State of the State 2022: In health care, it’s still about the pandemic

The new year begins much as the past two did, with Arkansas’ health care system facing uncertainty amid a pandemic. On Jan. 14, the University of Arkansas for Medical Sciences (UAMS) released its latest COVID-19 projections, and those numbers were ominous.

The model says as many as 500,000 Arkansans could be infected with the omicron variant through February if tends continue. By Feb. 5, the cumulative cases in Arkansas since the pandemic began could reach 900,294, while hospital cases could increase from 30,084 on Jan. 8 to 31,848 that day. The UAMS report was prepared by its Fay W. Boozman College of Public Health.

The report comes as infection rates are soaring: a record 14,494 known new cases were announced Jan. 19, bringing the known cumulative to 702,483. The known case count rose by 11,160 on Jan. 20, with the cumulative rising to 713,643. As of Jan. 20, known active cases rose by 2,251 to a cumulative 97,629, deaths rose by eight to 9,470, and hospitalizations were at a record 1,640.

‘MORE RELAXED’
The rates are being driven by the highly infectious omicron variant, which the UAMS report said is able to escape natural and induced immunity and reinfect people who have previously had COVID. While generally milder, the report said it still can be life-threatening and can lead to death and long-term health effects.

“Omicron appears to be very, very infectious, so it will infect probably at some point most Arkansans,” said Dr. Joe Thompson, president and CEO of the Arkansas Center for Health Improvement. “To the extent that it stimulates immunity in most Arkansans, we may be past the worst. But it’s going to be a pretty challenging month, and unfortunately, we’re going to have lots of folks get sick, and we’re going to lose folks that we could avoid if they had been vaccinated.”

Thompson said the virus’s fast spread may quicken the pace at which Arkansas reaches herd immunity. However, other variants could be following.

“I think COVID is probably not going to ever completely go away, but I think we can be out from under this threat scenario that we are now … by the end of the year,” he said. “‘Normal’ is a loaded term. I think we may be able to be more relaxed.”

COVID FATIGUE
Ray Hanley, president and CEO of Arkansas Foundation for Medical Care, is hopeful the omicron variant will peak soon and then recede based on the experiences of South Africa, where it was first identified. He expects the federal Centers for Disease Control and Prevention to change the definition of “fully vaccinated” to include booster shots. If that were to happen, the percentage of Arkansas falling into that category would fall drastically. Just over half of the state’s total population is considered fully vaccinated, but less than 500,000, or one-sixth of the total, has received a booster shot.

The Biden administration is making a billion at-home tests available for Americans, which will make it more difficult to track infections. Earlier this month, the Arkansas Department of Health confirmed that on Jan. 17 it was ending its contact tracing efforts where it contacts newly infected individuals to find out where and with whom they had been in close proximity.

The changes come as Arkansans are experiencing “COVID fatigue,” where they are tired of the steps being taken to protect themselves and to mitigate the spread. Hanley contrasted the full stadiums watching college bowl games with his visit to Italy the first part of the month, when police were ordering citizens to wear their masks.

The pandemic has had effects on Arkansas’ health care system beyond infection rates and hospitalizations. Hospitals have been stressed, Thompson said. While short-term federal funding has been available, they’ve been forced to hire traveling nurses at 3-4 times the cost of their regular nurse force. COVID relief funds eventually will be exhausted, and there’s been an inflationary effect on large and small health care systems, with smaller systems affected the most.

Thompson said COVID will continue to create challenges for the health care workforce, which already faced shortages. Many providers are considering transitioning out of health care delivery. The state has opened two osteopathic medical schools in recent years, but a lack of residencies and fellowships constricts the pipeline.

TELEMEDICINE
Another change accelerated by COVID has been the increased use of telemedicine. According to a report by the Centers for Medicare and Medicaid Services (CMS), telemedicine use among Medicare beneficiaries was 30 times larger during the first year of the pandemic than it was during the preceding year. But telemedicine requires adequate broadband, cybersecurity measures, and changes to the way medical providers run their businesses.

“Telehealth is not going to go away, and so the challenge is going to be how to appropriately use it,” Hanley said. “You’ve got medical providers who used to operate with full waiting rooms, and then a lot of their patients go to telehealth, so they have to figure out how to rightsize their own offices and practices. You’ve got payers that have to adjust for it, decide which procedures they’re going to allow telehealth for it and how much they’re going to pay. You’ve got the patient experience with telehealth, and there’s still an educational aspect.”

The pandemic also has had an effect on the state’s Medicaid system. About 150,000 cases must be verified for continued eligibility, a process that was put on hold during the pandemic, Hanley said.

Also, the state is in the process of re-upping its Medicaid expansion waiver. The program covered 330,421 individuals on Nov. 1. First known informally as the “private option” and then under Gov. Asa Hutchinson as “Arkansas Works,” the latest version is known as ARHOME.

CMS has approved Arkansas’ request to continue the program’s core provision: using Medicaid dollars to purchase private insurance for lower-income individuals. However, the federal government is still reviewing the program’s newly proposed Life360 Homes targeted to rural Arkansans, pregnant women and babies, and young adults at risk for long-term dependency. The program has helped Arkansas avoid the rural hospital closings that occurred in other states that did not expand Medicaid, Thompson said.

Thompson said rural areas are continuing to lose healthy working age individuals, leaving behind sicker, older residents and putting pressure on the health care system. A strategy is needed for financing rural healthcare and maintaining a rural healthcare workforce. In much of the state outside of Northwest Arkansas, the financing and pressure points likely will lead to additional consolidation or integration of healthcare facilities.

The pandemic not only has affected Arkansans’ health care, but also their health. Thompson noted there’s been an increase in substance abuse and deaths from overdoses and in mental health issues, including a twofold increase in substance abuse among adolescent girls.

Editor’s note: Link here to connect to the State of the State section.