As health systems begin the process of “re-opening,” there are several operational dilemmas that need to be addressed immediately:
- How fast should you ramp up elective surgery?
- What testing protocols should be in place?
- How do you let the public know the hospital is safe?
While these issues are of immediate concern, the key long-term questions are:
- What is the new normal regarding volume?
- How is your cost-structure positioned to sustainably address the new normal?
The next set of assumptions involves care delivery. There has been a huge shift towards the acceptance of telemedicine as a modality for delivering care. It can be assumed this will only increase, particularly given that patients are demonstrating their hesitancy to step foot in a hospital for fear of COVID-19 exposure. Hospitals will have to address not only how to deliver care in a safe manner but also find a way to broadly demonstrate how safe it is and reassure the public that they may come back to the hospital. The relevance of these various assumptions will remain until a safe and effective vaccine is in place. Despite recent suggestions that a vaccine could be commercially available in 6 months, the history of medical research signals that this is a highly unlikely scenario, making this set of assumptions cogent for at least the next year.
With these factors as a backdrop, here is what I believe hospitals need to prioritize in the near term:
- Reduce Your Cost Structure:
While hospitals have prioritized this over the last 5 years due to ever-increasing reimbursement pressures, sudden volume decreases present an opportunity to make changes that might have been more difficult previously. Reducing or eliminating programs that are not adding value or performing sustainably and shedding or consolidating operations should be considered to eliminate costly sites of care. - Re-examine Your Physician Alignment Strategy:
Many providers, particularly independent ones, have experienced catastrophic financial losses. There may now be an opportunity to re-align those providers for consistency with your overall strategy. The COVID-19 crisis has allowed for the development of a burning platform for change around eliminating unnecessary variation in order to improve outcomes and lower cost. Having those conversations and implementing digital tools that facilitate this will be critical. - Know Your Patients:
For those involved in risk-based contracting, understanding and stratifying patients by risk category is old hat. Now, hospitals and their associated clinically integrated networks, must immediately identify high-acuity patients that need to be seen now, those who need to be seen but are hesitant because they fear being exposed, and those who may have been completely lost to follow-up. Effectively, fear of exposure becomes a medical risk category that needs to be managed. Through identification of these patients, resources can be appropriately allocated to re-engage them efficiently. This will likely need to be done at a macro level through mass media and on a micro level through traditional care management. - Implement New Operating Procedures for the Next Year:
Many hospitals are already barely hanging on after having significant shutdowns in operations as a response to this crisis. Another surge would surely result in closures. Therefore, hospitals must develop sustainable models in the clinics, operating rooms, and emergency departments that are protocol driven to both assure patient safety but also project a sense of safety to the patients. Many organizations have begun standard procedures regarding patient and visitor screening, patient cohorting, transportation around the hospital, and staffing models that would allow flexibility to address future surges in COVID-19 cases. - Assess Strategic Opportunities:
Consolidation of hospitals and physician groups is not new but has decreased in recent years. Hospitals and health systems should not only assess what opportunities there are to align with other providers more strategically, but should also consider the implications of this crisis with their current relationships. This is not to suggest that hospitals should be opportunistic due to this crisis but rather assess the value exchange with any partnership opportunity and how it might give a competitive advantage to both parties.
Obviously every market is different and your specific set of circumstance and priorities may well differ. One thing is certain however – prioritization of your efforts in order to assure the long-term success of your hospitals or health system is necessary even while implementing the required short-term operational structure to address the immediate crisis.
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