Reactivating elective surgery: Four challenges and an imperative

The stoppage this spring of most electively scheduled surgery and other procedures caused widespread financial strain on provider systems. Some data models indicated an aggregate 77% decline in five service lines with the highest overall elective surgery volumes, as of April. Coupled with negative margins often associated with treating COVID-19 patients, the revenue gap for many hospitals has been devastating. Financial sustainability will require organizations to salvage as much revenue as possible, as soon as possible. 

But resuming elective procedures to earn back lost revenue isn’t as simple as reopening and rescheduling postponed procedures. Organizations must embark on developing a thoughtful elective surgery reactivation plan that accounts for capacity, payer, safety, personnel and other considerations – even as the presence of COVID-19 lingers. This task is fraught with challenges to navigate in the post-surge environment, including some that are outside a health system’s sphere of influence. 

Many factors are within a hospital’s control, however, and can be overcome with an organized plan, the right data and expertise, and staff engagement. Some approaches to addressing four of these issues are described below.

Lack of actionable data to inform restart planning – Without clear, transparent, interconnected data, hospitals will find it difficult to identify actual surgical needs and available capacity quickly and accurately. Forecasting, clinical and operational data can help guide the tactics necessary to optimize capacity. 

• Hospitals must prioritize case backlog, improve patient readiness and throughput, and maximize surgery and procedure utilization.
• Robust spend analysis can drive effective supply conservation and optimization.

Care coordination challenges – Inconsistencies with scheduling, equipment availability, patient preparedness and other departments hinder rapid, efficient use of perioperative resources. Health systems need data-enabled agility to redesign care delivery.

• Optimize high-margin growth to focus on areas that drive revenue and align with market needs for managing community wellness – including surgery, ambulatory, virtual health and others.
• Build flexible capacity to scale up and down to adapt to different surges quickly, efficiently and cost-effectively. 

Payer mix – Soaring unemployment claims are associated with widespread loss of health insurance coverage. Stabilizing from the ripple effect as the job market and debt begin to stabilize and unwind will take time. 

• A payer mix analysis can help prioritize elective cases and determine the financial viability of specific procedures. 
• Hospitals that manage payer relationships and develop a sound payer strategy are taking a big step toward recapturing lost revenue.
• Optimizing documentation and coding can maximize compliant reimbursement from all inpatient discharges and ED visits (including COVID-19 cases) and physician fees.

Shifting landscape and resource impact – The ongoing pandemic environment has changed the US health care landscape, with consumers, providers, payers, suppliers, the government and others all shifting their expectations. Financial and organizational uncertainty may create extreme stress on physicians, nurses and staff and will pressure-test your core culture. 

• Take a strategic approach to assessing physician alignment to evaluate landscape, identify risks and deploy strategy. 
• Efficient scheduling and use of staff and labor resources means freeing up time, resources and bandwidth to minimize disruptions and maximize surgeon efficiency.
• Identify adaptive workforce strategies to build resiliency. 

Taking these and other immediate and subsequent actions will enable organizations to reignite the revenue engine by salvaging as much elective surgery as possible in 2020 and beyond. Engaging a centralized planning team that includes strong data and expertise will empower your organization to model demand and capacity, anticipate and address operational hurdles, and accelerate the rollout of a successful plan.

Despite a hospital’s comprehensive efforts to implement a sound reactivation plan, success also hinges on a more subjective factor: whether patients feel safe seeking care at the facility. Consumer trust – regarding health as well as financial factors – is vital to restoring procedure volume, and transparent communication is essential to mitigating patients’ fears. Hospitals must proactively address cleanliness, screening, exposure management, payment resources, even the ability for a loved one to accompany them; and those that can demonstrate consistent application of appropriate interventions stand to benefit from market differentiation.

Challenging situations often reveal hidden opportunity. The COVID-19 crisis provides the impetus to apply a strategic lens to your health system’s operating model, as well as to develop a real-time strategy, operational integration and dynamic planning process – lending a sense of urgency to make difficult decisions that may have lingered on the backburner.

Health systems that focus beyond the short-term considerations of recovery and reactivation to longer-term modeling and cultural evolution are well-poised to succeed in the future of health care.