Patients Wanted

Drastic reduction in patient population, layoffs, limited sources of revenue. How hospitals are managing one of the worst crises in the industry and what they are doing to recover from it

By Deborah Jeanne Sergeant

HospitalWhere have all sick patients gone? The good news for the hospitals is that they are coming back…very slowly.

While healthcare providers caring for COVID-19 patients have been busy throughout the pandemic, providers in other areas of hospitals, such as numerous surgeons and related personnel, had been on furlough.

The only surgeries permitted at hospitals during the pandemic were life- or limb-saving procedures or those that are time-dependent for positive outcomes.

As a result, hospitals have lost considerable revenue.

How much they have lost? According to a report released in May by the American Hospital Association, hospitals nationwide will have lost an estimated $202.6 billion from March 1 through June 30, an average of $50.7 billion monthly from direct and indirect effects of COVID-19.

While the related costs include expenses for COVID-19 hospitalizations — additional personal protective equipment and extra support for some hospital employees — a large portion of that loss is from canceled and delayed elective surgery. Ambulatory surgical centers have also experienced losses.

Moving personnel, such as nurses going from the surgical team to an acute care team, isn’t as easy as some might think because of specialization in nursing. As a result, hospitals’ typical personnel shortages were exacerbated during the worst part of the pandemic.

Some hospitals are considering options that could safely make an in-patient surgery an out-patient surgery to reduce the number of patients using hospital space and resources — especially since if the number of COVID-19 patients surges again, those beds will be needed.

Rescheduling patients isn’t easy, even outside of a healthcare system coping with a pandemic.

For hospitals and surgical centers, their economic survival may depend upon efficiently scheduling patients to both meet their healthcare needs and also generate much-needed income.

“Surgery is the economic engine of a hospital,” said Dorothy Urschel, doctor of nursing practice who heads the nurse practitioner program at Daemen College and serves as chief operating officer at Columbia Memorial Health near Albany. “We had to close some surgery sites and primary care sites.”

She calls the current situation ironic since hospitals must care for the sickest patients while they had to furlough some staff.

“Most hospitals look at their cash positioning and evaluate ‘How do we work together to make sure we’re financially healthy at the end of all this?’” Urschel said.

Early in the outbreak, she didn’t think surgical units would have to be shut down, as even during a bad flu season, surgeries continue. Urschel said that she felt “shock” as state and federal orders suspended elective surgery.

One big key is getting elective surgery patients back to the hospital for care. Many still feel concern over social distancing, especially in a medical setting. In general, they feel that visiting a hospital is a sure way to contract the coronavirus.

“We’re working with the community at large and developing a ‘marketing campaign’ to make sure they understand it’s a safe place to come back to,” Urschel said. “We need to make sure that we present ourselves as a hospital they trust. What we’re looking at is COVID awareness, preparing the patients and staff and the community at large and each patient issue to still deliver a high quality of care.”

Urschel also believes that it’s a good time for hospital administration to evaluate how they can improve their organizations and look at how they can manage resources better, grow and increase revenue.

In an April 23 release, Catholic Health’s president and CEO Mark Sullivan said that the organization’s leaders would take temporary salary cuts, but that wouldn’t be enough to make up the difference.

“Because we will not be able to resume full services at all our facilities for some time, we have made the extremely difficult decision to furlough associates throughout our system,” Sullivan said. “The steps we are taking are based on the needs of our system at this time and do not reflect our associates’ work performance, or the value we place on the care or services they provide. As always, high quality care and patient, resident, and associate safety remain our top priorities.”

The health system furloughed up to 1,200 management and non-management in its first phase.

“In times of crisis, we must make hard decisions to face the challenges before us, ensure we are able to meet the needs of our community, and provide for and protect our associates for the longterm,” Sullivan said.

On May 6, area hospitals were given the green light to resume elective surgeries.

Another area struggling is the emergency room.

In an April 25 statement, David Hughes, MD, chief medical officer at Kaleida Health, acknowledged that some people fear seeking medical care for health threats.

“We are still seeing people coming in with chest pains and stroke symptoms,” Hughes said, “just not the sheer volume that we had before. And there are some national statistics to show that people are staying away. We want people to seek care immediately if they are experiencing any signs or symptoms of a serious condition.”

At that time, Kaleida was receiving about half the normal emergency room visits.