On the other side of the curve – Coronavirus News – May 28

With a continued reduction in COVID-19 cases, one health system was busy mapping out next steps to resuming elective surgeries and procedures

At its high point, Ochsner Health was located in one of the nation’s COVID-19 hotspots. The New Orleans-based health system had confirmed inpatient cases that reached into the mid-800s.

But there were positive signs by mid-April. On April 17, the number of inpatient COVID-19 cases had lowered to 573. Another positive trend was more people being discharged home who were COVID positive. Ochsner discharged its 1,500th COVID patient by April 20, just over one month after Ochsner admitted its first COVID-19 patient on March 9. More patients were coming off ventilators and fewer were having to go on them.

Warner Thomas, president and CEO of Ochsner Health, said the health system was working with local and state officials on how to open back up some of its operations. “We’re working towards getting ready to get back to do other surgeries or procedures that we’ve had to delay,” he told media members in a conference call. “We delayed them during the peak, but these patients still need care. Cancer surgery, heart surgeries and other things have been delayed, so it’s time to get back to taking care of folks.”

Delay of care

Thomas said one of the fears from a public health perspective is there were people delaying their medical care due to COVID-19 concerns. Many people with medical issues were fearful to leave their house. “That has significant implications,” said Thomas. “We’ve heard of people who have had strokes who delayed care out of fear. Minor heart attacks as delayed care. People with broken hips that have delayed care for multiple days. That is not a good situation.”

Dr. Robert Hart, chief medical officer, Ochsner Health, said ER physicians had seen cases where a patient with a heart attack stayed at home a few days rather than coming in for treatment. On the surgery side when the stay-at-home order was in place, Ochsner was only performing emergency surgeries. “There are some tiers of surgeries we laid out that could be put off and some that couldn’t,” Hart said. “We’ve got to begin considering getting people back on the schedule to get them taken care of before we wind up doing more harm than good out of this.”

Thomas said Ochsner was taking the right precautions in its ERs and clinics by temperature checking everyone that comes into the organization, whether patient or employee. If anyone has a fever they are getting tested appropriately and sent home. Ochsner had the appropriate amounts of PPE for healthcare personnel, and patients were given masks, he said.

“It’s important we don’t see ongoing delay of care, because frankly that’s going to create a bigger medical issue for folks going forward,” said Thomas. “We worry about the escalation of chronic disease or the delay of care that need to be dealt with.”

Testing

Testing for COVID had become a routine part of the screening process for patients and employees. By mid-April, the health system had tested over 23,000 people for COVID-19, with more than 7,000 confirmed cases – about one-third of Louisiana’s COVID-19 cases. Ochsner had ramped up to conducting 1,300-1,400 tests a day, either same-day tests or point-of-care testing.

Thomas said patients being admitted into the ER for any reason were being tested for COVID. People having surgeries were being tested proactively. “We’re making sure to test and screen people as they come in,” he said. The rate of testing was only going to increase as the health system worked to begin surgeries and procedures that had been postponed.

“If you come into one of our facilities you are going to be tested, whether you come in to be admitted, or have a procedure,” said Hart. “If you go to one of our infusion centers you are going to be tested. For instance, if we give you chemotherapy or infusion that may compromise your immune system, we want to know first whether you are positive or not. Because it may be something we want to put off a couple of weeks for your safety.”

Ochsner started antibody testing the week of April 20. The initial focus was antibody testing for the frontline caregivers such as critical care and ED staff who have been working around COVID-19 cases since at least early March. “There is a sense now with people this was simmering in our community in New Orleans prior to Mardi Gras,” said Hart. “We may find out that a lot of people who could well have antibodies to COVID-19 not even realize they were exposed along the way.” From there, testing would expand to other inpatient areas, procedural areas, and into clinics.

Financial impact

Thomas said during the peak of the COVID-19 cases, Ochsner had delayed well over 6,000 surgeries and procedures. “We’ll be in contact with those patients to get them scheduled soon,” he said. “We know many of those procedures need to be done. We’ll be having the right conversation with folks coming in and talking through that.”

Fortunately, the health system has not had to lay off or furloughed anyone, Thomas said. “We’ve redeployed a lot of people, taken folks that were less busy and moved them to other areas.”

Many Ochsner employees in areas less busy were taking their paid vacation during April and May. “We’re doing that for a couple of reasons,” said Thomas. “No. 1, because we have time for them to do it; we don’t have as many patients. We also think in the second part of the year, we are going to have to be catching up with these 6,000-plus surgeries and procedures, visits. We want people ready to go in the second part of the year.”

