Major health care systems around the country are reporting significant declines — as much as 60% in some cases — in patients seeking both routine and emergency care during the COVID-19 pandemic. Some patients don’t want to go to the emergency room or see their doctor out of fear of contracting the disease, while many others are putting off medical care because they’ve lost their health insurance along with their jobs.
Doctors are worried about what the New England Journal of Medicine called “the untold toll” of the pandemic – non-COVID patients who neglect symptoms that need attention, or who are neglected by health care systems that are rapidly reconfiguring to handle waves of COVID-19 patients. Diverting resources to cope with the surge of infected patients made sense in the initial months of the pandemic, which has killed more than 176,000 Americans so far this year. But as the pandemic lingers, health care systems both large and small must find better ways to manage care for all patients.
Wharton operations, information and decisions professor Hummy Song has co-authored an opinion piece published in Harvard Business Review that offers a four-point strategy for tackling this problem through the lens of operations management. Her fellow authors are S. Ryan Greysen, Scott D. Halpern and Rachel Kohn, all physicians and professors at the Perelman School of Medicine at Penn, and Ghideon Ezaz, a physician and professor at the Icahn School of Medicine at Mount Sinai, New York.
“It is critical that we not only focus on the acute care of COVID-19 patients, but that we also proactively manage patients without COVID-19, particularly those with time-sensitive and medically complex conditions who are postponing their care. This is important not only to sustain health and life, but to preserve future hospital capacity,” the professors wrote in their piece.
They recognize that the recommendations are challenging to implement, but they also believe that doing so now will help health care providers “be better prepared for future waves” in this pandemic.
The four strategies the authors outline in their HBR op-ed are:
1. Proactively manage non-COVID patients who have high-risk conditions.
Emergency rooms are the first place to bottleneck during the pandemic because non-COVID patients who avoid regular care eventually wind up at an ER when their symptoms become acute. One way to avoid a bottleneck, which strains resources, is for doctors to take a more active role in helping their patients who have chronic conditions such as uncontrolled diabetes or hypertension. While most doctors have adopted some form of telemedicine during the pandemic, that’s not enough, the professors said. Doctors should seek out their most high-risk patients and initiate contact, perhaps even supplying them with devices that can help them better manage their conditions from home. Follow-up monitoring is important to help keep those patients in a steady stream of care and hopefully avoid a visit to the ER.
“If these were normal times, having only telehealth for high-risk patients is not the most ideal. But when the alternative is very much limited in terms of how many in-person visits we can provide, it’s the next best option we’ve got. There are many things we can do to think creatively, act creatively, to make it high value,” Song said during an interview with the Wharton Business Daily radio show on Sirius XM. (Listen to the podcast at the top of this page.)
2. Use ‘location pooling’ to combine critical non-COVID services across hospitals.
The professors advocate for a logistics strategy known as location-pooling. Simply put, it means all the hospitals in one region should work together to combine non-COVID services, rather than spreading them out. One facility can handle all the cancer patients, for example, while another takes care of all transplant patients. The demand – along with patient flow – is balanced out across the hospitals so that no single facility is gaining or losing all the revenue.
“Implementing this strategy is fraught with challenges as hospitals are currently organized independently and compete with one another for patients and revenue,” the professors wrote. But it has been done before. In Boston, rival hospitals worked together during the first wave of the pandemic.
3. Create cohort wards for COVID-19 patients.
COVID-19 patients with the same underlying conditions can be grouped together in “cohort wards” to more efficiently manage their care. In such a ward, specialized doctors, such as cardiologists, can work together with the doctors who are treating the patient for the virus. While cohort wards may be less efficient to set up, doing so should result in better outcomes for the patients receiving the specialized care.
“It’s really going to be about leveraging the skills of the doctors and the nurses who are used to taking care of the patients with those specific complications and conditions,” Song said. “And it’s just going to be much easier to do that effectively and efficiently when those patients are co-located in the same ward.”
4. Separate patients during post-acute care based on COVID status.
Many patients, regardless of whether they have COVID-19, aren’t ready to go straight home after a hospital stay. That’s when they are transferred to a nursing, rehabilitation or acute-care facility. The professors recommend leaders in the health care space collaborate to establish separate, regional, post-acute care facilities for both non-COVID and COVID patients. Doing so will improve patient flow and avoid bottlenecks while also improving care for both sets of patients. Such a model also reduces the infection risk for recovering non-COVID patients. Rapid and accurate COVID-19 testing is key in this model so that patients can be routed to the proper facility.
“Post-acute care, as we’ve seen over the past several months, is a hugely important part of the health care continuum that we need to keep in mind,” Song said.
In their op-ed, the professors shared a conceptual model for their operations management strategies. Click here to see the schematic.
Frontpage September 25, 2017