COVID-19 Pandemic Brought Changes, Requiring Significant Adjustments in Health Systems


Pandemic-related growing pains were common within health care, bringing unique challenges for health systems.

Busy hospital scene -- Image credit: Kurosch |

Image credit: Kurosch |

Oncology health systems and the workforce have changed significantly since the COVID-19 pandemic, explained session moderator Alyssa Schatz, MSW, senior director of policy and advocacy, National Comprehensive Cancer Network (NCCN), during a panel discussion at the NCCN Annual 2024 Conference in Orlando, Florida. Although the effects of COVID-19 have differed between medical centers, the panelists all agreed that the pandemic brought change and economic strain to health systems, health care workers, and patients, prompting necessary adjustments to provide proper care for patients.

When discussing initial changes related to the pandemic, panelist Maria M. Gonzalez, MPH, BS, vice president, cancer service line, Stanford Cancer Institute, noted her institution experienced challenges in balancing decreased reimbursement and budget strains while maintaining a health workforce. She discussed the importance of addressing the economic pressures and increasing personnel costs in order to provide higher wages for employees, despite the pandemic-induced strains on health care. Further, Gonzalez also emphasized the initial difficulties her institution experienced when switching to a hybrid model work environment.

“I think something that we've struggled with is the remote hybrid workforce. That has been increasingly a burden on leaders to manage. We also have dealt with patient complaints, because as we've come back [from a hybrid setting], we've had some care coordination challenges,” said Gonzalez during the panel. “Patients are on-site, staff are remote, and then the impact that the staff on-site carry to essentially counterbalance that…[they ultimately] feel less supported… We're imbalanced and, [in] certain areas, the staffing has changed pretty dramatically.”

Panelist Lawrence N. Shulman, MD, MACP, professor of medicine and director, Center for Global Medicine, Abramson Cancer Center, University of Pennsylvania, echoed this sentiment for his institution. He also noted the importance of learning how to staff differently both during the pandemic and when transitioning back to in-person care, while also accommodating patients with how health care workers deliver care and maintain efficiency.

“The strain on clinicians during COVID-19 was extreme. And I think we need to remember back to those times. It almost seems like a distant past, but it's not, and [our clinicians have] come out of that to a whole new set of strains and a whole new set of factors that are affecting their lives, and it's really hard on them. I think…it's a personal factor there, aside from just the financial factors,” said Shulman during the panel.

In addition to the stress experienced by health care workers, the panelists emphasized the financial factors and strains on health systems as a result of the pandemic. Panelist Richard J. Bold, MD, MBA, professor of surgical oncology and endocrine surgery, Mayo Clinic Comprehensive Cancer Center, highlighted the pressure health systems experienced when balancing revenues and expenses after the pandemic. He explained that in order to effectively cover these expenses and maintain a margin, he needed to either reduce expenses or address revenues; however, unique pressures exist on both sides of this approach. Notably, Bold explained there are difficulties when addressing expenses due to more personnel and price increases while recovering from the COVID-19 pandemic, especially when margins were suffering during this time.

Furthermore, Schatz addressed that payers who are trying to balance their own revenues use various utilization management strategies to successfully do so; however, this only places more pressure on centers, patients, and health care providers. According to the panelists, there is often push and pull between the 3 groups when it comes to care delivery because of the discrepancies or differing opinions between the parties. For example, Bold explained that a payer sometimes likes to make changes in the health care system’s delivery model, which may pressure systems to move sites of care between settings (eg, hospital to outpatient), which be misaligned with the providers’ and their patients’ perspectives on their care.

“That tension, I think, is more acute now than it has ever been, in which we're feeling that we are losing our autonomy and our independence on what we think is best for patient care because [they] have their own perspective,” said Bold.

The impact of COVID-19 also forced health systems to adjust how care is provided for patients, and virtual telemedicine appointments are likely the biggest change that resulted from the pandemic, according to Gonzalez. She explained further that Stanford continues to provide online appointments as an option for patients, of which 40% of the daily patient visits are virtual. Shulman countered this by noting that Abramson no longer supports telehealth appointments. According to Shulman, after making the adjustment, the option was downscaled, and care was reverted back to primarily in-person visits to cater to the patients located within the city; however, Shulman said that the virtual option is still open for patients living out of state, most notably New Jersey and Delaware.

“[On a personal note], I have 2 extremes in my family: my mother in her eighties who looks forward to going in [for her appointments], to talk to her doctor…if you offer her a video visit, she'll decline. My daughter, on the other end, never wants to go in a physician's office, and wants a video visit every time,” said Bold during the panel. “So now, we are really expanding our methods of care delivery and meeting [patients where they are]…and we'll work out how to coordinate [with them]. [Rather than] throwing out the resources, expanding that repertoire of care delivery models, I think, is going to be part of our future and probably going to be even further expanded.”

The panelists also emphasized that an oncology service line model to enhance patient care and empower patients may be necessary in helping their care journey. As someone who works within this model, Gonzalez explained that the model allows the health system to operate with a broader view, collaborating with 16 different departments or divisions. The service tool embedded into this model allows for strategic investment decisions which elevate all the departments and divisions within the system.

“One thing I would say—and this is sort of a trite quip—but you can do something differently, or you can do a different thing…and this [model] is sort of breaking the old mold and doing something that's really quite different,” said Shulman.


Schatz, A, Bold, RJ, Gonzalez, MM, Shulman, LN. Changing Economics in Cancer Care: Optimizing Resources and Strategic Tactics to Improve Patient Outcomes and Protect the Workforce. Presented at: National Comprehensive Cancer Network Annual 2024 Conference; Orlando, Florida; April 5-7, 2024.
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