Health systems across the nation, reeling financially from the coronavirus pandemic, are assessing how and when to resume elective and other non-COVID procedures. Having seen a significant drop in COVID-19 cases, Atlantic Health System in Morristown, N.J., developed a five-tier ranking for how it will bring cases back to its hospitals. Amy Perry, senior vice president of integrated care delivery and CEO of the hospital division, discussed Atlantic Health’s strategy with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: What is the status of Atlantic Health’s coronavirus caseload?
Perry: We’ve had a significant decline from our peak. We have seen almost 5,000 admissions for COVID and additionally, 5,000 emergency room treat-and-release COVID patients, so this has been a very significant part of our patient population over the last eight weeks. But now we have, significantly, a little bit less than 200 patients across our health system with COVID, and our non-COVID patient population is a majority of the patients that we have in-house.
MH: As you think about that eight-week period, what kind of financial strain did that put on Atlantic Health, where you’ve had to postpone elective procedures?
Perry: It’s had a significant financial impact because of what we had to do to handle the surge. It’s not very easy to quadruple your critical-care beds within a week. I would say that’s an incredible feat, and the amount of resources that it takes from facilities, for equipment, supplies, team member deployment, is really quite beyond your wildest imagination. Those expenses, coupled with the fact that the elective procedure volume dropped significantly, had a dramatic impact over the last couple of months. We are working through that right now.
MH: Can you put a number to that in terms of a drop in revenue?
Perry: It’s definitely more than $100 million.
MH: Let’s talk about bringing some of those cases back. You have a five-tier ranking system, right?
Perry: It’s a ranking system that we’ve used throughout this crisis. Over the last eight weeks, at no time did we shut our emergency department down. I have to … emphasize that as a health system, this isn’t a reopening; we never had the luxury of closing. We have focused on taking care of our sickest patients. We have a trauma center, so we took care of trauma patients throughout this ordeal. We took care of brain tumors. We had stroke, (neurological) procedures. We had heart surgeries. And on the happy side of things, we delivered more than 1,000 healthy babies during the last eight weeks. We have continuously cared for a non-COVID population this entire time.
MH: But as you bring back cases that weren’t coming in, how did you decide to do a ranking?
Perry: In the surgeries that continued throughout, we would categorize lifesaving as No. 1—those procedures, if we had to intercede in 72 hours, we called that time-to-impact. Our second level, we called urgent—again, with a time-to-impact score—essentially if somebody’s health could be irreversibly impacted if we didn’t intervene.
We want to make sure that none of our patients suffer short-term or long-term because we’re not taking care of their issues. Now we’re dealing with the third level, which are things that had maybe a 30-day or a 60-day time to impact. So we’re putting all of those patients on the schedule. Our key goal is to ensure that nobody’s health is negatively impacted because of a delay. Our decisionmaking revolves around the time-to-impact for our patients.
MH: What impact did this have on readmissions, where a patient may have had to come back for an infection?
Perry: We handled all of our readmissions as necessary for somebody who had an unforeseen condition after they left our walls. But of course, like many other hospitals, we have accelerated our telehealth capabilities dramatically. We went from essentially 50 telehealth visits a day to more than 3,500 televisits a day in a couple of weeks.
The hotlines, the outreach, and what we’ve done to try to help people stay at home and stay healthier has had a dramatic impact. Our home health agency has been a key driver of keeping people home as well. Also, we put in a new program that’s working extraordinarily well called observation at home. We have more than 100 patients who have taken advantage of this program, which has remote vital monitoring capability along with home oxygen supplies. We’ve allowed our patients to really convalesce in the comfort of their homes where it’s appropriate.
MH: Are you being reimbursed for that?
Perry: No. The reimbursement has not caught up to anything that we’re doing. There’s some understanding of that; there’s no playbook for anyone right now. There’s no playbook for us, and there’s no playbook for the federal government in terms of how they’re trying to distribute reimbursement for the various things that we’re taking care of. What’s happening are these kind of large, blanket approaches and hopefully, over time and seeing what’s been effective, we’ll be able to keep in place the things that work, and help us keep our patients safe, stronger and more independent in their homes.
MH: You are only bringing back procedures at hospitals, not outpatient settings, right?
Perry: That’s true, for the most part. And that’s really to protect our personal protective equipment. We still have a resource balancing that we have to do to make sure that we are ready at all times for any hot spots or any surges that might occur.
MH: What are you doing in terms of testing patients and staff?
Perry: We have a program where we test our patients for active virus, whether they are antigen-positive or not. We do that within three days of the time of their procedure to make sure that we are working with people who are COVID-free. The reason for that is when someone has COVID, they might have more complications. We try to reduce the complications where we can. But we have operated on people with COVID because their condition needed immediate care. So it’s not a straight line. We try to wait when we can, because it’s safer. And we want to know, to the extent we can, if somebody is asymptomatic so that we can take extra precautions for us and our team members.
MH: What’s the struggle in convincing patients that it’s safe to come back to the hospital now?
Perry: I think people generally trust their care providers. To the extent that they’re talking to their physicians about the urgency of their healthcare issue, we find that people are comforted by that and they feel confidence in that. The other thing that we’re trying to convey is what it’s like at Atlantic Health System. We want to talk about safety. One of the very interesting things is when I would go home from work and watch the news, I would be scared. I would see chaos. And it created fear for me. And then the next day I would go back to any one of our hospitals, and I would see a calm, confident, competent, coordinated approach to care.
Patients see that, physicians see that we’re not just safe for one moment in time. I do think that there’s an interesting narrative that is happening now in our field, where it’s like, “Well, we’re going to certify this unit safe.” Well, that’s certified for about five minutes.
What we need, and what we have deployed at Atlantic Health, is we are always safe. We have checklists. We are cleaning hourly. We are cleaning daily. We are treating our surfaces, our air handlers, our filters. We have this continuous commitment to safety.
As I mentioned to many people, when you get on an airplane, you assume that your pilot doesn’t want to die and that they’re doing their checklist. That’s the way we look at it at Atlantic Health. No one here … wants to get sick, and they’re protecting themselves as much as they’re protecting everyone who comes in the door.
That messaging, I believe, is getting through to our patients because we’re seeing significantly less resistance to doing the kinds of things they need to do to protect their health. They tell their friends and that is building our momentum for safety, which is really the future for our continuous readiness that we need to all be in this next phase.