After significant drops in patient volumes in mid-March and April under a state mandate to postpone nonessential surgeries and procedures, Ohio health systems are working to help patients understand that it is safe and important that they return for care.
The Cleveland Clinic's patient volumes have climbed to about 85% of previous levels in January and February. University Hospitals reports that it's pretty much back to its budgeted patient levels. And Summa Health is between 90% and 100% of its pre-COVID-19 volumes across services.
As hospitals encourage patients to return, they're seeing a concerning pattern of patients continuing to defer care or returning after delayed care with more severe issues.
"That's really what is going to be the much higher price than COVID in the long run," said Dr. Beri Ridgeway, associate chief of staff for the clinic.
During COVID-19, the clinic saw "far fewer" heart attacks, strokes and other emergency conditions, she said, adding that these were still happening, but people weren't receiving care as fear of COVID-19 outweighed willingness to come in for things like chest pain or one-sided weakness.
Dr. Daniel Simon, UH's chief clinical and scientific officer and president of the UH Cleveland Medical Center, said that as a practicing cardiologist, he saw a burst of patients at the end of May and June who were having ongoing heart issues and admitted they hadn't felt comfortable calling because they knew that if they did so, he would have told them to go to seek immediate care. The system saw this across all specialties, he said.
Beyond acute emergency needs, patients also delayed preventative care. Ridgeway said she and others are very worried about the longer term impacts of patients delaying routine screenings or visits to manage chronic conditions.
"This will have consequences for years to come," she said. "We really worked hard to manage chronic conditions either in person or over a virtual visit, but there's also some reticence for others, and others who may not prioritize that health condition as much as it should be, given their fears of COVID."
In April, UH's discharges were down 32% to budget and total surgeries were down 73%. Volumes have since been climbing, and in July, discharges were at budget and surgery was only down 7%, Simon said. Outpatient levels, which were down to about 30,000 a week in April, have also bounced back to budgeted levels of around 65,000 a week this month.
Summa's patient volumes also dropped precipitously in March and April, said Dr. David Custodio, Summa's senior vice president and president of the system's Akron & St. Thomas campuses. Surgeries have returned to around 98% of pre-COVID-19 levels and most all other services are between 90% and 100% of previous patient volumes, he said.
Summa, like others, has implemented safety measures for returning patients to adhere to social distancing, hand hygiene and universal masking guidelines. They changed lobby setups and shifted some registration processes to have patients wait in their car.
Some of these changes — such as extra cleaning between patients, staggered office starts or not having patients sitting ready in a packed waiting room — have slowed the process of moving patients through.
"We don't mind doing it," Custodio said. "It doesn't make us as quick as we were before, but obviously, patient safety is the key."
In March and April, the clinic's surgical services dropped by about 75%. Outpatient volumes saw a similar drop.
In asking different cohorts of patients why they were deferring care, the clinic learned that the great majority are doing so because of their personal preferences. A number of others reported child care issues with limited day care and schooling options.
A small portion of patients cited financial challenges — losing or changing their insurance, employment issues, etc. — as the reason they haven't returned. Ridgeway said this group is actually smaller than she would have predicted, but she expects it will continue to grow. The clinic is working with these patients to help them through these challenges.
The clinic was able to significantly increase its volume for surgical services in May, but then hit a plateau in June and July and it remains around 85% of its previous volumes for surgical appointments. Outpatient services were a little bit slower to recover but have also leveled off in August and remain between 80% and 85% of their previous levels, Ridgeway said.
Ridgeway notes that August is a tough month to judge, though, because families tend to have a lot going on, such as vacations.
"We're interested to see what will happen in the fall as we continue to reach out to our patients and stress the importance of coming back for care," she said.
As fall approaches, and with it flu season, hospitals are monitoring their capacity and the availability of personal protective equipment — two major factors that contributed to the mid-March postponement of nonessential surgeries and procedures.
Simon said he feels confident about the PPE on hand at UH, which now has 300 to 500 days' worth of these supplies, compared to an average of roughly 100 days they maintained before the pandemic. It has also worked to develop connections with U.S. companies that produce PPE.
Hospital capacity is a bit harder to predict, as it will depend a lot on the severity of this year's flu season.
Infectious disease doctors hope the practices implemented to slow the spread of COVID-19 will help to significantly lessen the severity of the flu this year. Also important in managing flu season: vaccinations. Ridgeway points to recent data that suggests those who have been up-to-date on vaccines, including influenza vaccinations, fare much better with COVID-19.
She stressed that it is both safe and important that patients resume their care.
"This isn't just something that's going to affect them this month or the next," she said. "COVID will definitely be with us for a while, and we can't stop tending to our normal health. That's going to be critical to have the best outcomes for each individual."
"As hospitals' volumes climb, leaders urge patients to seek needed care" originally appeared in Crain's Cleveland Business.