Teaser Image
Episode 4: Can we correct our course

Display Date

April 07, 2022

Header Title

Episode 4: Can we correct our course? — Navigating the post-pandemic healthcare landscape with Dr. Mark Pimentel

Wistia Audio
Description

Dr. Mark Pimentel, executive director of the MAST Program at Cedars Sinai Hospital in Los Angeles, joins Justin and Brittany to discuss the long-term implications of pandemic-related delays in care on providers, facilities and patients, as well as solutions for bringing hesitant patients back into the care continuum. Mark, Justin and Brittany also explore the potential impact of patients bypassing primary care for specialists, and consider how healthcare access can be improved in rural and underserved regions.

We want to hear from you...

Have an idea for an episode? Got the inside scoop on a trending topic? Let our team know!

Episode transcript

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at: definitivehc.com.

Justin Steinman:
Hello and welcome to the latest episode of Definitively Speaking, the podcast where we have data driven conversations on the current state of healthcare. Today’s conversation is about pandemic related delays in care. There’s no question that COVID has impacted every facet of our lives today, and we’re all painfully aware of COVID-related illnesses and death.

Justin Steinman:
By this point, I think it’s safe to say that almost everyone knows someone who has gotten sick with COVID or gotten it themselves. But one of the lesser talk impacts of COVID pandemic are the delays in medical care. Millions of people have chosen to delay care by choice or millions have had their medical facility delay their care without a choice. And I think it’s safe to say that we’re going to feel the impact of these delays in care for years to come. To help shed a little bit more light on the subject I’m joined today by Dr. Mark Pimentel who is the Executive Director of the Medically Associated Science and Technology Program at Cedar-Sinai Hospital in Los Angeles, and by my colleague and co-host, Brittany Morin-Mezzadri. Mark, thanks for joining us today.

Dr. Mark Pimentel:
It’s my pleasure.

Justin Steinman:
So to kick things off, could you just share a little bit about your personal background and give the audience an overview of the Medically Associated Science and Technology program?

Dr. Mark Pimentel:
Oh, I’d love to. So I’m a gastroenterologist. I’ve been at Cedar-Sinai for 25 years. And about 10 years ago, all throughout my time here, I’ve been doing research and seeing patients, and trying to develop new technologies that help people. And Cedars wrapped a program around this. So we’re developing technologies to help patients because we see the patients so we know what they need and then see if we can get it out to them and help them. So that’s what the Mass program’s all about.

Justin Steinman:
That’s interesting. It almost seems like you’re straddling the world between treating patients and doing cutting-edge clinical research and collaboration with pharmaceutical and other private companies. Is that how to think about it?

Dr. Mark Pimentel:
Yeah, that’s exactly right. So sometimes pharmaceutical companies aren’t related to a hospital. They can’t touch the patient; they have to use arm’s length. We can. And so we’re able to identify the problems, maybe solve a problem. And then, obviously, we have to partner with somebody at some point to get it to the patients commercially, and that’s what we do.

Justin Steinman:
Well, I think, Brittany, we’re going to have to bring Dr. Pimentel back for a future episode on this topic. But right now, why don’t we pivot to the topic of the hour so to speak: pandemic-related delays in care. Hospitals are busier than ever, and it’s not just because of COVID-19 patients. When the pandemic hit, millions of Americans postponed care to avoid exposure to the virus. Additionally, the CMS recommended that hospitals postpone elective procedures to maximize resource availability for the surge of COVID-19. Then they let people back in, and then towards the end of 2020, they said, nope, just kidding. Everybody back out again.

Justin Steinman:
People are starting to feel better about getting back to the doctor’s office; particularly thanks to all the vaccinations and the better treatment options. But I think we’ve seen … and we’ll talk about some of the stats as we get in here. These delays in care means that there is a significant backlog in appointments and procedures; and two, there are unrelated illnesses that become really exponentially more acute. All of this combined with staffing shortages and burnout has created a perfect storm, and hospitals are sometimes struggling to keep up. So Mark, my first question to you is to get us kicked off here is: What does all of this mean for the year ahead? All this care that’s been delayed. How do we start to think about it?

