It is often noted that the American healthcare system is the most expensive in human history with varying degrees of quality depending on where patients are located, the conditions they suffer from, the degree to which they are insured and other factors that plague the American healthcare system, like persistent racial disparities. What gets less attention is how the health care system is organized and regulated and how these factors create hardships for patients, loved-ones, and providers.

The healthcare system that Americans experience today is oriented almost entirely around facilities of one type or another that house providers whose jurisdiction over our health is highly fragmented. To get healthcare, most Americans travel to multiple doctors’ offices, urgent care centers, hospitals, physical therapy centers, rehabilitation centers, assisted living facilities, nursing homes, dialysis centers, imaging centers, hospice etc. These different sites of care are also regulated and reimbursed separately, mirroring the fragmentation patients experience. The COVID-19 pandemic forced changes to that model. Telehealth opportunities were greatly expanded and regulatory and payment barriers were lifted such that patients could get doctor’s visits, x-rays, infusions, cancer care and, thanks to the CMS Acute Hospital Care at Home Waiver announced in November 2020, even in-patient level hospital care via a combination of telehealth and in-person visits in their homes.

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Home Care COVID-19

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