The COVID-19 pandemic has pushed hospital system capacity to the breaking point in some parts of the U.S., and wrought particular havoc in the skilled nursing setting.
All eyes have been on the health care system, with a particular focus on ensuring hospital capacity: Calls to stay home and “flatten the curve” often come with the explanation that those steps are vital to prevent the coronavirus from completely overrunning the nation’s hospitals.
But Randy Oostra, the president and CEO of ProMedica Health System, is not so sure that hospitals alone will be the answer to the cracks in the foundation of U.S. health care, which the novel coronavirus has dramatically highlighted.
His perspective is unique; ProMedica in 2018 acquired the operations of prominent nursing home chain HCR ManorCare, and went to work reinvesting in the network of 171 SNFs and other senior care facilities.
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That gives Oostra a wide-ranging view of the COVID-19 national emergency. On April 22, he joined Skilled Nursing News’ “Rethink” podcast to talk about how the health care system in the U.S. is coping, what ProMedica and ManorCare are doing to share resources, and what has to change about care delivery and infrastructure.
How would you assess the response of the U.S. health care system to the COVID-19 situation thus far?
It’s probably multiple answers. Our organization is kind of a traditional delivery system, with employed doctors in hospitals in, traditionally, northwest Ohio, southeast Michigan — and a health plan, which is in multiple states. And then now, of course, with the purchase of HCR ManorCare, we’re in 28 states, and so state by state, we’ve seen kind of a different sort of response.
We’re working with multiple states, multiple governors, multiple ideas and regulations and how they’re working. Nationally, I think what we’re seeing is again — in some ways as much as we want to criticize, we’re probably doing as good a job as we can. I think the idea that our stockpile should have been created and more up-to-date, I think that’s valid. I do think we’ve made a lot of mistakes in testing early on, and we’re paying the price for that.
But I think in the markets that we serve, we see some markets where things have stabilized and are going down. So that’s positive. And then we’re in other markets where we’re still caught in the eye of the storm, and a lot of activity and a lot of hard decisions about care are being made.
I think what you look at is the lesson here, and the lesson that strikes us, is that the health model in America is broken, and we’ve had the wrong priorities for a long time. And I think what we’re seeing now is this idea that we need to change our priorities.
So what does that look like? What needs to change?
You hope we’re going to change, and what you worry about is we’re going to just stay with what we know. Everything we know about the American health care model was broken. In just a few years, we’ll be spending $6 trillion, over 19% of the gross domestic product, on a model that’s broken, that doesn’t work anymore. It was a model that was created [as a] very hospital-focused model. Then we look at the unaffordability of bankruptcy being caused by health care, the number of seniors filing bankruptcy, reports about people not being able to access care.
We have this high-cost model with lots of waste in it, with a country that has maybe not the outcomes we want — in lower life expectancy.
Then when you look at the demographics. We have great caregivers, I think we see that, but the model doesn’t work. So we need a model that’s much more based on taking care of seniors, much more based on looking at social determinants of health, what it impacts people daily in their lives. I think we’ve seen that, as people with social determinant issues are more negatively impacted by COVID.
And then our complete lack of investment in public health. The only way those things happen is: The model has to be changed. One of the things that we’ve been talking about for several years, kind of rattling around Washington, D.C., talking about a national commission on health. The idea there is to create a new model for the future, and that we would pivot to something different over a period of time. We’re hoping that what comes out of this is that kind of focus.
How is ProMedica putting that into practice with ManorCare? Do any of the steps change now that COVID-19 is here?
I think the priority of senior care, at least nationally, should rise here. It’s been obnoxious to see how the country’s responded to the people providing care in nursing homes and senior facilities across the country, the level of arrogance.
We’ve created a situation from a reimbursement standpoint that we’ve made folks working in senior facilities a punching bag for the media, for plaintiff’s lawyers, for government officials; Medicaid continues to cut them. We’ve layered them with with tons of bureaucracy and regulations. Even now, you know, this demand for transparency, and [in] a lot of states the idea that the hospital is going to come to the rescue — but in the past, they’ve largely ignored the whole industry.
Source: Skilled Nursing News