By Aaron Bours
Before we can dive into the current state of hospitals and clinics across the U.S., we must first understand how the pandemic has wholly upended the $8.5 trillion healthcare market.
When confronted with the following statistics, it’s impossible to overstate the impact COVID-19 has had on the main channels of revenue for healthcare organizations: elective procedures, ongoing medical care, and patient volume.
- Hospital visitation volumes dropped by 32%-60% between March 1st and March 29th, compared with pre-COVID-19 volumes. (TransUnion)
- The number of outpatient visits to practices has dropped by 60% since April. (The Riverdale Press)
- Emergency room visits in the U.S. fell by more than 40% in April. (CDC)
- The average number of weekly ER visits was 1.2 million between March 29th and April 25th, a 42% decline from the 2.1 million visits seen during the same period last year. (Becker’s Hospital Review)
- NYU Langone Hospital’s patient admissions between March 1st and May 9th dropped 31.9% this year compared to 2019. They were down 43% this year compared to 2018. (Healthcare Dive)
These figures paint a sobering picture and reflect the indirect, often overlooked repercussions this pandemic is having on healthcare organizations and the patients they serve. In a survey conducted by TransUnion Healthcare in April, about one in four patients surveyed (27%) said they had an elective surgery, appointment, or procedure delayed or canceled due to COVID-19.
Of the patients who had an elective procedure deferred, nearly 50% indicated they will only reschedule once they no longer believe there is a high risk of COVID-19 infection or once guidelines advise it is safe.
Mandatory or self-imposed, these deferments of treatment have been a source of discomfort for some and, sadly, of lethal outcomes to others.
Take heart disease, for example. A comprehensive analysis by the Washington Post suggests that the postponement or cancelation of heart disease procedures has led to irregular spikes in mortality. In the five hardest-hit states (Illinois, New York, New Jersey, Michigan, and Massachusetts), there were 8,300 more deaths from heart problems than would have been typical in March, April, and May — an increase of roughly 27% over historical averages.
Source: Washington Post
Alongside the evident toll on human life, the economic hit on the healthcare sector is almost hard to grasp. In April, the American Hospital Association estimated that hospitals were bleeding more than $50 billion per month. In a candid interview with CNBC, Dr. Bob Watcher, Chairman of the Department of Medicine at UC San Francisco, admitted that he expects that UCSF’s hospitals will lose $600-$700 million this year alone. According to Nathan Kaufman, a strategic advisor to hospitals, emergency room visits have plummeted. Kaufman notes that hospitals had their “worst month ever” for operating margins in April, adding that “indirectly, these emergency room visits impact about 40% of the non-COVID-19 revenue of a hospital.”
The Road to Recovery
As the initial shock begins to wane, and the pandemic transforms from a cataclysmic event into a constant reality, patients are trickling back into hospitals. According to Epic, screening tests for breast, colon, and cervical cancer, which plunged by 80–94% early in the pandemic, were running just 20–30% below normal as of mid-June. A report by the Commonwealth Fund found that visits to physicians’ offices, which declined 60% from mid-March to mid-April, are now running 20–30% below pre-pandemic levels. Chris Mast, Vice President of Clinical Informatics at Epic, estimates that hospital volume based on revenue is back to 80–90%.
This is all, of course, fantastic news for patients and practitioners alike, but the hard-learned lessons of the last few months are still fresh-in-mind, and any return to service must be executed with surgical attention to safety and best practices to avoid a costly relapse.
To that end, some of the country’s most prestigious healthcare associations recently released their road maps for a return to routine care. A joint statement by the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and the American Hospital Association, in April, charted the steps to resume elective surgery, while AAMC released its own set of critical recommendations in late August.
In both documents, one of the most crucial steps outlined for any restart plan is an intensive, laser-focused screening process of employees, patients, and visitors, with AAMC even going as far as urging all organizations to ‘screen almost everyone, a lot.’ Using UCLA Health as a case study, they’ve asked Chief Medical and Quality Officer Dr. Robert Cherry to share his medical center’s scrupulous screening procedure:
“UCLA Health’s screening process includes posting staff at each entrance to ask everyone entering the hospital about possible symptoms and take their temperature before allowing them in. Hospital staff can start their own screening process before they come to work by tapping into a smartphone app to answer questions about their health conditions. Those who might have coronavirus symptoms are steered to a call center for further assessment and determination of next steps.”
