How can virtual health help expand capacity in the wake of an anticipated COVID-19 surge? has been saved
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by Felix Matthews, MD, MBA, managing director, and Urvi Shah, senior manager, Deloitte Consulting LLP
The rapid expansion of the COVID-19 outbreak is threatening a possible surge in demand for both ambulatory and inpatient services. Areas likely to be impacted include infrastructure, workforce, and equipment. In terms of infrastructure, the US has about 46,000 medical intensive-care unit (ICU) beds already operating at or near full capacity.
A moderate impact from the COVID-19 outbreak, with social-distancing measures in place, could still result in about 200,000 patients in need of hospitalization in an ICU, leaving the country unable to respond to the potential demand.1 Inpatient capacity exists but is unevenly distributed, and high-acuity inpatient beds and ICU spots remain scarce. If all existing ICU beds in the US were freed up for patients affected by COVID-19, the total capacity required would still have to be increased by 74 percent. Even then, many hospitals have a limited supply of ventilators and too few specialized medical staff who can care for extreme cases.2
Beside the inpatient challenges, outpatient settings such as clinics and offices are also running into many organizational and operational challenges while managing an increased volume of patients—especially within urgent care and emergency rooms—while triaging patients based on severity and making the right providers available, in a coordinated manner.
Flattening the curve: An uncontested imperative
Health officials and the US Centers for Disease Control and Prevention (CDC) anticipate a surge in the outbreak and subsequently a surge demand from health systems across the country. The CDC recommends social distancing and hygiene measures to help “flatten the curve” (i.e., reduce the peak demand for health services related to COVID-19) with the hope that overall demand stays below the aggregate system capacity.3
There continues to be uncertainty about how the disease will progress in the US and the extent to which social-isolation measures will be followed. It could be several weeks, possibly months, before the uncertainty is lifted.
Is the health care capacity line really horizontal?
The capacity of our health care system is typically seen as fixed, meaning there is a finite supply of health services that cannot be exceeded. This capacity—regardless of how it is calculated—is far from static. Indeed, aside from fixed assets constraints (number of beds) and supply and equipment shortages (too few masks, too few ventilators), there is a real risk for declining capacity due to workforce constraints on the frontlines. Consider the following:
Furthermore, specific operational measures, protocols, and precautions in caring for COVID-19 patients could lead to less-efficient health care delivery. For example, recovered COVID-19 patients might spend several days in inpatient facilities and critical care beds awaiting test results before they are discharged, further decreasing capacity.4,5
As a result of abovementioned factors, the supply side may in fact decrease (downward-sloping line), despite efforts across the nation to bring additional reserve capacity online.
What are the implications of capacity shortages?
As we think about flattening the curve, we should account for the likely possibility that health services capacity may indeed decline, as described above. This could mean that delays in testing and caring for patients will result in greater incidence and prevalence from undiagnosed and/or untreated individuals (see chart). The greater prevalence, promoted by supply-side shortage, could cause demand for services to increase further. On the chart, this could correspond to both increase in total number of cases (surface under curve) as well as peak demand (vertical amplitude of curve). This could apply under both the scenario with social distancing and without social distancing.
What is the role for virtual health?
In response to the COVID-19 outbreak, federal regulators have loosened some restrictions around virtual health. On March 17, the US Centers for Medicare and Medicaid Services (CMS) temporarily waived restrictions on the use of virtual health among Medicare members. Previously, telehealth services were only covered for beneficiaries living in rural areas. In addition, the agency waived enforcement of HIPAA health-privacy law violations, which will make it possible to conduct virtual health visits via non-compliant social medial platforms. The relaxation of these regulations are key factors that can help accelerate adoption of virtual health.6
Many predictions anticipate a surge in demand for both inpatient and outpatient services due to COVID-19. With declining clinical workforce capacity, health systems should consider the following benefits of virtual triage and tele-medicine capabilities:
Acknowledgements: Preethi Kannan
1. What US Hospitals Should Do Now to Prepare for a COVID-19 Pandemic, Clinicians' Biosecurity News|Johns Hopkins Center for Health Security, 27 Feb. 2020
2. Are Hospitals Near Me Ready for Coronavirus? Here Are Nine Different Scenarios. ProPublica, March 2020
3. “Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 June 2017, www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm.
4. Carilion Clinic Waiting on 100 COVID-19 Test Results after 165 Patients Tested, WSLS 10, March 19, 2020,
5. Weeks Ahead of When Coronavirus Will Peak In Colorado, Hospitals Are Already Seeing Shortages, Colorado Public Radio, March 18, 2020
6. Medicare Telemedicine Health Care Provider Fact Sheet, CMS, March 17, 2020
Dr. Matthews is a Managing Director and physician leader at Deloitte Consulting LLP. Felix is the National Lead for our Academic Health / Research Leaders practice. He advises his clients on strategies to succeed in an increasingly competitive market. His clients include academic health systems, national health plans, and life sciences companies. He is experienced in corporate strategy, care model innovation, physician engagement strategies, clinical affiliation strategy, value-based payments, operating model design, and digital strategy, among others. He also advises his clients on strategy implementation and enabling capabilities. With over 20 years combined experience in medical practice and health care consulting, Felix brings to his clients a unique blend of clinical understanding and business insight. Felix trained in trauma surgery and accident medicine and has led research focused on clinical technology innovation at major academic centers in the US and abroad. Felix is also a published author in peer-reviewed medical journals and a columnist on virtual health.