Dr. Mark Pimentel:
Well, it’s had a tremendous impact for … in a lot of aspects. I don’t want to jump straight to Canada or other countries; but Canada, for example, because they have socialized medicine. I am Canadian. So I follow this. They really had to push everything off because their hospitals were overwhelmed. They have very slim ICU bed numbers, and so they had to use every available bed. I think we didn’t see it to that extreme here in the US. I think hospitals were able to compensate. But the reality is virtual visits aren’t touching the patient. They’re not feeling for the thyroid nodule. They’re not listening for the new heart murmur and how much worse it is. And so virtual visits have delayed the identification of illness because you can’t touch, feel, and examine the patient. And we’re going to play catch up. And we’re going to see that with cancer, we’re going to see that with heart disease, we’re going to see that with pulmonary disease, where patients have become more advanced in the setting of a virtual environment.

Justin Steinman:
That’s really interesting because we’ve talked a lot about the virtual care with other guests on this podcast. It almost seems like you’re saying virtual care is better for ongoing treatment once the initial diagnosis has happened. Is that right?

Dr. Mark Pimentel:
Well, absolutely. If you can’t see your endocrinologist or an endocrinologist at all for a delayed period of time, maybe that thyroid nodule is bigger by the time you get there and is less treatable by the time you get there. Or nobody’s examined you for a while. Maybe your primary care knows all your problems, but nobody’s taken a look at you for a long time, and that nodule is now there and they could have felt it. You know? There are a lot of not yet identified problems that we are now going to start to identify as these patients start coming back to clinic live.

Justin Steinman:
Interesting. Intuitively, I knew this was an important issue, but I didn’t realize how prevalent these delays were until I read some, did some research preparing for today. And one data that jumped out at me was according to a recent survey from Yale, NPR, the Robert Wood Johnson Foundation, the Harvard T.H. Chan School of Public Health is that nearly one in five American households had to delay care for serious illness due to COVID. 76% of those households said they had, and I quote, “A negative health outcome as a result of that.” Does this number surprise you?

Dr. Mark Pimentel:
It’s higher than I thought, but it doesn’t surprise me too much. You could sort of equate the COVID pandemic as war time, right? War time is you treat not the patient, who’s the sickest, but the patient who’s most likely to survive. And it’s triage medicine. And we’re approaching a triage medicine type of phenomenon with this COVID pandemic. So you have to delay who you can delay and treat who needs the treatment now. And that put a stop on a lot of things that could have been treated or a lot of surgeries that could have been done this month, but end up being done next month or the month after, or whatever the delay might be given the waves we’ve experienced.

Justin Steinman:
That’s interesting. And I read somewhere that many hospitals are so full of … mostly at this point, unvaccinated COVID patients that they can’t operate normally, right? So they’re pushing out “voluntary surgeries” or “non-essential procedures.” But to me, that definition of non-essential seems pretty subjective, right? If I had a pinched nerve in my back and I can’t really walk, it’s not going to kill me, but it certainly has a major impact on my quality of life. I don’t think if … I’d never had a pinched nerve, but I think I’d probably not classify it as essential and non-essential. What’s the situation like at Cedar-Sinai Hospital?

Dr. Mark Pimentel:
Well, I have to be careful not to say too much because I’m not a representative of all those decision makings. So I don’t want to suggest anything.

Justin Steinman:
Of course.

Dr. Mark Pimentel:
But the physicians and myself included, we aggressively advocate for our patients. So if I know somebody needs something, I’m going to aggressively advocate and make sure that that happens in a fashion that doesn’t compromise their healthcare. And I think that’s the approach we’ve been trying to take here, at least in my practice. I can’t comment on the greater health system because I just don’t know all the policies. But I personally think we’ve done quite well here at Cedars, speaking on personal experience of what I’ve seen. But other places that were less prepared had trouble. And I think that that’s what we’ve been seeing across the board.

