Intensive care: America’s patients need prevention, not procedures

With the recent rise in flu cases and the increase in respiratory syncytial virus (RSV) cases nationally putting a strain on the health care system, the burden on health care professionals across multiple professions is rising to levels last seen during the height of the COVID-19 pandemic.

Through each wave of the pandemic, in intensive care units (ICU) across the country, teams worked to pull patients back from the brink of death using invasive, life-sustaining therapies.

A study of more than 400,000 patients hospitalized with COVID-19 found that 94.9 percent had at least one underlying, or chronic, condition such as obesity, diabetes, hypertension or heart disease. The mortality of patients with a chronic disease was 12 percent, more than four times higher than that of patients without an underlying condition.

These findings demonstrate how the health care system failed patients with preventable, chronic disease long before the pandemic — and patients have paid the price. 

The United States spends more of its gross domestic product on health care than any other high-income country yet ranks last in access to care, administrative efficiency, equity and health outcomes.

According to a National Health Expenditure report, health care spending increased 9.7 percent, or $4.1 trillion, in 2020 and accounted for 19.7 percent of the GDP. It is projected to grow at an average annual rate of 5.4 percent and reach $6.2 trillion by 2028. Of all health care spending, preventative care spending accounts for less than 3 percent of total health expenditures.

As a registered nurse at a major metropolitan hospital with more than 15 years of experience, I have seen the devastating impact of chronic disease on life expectancy and health outcomes.  These impacts were made more acute by the pandemic that strained the health care system. 

America’s health care system is a fee-for-service structure; physicians and advanced practice providers are paid for each service they perform.  This model incentivizes more tests and treatments because payment is dependent on the quantity of care versus quality of care.

Health care providers use current procedural terminology (CPT) codes to bill for medical services and procedures. Using CPT codes, total fees for care are calculated based on the patient’s diagnosis, the amount of time spent receiving care, and complexity of care, which may include chronic disease management of two or more conditions.

On this sliding scale of reimbursement, insurers pay for preventative screenings and disease management education at a significantly lower rate when compared to other, more invasive, procedures. In the United States, it does not pay to prevent disease.

The Affordable Care Act (ACA) was signed into law in 2010 with an ultimate goal of achieving universal health care, decreasing health care costs and increasing preventative care. Over the past 12 years, politicians have debated the law’s effectiveness and constitutionality, but this has led to few changes in the ACA. The law has increased the total number of insured individuals by more than 20 million, slowed the overall growth rate of health care expenditures, and helped hospitals and health systems find ways to improve access and patient care outcomes.  

In this same time period, voters have grown increasingly vocal about the need for health care reform. In 2018, approximately four in 10 Americans voting in the midterm elections rated a candidate’s plan for reducing health care prices as “very important” or “somewhat important” to their vote. In October 2022, this number rose to nearly nine in 10.  

Newly elected freshman representatives and senators may want to take a “wait-and-see approach” to health care reform when sworn in in January 2023. Experienced representatives and senators may continue to debate along party lines. If taking this approach, patients may continue to suffer; we are in a health care crisis now.

It is critical that policymakers work in tandem with health care professionals and administrators to make meaningful changes to health care systems to reduce the costs associated with preventable, chronic diseases and make access to care more affordable. Health care access may be political, but it does not have to be partisan — and no one should suffer because of it.

Molly Moran, MSN, RN, CCRN, is the senior director of ambulatory clinical practice and workforce development at Rush University Medical Center and a Public Voices Fellow through The OpEd Project.