Berkshire Hathaway Specialty Insurance-sponsored Business Insurance Risk Perspective

What's ahead for the healthcare industry?

Recovery is happening while risk awareness intensifies

By Leo Carroll, Head of US Healthcare, Berkshire Hathaway Specialty Insurance

Difficult experiences during the COVID-19 pandemic will be long remembered, particularly if you work in the healthcare industry. Among the positive things we can take forward from the pandemic is greater awareness of health risks — personally as well as for clinicians and caregivers. This awareness is unlikely to fade.

Now that light is appearing at the end of a long tunnel, and we hope the worst parts of the pandemic are behind us, more healthcare practitioners are returning their attention to other conditions. At the same time, they are more aware of the risks that exist in different care settings, from acute-care hospitals to ambulatory clinics to senior living facilities.

Risks need to be managed

Recovery from the pandemic will happen, and risk awareness will intensify. Risk mitigation, meanwhile, remains an ongoing task amid healthcare trends that include:

Return in patient volume. Even before the pandemic, U.S. hospitals handled an enormous number of patients. According to the Agency for Healthcare Research and Quality, there were 143.5 million emergency department visits in 2018, 14% of which resulted in a hospital admission. AHRQ data for the most recent year available on inpatient admissions showed nearly 36 million hospital stays, with an average length of 4.6 days, in 2016.

There was a significant decrease in hospitalizations for non-COVID-19 cases during 2020. A Kaiser Family Foundation analysis found that, as coronavirus cases surged, hospital admissions for patients with non-COVID conditions declined. In November 2020, for example, non-COVID hospitalizations nationally were 80% of the expected number.

But the recovery in patient volume is well underway. An analysis by Vizient forecasts that both outpatient and inpatient visits will exceed pre-pandemic levels sometime in 2022 and will continue to increase through 2029, with a decline in emergency department visits as alternative, outpatient care settings proliferate.

As non-pandemic patient volume returns, especially for those who might have deferred routine care or whose underlying conditions worsened during the past two years, clinicians are refocusing on improving treatment efficiency while maintaining patient safety.

Continuing staff shortages. The surge in pandemic cases led to staff shortages at many hospitals across the United States in 2020 and 2021. As of January 2021, in 40 states, 10% or more of their hospitals reported staff shortages. In New Mexico, Rhode Island, Vermont and West Virginia, at least 41% of hospitals suffered from staff shortages. Adequate healthcare staffing is an ongoing, long-term problem in virtually every care setting, from hospitals to ambulatory facilities to senior living. Employee turnover remains high, which means healthcare organizations are incurring higher costs for recruiting and training. A large number of experienced clinicians also retired, left the field, or changed roles during the pandemic, and it will take years to fill the gaps they left behind.

Ongoing care transitions. For many patients, the course of treatment can involve clinical "handoffs," or care transitions. This is particularly common for the elderly, who may be treated in multiple care settings — such as moving from a residential senior living facility to a hospital, to a rehabilitation center, and back to residential care. Each of these brings a transition, with different healthcare providers involved who need a seamless understanding of the patient's condition and treatment plan. Every transition raises risk for caregivers, from miscommunications about patient needs, to medication errors, patient falls and even elopement.

Addressing population health. Maintaining the health of patients across various demographics and managing co-morbidities is becoming more complex, especially for those patients who deferred care for non-COVID conditions during the pandemic. The Centers for Disease Control and Prevention estimates that six in 10 Americans suffer from chronic disease, such as heart disease, diabetes, or cancer. Improving outcomes and reducing the distribution of chronic disease in various populations are critical steps in increasing overall health.

Looking ahead with reasons for hope

What carried the healthcare industry through the past two years can also keep it moving forward. Healthcare practitioners and caregivers in all settings demonstrated an admirable dedication to their mission, and they helped many patients get through an extremely difficult time. Supply-chain challenges and staff shortages in the middle of a public health emergency tested providers, and these hurdles are part of an ongoing recovery from the pandemic.

There are good reasons providers can stay hopeful as they look to the future. Recovery is happening, awareness of health risks is greater now among patients, and providers can better connect and partner with patients as a result. A deeper understanding of healthcare risks and the value of strong partnerships will improve risk management practices, for the benefit of the entire industry and those it serves.

For more information about healthcare risk management solutions and resources, please visit:


Leo Carroll is Head of US Healthcare at Berkshire Hathaway Specialty Insurance. He is responsible for the strategic growth and performance of the group's Healthcare Professional Liability products.

Berkshire Hathaway Specialty Insurance ( provides commercial property, casualty, healthcare professional liability, executive and professional lines, transactional liability, surety, marine, travel, programs, accident and health, medical stop loss, homeowners, and multinational insurance. The actual and final terms of coverage for all product lines may vary. It underwrites on the paper of Berkshire Hathaway's National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor's. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Houston, Indianapolis, Irvine, Los Angeles, New York, San Francisco, San Ramon, Seattle, Stevens Point, Adelaide, Auckland, Brisbane, Cologne, Dubai, Dublin, Frankfurt, Hong Kong, Kuala Lumpur, London, Macau, Madrid, Manchester, Melbourne, Munich, Paris, Perth, Singapore, Sydney and Toronto.

The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.

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