Brittany Morin-Mezzadri:
Question for you. We’ve talked about … with our clients, we’ve understood that COVID-related delays of care have certainly affected, and we even talked about it here, have affected oncology, cardiovascular, metabolic. A lot of those therapies that should be caught or are generally seen in a primary care setting. How has this affected gastroenterology? I don’t feel like that’s talked about quite a bit, and I’m curious how these delays of care have affected your gastroenterology patients and what you’ve learned from them. What’s new? For lack of better words, what’s interesting about these patients?

Dr. Mark Pimentel:
Colon cancer screening needs to be done at a particular time. And so that’s always one of the things that could be triaged in a health … We’re a tertiary care medical center, so things are usually more acute and more acute means you got to deal with it when you have to deal with it. And we did. And we do. But in more in the secondary gastroenterology care of those outpatient surgical centers where they may have delayed the colonoscopy because they were shut down … This was especially true in the first parts of the pandemic where we really didn’t understand what was happening. I remember driving down Robertson Avenue, which is a big street here in Los Angeles, in the first few weeks of the pandemic, 9:00 at night, there wasn’t a car on the entire street.

Dr. Mark Pimentel:
And so people were frightened. They didn’t understand what they didn’t understand. And of course, things started to change as we knew how to protect ourselves. But same thing with the surge in centers. They basically closed up because they didn’t know what was going to happen, how bad this was, or how to operate under the circumstances. So yeah, for some period of time, things were delayed. But to take it on another way to look at it, if I’m the patient and I need a colonoscopy and it’s my five-year time to do my colonoscopy, I’m saying, I don’t want it. And so we experience that a lot. We have patients who say, “Look, I don’t want my colonoscopy. I don’t want to get COVID.” “I don’t want to come to the hospital. I don’t want to be near healthcare providers or clinics.” And that also factors in to the delay in care. So even though I think the patient needs it, the patients saying, “Look, I’ve got somebody frail at home. I can’t get COVID. I can’t get this colonoscopy right now. We’re going to have to delay.”

Brittany Morin-Mezzadri:
How are you getting those patients back into their care journey? How are you re-engaging this patient population?

Dr. Mark Pimentel:
Well, we keep constant communication. We understand that this is fluctuating. We have to give them some confidence in what’s happening. Obviously, COVID is not zero. Everybody knows it’s not zero. And it’s not a zero risk. But we give them what we know in terms of confidence. Obviously, we do a lot of testing to be sure that everybody who’s looking after the patient and the patient themselves as they come to procedures are negative, so that there’s less chance of any problems. So we figured out how to navigate, but as was pointed out earlier in our discussion, I still think there’s a lag. There’s still … We haven’t caught up to some of this. The important stuff was done. Patients with really acute illness got taken care of. But some of the more routine procedures like colonoscopy are probably still behind.

Justin Steinman:
I read in the Wall Street Journal recently that one of the biggest impacts of COVID is actually the missed and delayed cancer screenings that you just talked about. The Journal reported that hundreds of thousands, if not millions, of cancer screenings been deferred over the past two years. And according to the National Cancer Institute, these missed screenings and other pandemic-related cares could result in more than 10,000 additional deaths from breast and colon cancer alone over the next 10 years. You just talked, Mark, a lot about the lag. What do you think that lag is going to look like? Are we going to see a lot more people dying, a lot more critical cases? An overcrowded healthcare system? What’s that lag going to look like over the next three to five years?

