More than 3,000 surgeries have been put off at Yale New Haven Health since mid-March, which accounts for about 80% of its total surgeries.
That scenario mirrors health systems across the country that have had to delay procedures deemed less urgent as they focus on the COVID-19 pandemic. At Yale, overall outpatient services have declined by about 50%, said Dr. Keith Churchwell, the system's chief operating officer.
"The numbers are staggering," he said, noting that the 3,000 doesn't factor in diagnostics and imaging. "The impact has been significant and going forward, we have to plan how to restart that."
Restarting deferred surgeries pose a series of series of hurdles related to operations, finances, testing, staffing, supplies and patient safety, among others. One of them is how treatment will be prioritized.
The significant drop off in the number of patients receiving emergency care related to heart attacks and stroke is a major concern, Churchwell said.
"This patient population hasn't gone away," said Churchwell, adding that fear has likely kept them at home. "We are concerned that there has been a missed opportunity to give appropriate care and that we will be seeing patients down the road who will be sicker and more complicated, unfortunately."
Nearly 55% fewer Americans sought hospital care over the past two months, resulting in a $60.1 billion average monthly revenue loss across all U.S. hospitals, according to a new Strata Decision Technology analysis of more than 2 million visits from 228 hospitals. Those losses represent about a fifth of the healthcare industry's monthly output.
A decrease in procedures for life-threatening illnesses was particularly alarming, researchers said, noting a 57% decrease in services related to cardiology, 55% decline to breast health and 37% decrease to oncology.
"When you see things like heart attacks down 50% to 60% and the number of necessary procedures like stenting down 45%, it is really remarkable," said Steve Lefar, executive director of Strata Decision Technology's StrataSphere line of business. "This tells the story of the secondary implications of all this care deferral."
About 40% of inpatient admissions at Edward-Elmhurst Health are non-urgent procedures. The health system in the west Chicago suburbs saw significant declines in cardiology, orthopedics and cancer care, said Denise Chamberlain, chief financial officer at Edward-Elmhurst.
"Procedures that were considered elective have now become urgent," she said.
Treatment related to chronic conditions like hypertension and diabetes fell 37% and 67%, respectively, according to Strata data. Preventive wellness visits, gynecologic wellness and screenings, and gastrointestinal benign neoplasms and polyps all saw volumes drop by more than 75%.
That pent-up demand threatens to overwhelm providers. Edward-Elmhurst continues to reconfigure its workforce, ramp up testing, reorganize its facilities to improve social distancing and add to its personal protective equipment supply, which has been one of the biggest obstacles, Chamberlain said.
Eisenhower Health has had a similar problem, said Ken Wheat, chief financial officer at the Palm Springs, Calif.-based system.
"The biggest challenge from the planning and prioritization standpoint is PPE," said Wheat, adding that the organization incrementally restarted elective surgeries about a week and a half ago. "But we are a long way from having enough PPE to open up the gates."
As for the financial impacts, inpatient surgeries and procedures typically account for the majority of hospitals' revenue. Some of the biggest impacts stemmed from a 99% decline in knee replacement surgeries, 81% decline in spinal infusions, 79% drop in hip replacements and 38% decrease in fracture repairs.
Meanwhile, the number of self-pay patients has increased by 114% in just 90 days as millions have lost their employer-sponsored insurance. In January, 7% of all patients lacked health insurance. By April that figure had risen to 11%, and early results from May indicate 15% of all patients are uninsured, Strata found.
"This is the equivalent of the banking crisis of 2008," said Dan Michelson, CEO of Strata Decision Technology. "We're on the verge of a financial collapse in healthcare."
The $3.6 trillion healthcare economy makes up around 18% of the country's gross domestic product, he noted.
Going forward, relying on the fee-for-service system is not sustainable, Chamberlain said.
"We have to get off the model where we get paid the most for patients being in the hospital—I don't think that model works in the future," said Chamberlain, expecting more of a capitated model. But that will require convincing self-insured employers that approach will lower costs and improve outcomes, Chamberlain said.
"I don't think healthcare will go back to the way it was."
