The financial impact of COVID-19 and the restrictions that have resulted are severe. Average US hospital revenues dropped 40% during 2020.[1] This has impacted all hospitals and healthcare systems. Especially critical are small rural hospitals who are now facing closure due to sharply reduced revenues. A key factor in cutting revenue was the directive to stop elective procedures across the country.[2] Elective procedures are a major source of revenue for hospitals, systems and practices. While revenue dropped, expenses increased due to:
- increased cleaning and infection control,
- the cost and supply of personal protective equipment (PPE),
- additional staffing needs for critical COVID-19 patients,
- converting rooms to higher levels of monitoring and care,
- purchasing/supporting telemedicine solutions,
- plus, the increased testing of both patients and staff.
In addition, continuity of care was interrupted for patients. Follow-up appointments and post-procedure care (rehabilitation, etc.) were not taking place and thus, these revenues were interrupted as well. One key factor is that patient’s fear that it’s not safe to come into clinical sites for care. Patients do not want to come into waiting rooms. They know the risks and will avoid seeking care if sitting in a waiting room is part of the process. Yet, the impact of delayed care or no care can be detrimental both for patients (see increases in CHF deaths during COVID-19[3]), and for the hospital, or clinic, and/or provider because it cuts into appointment revenues, provider appointment revenues, as well as revenues generated by associated tests imaging, etc.[4]
The impact on staff has also been significant.[5] Loss of staff due to infection, fear of infection,incapacity and death, excess stress, family and home schooling/education issues all put additional strain on staff and operations. Keeping staff healthy and productive physically and mentally is critical. Frequent infection testing of clinical and all other in-hospital staff is an important first step. It is also critical to provide for the behavioral health needs of all staff. Clinical staff have been placed under significant stress providing care for patients, at times without proper PPE, risking infection of themselves and their families if not quarantined. If clinical staff are quarantined, they suffer from long-term separation from family and friends. In-hospital support staff (including for example, food service, maintenance, infection control, administration, etc.) are also under increased stress. A continuous management focus on moral and easy access to behavioral health support is critical for all personnel[6].
Ideas:
- Keep infection risks to a minimum.
- Divert potentially infected before they arrive at the hospital or clinic (see Critical Need #3)
- Conduct standard and appropriate specialty appointments with telemedicine and bill for encounters where possible (see the Pandemic Action Plan Policy and Regulatory Summary)
- Allow and enable staff to work from home whenever possible reducing their exposure and the risk of carrying infection into the hospital. This will also allow staff that have been exposed to COVID-19 or are infected, but not seriously ill, to continue to fill at least a portion of their operational role.
- Assure connectivity to the home especially in rural areas.
- Conduct a connectivity survey of all employees who can potentially work from home. Know the connectivity capabilities and gaps in advance. Update every year.
- Close down/get rid of physical waiting rooms and create virtual or drive-up waiting rooms. This is an essential step to prevent spread of the virus to patients and staff, moreover, it is also an essential service move for patients. Keep infected people out of the facility wherever possible. (see Critical Need #3)
- Apply queueing software to eliminate waiting rooms
- Self scheduling for appointments (queueing) is essential to eliminate waiting rooms and for scheduling and queueing for vaccine application.
- Apply Covid screening tools to registration (widely available in almost all telemedicine and other self-scheduling and registration systems)
- Protect providers by reducing the need to enter infected rooms with infection risk – (See Pad on a Pole below)[7].
- Consider robotics to avoid in-room contact with patients, delivery of food, medications and supplies, removal of soiled linens.
- Use simple “Pad on a Pole” or similar technologies to reduce isolation, infection exposure of staff and demand for PPEs. Allowing patients to interact with staff and allowing the staff to visit the patient in their room virtually reduces the need to physically enter the room, exposure risk and change PPE. This application has shown a dramatic reduction in the demand for and cost of PPEs. Video Robots can also be considered and are widely available.
- Use Pad on a Pole or similar technologies to allow patients to interact with family reducing both isolation and infection risk. These also reduces PPE demand by visitors
- Relieve workload on key providers who have additional demands placed on them especially in dealing with public and patient inquiries.
- Provide call management/alternatives to answer questions (reduce demand on) critical resources.
- Employ call center resources or chatbots to answer basic calls, inform and direct patients.
- Assess the condition of your staff. Use surveys and other tools. Assure effective management interaction with staff.
- Inform your patients and community of the actions and procedures the organization has made for their safety to give them confidence to use care services.
- Implement a coordinated care plan with public health at the local level.
- Implement a communication plan and budget for patient outreach and communication. Attempt to coordinate at state and local levels with health departments but also use local communication (See Critical Need #11).