Dr. Mark Pimentel:
Yeah. It’s really hard to predict at this point. I think … It’s the example of the thyroid cancer I gave you earlier, or the patient who’s postponing their colonoscopy because they’re afraid or the doctor’s offices were closed. Whatever the reason may be for that delay, we just don’t know what kind of an impact that’s going to have. Clearly you can predict what those models will look like. But I can tell you if somebody had bleeding from the rectum … sorry to be so graphic … and they were bleeding now, they’re getting a colonoscopy. Somebody’s going to figure out where to do it. The doctor will figure it out. And that’s what we’ve done. But it’s the ones that you don’t know, just routine screening that you might have missed and maybe that’s been delayed for six months or a year, and that cancer is allowed to progress more than it would’ve if it had had been done earlier, those are the things that we’re monitoring and making sure …

Dr. Mark Pimentel:
I think there’s going to be … You’ve got this wave of publications, COVID publications. In fact, we’re almost beaten over the head with so many publications on COVID. But the COVID publications, to your point, are going to continue for a decade. What this all did it, how it impacted all of healthcare, and how the delays have changed some of the prognosis, prognoses of patients. So it’ll be interesting to see.

Justin Steinman:
What’s been the impact on your personal practice?

Dr. Mark Pimentel:
Well, it’s been challenging. So for those that, as I mentioned, for those cases where the patient doesn’t want to come in, or the patient doesn’t know they have COVID, then they come to the office and then you don’t know until two days later and they say, oh, by the way, doc, you may not have known this, but I was COVID positive when I was in your office. And then all of us are scrambling around trying to figure out who was exposed and whether we were exposed or any risk.

Dr. Mark Pimentel:
Overall, our team has been very careful with the proper masks. And so, healthcare providers are better protected and we try to maintain protection. But I will say that I feel a little disconnected with some of my patients because of this virtual visit anomaly. One rainbow. I’ll say “one rainbow” because it sounds all doom and gloom, is I see a lot of irritable bowel syndrome patients and diet plays a big role in irritable bowel syndrome. And most of these patients weren’t eating at restaurants and were eating at home the whole while. And they were better because they picked the foods that were better for them and they weren’t trusting some chef in the back who says, they’re is no dairy in this, but it is. So there’s a couple of small rainbows that these patients were actually doing better or some of them were.

Justin Steinman:
Shifting gears a little bit. It feels somewhat awful to bring this up, but there are financial implications here for hospitals. To put it bluntly, treating COVID isn’t as profitable for hospitals as some of these other elective surgeries. Right? And according to an article that I saw in Becker’s Health Review, hospitals lost more than $161 billion. It’s billion, with a B, in canceled services in 2020, and that includes non-elective surgeries. How do you think all this lost revenue impacts a hospital at a macro level?

Dr. Mark Pimentel:
Yes. I think there is a financial impact to hospitals. And then the question is, does that impact, for example, the building, let’s say as a secondary care hospital somewhere, building of their little cancer building that they were going to make so that they could take care of cancer patients or future projects, or better equipment because they just don’t have the budgets for it. I think the real scary part of all of this that we haven’t touched on yet is a lot of people have left healthcare. A lot of people can’t do it anymore. Or they burned out and there’s a shortage of nurses. There’s even a shortage of certain types of practitioners. That will affect healthcare for a long time because we just don’t have enough nurses. And then if this, all these patients come back, when they come back, that’s another challenge.

Brittany Morin-Mezzadri:
So I recently did a webinar and for that research, I learned that we’re going to lose about 80,000 primary care providers in the next five years, which is a horrifying figure. For a system that’s already scrunched with the providers available, we’re finding that a lot of patients are going to specialists for their primary care and bypassing their primary care provider. Do you find or are you finding that patients are … you are their first entry into the healthcare system? Has that changed over the last couple years? And how do you imagine that is going to affect patient outcomes where the specialist is serving as that primary care? Or are you experiencing that at all?

Dr. Mark Pimentel:
So I’m at really high, not high level. I don’t mean to say that in an arrogant way, but you can’t see me without seeing a gastroenterologist. So I’m not the perfect person to experience that. But we do see that a lot from our patients where they’re using their subspecialist as their primary care physician. And maybe it’s happened more in COVID because the patients don’t want to see 10 different doctors for their illness. They want to try and do a one touch with a physician in order to prevent their exposure as well. But, but there is a pattern towards shifting away from primary care. I’ve seen it over 25 years of practice that that’s happening here in the US, as well, in addition to the pandemic. So that is true.

