In the early days of the pandemic, New York health systems and hospitals were thrown for a loop. Surges in patient volume and the loss of revenue when elective procedures were suspended by state order left local facilities feeling pushed to their limits. But in the ensuing months, and with the crisis appearing to be winding down, they say they have learned important lessons that will help them change the way they work.
“We were built to withstand blows and deliver care,” said Dan Widawsky, chief financial officer of NYU Langone.
And in picking themselves back up, health systems have become better prepared for the next disaster, he noted.
“An analogy I like to use comes from hockey,” he said. “You don’t want to skate to the puck; you want to skate to where the puck is going.”
Thinking ahead
Having to go through the thick of the pandemic last year without necessary resources really put the old way of doing business into perspective, said Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals.
“One of the mistakes of previous management practices is not keeping excess inventory because of the risk of medication or equipment expiring,” he said.
That led to the health system being stretched thin when it came to personal protective equipment and other supplies.
“We can’t always run hospitals the way many of us were taught, which is to buy supplies at exactly your census and order meds based on how much you used last month, exactly to the dose,” Katz said.
The public health system is now maintaining large supplies of PPE and critical medication, he said.
The pandemic also has taught facilities that paying attention to what’s going on in other places and shoring up supplies just in case pays off. For example, when COVID-19 was unfolding in China in December 2019, NYU Langone made the gamble to start buying PPE.
“It was an expense, but that made a huge difference in March and April,” Widawsky said, noting that prices for N95 masks increased tenfold during the pandemic’s height.
Going forward, the health system will factor the expectation that costs could rise in a crisis into its budget.
The pandemic also pushed Northwell Health to rethink its supply chain.
“We had been heavily dependent on China for many of our supplies. But that became an issue when they were hit hard, disrupting our own supplies,” said Michael Dowling, CEO. “Now we’ve expanded our contacts beyond just China.”
Internal investments
As local health systems saw their capacity capabilities tested during the patient surges at the height of the pandemic, they learned the importance of investing in infrastructure to meet service demands.
Some have explored high-tech solutions. NYU Langone, for example, built a real-time dashboard that can track a patient’s journey from admission to discharge. It has saved the health system hours of data gathering and helped it manage its patient capacity, Widawsky said. The platform was actually created before the COVID-19 crisis began but was adapted to suit the pandemic.
Northwell created a daily dashboard that tracked patient capacity at each facility and updated its playbook for transporting patients between sites safely, Dowling said.
New York-Presbyterian used technology to standardize and share medical information across its network, said Dr. Laura Forese, executive vice president and chief operating officer. Last year it adopted a new electronic record-keeping system, although the plan dated back to before the pandemic. It also set up a hotline to provide remote treatment for COVID-19 patients.
Others came up with simpler solutions. Health + Hospitals, for instance, made minor fixes such as replacing wooden doors with glass ones to allow for greater patient visibility and placing cameras and microphones at nurses’ stations to improve response time, Katz said.
One investment that hospital leaders agree will make all the difference during a future health crisis is in their staff. It’s important for medical workers to receive ample training, and after a year of fighting a devastating virus, their mental health and well-being will need to be addressed as well.
Earlier in the pandemic, Maimonides Medical Center offered “hello rounds,” during which attending psychiatrists and senior residents checked on other staff. More recently, the hospital created a webinar on coping with the stress of COVID-19.
Maimonides is also training physicians to work across specialties, which they had to do early in the crisis.
“We had orthopedists and pediatricians treating virus patients,” said CEO Kenneth Gibbs. “From doctors to nurses, folks needed to be cross-trained.”
Financial kinks
Hospitals work on thin margins that are easily threatened by revenue disruptions, making preparing for future crises all the more difficult. This is compounded by lower reimbursement rates from the government and consumer health insurance plans for certain services and populations.
Gibbs noted that reimbursement for services for individuals who are on Medicaid or otherwise in need are too low to allow for adequate care, especially if services need to be ramped up.
Health systems that regularly treat a more affluent patient base have plenty of resources to help them weather tough times, but finances will remain shaky for safety-net facilities that rely on public health reimbursement, he added.
Questions remain on how to create excess capacity for future crises.
“During this major surge, we shut down all our operating rooms and even transformed our hallways to accommodate COVID patients, but we can’t always do that,” Dowling said.
It’s not clear whether it’s feasible for health systems to build beds, staff them and leave them empty until another crisis hits.
“Who’s going to finance that?” Dowling asked, though he noted that President Joe Biden’s commitment to upgrading infrastructure might help.
One way hospitals took in revenue last year as patients stayed home was through the use of telemedicine. But reimbursement rates for virtual care are not yet on par with those for in-person services, so some doctors opt not to use it.
Telehealth visits surged to over 7,000 calls per day during the height of the pandemic for NYU Langone, Widawsky noted. It has since mellowed to about 600 per day.
“It is not going anywhere and will be a mainstay of how we deliver health,” he said. But, he added, the reimbursement issues have to be ironed out to make the tool truly beneficial for physicians.
Despite the lack of parity, though, health systems cannot drag their feet on integrating telehealth into their care models, Dowling said.
“We can’t afford to sit around and say, ‘We can’t do this’ simply because reimbursement has not caught up,” he said. “We all know telehealth is the future.”
As health systems beef up their readiness for the next crisis, however, the work to improve their operations will never be truly done.
“Even if we think we’re doing great, there will be 20 things we can be doing better,” Widawsky said.
