As the federal government shutdown enters its fourth week, hospitals and physician practices across the country are facing growing uncertainty.
For physicians, telehealth benefits expanded during the COVID-19 pandemic expired Oct. 1 and the federal government ended CMS reimbursement for many virtual visits. Hospitals and physician groups have set up broad infrastructure for virtual care and telehealth visits, assuming Congress would eventually make the benefit permanent.
Several healthcare leaders told Becker’s that the effects are rippling across systems, impacting patient access, reimbursement and the morale of clinicians.
Disruptions to patient care and access
Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael’s Campus of Yale New Haven (Conn.) Hospital, said the shutdown is already affecting patient care as health systems suspend appointments.
“Patients living in rural areas or who have mobility or transportation issues are impacted the most,” he said. “This will result in some patients requiring unexpected emergency care.”
These disruptions, he added, compound existing access challenges and make it increasingly difficult for healthcare organizations to plan strategically.
“Capriciously pulling funding and creating chaos increases costs, delays implementation and unnecessarily harms patients,” Dr. Mazurek said. “It’s impossible for health systems and providers to create a strategic plan without stability.”
Financial instability
Beyond patient access, the shutdown has strained the financial infrastructure of hospitals and physician groups.
“The disruption in billing and cash flow is also exacerbating an already challenging economic environment,” Dr. Mazurel said. “This is more chaos, and it’s difficult for patients, providers and healthcare systems to pivot and adapt.”
He called on policymakers to create a more stable, long-term funding model.
“Congress, HHS and CMS should create a policy and framework for funding and other requirements that is permanent, predictable and adaptable,” he said. “Telehealth is an important method for the provision of care, and it is inevitable that telehealth services will expand.”
Hospitals reassess services and spending
Kevin Post, DO, CMO of Sioux Falls, S.D.-based Avera Health, told Becker’s that the uncertainty has led hospitals to exercise “increased caution in discretionary spending and future capital decisions.”
“Due to even tighter financial margins being expected, hospitals and health systems are closely examining services that typically are low-volume, high-cost or with marginal profits that remain an important service in the lives of our patients, such as maternity care and behavioral health,” he said.
He added that patient access is being “slowed or temporarily stopped where reimbursement appears to be the most uncertain,” particularly for telehealth services that are vital to rural patients.
The result, he warned, could be a reduction in specialty access in communities already struggling with physician shortages and transportation barriers.
The strain on physicians
For physicians, the shutdown poses a deeper, more personal toll. Dr. Post told Becker’s that the most significant effect “may be concern for their patients and communities they serve, and how can high-quality, safe care continue to be delivered with a model that is not financially stable long term.”
To maintain overall care, some physicians may “reduce services (telehealth, affected appointment types), alter care team models or reduce access to affected patient and visit types”
“This can lead to moral injury for physicians and caregivers by violating their personal values and motives for entering medicine when they are unable to deliver effective care due to resource limitations from diminishing reimbursement structures that are seen as unsustainable,” he said.
Telehealth looms large
The reduction in telehealth coverage “looms large” for many physicians, Richard Chazal, MD, medical director of heart health at the Lee Heart Institute, told Becker’s.
“While the potential for the use of remote visits had been partially envisioned, the COVID crisis illuminated the convenience for patients and the efficiency for clinicians,” he said. “As physicians, many of us find that a great number of visits can be effectively completed using video conferencing which can allow for more quality visits in a fixed time frame.”
He warned that “lack of appropriate reimbursement for such care will slow progress,” undermining the promise of telehealth and remote patient monitoring at a time when personnel shortages are already challenging the healthcare system.
Administrative strain
Rachel Hitt, MD, medical director of patient experience, chief of breast imaging and associate clinical professor of radiology at Boston-based Tufts University School of Medicine, told Becker’s the shutdown has also placed an administrative burden on healthcare teams.
“It is not an easy task to segment patient lists, prioritize services when folks still need the care and reassign telehealth appointments to in-person visits,” she said. “Patients choose Telehealth versus in-person appointments for many reasons — ease, lack of disruption to their workday, and subsequent lost work hours, childcare, transportation issues, etc.”
She added that converting appointments back to in-person formats “puts additional strain on already tight patient access,” further compounding care delays.
