Cash-strapped hospitals are sending emails and buying ads to entice patients back from Covid-19 lockdowns with a plaintive reminder: It’s time to fix that hernia.
But the effort to recover some of the tens of billions the industry says it lost from the cancellation of elective surgeries is colliding with a burst of new coronavirus cases in most of the country — and again putting economic recovery in conflict with disease prevention.
Hospitals until now were recession-proof and remain among the biggest employers in some communities. The pandemic brought historic levels of layoffs and furloughs among health care workers; the March jobs report showing the worst loss in health care jobs in at least 30 years.
If the hospitals close back down, it could drive up unemployment and the number of uninsured — as well as prolong delays in needed but non-emergency care. But trying to restore some postponed business could put more stresses on front-line health workers and possibly expose non-Covid patients in wards to the virus.
The hospital chains saw the summer as a potential respite when they could resume postponed hip and knee replacements and even some cancer surgeries. Despite record admissions during the public health crisis, the industry is struggling because profit margins on non-essential care are so much higher, though some systems have deep financial reserves.
Now, the swath the virus has cut through the Sun Belt is putting a premium on beds and ICUs: Hospitalizations are where they were in late April, according to the Covid Tracking Project, and bans on elective surgeries were reimposed in the past month in more than 100 hard-hit Texas counties and all of Mississippi.
On Thursday, Florida reported again surpassing its record for daily new hospitalizations, and hospitals in hot spots are once again halting elective procedures. Arizona a day before announced it was bringing in more than 600 out-of-state critical care and medical nurses to boost capacity. Los Angeles County could be moving to another stay-at-home order with record-breaking hospitalizations this week, according to local reports.
National Nurses United is urging a nationwide pause in non-emergency procedures, citing shortages of tests and protective gear that’s exposing its members and patients to unnecessary risks.
"Any hospitals that did reopen elective surgeries should now shut them down, especially given the daily shattering of records of number of infections,” the largest national nurses union wrote in a statement to POLITICO.
But local officials would have to weigh any broad mandate against pressure to put people back to work and to get patients care. Nearly half of Americans said they or a family member delayed treatments when the pandemic was raging in the spring, according to a Kaiser Family Foundation poll released in late May, and hospitals argue that further prolonging care is harmful to Americans’ health.
“It seemed prudent and appropriate to get back to the business of caring for the more common ailments of patients,” said Nancy Foster, of the American Hospital Association. “And I think we were particularly persuaded of that because we had seen this alarming drop in the number of patients who had truly serious and urgent conditions — like a heart attack or a stroke symptom — not coming into the hospital.”
Foster said decisions to close down should be made by local leaders and be informed by the incidence of cases in their communities, whether the beds in the hospitals are needed to care for Covid-19 patients and by hospital staffing levels.
For now, the industry is pushing ahead with its aggressive marketing while playing up new safety protocols like mask requirements, visitor screening and adherence to CDC recommendations to prevent disease spread.
“We are safe and ready to serve you,” the subject line of a MedStar Health email states.
“Keep social distancing, stop medical distancing,” a narrator says in an ad from a new health care industry alliance.
“Please don’t ignore your symptoms, your life could depend on it,” a doctor says in a four-week, $6 million ad campaign from the Greater New York Hospital Association.
While there’s no federal mandate to test patients before surgery, multiple hospital trade groups and health systems say it’s become essential. Some hospitals with in-house testing labs are able to turn around results quickly while others may require patients to quarantine for days before they’re admitted for surgery, though there’s no way to ensure that they do so.
At MedStar Health facilities in Maryland and Washington, D.C., patients are tested no more than five days before a scheduled elective procedure and then asked to quarantine. The health system initially required a second test within 24 hours of surgery for anyone who hadn’t quarantined but backed off after thousands of tests didn't turn up a positive case, Terry Fairbanks, MedStar’s vice president of quality and safety, said in a statement.
In New York, the state health department last month changed a requirement that hospitals test all patients scheduled for elective procedures from three days beforehand to five days — with the only exception being in the case of an emergency. Some members have had to reschedule procedures because of a shortage of testing supplies, though hospitals generally have been able to meet that requirement, a GNYHA spokesperson said.
Meanwhile, many hospitals are still facing the same issues that plagued the nation in the spring: persistent shortages of personal protective gear and testing backlogs that some worry could put staff and patients at risk of contracting the infection. A Premier Inc. survey in June showed that essential gear is still hard to buy: nearly 53 percent of respondents noted that N95 masks were heavily backordered, and 40 percent said that testing swabs and kits were also backordered.
That situation is playing out among workers on the ground.
At Doctors Hospital of Sarasota, staff are required to wear the same N95 and surgical mask throughout the day, a lack of PPE that concerns Geniece Hunt, a registered nurse at the hospital, who says they should be thrown out after seeing every patient. Hunt, who is a member of National Nurses United, said workers were told they wouldn’t be tested unless they had symptoms.
Monica Yadav, a spokesperson for the hospital, said the facility follows CDC guidelines for personal protective gear, and that everyone who enters wears a mask.
“We contact trace every COVID positive case in our facility to be certain our caregivers are not inadvertently exposed and test accordingly,” she wrote in an email, adding that the hospital has restricted elective inpatient and outpatient surgeries as cases and hospitalizations rise in the community.
Alexandria Cutler, a food service attendant at UPMC Western Psychiatric in Pittsburgh, said she’s also required to wear the same mask all day, and was told by hospital administrations that they can’t get tested unless they’re symptomatic.
In an email, Sheila Davis, a spokesperson for UPMC, said that staff receive a new mask every day, and if it gets soiled, can request another. UPMC employees are tested when contact tracing determines “they had unprotected exposure AND any symptoms, or if the test is ordered by their doctor because of their symptoms.”
“Testing absent symptoms is of limited value and is often misleading—for instance, producing a negative result shortly before the person turns positive or develops symptoms,” she wrote.
Cutler still worries about bringing the virus back to her family. She takes care of her elderly dad and her aunt, and said “the thought that I might take something like this to them and that their deaths will be on my hands kills my entire soul.”