How to Keep Care—and Hospital Revenue—Going During a Pandemic
COVID-19 is scary and unpredictable for everyone, including healthcare providers. The brave frontline clinicians putting their health and safety at risk to treat COVID-19 patients are heroes and deserve all of the commendations they have been receiving—and then some.
What is unfortunate, however, is that while so many clinicians have worked tirelessly in full facilities, many waited—or are still waiting—for a surge in nearly empty buildings with ample inventories of ventilators and personal protective equipment (PPE).
Meanwhile, hospitals across the country suffered a brutal month financially in April, as steep volume and revenue declines drove record-poor margin performance—setting the stage for not only a difficult recovery, but a permanently changed healthcare delivery environment, according to Kaufman Hall. Operating margins fell 174% in April compared to the same period last year and were down 118% from March, as hospitals felt the first full month of COVID-19’s impacts. These financial challenges, which are ongoing, have resulted in pay cuts, furloughs and permanent layoffs at hospitals across the country.
One factor that has magnified these financial problems was the early decision by many states to issue mandates to discontinue elective procedures. While some states are beginning to allow elective procedures again, in many cases the damage is already done due to an unnecessary pause in these services during the past few months.
Certainly, many patients had already canceled or would have canceled elective surgeries and other procedures to avoid visiting a healthcare facility, but others who have been waiting weeks or months to receive a procedure to potentially improve their lives or eliminate chronic pain or other issues would have jumped at the chance to have their procedures done as scheduled. Keep in mind that many procedures labeled “elective” are still medically necessary.
The widespread cost-cutting measures taking place now could have been avoided with broader-scale planning and coordination between health systems with specialty centers and the community hospitals that refer patients to them. Certainly, treating patients with COVID-19 and preventing the spread of the virus should be the top priority. Yet with better visibility into available beds, provider capacity, PPE and equipment availability and some creative thinking, more non-COVID 19 patients could have safely received needed care while allowing elective procedures to proceed—which could have stemmed significant financial losses for healthcare organizations.
Too many empty beds
Before COVID-19 became a major issue in the United States, we witnessed how hospitals and health systems in China, Italy and Spain were overrun with patients. Then when the first surge occurred in the New York City area, many states and communities were expecting the worst, too.
Since we had never faced anything like COVID-19 before, many hospitals and health systems were ordered to stop elective surgeries and other types of non-emergency care to conserve PPE and to prepare for anticipated surges of patients. However, in many states, that hasn’t happened yet. For example, a field hospital that was scheduled to be built in a suburban Detroit convention center was scaled from 1,100 beds to 250 due to fewer than anticipated cases. Such outcomes are likely evidence that stay-at-home orders and social distancing practices have been effective.
At the same time, however, due to the elective procedure restriction, hospitals and health systems are expected to lose nearly $51 billion a month through June 30, according to the American Hospital Association.
These organizations were already cash-strapped before COVID-19 and cannot afford to incur such losses, even with financial assistance from the federal government—which, by the way, may not cover the cost of care for the COVID-19 patients.
At the same time, while many clinicians worked seemingly endless shifts, others were laid off. The healthcare industry, consistently a job-creating sector, lost 448,000 jobs in April, not including dentists, and particularly hard hit were ambulatory services. Health systems in some states were waiting several weeks for a possible surge in COVID-19 cases and were unable to deliver most care unrelated to the pandemic.
What should have been done
The state mandates to discontinue elective surgeries may have been prudent in some cases (and still are where surges are occurring)—but likely not across entire states at the same time. Some states issued the restrictions well before they were necessary. Here’s how we could have maintained access to non-COVID procedures—and still can—while delivering safe and effective care to patients with COVID-19.
1. Shift resources
Cohorting COVID-19 patients to a designated facility, department or temporary setting certainly protects other patients and clinicians. Health systems often have many facilities across large geographic areas. A network-wide perspective of vacant beds, surgical suites and provider availability can give health systems the critical information they need to create dedicated facilities for elective procedures, separate from patients with suspected or confirmed COVID-19. Granted, some procedures can only be performed in a designated facility for safety and compliance reasons, but real-time network-wide visibility into resources can give health systems the information they needed to be nimble and adjust operations as the conditions demand.
2. Partner with referring hospitals
Health systems with centers of excellence (COE) for stroke or trauma often admit patients from a large geographic area, typically after a referral from a physician in a community hospital that lacks specialty physicians or equipment. These referral networks could be leveraged during COVID-19 for “reverse” transfers, where a health system would send a patient back to the community hospital for an elective procedure and have the COE physicians and any needed equipment travel there so the procedure could be performed. Using this strategy, the health system and the community hospital could share in the revenue and the patient would not need to wait even longer for surgery.
3. Drop the competitive boundaries
Some states—such as Arizona—are uniting all hospitals and health systems, including competitors, through a single access center during the pandemic to ensure an adequate number of beds, providers, equipment and supplies of PPE. These access centers provide real-time updates on capacity so decisions to transfer patients are made quickly and patient loads are balanced between hospitals. By having this information at their fingertips, health systems across the state can make data-driven decisions about whether elective surgeries and other procedures should be canceled or postponed. In Arizona, given the surge in patients they have been facing in the month of June, it makes sense to do so in some cases.
In addition, why stop at state borders? When one metropolitan area experiences a surge, there are likely many empty beds and vacant surgical suites in other states waiting for a surge that has already happened or might not occur for weeks. Thousands of airline flights are still taking off every day. If patients are willing to travel, they could be tested for COVID-19 before travel and upon arrival. If negative, the surgery could occur as planned.
A timely, broad perspective into facility capacity and provider availability is necessary to make these clinical decisions. Unfortunately, too many health systems operate in siloed environments, which means that identifying bed vacancies, equipment and PPE supplies and provider capacity involves many phone calls to multiple clinicians and departments. Other health systems have little or no visibility into patient transfer traffic or why transfers were canceled, which prevents them from identifying opportunities for improvement.
Lack of interoperability within health systems and across communities is a significant problem. Data is not effectively shared between organizations, so much so that the White House Coronavirus Task Force required hospitals and health systems to share information daily about capacity and utilization—not through automated data feeds and application integration, but rather through offline spreadsheets.
Leading health systems with network-wide access center capabilities are already automatically sharing this information through integrated platforms that offer real-time perspective into resources, while also communicating with relevant clinicians so that patients receive the care they need sooner. Eliminating the care access friction in this way also improves the experience for the providers trying to orchestrate care for their patients.
COVID-19 is an unprecedented public health crisis, but halting elective procedures was not necessary for everyone at the same time. Rational planning and orchestration could have maintained broader care access for patients and spared hospitals and health systems from making painful cost-cutting decisions that harmed valued employees.