Brittany Morin-Mezzadri:
I guess maybe not you, specifically, but from your subspecialists and from hearing from your colleagues, is that to the benefit of medical care and development? Or is that slowing the process down? How is that affecting patient care?

Dr. Mark Pimentel:
Well, I have to say sometimes I really like the primary care physician because they act as the hub, the coordinator for all the subspecialists. This is very important in patients with multiple illnesses or multiple problems. Multi-system problems is what I really mean to say. But if they have a single problem and a single system, then maybe it is more cost effective just to see the gastroenterologist in my case because the primary care may not have their answer, and then they’ve got to touch two points to get to their answer. So it just depends on how complicated the patient is. But I always like a primary care when it comes to multisystem problems.

Justin Steinman:
Let’s go down that path a little bit more, Mark, because I think it’s really something interesting that you touched on it, right? So many patients, particularly in the Medicare population, are scared of going to their outpatient appointments. Let’s talk about my parents for a second who are terrified of still going out, even though they’ve all had all of their shots. And I’ve read recently in a survey from the Urban Institute that 11% of adults said that “worries about coronavirus had caused them to skip a primary care visit in the past 30 days.” So we all know what happens when you miss primary care, right? Suddenly the very minor problem that your primary care physician could diagnose and treat instantly left untreated becomes a bigger problem. And then somebody who may not have needed to see you, ultimately does wind up seeing you for a very serious medical condition. How do we think we get these people back into this system? Is it marketing? Do we need to have different outreaches? Do we need to put the old doctor on the street doing house visits again? How do we think about this?

Dr. Mark Pimentel:
Yeah, I think primary care is critical to … Primary care, the way I see it, is their number one job is prevention. Their number two job is guiding the patient in the right direction in terms of, yeah, right, it could be just a slight adjustment in medication. You don’t need to see the gastroenterologist or a cardiologist. It’s a slight adjustment. Big decisions probably need to be made by the specialist. But it’s that “tweaking” as I call it, that the primary care is really good at and can mitigate cost. But also, the other thing I like about primary care is that relationship with the patient, gaining their trust, and making sure that they’re doing all the things they need to do to maintain their health.

Justin Steinman:
I want to come back to something that you said about five minutes ago, or I think we went down an interesting tangent, but I want to … went down an interesting path, but I want to come back and talk about this, which is we are creating a bulge, if you will, of people coming back to get care in this system. So demand is going up. And then as you pointed out, supply of medical providers is going down. That seems like a really dangerous combination. What do we do? How do we fix this? How can we address this? Is it even addressable?

Dr. Mark Pimentel:
Well, I was talking to my colleague the other day and I said, “So here we are, and I wasn’t touched with COVID in the way that ICU doctors or pulmonologists were. But we were all affected.” We were all working extra hard; and so, we basically worked overtime during COVID. And now when it comes out of COVID, we don’t get a break. We were working overtime again to catch up. And physician burnout, nursing burnout, even more so because the nurses are really touching the patients directly who have COVID and they’re in there, in the trenches. It’s just, the burnout is a problem. I don’t know that there’s a solution. You know? I really don’t know. I think you’re right. There isn’t a one answer. We can’t just make more medical doctors. We can’t just make more nurses. It doesn’t quite work that way. Or it takes up to a decade to fix that problem. So I don’t know. I hope that the burnout resolves and everything gets back to normal quickly,

Justin Steinman:
I saw it. It’s a little scary step, but we’re roughly going to be short a million nurses this year.

Dr. Mark Pimentel:
Yeah.

Justin Steinman:
Based on the need in the country for what we have. And you’re right. We can’t just roll them off the assembly. We got to train them, get them through the school systems. We can’t address that instantaneously.

Dr. Mark Pimentel:
The other costs to the system is you get traveling nurses. And traveling nurses cost almost twice as much as a nurse that’s employed at your institution. And a lot of institutions are relying on these. So it all amounts to more costs for healthcare.

