As Coronavirus pandemics are spreading across the United States, it is also straining the country’s healthcare resources. As it is putting the medical delivery system to the test, the nation’s collective response to the natural emergency is further displaying to be flawed.

In an event where any robust system, especially in a developed country, must entertain a full and active response, there is an increasing deficiency in a primary medical care capacity. In fact, many Americans today lack access to affordable medical services they know and trust, or by someone who knows them. The reduced access to a physician, at very least, does not seem to be economically driven, as trillions of dollars are at this time being wasted. Instead, the major problem is the establishment of a suitable infrastructure that is in line with the needs of every individual community.

During the epidemic, breakout, physicians extend the first line of support thru trusted advice and care that keeps patients from overflowing emergency rooms and hospital outpatient departments- when they don’t need to be there. When clinics and emergency rooms are fled with people who less likely to possess Covid-19, they delay care for those who genuinely have the COVID-19 infection and expected to get infected themselves.

There is obviously an extended need for healthcare manpower during a pandemic, such as the one we are experiencing right now. But unfortunately, the reality is farther from what is desperately looked-for.

corporate medicine
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Many clinics and hospitals have canceled their non-urgent appointments, particularly the ones of Non-COVID cases and elective procedures. As a consequence, the medical staff, including physicians, have either reduced their hours of work or simply closed their doors. Obviously, as common sense conveys, there is no need for those physicians for the care of COVID-19, because they are not called to help in other facilities. Instead, what we are observing is healthcare shutdown addressing immediate COVID-19 patient needs leaving out the rest of the healthcare communities at furlough.

Undoubtedly, the scenario of shutting down healthcare facilities due to the economic upshot of Pandemic resembles the catch 22 metaphor. Since COVID-19 pandemic response by the current system is a dilemma from which there is no escape only due to the reciprocally conflicting conditions of crisis that need healthcare, something that we simply don’t have one. There seems to be a lack of reserve capacity to handle healthcare crises of the scale that the communities are experiencing right now. Or- there is a significant maldistribution of resources due to faulty logistics; thus, I concede with the last. Surly, Coronavirus has successfully exposed the deficiencies in the U.S. HealthCare system, not necessarily from the fiscal perspective but as well from a logistic and delivery viewpoint.

Coronavirus is already affecting the way physician will see patients

Drop-off inpatient visits to primary care practices and declining patient clinic encounters over the last couple of months due to the coronavirus pandemic have turned into a robust driver for physician practices; also the business.

According to a survey, approximately 8 out of 10 primary care clinics have been under significant strain due to the COVID-19 crisis. To address that problem, the federal Medicare program and some commercial health plans have begun offering advance payments to physicians, effectively prepaying physicians a lump sum based on an estimate of how much they would expect to collect from seeing a consistent stream of patients. But the concluding is nothing short of advance payment on the paycheck. Few experts see this move by the administration as an initial step toward redefining the traditional office visit and expanding telehealth. They also stipulate that new action by the government is the sign of further abandoning the already alienated customary fee for service scheme.

Physician with mask
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Physician practices seem to be adapting more of the telehealth visits, a move universally hailed by public health authorities. Nevertheless, the payments for telehealth services are still lower than those of the office visits.

COVID-19, without a doubt, endangers the fate of Independent physicians

The curtailment of patients at the center of a Coronavirus predicament is a condition suffered by most, if not all, small practices nationwide. This is only a part of the lopsided strain placed on the health care system by the Coronavirus. After the initially reported coronavirus pandemics in mid-March, physicians began advising patients to stay out of the doctor’s office, to protect doctors and patients. Since then, most offices have been postponing annual checkups and preventive visits. They’ve told patients to call before they come in, and they’ve started seeing patients virtually.

The decreased traffic has been costly to doctors

Many physician practices have seen in-person patient visits fell 50% to 75%. The fall in-clinic visits have left physicians striving to survive and forced growing numbers to lay off workers or shutting their doors. Some surgery centers have reported dropping as much as 95% of revenue.

Some independent physicians have held taking a salary.

