Health systems, facing steep shortfalls after their most lucrative business lines ground to a halt in March when the COVID-19 pandemic intensified in the U.S., are turning to the task of convincing patients it's safe to come back.
Surveys show people are not in a hurry to return.
The Alliance of Community Health Plans and the pharmacist lobby AMCP in a survey found 74% of respondents believe a resurgence of COVID-19 in the autumn or winter months is likely or very likely, skewing perceptions about future care. Nearly 40% already say they would like to put off obtaining care for at least six months.
Amidst these challenges, mega health systems with hospitals in dozens of states are trying to coordinate their reopening efforts based on varying state guidance. At the same time, federal guidance is voluntary and lacks many specifics.
Intermountain Healthcare dominates parts of the west with 22 hospitals in Utah and one in Idaho. Varying guidance between those two states allowed it to restart elective procedures early in Idaho, while Utah is re-opening on a more gradual basis.
"What we've found this week is the more we explain exactly what they should expect, the more comfortable they are with the process," Intermountain's Cassia Regional Hospital Administrator Ben Smalley said.
Cassia scheduled about triple the volume of surgeries of a typical week. New policies include temperature taking upon arrival and mask-wearing requirements. The 25-bed hospital in Burley, Idaho, resumed elective procedures on May 11.
Beyond elective procedures, the hospital wants patients to come back for other services such as mammograms and blood work.
A universal reopening of all facilities was crucial to the process, Smalley said. While considering how to resume hospital operations, an orthopaedic surgeon conveyed he couldn't reschedule preoperative and perioperative appointments if the clinic was still closed, prompting the move.
"They said if you're going to do this and go to this green status, that means you've gotta open everything up in order to make this work appropriately," Smalley said.
Other large health systems are less regionally based than Intermountain, operating clinics across a number of markets with different guidance on resuming elective procedures.
Dallas-based Tenet Health, among the biggest for-profit health systems by revenue, is resuming elective care in states as restrictions are lifted, though orders vary greatly across the nine states it operates in. Tenet's Baptist Health System has resumed elective procedures at its five acute-care hospitals across San Antonio.
Phillip Young, CEO of Northeast Baptist Hospital, said his location is already back to nearly two-thirds its pre-pandemic volumes for elective procedures after reopening about three weeks ago.
New protocols include providing face masks and spaced-out waiting areas with clear signage to enforce social distancing. Temperature checks are not required upon entry like they are at Intermountain's Cassia Regional, though both systems said they're requiring patients to get tested for COVID-19 prior to their procedures.
In late April, CMS issued guidance hospitals should follow when re-opening facilities for non-emergent care in regions with low incidence of COVID-19, including new social distancing and sanitation protocols in hospital settings.
The American Hospital Association, along with other industry groups, issued its own roadmap on April 17 for hospitals to safely resume elective procedures. That guidance focuses on ensuring hospital capacity, asking facilities to ensure they have appropriate number of ICU and non-ICU beds, personal protective equipment, ventilators, medications, anesthetics and all medical surgical supplies.
It also offers help for physicians dealing with backlogs and deciding which cases to prioritize while rescheduling. On Tuesday, AHA built on that with more guidance on how medical device company representatives can safely resume visits to healthcare facilities.
Both AHA and CMS' recommendations, along with new protocols at Intermountain's Cassia Regional and Tenet's Northeast Baptist Hospital, stress the need to constantly continue COVID-19 testing, especially among staff.
Tenet and other big hospital systems are working amid shifting COVID-19 case numbers as surges wane and governors announce re-openings.
Some have extended stay-at-home orders and others ended them early, but all are concerned with how their states can restart elective procedures and other services that concern long-term public health and the financial viability of local systems.
During a first quarter earnings call earlier this month, Tenet CEO Ron Rittenmeyer said the system "views May as the beginning of the recovery and are pleased with many facilities opening at 50% of pre-COVID surgeries last week and a more promising schedule this week."
But in some markets, such as Detroit, he said, "this restart may be slower as COVID cases are ultimately closed out over this next several weeks, and we will have to determine the flow of new and remaining cases by market to get a realistic cadence before we can draw reasonable conclusions."