Justin Steinman:
It is interesting. I was reading about these traveling nurses. There was an article, and I saw that a lot of them are leaving the rural parts of the country to go to the cities where they can get paid really large sums of money as a traveling nurses. So what’s happening is you’re finding these rural communities really severely understaffed for nurses because people are following the money, so to speak. And so you’ve got a real problem in these communities, which already are underserved.

Dr. Mark Pimentel:
Well, that’s what I was getting to is that we did okay in COVID, I feel, because preparation and all of that. But some of these smaller cities in towns where they live on the edge in terms of the number of nurses and physicians, I honestly don’t know how they did. It must have been the greatest challenge of their life.

Justin Steinman:
So let’s look at another angle here, which is around the cost of care. So the job market is certainly heating up across the country. We all see that all the time. But there are still many people struggling to afford care. According to NPR, 17% of US households reported serious problems in the last 30 days affording their medical care. So what do people do? They push it out until the situation becomes critical, which means unfortunately, they wind up in the ER, as adding additional costs to the healthcare system, which is greater than if they’d preventatively taken care of the situation. Meanwhile, you’ve got healthcare insurance companies reporting record levels of NBR and profitability because I guess, as I mentioned earlier, all these delayed procedures are more expensive than the costs of treating some of these COVID patients. Do you think the insurance industry has an obligation to deploy some of their savings back to alleviate the other cost pressures in healthcare?

Dr. Mark Pimentel:
This is a serious problem. It’s really hard to get insurance companies to do those sorts of things. But I suspect there’ll be some mandates that are above our pay grade in order to get the insurance companies to say, look, we need to cover these things. So I do believe that’s going to happen and that should happen. But I just don’t know the mechanism. I suspect it’ll be political rather than any kind of negotiation between hospitals and insurers.

Justin Steinman:
Yeah. It’s definitely above my pay grade, too.

Dr. Mark Pimentel:
Yeah.

Justin Steinman:
I think it’s a really interesting question to think about.

Dr. Mark Pimentel:
Oh, it absolutely is. I just don’t know … Insurance companies are quite stalwart in the way they handle things and they may be resistant to that notion, but they may be provoked to respond.

Justin Steinman:
Yeah. I think there’s just no question that we have to do something about the cost in the healthcare system to make it more affordable.

Dr. Mark Pimentel:
Yeah.

Justin Steinman:
I’m not necessarily sure we need to go to a Canadian system.

Dr. Mark Pimentel:
No.

Justin Steinman:
But I think the current system that we have is probably untenable.

Dr. Mark Pimentel:
Yeah. So having been to Canada, even during the pandemic, I think Canada has a great system, good access for a lot of patients. But it felt something during this pandemic that may actually, if smarter minds … Once the pandemic’s over, everybody says, “Okay, back to normal.” But what they should do is learn and say, look, our system is so on the razor’s edge and can’t handle much pressure. And it didn’t. I think they need to learn, too, that their system is just living on a knife’s edge. Our system may be too expensive. And maybe there’s a happy middle.

Justin Steinman:
As we’re exploring other angles of this, I feel there’s also a little bit of a socioeconomic angle to this situation. According to that same survey from the Robert Wood Johnson Foundation, Hispanic, Latinx, and black adults delayed care at nearly twice the rate of white adults: 16.2% versus 8.7% during the pandemic. Do you have any insight into what’s driving that disparity or how we could bring that 16% down to a more reasonable figure?

Dr. Mark Pimentel:
Well, I think, like you said earlier, it’s just disparities in the communities in which they live. They’re the populations who are less affluent. Are having community hospitals that are less capable, perhaps, and are responding in a different way and maybe not as well as other hospitals. And so, it’s affecting these underserved populations and minority populations much greater than it is more affluent parts of the country and parts of those cities.

