidable deaths of surgical patients (cancer and transplant patients especially, as waiting time is critical for them), and many hospitals going out of business due to a reduced revenue from surgeries, which are a financial lifeline for most of them.
Improving patient flow won’t just generate significant savings for Medicare, support biomedical research, reduce the national debt, fund education and serve many other private and public purposes; properly managed patient flow will also reduce medical errors and enhance quality of care. Whether it’s for our patients, the health care community, or the next generation, we owe it to them to break from the status quo.
Eugene Litvak, Ph.D., is the president and CEO of the nonprofit Institute for Healthcare Optimization and adjunct professor at the Harvard T. H. Chan School of Public Health. He is the subject of the new book “Hospital, Heal Thyself: One Brilliant Mathematician’s Proven Plan for Saving Hospitals, Many Lives and Billions of Dollars.”
Date: |
Topics
-
Business - MarketWatch
Mobileye’s stock is down 70% this year — and J.P. Morgan says it’s not done falling
Four of 30 analysts are now bearish on the self-driving-technology stock, and the latest one sees about 20% further downside.50 minutes ago -
World - ABC News
A top official with German Chancellor Olaf Scholz's party quits, a year before the national election
A top official with German Chancellor Olaf Scholz’s party has announced his resignation, a year ahead of an election in which the center-left Social Democrats face an uphill struggle8 hours ago - Germany -
Politics - The Hill
Russia never cared about ethnic Russians in Ukraine
What has transpired is anything but what Russia said it would do to aid ethnic Russians.7 hours ago - Russia -
Top stories - CBS News
How far will HELOC rates fall in October?
Home equity borrowing rates have been dropping recently, but how far could HELOC rates decline this month?6 hours ago -
World - Yahoo News
Ethiopia president replaced after falling out with PM
3 hours ago - Ethiopia -
Top stories - CBS News
How twin sisters raised in foster care became community leaders in Louisiana
At 40 years old, twins Cherry and Sherry Wilmore are known for their generosity and impact on the community. Raised in foster care, they're now giving back and inspiring others in Louisiana.7 hours ago -
World - The Guardian
Pakistan bans Pashtun group as government cracks down on dissent
Protests have been broken up with violence and opposition politicians from Imran Khan’s party arrested. Pakistani authorities have unleashed a draconian crackdown on dissent, breaking up opposition ...9 hours ago - Pakistan -
Entertainment - ABC News
Donald Glover cancels Childish Gambino tour dates over health issue
Donald Glover has canceled the remaining dates of Childish Gambino’s North American and European tour18 hours ago -
Top stories - CBS News
How twins who grew up in foster care are paying it forward
Cherry and Sherry Wilmore are known in their hometown of Houma, Louisiana, as "everybody's favorite twins."5 hours ago
More from The Hill
-
Politics - The Hill
White House, Fox News' Peter Doocy spar over Helene response
White House press secretary Karine Jean Pierre and Fox News reporter Peter Doocy sparred on Monday over the Biden administration's response to the damage and destruction wrought by Hurricane ...35 minutes ago -
Politics - The Hill
Sen. Rubio: Milton looks 'almost identical' to worst-case storm scenario for Florida
Florida Sen. Marco Rubio (R) said Monday that Hurricane Milton looks “almost identical” to a worst-case storm scenario presented to him for the Sunshine State. “Several years ago I asked [the ...44 minutes ago - Florida -
Politics - The Hill
Al Pacino claims he almost died of COVID: 'I was gone'
During a podcast appearance on The New York Times’ “The Interview," Al Pacino claims he once nearly died of COVID.47 minutes ago -
Politics - The Hill
Costco gold bars are selling out as prices for the precious metal break records: Survey
Move over, gas and hot dogs. Costco shoppers are snatching up the store's 1-ounce gold bars despite the market's lofty price for the precious metal.1 hour ago -
Politics - The Hill
FTC antitrust case against Amazon moves forward, several state claims dismissed
The Federal Trade Commission’s (FTC) antitrust case against Amazon will move forward, but several state claims against the e-commerce giant were dismissed, according to a newly unsealed ruling. In ...1 hour ago