With Hospitals Empty of Traditional Patients, What Happens When We Get Back “Normal?”

Hospitals are empty.

Empty in a way many never thought possible or expected. There are few, if any, elective surgeries taking place today as hospitals and health systems work to diagnose, treat and save those with coronavirus.

While the number of coronavirus cases increases across the U.S.—839,675 as of April 22, 2020—the traditional hospital patient has all but disappeared. As more coronavirus patients present to the ED or are admitted to the ICU, the patients who usually fill waiting rooms and surgical suites are disappearing.
Hospitals are empty of their everyday customers:

• Those with acute issues needing help in the ED.
• People looking to receive elective surgeries.
• Those who need transplants.

Many treatments received in hospitals, including elective surgeries, are mostly low risk for patients and come with high returns for the hospital. These surgeries—hip or knee replacements, for example—are canceled for the time being. No one knows when they might return.

“By this past Friday,” The Atlantic wrote on March 17 about a man who needed his gallbladder removed, “everything had changed. The doctor’s office called to say that his gallbladder-removal surgery would be postponed indefinitely.”

The Atlantic reported just over one month ago: “All over the country, patients are finding their non emergency surgical appointments canceled as hospitals prepare for a spike in coronavirus cases. Surgeries for early-stage cancer, joint replacements, epilepsy, and cataracts are all getting pushed back—to ration much-needed personal protective equipment, keep hospital beds open, and to shield patients from the virus.”

Several days before The Atlantic article was published, the American College of Surgeons issued guidance to its members recommending hospitals, health systems and surgeons should “thoughtfully review all scheduled elective procedures” and plan to postpone or cancel them altogether until it could be determined the healthcare system could handle the, at the time, potential influx of coronavirus patients.

The Centers for Medicare and Medicaid Services weighed in on April 7, outlining recommendations for elective surgeries saying, in part, it developed “a tiered framework…to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition.”

Even surgeries one might consider necessary have been put on hold for the time being. The coronavirus has affected even those waiting for organ transplants.

“The coronavirus epidemic has only heightened the significant risks and hoped-for benefits of transplant surgery,” writes Elizabeth Cooney at STAT. “Organ donations are down by a third and the health care system itself is in full-blown scarcity, triaging elective surgeries to some unknown future date so only emergency cases find their way into precious operating rooms and intensive care beds. As life-saving as they are, even many transplants are being put off.”

In addition, patients waiting for transplants can’t have the coronavirus, as many times they must take immunosuppressive medications prior to and following the transplant. And donors must not have the virus, as well.

Some patients are self-selecting and deciding not to receive treatment because of concerns about contracting the coronavirus while under care. A survey of nine hospitals found a 38% reduction in patients seeking treatment for heart attacks beginning March 1, leading the researchers to conclude these potential patients were avoiding “medical care due to social distancing or concerns of contracting COVID-19 in the hospital.”

Physicians are experiencing extremely difficult times, as well, although those who are part of healthcare systems are doing better financially than independents. The Medical Group Management Association (MGMA) polled its members and found on average they had a 55% decrease in revenue and a 60% decrease in patient volume since the start of the coronavirus crisis. In addition, many practices told MGMA they may be forced to lay off or furlough staff at high numbers, 36% and 60%, respectively, by May.

What Happens Next?

The challenge here is no one knows. As I write this, several states are partially “open” again. In Denver, you can play golf, but only when following very specific social distancing regulations. You can paddle in the surf at some Florida beaches. And in Georgia, you can bowl a few frames and get a haircut. If we’re slowly returning to our old, everyday lives and activities, will the same happen in healthcare?

What will happen in healthcare? Will there be a flood of elective surgeries? Will the number of transplants surge? If so, when?

Many seem to think the old normal will not become the new normal.

A two-year-old telemedicine study published in the Annals of Internal Medicine may contain a partial answer. The researchers looked at the effectiveness of an “e-consult” on five specialties and found they performed well in limiting the need for a follow-up visit within three months with an overall rate of slightly more than 81%. In addition, 94% of the “e-consults” were deemed appropriate after a review of medical records. And, of course, no face-to-face contact was necessary.

Ezekiel J. Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, told Politico: “For years, telemedicine has lingered on the sidelines as a cost-controlling, high convenience system. (S)taying home for a video call keeps you out of the transit system, out of the waiting room and, most importantly, away from patients who need critical care.”

Earlier this month I wrote about the ways telemedicine was being used to help prevent the spread of the coronavirus while healthcare providers used it to continue providing medical care. Telemedicine continues to have the ability to lessen the number of cases of coronavirus through its no-contact model and allow healthcare professionals to diagnose and treat many acute and chronic conditions.

All things considered, the increased use of telemedicine may be the only thing “good” to come from pandemic as long as healthcare providers continue to be reimbursed.

Providers and payers alike must layout revenue cycle strategies today to help collections in the future as the economy returns to some semblance of normal, whatever that ends up being. Undoubtedly, some charges and accounts will be written off as total losses, while partial collections may be the best that can be hoped for for the majority of accounts.

Until then, this headline from Medical Economics says it all: “Physician practices reeling from COVID-19 financial losses.”