Dr. Mark Pimentel:
Again, it’s not an easy fix, but we have to do something. We have to be able to … everybody needs to have equitable healthcare. It has to be equitable. It’s not … I guess, I may be political in saying it’s, it should be a … It shouldn’t be purchased. It’s got to … You’re a human, I’m a human, we’re all equal and we should have equal access to healthcare. And I don’t know that … Again, that’s a political problem to solve and a socioeconomic problem to solve and a racial problem to solve. But coming again from Canada’s perspective, it’s not perfect, either, but it’s more equitable because everybody has access in a socialized system. But here, it’s challenging because it’s got a lot to do with how much money you make and what kind of insurance you have and where you live; and unfortunately, that creates barriers to care.

Justin Steinman:
I couldn’t agree more strongly with you. It’s one of those things and kinds of problems that keeps me up at night. And it’s one, I think, that we’re going to have to really have across industry, across functional, across political party, across everything to solve.

Dr. Mark Pimentel:
I remember when I was training in Canada, again, bringing that up, we were in the Emergency room and there were seven people in bays and one of them was a member of Parliament. And I can tell you, we did not treat that person quicker than anybody else in the bays who was treated according to … and I was surprised, even as a resident. I was surprised at how that system operated. They didn’t get VIP. It was who was sicker, that’s who got the first doctor standing by the bedside. So that’s how I’d like to see everything.

Brittany Morin-Mezzadri:
I had a conversation with one of our clients recently and it was an absolutely fascinating conversation. And she pointed to her research that, obviously, we’re in a market driven society and that healthcare is driving towards building new locations and new services in more commercially populous areas. That there’s no financial incentive to build in rural communities. That they want to build where there are more commercial patients. And I’m interested to see how, as a society, how we address that. How do we make sure that people have healthcare access and that it is equitable regardless of your zip code and regardless of your proximity to these major teaching and research hubs? So that folks in rural Texas have the same access to quality healthcare that I do in Massachusetts or that your family does in Los Angeles.

Dr. Mark Pimentel:
Well, I want to take it in two ways. I want to look at the doom and gloom side of it, and then look at a little bit of the rainbow side of it. So some interesting things are happening in California, for example. So this is the rainbow side of it. Kaiser Permanente, for example, has a lot of outreach. In fact, some people say it’s almost 50% of healthcare lives are now managed by Kaiser in California. Cedar-Sinai is expanding and broadening its outreach with multiple facilities around the state. UCLA also. And so there’s starting to be satellite Cedar-Sinai operations in under serviced parts of the city and in parts of the city where they can’t have access to the Cedar-Sinai. And same is happening for Kaiser and so forth. And the quality of care is maintained across the system to try and keep things equal.

Dr. Mark Pimentel:
And I think maybe that’s a future rainbow. Maybe that’s how things should evolve. On the flip side, and I’m take a real left, sharp, left turn. Psychiatry’s gone. Where is psychiatry? Psychiatry is not being … There’s very few psychiatrists. It’s too expensive. It results in homelessness because patients can’t get medications and they can’t get the care they need. And so, we have a huge problem in Los Angeles with people with mental illness who are homeless and on the streets. And where are the facilities? That’s going to take some big, smart decision making.

Brittany Morin-Mezzadri:
Who makes that decision? Who are those smart decision makers that we need for that?

Dr. Mark Pimentel:
Well, I think it’s going to be a combination of the public and saying, look, we see the problem. We see it every day when we drive to work and not … We’re sympathetic to the problem. And we need to pressure our politicians to say, make the big decisions. Let’s build the right outpatient facilities, inpatient facilities, whatever’s needed to get the proper medication or the proper management of patients. And that’s just an example. But there’s a lot of other problems that need that kind of big solution.

Justin Steinman:
This whole pandemic related and care, it’s really, it’s a multifaceted problem and a lot of different impacts. And in my course of my research, I started to wonder a little bit about blood and blood donations. And so I went on the American Red Cross site and I saw that the number of people who donated blood over the course of 2021 was 10% lower than it was in any year prior to the pandemic starting. And blood drives at schools and colleges, which I think are some of the biggest blood donation sites that are out there, decreased by a whopping 62%. So what happens if we don’t address this blood shortage?

