Technology Can Ease Pandemic Challenges Faced by Hospitals, Ambulatory Surgery Centers
Hospitals and ambulatory surgery centers (ASCs) need elective procedures to be able to return to near pre-pandemic levels for both their patients as well as their hospital’s financial health, but the continued impact of the coronavirus pandemic complicates the issue in many geographies.
The American Hospital Association (AHA) estimates that the country’s hospitals will lose more than $200 billion during the first four months of the pandemic. Funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act have blunted the catastrophic losses medical providers have endured since the pandemic took hold, but red ink will dominate operating budgets in the near and medium terms.
In places where the virus has reasserted itself, ICUs are filling up, which puts a damper on resuming elective procedures given patient reluctance the difficulty obtaining sufficient protective gear. For hospitals and ASCs, elective surgeries are a critical revenue source, accounting for 60% of total hospital revenue.
Besides the direct effects of COVID-19, challenges for hospitals and ASCs include the availability of testing supplies, delays in test results, a weary workforce, and a frightened populace reluctant to receive care – even if they desperately need it.
One bright spot during these dark times is the availability of mobile apps that help give patients and staff vital information to put their minds at ease, provide advance symptom screening and help providers reduce elective procedure no-shows through better patient compliance.
Financial impacts mount
In March, the Centers for Medicare & Medicaid Services (CMS) dispensed $100 billion in advanced Medicare payments, a program designed to help providers deal with disasters such as hurricanes. But the repayment date is set for 120 days after receiving the first payment, and few organizations are in a position to repay.
CARES Act funding also propped up hospital finances. Looking at May financial numbers, the median hospital operating margin was 4%, according to the Kaufman Hall National Hospital Flash Report. Without the infusion of CARE Act dollars, the median margin would have been a negative 8%. An increase in OR usage over April numbers also helped, but overall operating margins are 13% lower than in 2019.
Operating margins for hospitals have been in single digits for years. In 2019, one-third of hospitals operated with a negative margin each quarter. In Q1 2020, that number jumped to 49%, a number that’s expected to hold steady throughout 2020 without additional financial assistance. “This is a dire and unsustainable outlook for a major portion of the country’s hospitals and communities,” the report states.
Product backorders, testing delays hamper care
Facilities quickly ran through their personal protection equipment and other supplies as coronavirus cases surged in their area, so organizations are now trying to replenish those supplies. Ninety percent of providers are contributing to local stockpiles generally expected to last 90 days, but backorders are hampering those efforts.
A survey released in late June shows providers are seeing backorders of N95 masks and surgical caps (53%), isolation gowns and shoe covers (49%), testing kits/swabs (40%) and surgical gowns (35%).
Adequate supplies and enhanced screening are central to a reopening plan outlined by CMS, as is a low coronavirus risk in the service area. Reopening should “not detract (from) the community ability to respond to a potential surge.”
Guidelines call for all patients and staff to be screened for potential symptoms before entering a facility. When adequate testing is available, patients should be screened before receiving care, while staff should be regularly screened.
However, a survey taken in late April shows that only 27% of hospitals were able to test patients perioperatively, mainly due to shortages of reagents and testing swabs.
Putting patients, staff at ease
During the first 10 weeks of the pandemic, when people were urged to stay home, overall ED use dropped by more than 40%, including 23% fewer heart attack patients and 20% fewer stroke patients.
Now, as hospitals and ASCs are opening back up, they have to overcome lingering patient concerns about their safety, particularly those in higher risk groups such as the elderly and those with multiple co-morbid conditions.
Easily customizable mobile apps can present timely and relevant communications to staff or the community. The needs of both audiences are slightly different.
The community can benefit through current local COVID-19 information, real-time access to virtual telehealth assessment and screening tools and optimized care coordination tools. A staff version can include secure communications from leadership to workers, reference libraries of relevant content, and hosting for internal user groups and forums.
Apps can include push notifications and alerts on customized facility information, breaking news or important updates.
Deaconess Health System, a seven-hospital system based in Evansville, Indiana, adopted an app for staff communications. In the first two weeks of deployment, 50% of staff had downloaded the app, using it for more than 23,000 sessions.
Attestation of coronavirus status
CMS reopening guidelines require staff and patient screening before reporting to work or receiving care. Using a mobile app is a quick and easy way to for hospitals or ASCs to receive attestations. Apps can be customized for a facility’s particular needs or to account for changing screening criteria.
Open the app, answer the questions and get immediate guidance on whether to proceed to the facility. If the response is anything other than OK, users are presented with specific information on what to do next. For employees, it could be stay at home and notify your supervisor. For patients, it could be tapping a button to contact the scheduling line.
In both cases, attestation information can integrate with the appropriate IT system to create a checklist and an audit trail.
Make every patient encounter count
Whether a facility is seeing few elective cases or is fully up to speed, the potential case backlog could surpass 45 days. To maximize revenues and throughput, you want to ensure that patients present on the day of their procedure fully healthy and in compliance with any pre-op instructions or preparations.
When same-day cancellations occur, nearly 75% can be attributed to inadequate patient preparation. A conservative improvement in the no-show rate can save facilities $199 per procedure. Post-surgery, a mobile app that clearly outlines patient discharge instructions in an easy-to-understand fashion can reduce preventable readmissions by $101 per procedure.
When scheduling a procedure, a surgeon can “prescribe” an app that includes information about the procedure, educational materials, post-care instructions and a checklist of items that need to be completed before showing up on the day of the procedure. Those checklist items can become notification alerts that patients view on their phones and check off as they are completed. Information from apps like these can flow to the patient record, so staff can manage the exceptions rather than an entire cohort of patients for that day’s procedures.
The benefits are two-fold: helping providers optimize procedures rooms and staff, while helping patients receive the care they need.
To keep critical revenue flowing, hospitals and ambulatory surgery centers need to resume elective surgeries and procedures as quickly as possible – and as safely as possible for both patients and staff. Patients, of course, want to know their conditions are being treated and that facilities care about their physical safety. Mobile apps can help both constituencies achieve these simple, yet critical, goals.