Doctors stirred their patient visits to telehealth, about 60% of the pre-COVID-19 total. Most medical practices have determined that their clinical practice can only support to pay staff salaries for one month.

Hospital and clinic trends across the country

According to an opinion published on Newsweek, a significant number of healthcare employees are being laid off or furloughed, at the least, at the time and location they are needed the most amidst coronavirus pandemic. It somewhat describes; the federal and state governments’ clumsy directives to halt all non-emergency procedures, even if it may seem to be for a good deed; limiting unnecessary exposure and safeguard staff, beds, and equipment. The shutdown has merely paralyzed the healthcare system altogether. This has not only affected the industry in the hot spots of the Coronavirus pandemic but also undermined the entire healthcare system nationwide. The administration’s harsh sanction of the medical industry has created a strain of its own plan, where empty hospital beds of historic proportions are furloughed when they are needed the most during the crisis. Hence, it has left hundreds of thousands unemployed. The biased epidemiological strategies economic upshot has practically surpassed that of the Pandemic self.

The hospitals across the country, unless part of a large chain of managed care systems, have resorted to unusual levels of layoffs to compensate for the temporary budget deficit. The latter may not apply to the hospitals backed by wealthy managed care organizations. Nonetheless, historically, Health Maintenance Organizations have not shown any particular curiosity to diligently involve in rural communities’ well-being, except for what they chatter. Instead, corporations have indiscriminately undermined the hospitals and clinics that are designed and operated to help underserved communities. Hence, The industry and economic drifts aim towards long-lasting deleterious outcomes unless prompt steps are taken.

By barring elective surgeries, which embraces a large display of surgical services, like knee repairs and minor procedures, hospitals and surgery centers have lost billions in revenue in just one month alone.

Entailing near 18% U.S. economy annually, healthcare is a $3.6 trillion industry. Additionally, outpatient services account for 50% of total hospital revenue.

Not surprising enough, the healthcare industry, so far, has dropped over 43,000 healthcare workers only in the first month of COVID-19 Pandemic. Even before the Pandemic, 25% of the rural hospitals were exposed to closing, only exacerbated by the current turmoil.

patient with mask
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It doesn’t take an economist to realize the economic upshot of the current trend. And, besides, it won’t just be rural communities that will suffer shortly.

The coronavirus dissemination is inevitable, as we may be able to slow its progress down for the sake of ability to address emergency medical needs, but highly unlikely we will eradicate it any time soon. So by letting the private hospitals and independent practices close down, we are only undermining our own healthcare system and empowering the big guys of the industry. Accordingly, our capacity to treat and prevent COVID-19 transmission will be rigorously restrained if as-yet-unaffected hospitals option to mass layoffs.

What kind of clinics are most affected by Coronavirus economy

Every industry, in one way or another, has been undesirably affected by the coronavirus pandemics. The Healthcare industry, too, as discussed earlier, has had its own share of setbacks. The economic damage incurred due to the crisis is not only due to the strain of the medical supply chain of Personal protective equipment (PPE) such as face masks and gloves but also is due to the public health policies that enforce self-isolation.

Almost every form of medical practice from large hospital systems to solo-physician practice has been affected by this clutter.

Certain Geographics affected by Coronavirus crisis more than the others

In 2019 over 20 hospitals across nine states closed down. The latter was long before Coronavirus Pandemic was declared in march of 2020. Post declaration, Rural communities were hit even harder. Some of the hardest-hit spots in the country, such as new york and San Francisco bay area, maybe flattening the COVID-19 infection trajectory curve. However, different parts of the country, including rural areas, are not even close to reaching the peak of the outbreak. Nevertheless, they still are being affected by the economic upshot of the crisis. For instance, a large pork plant in Sioux Falls, South Dakota, was ordered to shut down due to a coronavirus outbreak.

Some hospitals were forced to close down due to various factors such as declining rural populations, rising medical costs, insufficient Medicare reimbursements, large numbers of uninsured patients, state decisions against Medicaid expansion, and mismanagement.

