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Cover Story
RN, ICU nurse; Lara Haddad, FROM LEFT TO RIGHT: Natalie Bautista-Cruz, surgical tech; Maria Luz Esmeralda MRI tech Pharmacy Clinical Coordinator; Jirani Harris,
PharmD,
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how a pandemic changed healthcare
the state of healthcare and recognizing the heroes on the frontline
by Geoff Maleman
The global pandemic has forever changed the way the public views the hospital and healthcare industry, and the industry is attempting to regain its footing and plan for the future.
The first known coronavirus patient in the country was seen at Providence Medical Center in Washington on January 21, 2020.
The federal government declared the public health emergency 10 days later.
The World Health Organization said the novel coronavirus was officially a pandemic on March 11.
Then Centers for Medicare & Medicaid Services suggested hospitals cease elective procedures on March 18 in order to free up space for potential surges of COVID-19 patients.
There‘s no doubt that it was March of last year when the vast majority of people in the country realized the pandemic was about to change their way of life, at least for a while. Working from home became the norm for those with that ability, stay-at-home orders came down and, eventually, mask mandates started appearing. Challenges were even more acute on the frontlines of the pandemic, where there were critical shortages of nurses, beds, medical supplies and personal protective equipment. The public began to recognize how important medical workers were and their commitment and dedication to their jobs, even in the face of a life-threatening virus, elevated them to hero status.
A year and a half later, hope is beginning to bloom as three coronavirus vaccines have been authorized for emergency use in the United States. As of this writing, 87.5% of Californians have received at least one dose of the vaccine, and distribution is improving every week.
For the healthcare industry, much has changed, and some of those alterations may be permanent.
Providers have learned a lot over the past year, including how to improve systemwide communications and work on more efficient patient flow strategies. And hospital staff have faced unprecedented levels of stress and burnout, leading to concerns about hiring enough people and keeping them well in the future.
Meanwhile, most primary care providers have largely recovered from the pandemic financially and are starting to look to the future for new and better ways to deliver services to those who need them.
“We continue to be focusing on efficiencies – how do we reduce our health care costs and expenses? And really focusing on improving access through strategic growth,” said Dr. Jeff Smith, executive vice president of hospital operations at Cedars-Sinai Medical Center. “For us at Cedars-Sinai, growth comes in a number of ways – through growth of our specialized programs, through geographic growth, through opening new offices, and through some pretty unique partnerships.”
Smith said the hospital has a joint venture with UCLA Health which is the California Rehabilitation Institute, one of the biggest rehab hospitals on the West Coast; and is partnering with Kaiser Permanente in many ways, including a heart transplant program where Kaiser provides the pre- and post-operative care and the transplants are performed at Cedars-Sinai.
Perhaps the biggest local investment Cedars-Sinai is making is in the construction of a new replacement hospital in Marina del Rey. “That will replace a 50-year-old hospital with a state-of-the-art, nine-story, 160bed facility so that people in the region will not need to leave the area to receive care,” Smith said. “So, the future is bright even though there are challenges.”
Dr. Kirk Tamaddon, area medical director and chief of staff at Kaiser Permanente West L.A., said hospitals will have to handle a new wave of patients – those who put off routine visits during the pandemic.
“From an organizational standpoint, one of the challenges we‘re seeing right now is all of the pap smears and other check ups that didn‘t occur, due to the shutdown of the State which was reasonable, but care was delayed due to patients not coming in,” Tamaddon said. “Last year we saw an in-patient hospital surge of COVID patients, and now, a good challenge we’re facing is seeing an ambulatory clinical surge of patients coming in and asking for appointments for blood pressure checks, colonoscopies and other things that were delayed due to the pandemic.”
Hit particularly hard during the pandemic, Tamaddon said, were people of color and those living in lower socio-economic areas where access to healthcare, particularly in the midst of a pandemic, was limited. He said a new focus on access to healthcare for everyone is one of the silver linings that has come out of the pandemic’s black cloud.
“As far as priorities in the future, it‘s going to be really important to focus on making sure that some of the health care inequities that have surfaced as a result of COVID-19 this past year are addressed in the community,” he said. “The COVID-19 pandemic exposed the inequities in healthcare that we all know have existed in certain communities for a long time and for Kaiser Permanente, it is a priority and focus to make sure we leverage the learning that started during the pandemic to close those health care inequities.”
Major recognition of health disparities began nearly two decades ago with two Surgeon Generals’ reports published in the early 2000s that documented disparities in tobacco use and access to mental health care by race and ethnicity. Despite the recognition and documentation of disparities for decades and overall improvements in population health over time, many disparities have persisted, and, in some cases, widened. Recent data from before the COVID-19 pandemic showed that people of color fared worse compared to their white counterparts across a range of health measures, including infant mortality,
pregnancy-related deaths, prevalence of chronic conditions, and overall physical and mental health status. As of 2018, life expectancy among black people was four years lower than white people, with the lowest expectancy among black men. Research also documents disparities across other factors. For example, low-income people report worse health status than higher income individuals, and lesbian, gay, bisexual and transgender (LGBT) individuals experience certain health challenges at increased rates.
Part of closing that healthcare gap is reaching out to communities of all levels and encouraging more well-care to prevent more serious conditions from developing.
Michael Ricks, chief executive officer at Saint John’s Health Center, said his system has already put its money where its mouth is in addressing healthcare disparities.
