What Does “The New Normal” Look Like for Acute Care?
Hospitals around the country have reached what one might consider an uneasy stabilization in regard to the influx of COVID-19 cases. For the most part, the United States has been able to avoid the widespread resource strain that was feared back in March, and most facilities have been able to delineate areas of the hospital designated for COVID patients and those designated for other patients.
Combined with all 50 states undergoing at least some form of an economic reopening, we’ve stepped into a new stage of combating the virus, one in which healthcare workers are tentatively looking ahead to what comes next. With elective procedures ramping back up and patients more comfortable with visiting their doctors, capacity is slowly filling back up.
However, this “new normal” is anything but, and how healthcare appears right now will look completely different from where we’re at two months from now. After conversing with some of our hospital contacts and researching the types of processes taking place, we have some takeaways about what acute care providers ought to do now and how they can plan for the future.
The big takeaway? That future might look unlike anything we’ve ever seen.
One thing that’s rapidly become apparent as hospitals bring their acute care teams fully back online: the ability to quickly adjust capacity on the fly will become one of the most important things a healthcare organization can accomplish moving forward.
With states and even individual cities opening up in a multitude of different ways, from careful removal of lockdown procedures with strict social distancing to throwing the doors wide open to all businesses, we can’t expect a uniform rate of COVID cases over time. Hot spots will ebb and flow, affecting different areas for differing lengths of time.
So even as you bring back elective procedures and return to the standard provision of care you were used to pre-COVID, you need policies in place that allow you to quickly rope in additional resources for COVID patients if and when there’s a spike in case numbers in your area.
This completely alters the hospital revenue landscape, where the prevailing wisdom has long been to maximize resources and not let anything go to waste. Now, however, you’ll need an excess supply of PPE, ventilators, other medical equipment and, importantly, beds. These might sit there unused for a long time, but when you need them, you’ll need them fast.
New policies will need to be created to manage an influx of patients, deploy equipment where needed and direct entire departments to different tasks. For many hospitals, this will mean getting creative with space and determining where they can keep an excess supply of materials.
One promising sign is CMS’s willingness to accommodate flexibility, chiefly through the newly deployed Hospitals Without Walls program. Recognizing that space in an acute care facility may be at a premium in the foreseeable future, CMS has basically said that they’ll extend reimbursement for acute care outside the hospital, eliminating a revenue hurdle that would have otherwise hindered appropriate provision of care when COVID cases exceed a hospital’s supply of resources.
Acute care facilities ought to work with post-acute care organizations, both inside and outside their preferred network, to determine if they have capacity to accept COVID and non-COVID patients when they themselves have reached capacity. This will require rapid deployment of personnel and equipment to those facilities, so again, you must carefully think about how this might work. But in a pandemic, when time is of the essence and you need to be able to add additional capacity fast, having a release valve in the form of rehab facilities, skilled nursing homes, behavioral health facilities, etc., is crucial.
The ability to communicate instantly between providers will become ever more important.
Reliance on your post-acute providers will be twofold: first, you need to know immediately if they’re able to accept recovering COVID patients who no longer need acute care, as getting those patients discharged fast will help you free up beds and resources and maximize your staff. Second, if and when you do experience a surge in patients, instant communication will enable you to quickly set up acute care in a non-traditional setting among those post-acute partners who are willing to offer up that service.
Given what we know about the ebb and flow of patients you may experience, having the capability of coordinating the successful transition of these patients between locations and between levels of acuity is more important than it’s ever been. You can’t do that relying on faxing and telephone calls, as those processes are too slow and eat up far too many resources.
It can only be accomplished with electronic communication between providers, which enables the quick acceptance of discharged patients and appropriate resource use at all levels.
Bringing Back Staff and Training Them Up
Hospitals that furloughed or let go of staff and need to rehire are beginning the process of bringing people back. But this is another tricky area, as you once again have to balance the need to earn profit with the reality of a surging and waning COVID-19 population. Balancing staffing capabilities with the needs of the incoming patient population may require rethinking your previous hiring practices.