Poor socioeconomic factors experience the worst amid COVID-19 pandemics

According to a report published in the USA today, The 24-bed charity hospital, Lallie Kemp Regional Medical Center in Louisiana’s small town of Independence, lost more than $15 million in 2016 and $19 million in 2017. After Coronavirus reeled Tangipahoa Parish, where Lallie Kemp strives to help treat the community’s hundreds of confirmed COVID-19 indigent victims, unable to pay or rely on low reimbursing Medicaid. After the government restrained elective procedures, the Pandemic slew $1.3 million in budgeted revenue.

How are managed care systems doing with the Pandemic

Amid the steep uphill toil faced by rural clinics, managed care systems are thriving with their data mining missions. An Illinois Managed Care Organization is spending an overwhelming amount of money for Coronavirus by building artificial intelligence (A.I.) platform that will supposedly help identify high-risk patients and conduct important patient outreach to drive coronavirus testing.

Although the system is meant to assist the homeless, who do not have access to transportation, or who experience other social determinants, nevertheless, their ability to provide such technology is the reflection of how they have been able to use corporate power to stay afloat amid prevailing crisis.

The discrepancy between the sustainability of the managed healthcare system and the private (Independent) medical entities points more to the prejudices of opportunity towards the benefit of the former structure.

Globalization and centralization is a mistake

Another perspective from which the system merits further attention is the notion of the Centralization, Consolidation, and Globalized essence of the current healthcare structure. The historical trend of the past couple of decades has imparted us that the globalization of socio-economy is a preferred bull’s eye for many entities. In conjunction with centralizing the process as well as data, the healthcare system has become highly dependent on other countries to maintain sustenance. The latter is not only domination susceptible but also counterproductive to the survival of underserved communities and rural zones.

Centralized systems such as that of managed care, and corporations culminate, chronologically have played an undesirable role in the delivery of countryside health care, as their predominant part in rural countries has been predominantly indolent.

Corporate for-profit systems gain of power along with interdependence of the global market has weakened the medical service logistics for rural regions. Governments’ mishandling of the problem, on the other hand, is extra discouraging to the medical society, be it through unsubstantiated mandates or supporting refuge to a corporate shakedown of “Medical Societies” siding with the dominant entities like managed care systems.

World pandemic COVID-19
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Sustaining efficient rural healthcare delivery lies in the grassroots because rural neighborhoods retain a unique perspective of health and healthcare only attainable through decentralization, independent physician empowerment, and patient engagement.

The ideal operations of the sovereign community are best established within the collaborative realm of that society. Meanwhile, it would subsist as the obligation of the administration to endure high level, transparent yet precise culpability to prevent economic rent.

Globalization and thus centralization is the upshot of modern-day slavery. Governments, managed care systems, along with Insurance and pharmaceutical entities, have captured the key pipelines of economic and political power lines within the healthcare industry.

Corporations have meddled billions of dollars’ worth of the healthcare market by strategically aligning themselves at the driver’s seat of healthcare logistics. So- they have been victorious in maintaining the control of the healthcare system.

The economic disposition of the corporate cartel within the healthcare capital settles them in a perfect orientate for the lobbying.

Primary care alone isn’t going to help

According to another report, a primary care Marshall Plan is being implemented that involves all health insurers, plus the business leaders and state and local government officials who sign their contracts, to move to promised payment rather than the costumery after-the-fact billing. This means, by looking at what they paid for their beneficiaries’ primary care needs the year before, they award those physicians the same amount.

Patient empowerment cannot be without physician empowerment.

It is also held that- the overwhelming abundance of primary care advocates with the backing of large healthcare networks has confidence in that there is a shortage of primary care doctors.

Primary care is not a clinical specialty; instead, it is an autocratically driven job description manufactured to exploit the medical profession. Plus, it is not the primary physician shortage that rural areas are experiencing amid the Coronavirus dilemma; but it is the poor distribution of opportunities for independent physicians to thrive outside the managed care dungeon.

