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Renton, Wash.-based Providence, one of the largest not-for-profit healthcare systems with 51 hospitals and more than 1,000 clinics, is situated at the U.S. epicenter of the COVID-19 outbreak. Washington is one of the states that has experienced the highest number of coronavirus cases at more than 450; Providence hospitals have treated 60 of them. Modern Healthcare reporter Shelby Livingston spoke with Providence CEO Dr. Rod Hochman about the availability of essential COVID-19 tests, the hospital system's decision to pause coronavirus-related billing, and how the system is caring for its own staff. The following is an edited transcript.
MH: What's been the biggest challenge?
Hochman: Testing. Every doctor and clinician has been on TV and radio screaming about this. With a virus like this, or any outbreak, you really can't understand it unless you know what the denominator is. What that means is every time someone is exposed, we don't know whether they've infected other people unless you can readily test. So right now we know that a number of patients have gotten very sick—obviously they've been positive—but the question is who else around them is carrying the virus? This information is critically important. On the (Grand) Princess cruise ship of 3,500 passengers—if we knew the COVID status of every one of them, it would tell us a lot about how this virus spreads, who spreads it, are there super-spreaders that spread a lot of virus to other people? That's one of our lessons learned from South Korea where they've done a phenomenal amount of testing so they really understood how this was spreading and where were the first signs of infection. If there's an outbreak in the nursing home, where did it come from? Unless you've tested extensively, you just don't know the answer to that. The problem is that we're about at least 6 to 8 weeks behind in finding that information out.
MH: What is the availability of COVID tests right now?
Hochman: It's getting better but it's still inadequate. Finally, (private lab company) Lab Corp. is getting up to speed and so is Quest (Diagnostics). University of Washington has testing available, but it's not limitless. And then we're going to start doing our own testing in Portland, Ore., in our own labs. It's still getting ramped up and it's going to get there I would hope by next week. The problem is also that there's a lot of confusion over who can order the tests and how do they get done. Depending on where the patient shows up or what practitioner they've gone to, it's not necessarily clear how to get the testing done. The other thing is once it's available we've got to make sure people know it's available and know how to get it done. Turnaround time is another issue. Sometimes the turnaround time is 24 hours; sometimes it's four days. It needs to be fast.
MH: When a patient shows up with symptoms, how long does it take before you can actually give them the test? How long do they wait?
Hochman: That depends on where they are. It depends on are they in a doctor's office, are they in an emergency room? It's very geographic-dependent.
MH: For patients who test positive for the virus, are they sent home or do they stay in the hospital? How do you determine that?
Hochman: It all depends. There's a whole bunch of protocols we've been using for how to deal with each patient, depending on how they present clinically, what their symptoms are, and what are their underlying diseases. With someone who is relatively healthy, a lot of them can quarantine at home and be cared for at home unless they get worse. We are sending patients home with monitoring (tools) to track their temperature and pulse.
MH: Providence said yesterday that it will not bill patients for coronavirus-related tests and treatment. Why did you make of the decision to pause billing?
Hochman: What we said was we've got to get these things done. We'll figure it out on the back end. What we don't want to do right now given the critical nature is delay things because of those issues. We want to encourage people to get tested and we'll figure that out on the back end, and for now we're pausing on that just to really encourage people and make sure that's not an impediment to them getting tested.
MH: How is your staff preparing for an influx of patients?
Hochman: Triaging is how we get the "worried well" to stay home and not come to the emergency room or doctor's office. We have a whole bunch of triage mechanisms electronically, for express care, etc., so that we avoid them coming to the ER or doctor's office. On the other side of it, I was just on a call with all of our hospitals particularly in Washington, thinking about what do we do about surge capacity, what happens if the number of patients needing ventilators increases, etc. That's all in the works. We're already planning for that.
MH: How is morale among your physicians and other staff?
Hochman: I would say overall good, but this is a long haul. We are very worried about it. As you know, our Gov. (Jay) Inslee declared a state of emergency, so all schools are out in Washington. Everything's been shut down. There are really two classes of employees. Service employees like healthcare workers can't work from home. We've got to go in. We've got a lot of our tech workers who are working from home, but a lot of service workers have to be there. So we're concerned and doing a lot of work to make sure they are well cared for, that they've got the right protective gear, and that we're doing the best we can in helping them with their child-care issues now that their children are home. It's top of mind for us because how do we care for people if we don't have the right staff?
MH: Are you having any issues with your medical supplies?
Hochman: The big three (concerns) are testing, supplies and then staffing. On the supply side, so far we've been able to find what we need. The concern is the long haul. This is not going to go away in a week or two weeks or three weeks. The good news is that we're a large system so we have supplies for 51 hospitals and 1,000 clinics, so our people are doing a lot of work trying to find out where those supplies are and how to get them to where they are needed and making sure they are secured. What we are concerned about for the country, as other hotspots occur, is the long-term supply that's going to be needed. It's top of mind for us.