We expect cross-training among departments and disciplines to become a lot more common as hospitals recognize the need to move clinical and non-clinical staff around the hospital to meet fluctuations in demand. Unfortunately, this could lead to some members of your team unable to work at top of license for periods of time, not the most ideal use of resources, but something that’s hard to avoid in this scenario.
Another consideration might be to rethink where your teams are located and how they work. We previously explored how some facilities are moving to a remote case management workforce, and we expect these kinds of broad reconsideration of previous policy to only grow more common.
And make sure that, at all times, staff is regularly trained on the newest policies. You may even have to hire some people exclusively to coordinate information and training among employees, knowing that up-to-date information can and will change regularly. Nowhere is this training more important than among new and furloughed staff, who will need to rapidly get up to speed on new infection control procedures, patient flow protocols and more.
Although most every hospital will have some form of crisis response and crisis communications plan in place, up until 2020, these processes probably didn’t get a huge amount of attention among many staff members.
That changes now. Crisis response will need to be baked into everything you do at your acute care facility. Annual trainings will no longer suffice. Within every aspect of your facility, and among every team member, there needs to be a strict understanding of the procedures that need to be followed in a number of plausible scenarios resulting from the outbreak of COVID-19.
What to do when employees contract the virus. What to do when ventilator space is limited. How to deal with a belligerent family member who won’t cooperate with new visitor policies.
These are just three scenarios playing out in hospitals all across the country. Healthcare teams are encountering emergencies faster than crisis experts can come up with the best ways to respond to them. We’re in brand new territory here, and having a nimble team that understands the protocols for a wide variety of common crises is essential. This will require additional training and probably some additional hires you never had to make before.
You may even find yourself working more closely with the public relations arm of your organization as they coach team members through how to respond to media inquiries, who should be appointed to speak to the press when a crisis situation present itself, and more.
The best thing you can do when leading your team is to have a plan in place, regularly regroup to study and update the plan, and be honest that normalcy is probably pretty far away.
Opening Doors, Closing Doors
Given the huge economic toll the coronavirus has taken on the country, acute care facilities also need to realize that many of their post-acute partners might not survive. Simultaneously, brand new facilities may spring up to take their place.
We’re already seeing how nursing homes, for example, can be decimated if they experience an outbreak of COVID-19 within their walls. Given the close quarters of residents, their medical needs and their at-risk status, the virus can spread rapidly at such facilities, devastating the population. This does a few things: it compromises that facility’s ability to provide care to current residents, limits their ability to accept new residents and risks creating a public backlash that makes acquiring new residents even more difficult, if not impossible.
That’s why there’s never been a better time to take a closer look at your preferred network and look at expansion possibilities. You may not be able to rely on organizations you’ve traditionally listed among patients’ potential discharge locations. If an outbreak happens, you need to quickly disperse that information to the relevant case management teams, and you need alternate options at the ready.
What’s more, you need to keep your ear to the ground and keep tabs on new facilities opening up that will be able to take your post-acute (and, in a Hospitals-Without-Walls world, acute) patients. Some hospitals are even spearheading this effort themselves, working with other leaders within their ACOs and umbrella institutions to create new post-acute and acute locations that fit their needs.
No one knows what happens next. For healthcare professionals who rely on certainty, that’s a scary thought. But one thing we do know is that things are changing, they’re changing fast, and you have to be nimble in order to change with them.
You can’t prepare for every eventuality, but you can prepare your team to expect the unexpected. You can create a system that anticipates change and is agile enough to adapt to that change. Processes may need to be adjusted on the fly, and everyone should go into this summer with the understanding that what healthcare looked like in 2019 will never again be what healthcare looks like. If you set this expectation now, you’ll have a much easier time getting through this than those institutions that insist on latching on to tried and true procedures that simply don’t work in the current environment.