“Our system leaders pulled $50 million from our reserves to fund downstream, data-driven interventions to eliminate health disparities in communities of color and other communities experiencing them, including the LGBTQ community,” he said. “We‘ve been engaged in community partnerships to reduce hypertension throughout L.A. County and we are partnering with other organizations to increase understanding and screening for colorectal cancer in some of our communities of color throughout L.A. County. So, it‘s a matter of not just talking about it, but really trying to do something about it.” He added that in order for the effort to be effective, the business model for hospitals has to change. “We need to continue to transform healthcare by focusing on keeping patients well,” he said. “Twenty-five years ago, we were focusing on sick care, and it was all about how busy your hospital was and whether that‘s good or bad. But now, we truly are beginning to focus more and more on wellness and prevention, and I think that needs to continue. We need to have alignment on the finance side to reward and recognize those organizations that are actually keeping patients out of some of the high-cost healthcare facilities when they really may not need that level of care.”
Ricks added that part of that drive to encourage wellness means reducing the drive people need to make to access the care they need.
“It‘s important to create better access,” he said. “In the past, people would travel to an acute care facility to get their care, but now all of us (healthcare providers) are investing in taking our care and our brand and our experiences to the communities we serve instead of having them get in the car and travel, which we know can always be a challenge in Los Angeles.”
Santiago Muñoz, chief strategy officer for UCLA Health highlights access to acute and non-acute healthcare as being one of the major lessons from the pandemic. “UCLA Health is committed to doing our part to make health care more accessible for all patients by establishing locations in the community to provide medical care outside of the hospitals. This increases acute care capacity in the hospital settings for which they are intended and increases access to healthcare for more patients. UCLA Health
has been investing heavily to improve access for all patient populations by growing the number of physical locations where we provide care in the community. With nearly 200 UCLA Health locations from Orange County all the way up to San Luis Obispo we are committed to continuing to improve access and bring quality care closer to home for Southern Californians.”
“One-third of L.A. County is on Medicaid, our health insurance program for low-income people,” he said. “Before the Affordable Care Act, you needed to be low-income and you had to have a qualifying condition to be on Medicaid. Well, fast forward to the Affordable Care Act and you just need to be lowincome.”
That change, he said, means more people can access healthcare, but it also means that medical institutions count on state and federal dollars more than ever before.
“All of our health systems, and UCLA being no exception, are very reliant on government funding to ensure that that we meet those missions,” said Muñoz, who added that the focus continues to be on expanding services deeper into the community. “We‘ve been investing very heavily outside the hospitals. There are now about 190 points of entry into UCLA Health, and we will continue to do that to offer low-cost community-setting alternatives to health care for Southern Californians.” The pandemic has also forced hospitals to be more flexible, something Smith said bodes well for the next time a virus gets out of control.
For Ricks, the pandemic also created a renewed focus on the frontline healthcare workers and making sure their needs are met.
“I think we were reminded that we can never lose focus on taking care of our caregivers,” he said. “We always are focused on taking care of our patients, but we also need to take care of the people that are taking care of the patients. It‘s about actually putting together resources that they can tap into – how do we care for their emotional, physical and mental needs during times of significant stress? How can we find ways to celebrate, reward and recognize the successes that we have in the lives that we‘re saving on a daily basis? That has become really important to us and something that we know we have to continue into the future.”
Muñoz agreed.
FROM LEFT TO RIGHT: Nezy Pullukalayil, RN Department Administrator of Kaiser Permanente Playa Vista Medical Office Building; Trina McCaleb, RN Senior RN of Kaiser Permanente Playa Vista Medical Office Building; Jerry Yu, Chief Operations Officer Kaiser Permanente West Los Angeles Medical Center; Rathin Vora, MD Physician in Chief of Kaiser Permanente Playa Vista Medical Office Building
“The pandemic is a lesson in exceptional vulnerability for our entire community,” he said. “No one can serve the community if we can’t provide care. The pandemic is not over. We are still in the midst of it, so at UCLA Health we are continuing to ask questions and seek answers for how we can do things differently and better to optimize the patient experience and provide excellent care to even more patients. As an academic medical center our mission is to deliver excellence in leading-edge patient care, research and education.
We were honored to receive the US News & World Report recognition of UCLA Health as #1 in CA and #3 in the nation, and remain committed to our vision to heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness.“
The public, too, has learned plenty of lessons from the pandemic. Going forward, Tamaddon said there will be changes, not just in healthcare settings, but throughout society.
He said he anticipates more attention to hygiene and hand-washing. More people will wear facemasks, even when they are not required. More people will get vaccinated, not just for COVID, but for the flu and other viruses. And perhaps the biggest shift, he said, is that telemedicine is likely here to stay.
Though patients were forced to seek medical care online because of the pandemic, Tamaddon said the convenience and the ability to reach more people more quickly means that virtual doctor’s visits will become the norm.
“As soon as the pandemic started, we went almost 100% virtual with video visits and telephone appointment visits to be able to meet our patients and members in their home or in their place of work,” said Tamaddon. “And we cannot let go of that. We have to ensure that people have access to us when they want to see us in person, on video, by phone, or by email. We have committed to making sure virtual care is here to stay permanently.”
He added that being able to talk to a doctor from the car during your commute, having your pink eye looked at from your home or being able to have a visit with a psychologist during your lunch break at work will change the way people think about health care. They will be more likely to talk to a doctor before their condition worsens if that access is simple and convenient, and that, he said, will free up hospitals to deal with critical cases that need emergent care.