Although the process described by Dr. Cherry may seem complex, expensive, or unfeasible, several leading tech companies have recently rolled out solutions and strategies that are slated to deliver and simplify screening and clearing on a mass scale.
A COVID-Free Passport
In mid-October, during the prominent virtual healthcare convention HLTH 2020, major players in digital healthcare doubled down on their fight against COVID-19. In one session that followed the other, Mayo Clinic and IBM Watson Health unveiled their solutions for safely returning people to public environments, especially employees to the workplace, both built on thorough screening and clearing processes.
In his keynote address, Dr. John Halamka, President of Mayo Clinic Platform, broke down the response to the pandemic into five consecutive stages: isolation, testing and contact tracing, pre-vaccine return to life, post-vaccine return to life, and lastly, the new normal. To that end, Mayo Clinic announced its new alliance with Safe Health Systems (SHS) to develop software and workflows designed to support these stages by, for one example, providing the connecting tissue between an employee or student’s negative test result and a designated secured app that employers and universities can trust and track.
IBM Watson Health introduced its latest product, the IBM Digital Health Pass, a built-for-smartphones “digital health wallet” containing a person’s health status. A QR code or result from a morning COVID-19 test, would be scanned at the entrance of any venue to ensure real-time screening. As per General Manager of Watson Health, Paul Roma, the digital health pass will be intuitive and easy to use, following four simple steps: 1. downloading and enrolling to the IBM digital app, 2. when health data becomes available, users can scan a QR code to add the information to the digital wallet, 3. users can share their health status, 4. verification through Blockchain technologies to confirm authenticity and validity of the user’s account and info.
The emphasis here is on security – there is fear surrounding these types of solutions that sensitive health information will inspire privacy concerns, or worse, breach. IBM maintains that security is paramount to their passport, and that people can share their health data while keeping the root source anonymous via an encrypted digital wallet built on blockchain.
Roma pitched a heartening scenario in which baseball fans could get back to their favorite stadiums with the widespread adoption of screening, but noted that travel and transportation will require heightened levels of strictness when it comes to passing certain wellness tests.
Back in June, another juggernaut in healthcare innovation, CVS Health, debuted its own workplace reopening product for U.S. businesses and universities with an emphasis on testing. Digital tools are included that allow for easy scheduling of tests, distribution of the results, and analytics capabilities. While CVS does not provide contact tracing, it does offer that option via third-party vendors. The Return Ready™ program features different testing options for students and employees based on their varying types of worksites and risk of exposure. Their testing sites (with over 1400 drive-thru locations) can support 15-minute turn around, leading to faster entry times for a wide array of venues. CVS will be consumers of their own product, as they plan to roll this out to their own roughly 300,000 employees.
Joining these big names is small conversational AI startup Hyro. Drawing from their experience creating complimentary COVID-19 virtual assistants for some of the foremost healthcare organizations in the country, such as Mercy Health and Montefiore Medical Center, the company revealed its AI-powered screening solution in late August. Taking a more enterprise-specific approach, Hyro’s solution proactively reaches out via SMS using preconfigured triggers from healthcare providers, and fields inbound screening requests through a web-based chat and voice assistant. While the process is handled end-to-end by conversational AI, health providers can use a dashboard to manage and monitor organizational activity for better visibility. If a department is starting to experience a spike in COVID-related issues, administrators can send alerts out quickly and stymie the flow of traffic to that hospital wing, for example. One added feature that’s a bit unique to Hyro is their Conversational Intelligence Platform, which will also reveal what patients, staff and visitors of hospitals are asking beyond the scope of screening and COVID-19.
Healthcare organizations use a 24/7 real-time dashboard to monitor COVID-19 screening.
A One-Two Punch
High tech screening solutions alone cannot be viewed as magic workarounds to this relentless and sophisticated virus. Instead, they serve as invaluable ammunition in the battle to bring back a sense of normalcy to our everyday lives. Social distancing, masks, and good hygiene practices are just as necessary as they were when the pandemic first broke out, but, finally, we may just have the tools in place to prevent mass-scale lockdowns. Until the majority of the population is vaccinated, the “hammer and the dance” continues, but these screening innovations will be vital in ensuring that the dance outweighs the hammer.