By Deborah Jeanne Sergeant
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 most 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 will have lost an estimated $202.6 billion nationwide 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.
“As you can imagine, if you stop what you do that generates income, it creates problems,” said Carla Stebbins, director of Institute of Health Sciences and Technology program at Rochester Institute of Technology. “Healthcare still lives on direct billing for procedures and when those aren’t done, there’s no layaway plan. You don’t put deposits down. It creates cashflow issues and income problems like for any business. In healthcare, a lot of the cost related to it are the people. When you don’t have money coming in, it’s a difficult situation to make payroll.”
Stebbins said that shifting 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.
Stebbins said that colleagues planned reopening for elective surgery by working out 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.
“There’s no question that the operating room is the heart and soul of a hospital or surgical center,” said physician Pasquale Iannoli who serves as chairman of the department of surgery at Unity Hospital. “It’s true that the financial health of an organization can be tied to its surgical volumes.”
Iannoli, who also practices at Westside Surgical Associates in Rochester, said that hospitals have a backlog of cases and surgeons are looking at patients’ cases to prioritize who’s first in line based upon medical needs as outlined by organizations such as The American College of Surgeons.
“Patients are being scheduled and operated upon and our hospital systems are working with state regulators and the Department of Health,” Iannoli said. “The period of waiting is impacted by the outcome if they wait.”
For hospitals and surgical centers, their economic survival may depend upon efficiently scheduling patients to both to meet their healthcare needs and also to 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 near Albany. “We had to close some surgery sites and primary care sites.”
She calls the current situation ironic that 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.
“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.
University of Rochester released a statement April 15 which said, “We have experienced significant lost revenue from suspending non-essential medical procedures in order to build capacity in our hospitals for an anticipated surge in COVID-19 patients. Similarly, we have incurred expenses to prepare to care for our patients through telemedicine and to prepare our faculty and students for online learning. We have refunded room and board fees for undergraduates who left campus in March, but continue to provide housing, food, and support for students who had to remain on campus…We cannot predict when clinical revenue from our healthcare system will return to the levels we experienced prior to the pandemic. The financial implications of this situation have been significant, and we don’t yet know how long these will last.”
On April 28, Thompson Health and other UR Medicine facilities began performing semi-urgent and elective procedures again.
In an April 30 press release, UR Medicine Thompson Health President/CEO Michael F. Stapleton, Jr., stated that “those with chronic conditions — who may have been putting off care since the onset of the pandemic — are especially encouraged to not delay care any further because their conditions could very well worsen without it.”
Facilities related to Rochester Regional Health and Finger Lakes Health also resumed elective surgeries by the end of April.