Indeed, the elimination of voluntary procedures has had a major impact on the organization’s revenue. Thomas reported clinics, outpatient procedures and imaging were down 60-70%. “It’s had a major impact on our revenue both at the end of March and the month of April.” Thomas said Ochsner was putting into place some expense reduction items, “things we think we can put off, programs we can stop temporarily, hiring we will stop temporarily in some of our areas,” he said. “Certainly not in our clinic areas but other areas.”

While the organization was still evaluating the extent of the economic impact, a lot of it would depend on how quickly people come back for medical care and what that looks like over the next couple of months, Thomas said. “We’re going to be watching that carefully.”

Dynamic Ventilator Reserve Program

Ochsner Health was participating in the Dynamic Ventilator Reserve Program that has been put together by the COVID Task Force at the White House in conjunction with the American Hospital Association.

The Dynamic Ventilator Reserve Program is “a collaborative voluntary effort led by a group of U.S. hospitals and health systems that has created an online inventory of
ventilators and associated supplies, such as tubing and filters, to support the overall needs of combatting the COVID-19 pandemic,” according to the AHA. “Hospitals and health systems will input into the database available equipment that they are able to lend to others in the country. Providers are then able to access this virtual inventory as their need for ventilators increases.”

Telehealth takes off

Ochsner Health’s telemedicine platform, Ochsner Anywhere Care, is seeing record numbers of enrollments and visits since the COVID-19 outbreak in Louisiana, according to the health system. Patients are able to see a provider on-demand, receive assessment and appropriate treatment, all from the comfort and safety of home.

In March 2020, urgent care on-demand and behavioral health scheduled appointments increased 852% in enrollments and 933% in virtual visits over February 2020, Ochsner reported in a release. The trend was continuing in April, with daily virtual visits growing significantly. Key highlights include:

  • March 2020 Ochsner Anywhere Care enrollments: 10,084 (February 2020: 1,059)
  • March 2020 Ochsner Anywhere Care virtual visits: 3,616 (February 2020: 350)
  • April 2, 2020 Ochsner Anywhere Care virtual visits: 2,700 (March 2, 2020: 39)

“It is reassuring and evident that those in need of non-emergent medical care are heeding the advice of local, state and federal officials during the COVID-19 outbreak and are sheltering-in-place, leaving only for essential errands,” said David Houghton, MD, MPH, medical director of Ochsner Anywhere Care. “Telemedicine has made it possible to safely and effectively treat illnesses from home and we are seeing thousands of patients choose Ochsner for their virtual healthcare needs.”

Ochsner Health was one of the initial six healthcare providers approved by the Federal Communications Commission’s Wireline Competition Bureau approved for its COVID-19 Telehealth Program. Healthcare providers in some of the hardest hit areas like New York could use this $3.23 million in funding to provide telehealth services during the coronavirus pandemic. As part of the recently enacted CARES Act, Congress appropriated $200 million for the FCC to support health care providers’ use of telehealth services during this national emergency

“This is changing the landscape around virtual care,” said Hart. “Not only with patients, but physicians are realizing how effective they can be with certain types of virtual care. I think this is going to be something that does not go away when COVID-19 is gone. It’s going to be something that not only the physicians, but patients will be looking at – how does this continue going forward in some fashion that everyone finds useful.”

Washington State Hospital Association to citizens: Don’t delay routine care

Hospitals across Washington were urging citizens to seek timely medical care for non-COVID-related health issues, including care for new or chronic health conditions.

Hospitals and health care providers across the state were reporting abnormally low volumes of patients seeking routine medical care, according to the Washington State Hospital Association. But patients who have arrived at the hospital seeking care have been more severely ill. People are waiting to seek medical attention – and endangering themselves as a result.

“Life is on pause right now, but your health care needs are not,” WSHA President and CEO Cassie Sauer said. “Do not delay needed care – you could get worse. Hospitals and clinics are prepared to safely provide services and you should get care when you need it.”

Health care conditions that are left untreated can worsen, making them more difficult to treat, or even become life threatening, the WSHA said. Many providers are offering virtual appointments, allowing patients to see their providers at home and determine if a physical visit to a hospital or clinic is necessary.

Pennsylvania: Elective surgeries can resume if guidelines followed

The Pennsylvania Department of Health announced in late April that healthcare facilities could continue with elective procedures, as long as certain guidelines are followed. There are three main criteria facilities must meet before elective procedures can resume:

  • First, facilities should make sure there is enough PPE in the event of a surge in COVID-19 cases.
  • Second, facilities should be able to treat patients without having to resort to drastic measures like prioritizing patient care if there is another surge.
  • Third, facilities should make sure there is enough trained and educated staff to handle elective procedures, as well as a potential surge in hospital patients.