Independent Physicians must prevail

Independent medical practice survival is the key to sustainable healthcare, especially during the pandemics crisis, such as COVID-19. For the reason that Independent medical practices are more flexible, less bureaucratic, easily maintainable given their size, and, most of all, personalized structure. They create jobs for the indigenous population and understand the basic needs of the grassroots.

Independent medical practices are the smallest yet the most fundamental elements of any healthcare framework, but unfortunately, are the least protected under the current system of administration.

Small Grassroots medical clinics and hospitals, under the right circumstances, can provide top-notch medical services to local patients; while maintaining a competitive attitude. However, the biased vision along with the pivoted mission of the current administration has not only tied the hands of private “mom and pop” type of healthcare industry in its back, but also gifted the entire sector to the corporate corner.

Barefoot Doctors (赤脚医生), and their impact on launching chronological evolution of primary care medicine

Strict Starks law is counterproductive

I would like to point to one of the most controversial legislation of the United States; “The Stark Law.” The latter bill was enacted in 1988 as part of the exercise of the “Ethics in Patient Referrals Act.” The bill primarily focuses on physician self-referrals of businesses and patients. Some of the concepts in the measure became part of another legislation; the Omnibus Budget Reconciliation Act of 1990.

Unfortunately, The Stark law does not necessarily apply to all entities and persons equally, as it prejudicially targets the independent physician sovereignty under the “ethics” title. In fact, the recent bill may well be targeting unethical conduct; nevertheless, its legal implications are headed in another direction.

To bypass the stark law so that it leaves some businesses and entities unaffected, other bills, including “Safe Harbor Statute,” are commonly passed in various shapes and forms and a variety of reasons.

The safe harbor is a provision or a regulation that defines; certain conduct will be deemed not to violate a given rule (in this care, the stark law). It is customarily encountered in reciprocity with a vaguer, overall measure.

Companies like the pharmaceutical industry and its associated agencies, insurance industries as well as many other corporations within the healthcare realm, which all serves in Contradiction to what the stark law commands.

Physicians need to own hospitals

Today, in the United States, Under the “stark law,” physicians are prohibited from owning hospitals. Although there has been pushback against the policy from rural community leaderships as well as some physician groups, yet it is still a losing battle for the latter.

As a form of exception to the rule, with good intention towards helping rural communities, Obama administration passed the Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act which imposed additional requirements for the physician to qualify for owning the whole hospital and rural provider.

A physician-owned hospital is presently prohibited from increasing facility capacity. However, a physician-owned hospital that qualifies as an applicable hospital or high Medicaid facility may request an exception to the prohibition from the Secretary.

Indeed, Physicians all over the world can own hospitals or, at the least, are shareholders in large hospital networks, without jeopardizing the integrity of the doctor-patient relationship. At the end of the day, the imperative is the patient’s health, satisfaction ensured at a reasonable cost to the patient. Meanwhile, treating professional medical physician included must be somewhat rewarded for his or her services.

And Yes- any form of profiteering off the patient is indeed not only unethical but also must partake legal implications. However, across the board, baring physicians from practicing legitimate medicine is nothing short of prejudiced.

Patients must be empowered, especially during the pandemics

The Healthcare system, particularly with regards to medical service, is one giant strenuous task. The routine undertaking of functions, more so during the crisis, such as coronavirus pandemics to the end, requires the coordination of others. It is the harmonized human relations that take on the role of incorporating the integration of time, enthusiasm, struggle, skill.

Any given collaborative environment utilizes the resources of multiple individuals to meet the broad goals of empowering patients and delivering top-notch care. Within that collaborative environment, there is not only a medical professional but also is a proactive patient.

To properly coordinate the responsibility for a single patient, he or she must be empowered beyond modest engagement. Coordination permits for the growing culmination of the otherwise larger tasks that one might encounter. That is even more important in the case of healthcare delivery.

The centralized system will perpetually fail to sustain patient sovereignty. Because it is inherently designed to place control in the hands of a few at the leadership of entities.

Technology must decentralize through blockchain innovations

Blockchain is decentralized, with nothing being stored centrally. This novel hallmark of technology utters it possible to store and access data from multiple locations. The patients, doctors, nurses, and other medical staff can individually access the information and also in combination, making room for expanded interoperability.

