Letter to the Editor: A Conversation with … Natasha Parekh MD, MS-Expert on Waste and Fraud in the US Healthcare System.

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To the Editor, In mid-January 2020, as COVID-19 began to spread across China, Clinical Orthopaedics and Related Research® published an editorial feature on waste and fraud in the United States healthcare system [5]. The author, Seth S. Leopold MD, described his interviewee, Natasha Parekh MD, MS, as a “firefighter” in this system and an expert on the inefficiency and redundant management in health care today. In the interview, Dr. Parekh offered insightful remedies for waste and fraud in the healthcare system. Although written just last year, that editorial feature feels of a different time—one that was mostly free of COVID-19. Today, it’s much harder to “take a real bite out of a trillion-dollar problem” [5] when there is an even bigger problem facing all of us. In the last year, we’ve learned much more about how to diagnose and treat patients with COVID-19. Unfortunately, the impact of this pandemic on healthcare systems worldwide has yet to be determined. In particular, the impact on the viability of centers and practices that deliver elective-surgery care is extremely uncertain. Vaccaro et al. [10] found that many small and mid-sized orthopaedic groups would struggle to stay open under lockdown conditions. Therefore, we need more evidence-based practices and operational plans that guide practices and hospital systems as they seek to continue to deliver high-quality, safe, and sustainable care during the pandemic. In many parts of the world, we have insufficient numbers of the types of providers that are needed to care for the number of patients who are desperately ill with COVID-19—intensive care unit physicians, respiratory therapists, critical-care nurses—and there is no easy fix for this. This problem creates uncertainty for providers who care and the hospital systems in which they work, and it can cause excess harm and death to their patients. China’s healthcare system adapted well and successfully controlled the first wave of COVID-19 in 2020. But our physicians were dealing with loss every day and it took its toll. In a recent CORR editorial, two orthopaedic surgeons in two tertiary hospitals in Wuhan, China sent “postcards from war zones,” describing their personal experiences combating COVID-19 [6]. Their heartbreaking stories of loss and perseverance will stay with you. In setting up for a long-term fight against COVID-19, secondary and tertiary healthcare facilities may be mobilized differently than in 2020 [1]. In early 2020, tertiary hospitals such as Tongji Hospital in Wuhan [7] were mainly responsible for all those with COVID-19 in China. Back then, being admitted to those tertiary hospitals seemed to be the final hope for patients with COVID-19. Today, the focus in China has shifted from treatment to early detection. Therefore, our regional hospitals (also known as our district hospitals), will play a larger role in the fight against COVID-19 in the years ahead [8]. In addition, gastrointestinal surgeons from eight tertiary hospitals in China shared their experience against COVID-19 and came to a consensus on how to maintain reliable surgery services during the pandemic [4]. A COVID-19 task force responsible for resource coordination and administration is recommended for each center. Once the task forces are available, gastrointestinal surgeons should adjust their healthcare services to patients stratified by risk assessment [4]. By doing this, we can provide a sustainable healthcare system in response to increasing expenditures and financing pressure caused by COVID-19 [2, 3]. The Chinese healthcare system will likely prioritize the recruitment of candidates who will be fighting COVID-19 for years to come. For example, we are seeing increased recruitment for Master’s and PhD candidates in clinical medicine and public heath fields [11]. We also anticipate higher recruitment levels in professions like anesthesiology, pediatrics, infectious diseases, and for those working intensive care units [9]. Therefore, additional financial support for medical education will be needed.