Hospitals Aim to Resume Procedures Postponed by Coronavirus

By Melanie Evans and Russell Gold, Wall Street Journal
April 22, 2020

Decisions pit vital revenue stream against infection risk; patchwork of state rules means uneven revival.

Hospitals, clinics and surgery centers are moving tentatively to resume surgeries and other procedures that were halted when the coronavirus pandemic reached the U.S., a shift that could help stanch the sector’s financial losses but presents new risks to infection control and public health.

Tenet Healthcare Corp. is preparing to restart some surgeries in Texas, said people familiar with the hospital and surgery-center company’s plans. HCA Healthcare Inc., a national hospital chain, said on an investor call Tuesday it expects to reopen across its 43 markets by the end of June. California Gov. Gavin Newsom said Wednesday that the state is working with health-care providers to resume postponed procedures.

One independent rural Missouri hospital is already advertising for patients to return. “If you stub your toe at 3 a.m. and think you broke it, yes, come in even if it’s not life-threatening,” said Randy Tobler, chief executive of Scotland County Hospital in Memphis, Mo., who went on a local radio show to announce the news. “We’re open for business.”

Opening up surgery will be welcomed by anxious patients who waited weeks for procedures that were important, such as some diagnostic imaging and gallbladder surgeries, but could be temporarily delayed. And for hospitals, outpatient procedures are a growing source of revenue and typically more profitable than treating critically ill, hospitalized patients. Shutting down elective surgeries led to layoffs, furloughs and pay cuts across the health-care sector. After weeks of delays, hospitals and surgery centers face mounting financial pressure and a backlog of patients.

Now, health care is joining other sectors of the U.S. economy making an uncertain—but urgent—push to resume business.

California’s governor said the state’s health-care system was working to reintroduce capacity to resume postponed procedures, without which patients’ problems could grow more acute. But Mr. Newsom also said the state would closely monitor results for capacity to handle another wave of Covid-19 patients. “We will not overload the system at peril of not being able to maintain our surge capacity,” he said.

California ordered hospitals to prioritize medical care and resources for the sickest patients, but didn’t directly suspend electives. It also said residents ought to postpone elective procedures, urging them to contact their doctors to find out what services would be provided.

Guidance from medical-specialty societies and federal health officials on how best to proceed points to heavy reliance on critical protective equipment, such as masks, and testing for the virus to limit further contagion.

But supplies of both are limited, raising questions about how quickly the industry can move, say health-care and infectious-disease experts.

“Testing would be ideal, if it was available and consistently accurate,” said David Hoyt, executive director of the American College of Surgeons. He urged a slow ramp-up in procedures, with close monitoring of community infection rates. “We would not recommend anyone would start like flipping a switch on.”

Experts agree that restarting surgical procedures will be difficult. “There is no easy answer to restarting routine health care in hospitals,” said Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. “It’s got to happen. We have to find a way to make it as safe as possible, but it’s not going to be completely safe.”

As the pandemic took off across the U.S. in mid-March, health-care providers began to delay hip surgeries, routine colonoscopies and other procedures that weren’t urgent, in an effort to prevent infection and conserve space and equipment for a potential surge of patients with Covid-19, the disease caused by the coronavirus. Some states urged hospitals to do so voluntarily. Elsewhere, governors and health departments mandated a stop.

The result was a patchwork of policies that threatened fines for violators in some states and left hospitals and doctors to make their own calls in others.

“Surgery is saving our bacon,” said Jennifer Riley, operating chief of Memorial Regional Health in Craig, Colo., which didn’t suspend surgery. The struggling rural hospital closed its obstetric services at the end of 2019 and she said it couldn’t afford the additional loss of business.

“People are thinking we are doing this just for the money,” she said. “They’re not wrong. We are doing this to remain economically viable.”

Many hospitals and surgery centers did halt surgeries. Continue reading the full article here »