How The Next Wave Of Patients Could Be Even Deadlier Than Coronavirus
LAUREN GILGER: The death count due to the coronavirus pandemic is nearing 100,000 in the United States. But our next guests argue there could be a third wave of patients who are sick coming soon, and it could be more deadly than COVID-19. And it will be caused by patients who have delayed care — those who have been afraid to go to the doctor, whose procedures or screenings have been put back. Dr. Jeff LeBenger is the CEO and chairman of Summit CityMD in New York, and Mike Meyer is the president of Meyer Consulting, based here in Arizona, which works with academic centers, hospitals and large health care systems across the country. The two have known and worked with each other for years and recently wrote an op-ed about this for The Wall Street Journal. I spoke with them more about it. And you'll hear Dr. LeBenger here first.
JEFF LEBENGER: You know, being a very large, integrated, multi-specialty group in the New York metropolitan area, what we saw when COVID presented itself, the volume of patients that wanted to come to the office diminished. It almost went away because people were very scared. They were worried. People with COVID were coming in. And the media, not that it perpetuated it, but it made it seem as if coming to a doctor's office, you won't be protected — there's people with COVID to spread. Yes, absolutely. And people had to wear protective gear to be seen. But the normal patients who had cardiac disease, some neurologic disease, diabetes, hypertension, COPD, the patients who have to be seen — and screenings for cancer all disappeared. And finally, after six to eight weeks, we are finally about 85% of volume that we saw pre-COVID, and that people are now coming in with these preexisting conditions again.
GILGER: So that's quite a delay. And you argue here in The Wall Street Journal that the number of people who could die as a result of not getting this kind of screening or treatment could actually rival that of COVID-19. Do you think it could really be that extreme?
MIKE MEYER: Yes. Yeah. I mean, if you look at just cancer, for example, which we do a lot of work in, there was a study last week out of New Jersey that said that about 2 million screening tests, mammographies, colonoscopies, have been postponed. People just aren't going into, you know, to get those tests. And the estimate out of that study was that could produce an extra 80,000 cancer cases. Do the math. If you have 600,000 people that die of cancer each year and they're delaying treatment or they're delaying testing, you're absolutely going to get more cancer cases next year and the year after. And that's the, that's the worry. And you have that in not only cancer, you have it in cardiology, you have it in a variety of other areas where people are either afraid to get screenings or they're afraid to go in when they're symptomatic. You know, one of the things that we're seeing across the country that Jeff alluded to, but specific to cancer, is we're seeing people not presenting with symptoms. They're not going in and talking to their oncologists. They're not even doing telemedicine calls. Now, maybe that's because they've become unemployed. Maybe it's because the kids are at home, but they're ignoring symptoms. And then you have the population that I would call not the urgent emergency situation which takes you into the E.R., but the emergent problem. Like what my father had, where he had a heart condition, he needed a procedure, but he wasn't sick enough to go into E.R., so he was considered elective.
GILGER: So Mike, you really experienced this on a personal level, it sounds like, with your father experiencing exactly this issue.
MEYER: Yeah, it was exactly. Now, the difference is he was in a situation where he had delayed care because of the fact that, that the governor had — and by the way, this is between a rock and a hard place. I don't want to go back into history and say that this was the wrong decision, but because in Arizona, we had shut down all elective procedures, there was a procedure that my father needed that he couldn't get. And I don't really want to go into the details because it's too painful. But I think the message here going forward is, now that elective procedures are allowed in Arizona, is people are afraid. Seniors are afraid. So how do we create a safe environment where people feel comfortable going back to their health care provider, whether it's a physician visit or actually, more importantly, whether it's a test? Because if you need a mammography, if you need a colonoscopy, if you need X, Y, Z — you're not going to do that through telemedicine. You actually have to go in somewhere and get that test.
LEBENGER: We will see a wave coming in about two, three months of more cancers that are just being picked up 'cause people are now coming — there was a delay. Cardiac conditions that will put off that hopefully could be rectified as well as, you know, it was unfortunate what happened. The governors instituted the right thing. Absolutely. Protect the sanctity of life. Above all, we all get that. But there is going to be a consequence for that, as well as closing an economy for as long as it was closed. And we have to do the best we can coming in the next month or two to get us back in terms of health care of where we were pre-COVID.
GILGER: You both also talk about how there's the patient side of this, but there's also the residual effects on the health care systems — the doctor's offices that have taken such big losses. How could that affect things going forward, especially if we do see this kind of third wave you're talking about?
LEBENGER: The stimulus bill is protecting hospital systems. They're getting some dollars. The individual provider, besides getting a small stimulus from Medicare, is getting nothing. So what we see in our community, OK, is a lot of small time practices are closing up shop completely. So the delivery of care is going to be somewhat put on a little bit of a pressure situation as we move forward.
MEYER: In terms to the economic impact, it's dramatic on individual physicians and it's also dramatic on larger health systems. Now, you've got some large health systems, obviously, in the West and in Arizona that are financially very strong. And you have other systems that are not financially very strong, or you have public hospitals that are struggling. Some of these systems probably will get in a position where they will struggle potentially with even meeting payroll. And I find it a bit ironic that at the same time, you're asking people to treat COVID patients and you're asking people like Jeff's organization to be on the front line. You're also creating an environment where they have to lay people off. The problem with the third wave — and this is true in Arizona as well as in, as well as on the East Coast — is that if you have this third wave of sicker patients and at the same time you have a resurgence of COVID due to lack of social distancing, due to a dozen other things that we don't know about, and you also have a bad flu season, and you have a stressed health care system — those four together potentially overwhelm the system. Now, am I saying to you, you're going to have people lining out the street for E.R. or operating rooms? No. But you could end up in a situation like what you have in Britain, where all of a sudden, instead of getting a TAVR procedure four weeks when you need it, it takes you three months.
GILGER: That is Mike Meyer, president of Meyer Consulting, based here in Arizona. And Dr. Jeffrey LeBenger, CEO and chairman of Summit CityMD in New York. Thank you both for coming on The Show.
MEYER & LEBENGER: Thank you.
GILGER: And you can read the rest of their op-ed in The Wall Street Journal. They include some important points about how we can prepare for this coming third wave as well.