Dr. Mark Pimentel:
Yeah. What’s remarkable about what you said is that the blood drives, the school and colleges are down by 60% … and were only down by 10%. So that’s pretty remarkable. So there are people stepping up to fill that gap, realizing the importance of it. But you’re right. In the end, the equation is still a 10% drop and that needs to be filled in. Maybe when schools are back online and everything.

Dr. Mark Pimentel:
But I can tell you a personal experience from patients is that they are worried about donating their blood. What if I give COVID to somebody? What if it came from me? There’s that side of it. There’s also the fear of coming to the hospital and donating in the course of a pandemic. So less surgeries, you need less blood, also. But this, again, this bubble that you referred to earlier in the podcast, it’s coming. So that bubble may need more blood than we ever needed before we do major surgeries that have been postponed. So hopefully, kids are back in school. These things start up again and we can stay on top of it. But again, time will tell.

Justin Steinman:
So Mark, thanks for your time today. We’ve covered a lot of ground on a very serious topic. And I know both Brittany and I appreciate your insights. Before we go, I got one last question for you. As we’ve talked about, COVID exposed a lot of fragility in our healthcare system. How do we prepare for the next pandemic or serious natural disaster, to ensure that we have enough capacity in our healthcare system, to ensure that everyone who needs care can get care?

Dr. Mark Pimentel:
So again, I’d like to be the optimist and the rainbow person. When we talk about the pandemic of 1917, we hardly had oxygen. We hardly had any kind of therapeutics and we didn’t publish a lot back then. The descriptions of the pandemic were quite clear and we were able to learn much. But we learned a hell of a lot from this pandemic. More than we … the number of publications is in the tens of thousands. So I think the people who study health policy, project things, will be much better prepared for the next pandemic, but we have to do the work. Take all that information and roll it in a bundle and be more ready than we ever were because it could be worse the next time. We don’t know. But I like to think that the scientists have gathered more information.

Dr. Mark Pimentel:
It’s amazing to me that a vaccine was developed in the almost amazing period of time of just a few months. So that was, couldn’t be done in 1917. So maybe we’re better prepared. Maybe now that we have better techniques for vaccine development, that we can be more nimble and be ready. Of course, that remains to be determined. But I think, from a healthcare implementation policy, from the point of view of being ready with the right number of beds and the right number, it all depends on the pandemic and how big it is and how it’s affecting us. So I don’t know if I’ve even answered your question. But I think, I’d like to look at it on the positive side on the end note of this podcast because I think we’ve learned a lot and hopefully it informs us for the next time.

Justin Steinman:
Wow. Well, so Mark, that was a really interesting answer and pretty insightful. I really admired your optimistic and positive attitude throughout this entire conversation, given the enormity of the challenges that we as a country are facing, and you as a medical practitioner are facing, in dealing with this upcoming surge related to the pandemic delays in care. So again, thank you very much taking the time to join us today. I learned a lot and I’m sure Brittany did as well.

Brittany Morin-Mezzadri:
Yes. Thank you so much.

Dr. Mark Pimentel:
It’s absolutely my pleasure. It’s been a great time talking to you.

Justin Steinman:
Thanks for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a special afterward episode where Brittany, Todd, and I will dive deeper into the topic of COVID-related delays in care and what Dr. Pimentel shared in today episode. Then join me in two weeks for a conversation with Kamal Gogineni, Dr. Rakesh Patel, from Invitae, a leading medical genetics company. The three of us will be discussing genetic testing. What it is, what to do with all the data that’s generating, and whether genetic testing is something that you should consider as part of your personal healthcare regimen. If you like what you’ve heard today, please remember to rate, review, and subscribe to the show on Apple, Google, Spotify, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, follow us on Twitter @DefinitiveHC, or visit us at: definitivehc.com. Until next time, take care, and please stay healthy.