Who's Responsible For Stealing Healthcare's Holiday Sale?

It's officially the holiday season, and as a nation, and we're all starting our clocks. How long will it take for the COVID-19 case numbers to jump through-the-roof — more than they already are — in the wake of holiday travel and gatherings? 

We all have different go-to metrics to figure out how bad the pandemic is looking. Case count, death count, and hospitalizations. Those are all significant numbers. Yet, it's also important to watch this number: how many hospitals are shutting down elective surgeries again. Of course, we hadn't met the level we saw back in the spring and early summer when there was a widespread shutdown of nonemergency procedures. Still, hospitals are gradually deciding to take a devastating financial hit to ensure they are protecting public health. 

Of course, this will put hospitals and health systems in another bind, similar to the financial tumult that sparked our urge for Rapid Recovery back in April. Beyond the apparent hit to hospitals' bottom line, there's a newly emerging risk for hospitals' reputations, which wasn't present in the first elective surgery shutdown.

It's been well-documented* that consumers tend to wait until the end of the year when they've met their deductibles before they rush to get the elective procedure they want or need at 20 percent of the cost. It's as if healthcare is on sale toward the end of the year. Once you meet your deductible, you can squeeze in pricey procedures at a fraction of the cost you would bear just a few weeks later when the calendar turns to January 1, the start of a new benefit plan. It's like healthcare's secret holiday sale. 

However, this most recent rash of hospitals pausing elective surgeries may preclude consumers who were putting off their knee or hip surgery from fitting their procedure in before their deductible and family out-of-pocket (OOP) max restarts in the new year. Even those who played their cards right and had a procedure scheduled for December 15 may not be able to get it in time. 

This makes the consumer dynamic different than it was in the spring and summer. The first time around, we dealt with the painful reality of delayed procedures that people needed, which wasn't a walk in the park. This time, we're dealing with those same factors plus the reputation risk of consumers feeling hospitals are stealing their "healthcare discount" if a shutdown happens for a second time. Or, hospitals weren't prepared this time around to deal with PPE and staffing and other issues. 

In reality, of course, hospitals are making a brave decision again to sacrifice revenue for the sake of public health. Yet consumers will often look for someone or something to blame if they aren't able to toast to the new year with the new knee (or hip or whatever) they'd hoped for. 

So, let's answer the question: whose fault is it? It's no one's fault. We're in a pandemic. Yet, throughout this crisis, we've seen countless people and organizations rise to the occasion and deliver on promises they didn't have to keep. Nurses have worked overtime on floors they've never seen before. Doctors have stripped in their garages, making a beeline to shower without hugging their children at the end of their shift. Hospitals have cut off their high-margin services. Employers have bent over backward to keep the lights on and their people employed. 

Insurance companies? Well, they've covered the costs of COVID-19 tests and telehealth visits. Even now, many of those benefits have been pulled back or reduced. This help the insurance companies have to provide is not nothing, but it doesn't hold a candle to the sacrifices made by other major players in the healthcare ecosystem. 

What if insurance companies extended deductibles into Q1 of 2021 for any consumer who had an elective procedure delayed due to COVID-19 in November or December? What if they picked up the slack and backed up hospitals and health systems on their responsible decisions to close down elective procedures? 

They won't because it doesn't benefit the health plans' bottom line.

Hospitals and health systems must be ready to ask the hard questions and band together in service of calling out health plans to provide the help they are more than capable of providing. We cannot keep asking hospitals to pick up the slack of this pandemic. Health insurance companies must pitch in extra, too, if we're going to make it through with our healthcare system intact.

Maybe hospitals and health systems should urge their communities to "ask their insurance companies" to extend 2020 deductibles, and family OOP maxes into Q1 or even deeper into 2021. No one is responsible for stealing healthcare's holiday sale, but insurance companies should be the ones to go above and beyond to deliver the value they promise to their members. 

*Colorado, Indiana, Ohio


December 1, 2020
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