New Haven Register (Sunday) (New Haven, CT)
Doctors face money woes as patients stay away
Connecticut health care providers say they were hit hard by the COVID-19 pandemic, as many people not infected with the respiratory illness delayed seeking care for other conditions.
Some experts said they hope to see a rebound as the state tentatively reopens — not just to repair the financial health of providers, but to preserve the physical and mental health of patients.
Research has shown a drop in medical visits across multiple categories during the pandemic. For instance, a poll released in April by the American College of Emergency Physicians and Morning Consult showed that 29 percent of the 2,201 adults surveyed said they had delayed or avoided seeking medical care due to concerns about COVID-19 infection.
The ACEP also reported that some hospital emergency departments reported a drop of nearly 50 percent during the pandemic. Though those fears are understandable, they’re harmful to the care providers and the patients, said Christopher
Lehrach, president of Nuvance Health medical practice. Nuvance is a health system that includes Norwalk, Danbury, and New Milford hospitals, as well as other care providers.
“Hospitals are already under intense pressure to contain costs and will have to double down on that notion” in the wake of the pandemic, Lehrach said. He said the health system has seen sharp declines in emergency department visits of anywhere between 40 to 60 percent in the past few months.
That means a huge loss of revenue from which it will be difficult to recover. Though he’s confident the Nuvance hospitals will survive, he does fear that other small health networks throughout the country could fold.
“There will be some hospitals that don’t make it,” Lehrach said. “I am concerned about independent hospitals that won’t be able to weather this storm.”
But Lehrach’s worries about a drop in patient volume are not just financial. During the peak of the pandemic, many patients were not seeking care for non-COVID medical conditions, such as heart disease, allowing those conditions to worsen, Lehrach said. “It speaks to how fearful our patients were,” he said. “It’s sad when you think about it — that people were at home suffering (because they were afraid to seek care).”
Though health experts and others have expressed concerns about a “second wave” of COVID-19 cases in a few months, Lehrach said he’s worried about a different kind of health crisis down the line.
“I think the real second wave is going to be from care that’s been neglected over the past few months, allowing conditions to exacerbate,” he said.
As Connecticut’s economy struggles to emerge from pandemic-related damage, local retailers remain cautiously optimistic that their customers will return.
“People are social animals,” said Terry Rogers, owner of Harbor Point Wines & Spirits in Stamford’s South End. “I think they want to be around other people and talk about what restaurants they’ve been to and other things they like.”
But the hope of a recovery is tempered by the hard realities of what has happened since mid-March, when an executive order by Gov. Ned Lamont shut down a majority of retailers.
For Laurie Acosta, the arrival of the pandemic in the United States in January ultimately sealed the fate of her second Red Owl Jewelry & Gifts location in Meriden’s Town Line Square shopping center. Acosta opened the store in October 2016, having started her first store in Cheshire at 205 Maple Ave. three years earlier.
“Once we saw that (coronvirus reaching the U.S.), we began the process of starting to permanently close the Meriden location the last week of February,” she said. Foot traffic at the Cheshire store disappeared shortly after that, according to Acosta.
John LeToureanu saw a similar dropoff in activity on Wallingford’s normally bustling Center Street. LeTourneau’s vintage lighting sales and repair business, Wallingford Lamp & Shade, has been there for 20 years, he said.
“The streets were dead,” he said. “And April and May were brutal in terms of our business.”
LeTourneau reopned his business to pre-coronavirus hours at the end of May, after having done business by appointment only prior to that. The store, at 124 Center St., is open from 9:30 a.m. to 5 p.m. Tuesday through Friday and from 9:30 a.m. to 4 p.m. Saturday, he said.
LeTourneau is the only employee, but said his landlord hasn’t offered him a break on rent despite how much the pandemic may have ravaged small businesses.
LeTourneau elected not to try to obtain a Small Business Administration loan.
“If I don’t have the money now to pay it back, there’s no guarantee that I’m going to have it several months down the road,” he said. “I think you’re going to see a lot of people defaulting on these loans.”
The Red Owl reopened to the public earlier this week. But from mid-March until now, Acosta said she was forced “to become more innovative,” as well as to temporarily lay off five workers, who since have been rehired.
“We do home delivery within five miles of the store, which we had never done before,” she said. “We do curbside deliveries.”
Her online business, which started long before the pandemic hit, “has been doing fairly well,” Acosta said.
Both Acosta and LeTourneau are taking safety precautions for customers.
Customers entering Red Owl can take napkins from an outside dispenser and use them to grasp the door handle. Inside, there are touchless dispensers that squirt hand sanitizer for customers to use.
Red Owl has even expanded its merchandise line to include stylish protective face masks and hand sanitizer.
Acosta is sensitive to her customers’ concerns about the coronavirus: Before starting Red Owl, she had been a registered nurse and served as an immunization specialist with the 103rd Fighter Wing of the Connecticut Air National Guard based out of Windsor Locks. Acosta also said she has a challenged immune system.
LeTourneau’s public health precautions at Wallingford Lamp & Shade extend to method of payment.
If paying by credit card, LeTourneau takes the customer’s card with a disinfectant wipe, runs it through the card reader and then hands it back, wrapped in the the wipe. If a customers pays with cash, LeTourneau has them drop the money into a plastic bag that he then spritzes with a disinfectant solution.
Once the customer leaves, LeTourneau wipes down both interior and exterior handles of the front door.
Other health providers shared Lehrach’s double-pronged concerns about the decline in patient visits, including Steven Heffer, medical director and owner of four AFC Urgent Care clinics — two in Bridgeport and one each in Fairfield and Shelton. During the pandemic, he’s seen patient volumes drop from anywhere between 50 and 75 percent at his facilities.
In recent weeks, he has seen some rebounding, but expects it to be slow. “People are still a little leery about (the idea of) sitting in a waiting room,” Heffer said.
There has been one bright spot during the pandemic that has allowed providers to give care, and let patients receive it — the rise of telemedicine services. Shortly after the pandemic began rising, many health providers began offering care remotely, via phone or computer.
At Stamford Health, about 30 percent of patients still prefer remote appointments with physicians — though the numbers are down from roughly a month ago, said Ben Wade, Stamford Health’s senior vice president of strategy and marketing. He said he expects virtual health to continue to be popular, but hopes more people will feel comfortable with in-person visits moving forward. “Medicine is, in many cases, about one person laying hands on another person,” Wade said.
Heffer said AFC Urgent Care’s telemedicine program has been popular as well, but shared Wade’s hope for a shift to more traditional visits in the future. “I’m hoping that, with things loosening up, people are going to be a little less fearful and realize there are things you can’t do with telemedicine,” he said.
One area where telemedicine has surged during the pandemic is mental health, said Jocelyn Novella, assistant professor of counselor education in Fairfield University’s School of Education and Allied Professions. Prior to the pandemic, she said about 90 percent of therapy was delivered in person.
“When the pandemic came up and people couldn’t be in an office across from each other, the (switch) was made to largely providing telemental health,” Novella said.
There was a huge learning curve for many providers, who hadn’t been trained to give care this way, she said. But, as with so much else during this odd time, there wasn’t much of a choice.
“The positive part of this was it got people over the idea that you couldn’t deliver therapy online,” Novella said.