Healthcare industry facing ‘an access crisis’

From spending days in an emergency department to waiting months to see a primary care physician, Stephanie Kovalick sees a common theme in healthcare today.

“It’s a crisis of access to care,” said Kovalick, the chief strategy officer of Sage Growth Partners, a healthcare advisory firm.

Stephanie Kovalick of Sage Growth Partners

“I think the biggest problem is access,” she said in a recent interview. “We’re in an access crisis right now.”

Kovalick talked with Chief Healthcare Executive about the difficulties some patients are facing in getting treatment, and the implications for the healthcare industry.

Two out of three healthcare leaders (67%) said they thought the state of patients’ health is worse now than before the COVID-19 pandemic, according to a Sage Growth Partners survey of hospital leaders in November. That’s likely due to delayed care, executives said.

While outlining the concerns of healthcare executives, Kovalick can also speak from personal experience.

She described the ordeal of finding a new primary care physician for her mother, and it was difficult to find a doctor taking on new patients. When she found a doctor welcoming new patients in August, the physician’s office said the first available appointment was in 2023, which was months away at the time.

Healthcare leaders said they are seeing the toll of patients with deferred care. Patients are sicker when they are coming to the hospital and often requiring longer stays, hospital leaders have said. Those longer stays are adding to the financial challenges of hospitals, executives said.

About one in five hospital executives (22%) said care delays are leading to increased acuity, while 12% said deferred care would lead to higher mortality, the Sage Growth Partners survey found.

Many patients aren’t choosing to postpone care, Kovalick said, pointing to her mother.

“She’s not delaying care,” Kovalick said. “She can’t get the care.”

“It’s not all about patient choice,” she said. “It's about the healthcare system failing patients.”

In her view, the healthcare industry is seeing “maybe the biggest primary care access crisis we’ve ever had.”

Beyond primary care, many patients who go to the hospital can spend days in the emergency department because no rooms are available. “That’s another access problem. You can’t get the acute care you need,” Kovalick said.

Patients are also seeing longer waits for elective procedures. Early in the COVID-19 pandemic, most hospitals temporarily halted elective surgeries to preserve resources for the influx of patients infected with the coronavirus.

Now, some patients are seeing months-long waits for elective procedures, which can have a negative impact on the health of patients. If patients are waiting for months for a joint replacement, “they’re not as active,” Kovalick said. “They’re getting less healthy.”

“The system is creating an escalating problem in care being delayed," she said.

Healthcare executives said they are working to get more patients to resume services and wellness visits, with nearly three-quarters saying they are ramping up email and phone outreach, acccording to the Sage Growth Partners survey. Nearly two-thirds (64%) are turning to social media to connect with patients.

Hospital officials have curbed some services due to budget constraints or a lack of staffing. When community hospitals close some beds due to lack of staffing, other nearby facilities become increasingly jammed with patients, Kovalick said.

Patients are also traveling farther to obtain some forms of healthcare. More than one-third of the nation’s counties (36%) don’t have hospitals offering obstetrics care and have no obstetric providers, according to a March of Dimes report in October.

“There are maternity deserts and just general care deserts in the middle part of the country,” Kovalick said.

More healthcare leaders have talked about the need to address health equity and ensure patients from underserved communities gain access to care. Still, many executives say that progress is slow.

Only one in five hospital executives (20%) said they feel that their organizations have made meaningful strides toward improving health equity, and only 28% have listed expanding access to care among their top three strategic goals in the next two years, according to the Sage Growth Partners survey.

“It concerns me. I think there are lots of issues around inequities,” Kovalick said.

Some who live in urban areas face more challenging social determinants of health, she said. However, many in rural areas don’t have easy access to healthcare providers, she noted. Many rural hospitals are at risk of closure due to their extreme financial distress, and healthcare industry analysts expect many facilities will find it difficult to stay afloat.

Healthcare leaders see remote care, including remote patient monitoring, and hospital-at-home programs, as a way to expand access, but some organizations aren’t investing heavily at this point.

Only about half (49%) of organizations are investing in remote care technologies, and roughly three in four (74%) say the lack of reimbursement is the key roadblock to pouring more resources into remote care, according to the Sage Growth Partners survey.

“I think economic feasibility is important,” Kovalick said. “Hospitals typically haven’t done something unless they get paid for it.”