The open-source nature of blockchain also helps in setting the foundation for interconnectivity of medical centers and medical offices on a user to user basis. Patients won’t need to wait for months to transfer their medical records from one provider to another. The latter scenario will enable patients and physicians alike with the flexibility and connectivity they need to stay at the top of their clinical needs.

The decentralized structure of blockchain and distributed nature of ownership among the original contributors of data also creates dispersed liability. Where data is stored centrally, the holder of the information is considered responsible in case of any breach. But blockchain distributes the responsibility on the same concept of its unique data ownership among the contributing owners.

The operation must be collaborative if we want to save healthcare at the time of crisis

In its applied understanding, collaboration is a premeditated relationship under which all parties strategically and optionally elect to concur toward accomplishing a shared result.

Despite overwhelming ideals, collaboration accompanies certain shortcomings, such as the incidence of Groupthink intuitive assembly within the collaborators stoking discriminatory behavior by way of influenced fragmentation. The latter, if left unprotected, will create an environment for shortcuts by forming selective consolidation. This, in turn, serves precisely like the reason why current systems typically fall back on accord as opposed to collaboration.


Efforts must be decentralized to encourage collaboration

The consolidative association of centralization is a process of unifying two or more persons or entities to operate as one discrete unit. It necessitates a strong sense of commitment to a single inflexible mission by uniting its elements; the persons.

The core nature of the collaborative feat is decentralized, where there is no sole authority that supports the final give or takes. The system that functions collaboratively often has access to considerable resources, recognition, and reward when facing competition for limited resources. Collaboration encourages meditation of demeanor and communication, thus increasing the success of teams as they engage in combined problem-solving. Uncommonly collaboration is fictitiously used for opposing purposes, displaying the notion of antagonistic cooperation.

Private hospitals and clinics must thrive amid COVID-19 Pandemics

There is never a legitimate reason for a developed country to fail to provide quality healthcare for its citizens. But unfortunately, the system is flawed, as hospitals and clinics shutting down when they are supposed to stay open and function with added robustness.

They say it takes a village to take care of a patient, but there is no such a village today. Amidst all the political and economic chaos around emerging pandemics, the main hardship is eventually on the patients.

The negative fallouts of politicizing Coronavirus are swift. However, the monopoly of corporate business is probably more flying than the pathogenic import of the real virus. The emerging infections have always triumphed throughout the spans. Nevertheless, they have merely contended if perceived as a money-making tool for corporations or vote-winning apparatus for politicians as soon as seen as achievable.

Public panic is the ideal strategy and not a consequence. Amidst Coronavirus pandemics, the Healthcare system is heading, faster than ever, towards the trap of neo-feudalists and survival of rural healthcare is not what feudal lords desire.

Neo-feudalism of healthcare is going global. Furthermore, amid neo-feudal striving for more serfs and vassals, the healthcare industry remains nowhere close to being immune from their oppression. Globalization is more attractive to the lords of the new-fangled world, as it strengthens their fiefs and obliges their ultimate nobleness.

To contain the illness brought upon the community by the COVID-19, we must first recognize our capacity as individuals, communities, then as a nation. The function described above pertains to resources and backings accessible to us at a given moment in time and place. Influentially, there is not an adequate economy in the world to thriftily sustain any community jeopardized by shelter-in-place. Hence, no economy in the world can stand continuous suppression for an extended period.

Globalization is heading for a new peak. The realist’s approach to international politics and foreign conviction does not apply much if any, courteousness to the theme of potential pandemics like the COVID-19.

Great powers fight for winnings and the lasting impediments to practical cooperation amongst states. Coronavirus and demise of private hospitals and clinics have little to say about epidemiology or public health best practices and more about cracks within the system.

The resolution to the current pandemic crisis rests within the choice between individual vs. entities. Corporate medicine is the prototype of a network of top-down policies- implemented in the medical domain. It is easy, cheaper, and, yet, susceptible to meddling by the hands of the executive chain of influence.

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Adam Tabriz, MD
Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.


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