Today’s guest columnist is Will Ferniany.
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Health care plays a major role in the Birmingham economy and touches every one of us. With 14 hospitals in the metropolitan area, 12 ambulatory surgery centers in Jefferson County, and hundreds of physicians’ offices, there are more than 63,000 people directly employed in medical/surgical health care in our area.
It is no secret that COVID is affecting hospitals during the crisis, but the effect on hospitals, health care, and our economy as we move into a post-COVID period will be transformative – not only for health care, but also for Birmingham, Alabama, and the entire nation.
The most immediate change will be in telemedicine
Prior to COVID, UAB Medicine physicians provided an average of 7 telemedicine visits per day. During the pandemic, this number moved up to more than 2,100 telemedicine visits, and we expect that we will provide approximately 35%-40% of our ambulatory visits via telemedicine in the future. Most patients and providers appreciate the convenience of telemedicine visits, when appropriate.
However, there are ramifications to increased telemedicine; the most obvious will be less urgent care clinics and fewer physician offices needed. Fewer people going out for care also means less being spent on gas, food, and other purchases, as well as fewer employees needed in physician offices.
The most far-reaching change may be in how we pay for health care
The Great Recession of 2008, which left millions unemployed and without health insurance, combined with the democratic administration and congress led to the Affordable Care Act. The COVID crisis has put a spotlight on the weakness in an employer-based insurance model and fee-for-service payments, and millions more are now unemployed and without health coverage.
There will be pressure to change our insurance system. And with the possibility of a democratic congress and president, we may have the opportunity and political will to make real changes and move away from the fee-for-service system. I don’t think it will be a “Medicare for all” solution, but it could be a Medicare option or voucher system combined with a national (not state) Medicaid plan.
These changes will take some time, and in the interim, Alabama should expand Medicaid to provide coverage to hundreds of thousands of people who need it. Additionally, expansion of Medicaid will help our COVID-crippled economy.
Addressing Health Disparities
Because COVID has heightened our awareness of social determinants and underlying structural issues, there will be an increased focus on health disparities and how we can better/more proactively address the needs of black, brown, and low socio-economic communities. To address the health equity issue, UAB Medicine is starting a Community Health Equity Program with our alliance partner St. Vincent’s and Cooper Green. UAB also has the Healthy Alabama 2030 program to improve health status throughout Alabama.
Other changes we will see include:
- The probability that more rural hospitals will close.
- More nursing and physician shortages as people decide to retire early.
- The need for more mental health and addiction services as depression, suicides, and drug abuse increase. In addition, there will be a significant amount of professional/clinician burnout that will manifest itself over both the long and intermediate term.
- Hopefully we will see increased funding for Public Health, as our Public Health system has been underfunded for decades. Had it been adequately funded, our response to COVID may have been more effective.
It is truly a time of great change in the health care and the ramifications of these changes will impact each of us in Birmingham.
Dr. Will Ferniany is Chief Executive Officer of UAB Health System, an 11-hospital academic health system that includes VIVA Health and the UAB Medicine/Ascension St. Vincent’s Alliance.
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David Sher is Co-Founder of AmSher Compassionate Collections. He’s past Chairman of the Birmingham Regional Chamber of Commerce (BBA), Operation New Birmingham (REV Birmingham), and the City Action Partnership (CAP).
Invite David to speak for free to your group about how we can have a more prosperous metro Birmingham. firstname.lastname@example.org.