Anatomy of an Outbreak

Your top questions about COVID-19, answered

Over the last few weeks we hosted webinars focusing on helping you address the Covid-19 pandemic.  We saw unprecedented attendance, and were humbled that so many of you turned to us for answers during this difficult time. We also received a high volume of questions, which our team has been working hard to address.

We’ve compiled our answers to your top questions below.  Missed a past webinar or want to listen to it again? You can now access a recording of the webinar on-demand.

1. How can we set up and leverage telehealth to ramp up capacity?

2. What measures should I be taking to ensure the wellness of my staff?

3. What flexible staffing strategies are other organizations using?

4. What information do you have in regards to hospitals and their care for oncology patients?

5. When will antibody testing be available? Will it help speed the reopening of the health system?

6. How will contact tracing work in the U.S.?

7. How did South Korea tamp this down so quickly?

8. How can I maximize reimbursement under Covid-19?

9. What is the clinical risk to healthcare workers?

10. Why are so many organizations furloughing staff, when we need hospital workers? Will they return to the workforce?

11. What is the right discharge strategy to post-acute?

12. What are the long-term prospects for telehealth and its reimbursement?

Also, be sure to bookmark our COVID-19 resource page to access our best materials for safely managing and preventing the spread of COVID-19.


1. How can we set up and leverage telehealth to ramp up capacity?

To shift volume to telehealth channels it’s important that you actively promote telehealth, ensure your technology is ready, and support your frontline clinicians with necessary training. Learn more about how to do this by reading our resource, 3 steps to prepare your telehealth response.

Providers can use telehealth to increase capacity in a few ways, including shifting existing appointments to telehealth visits, standing up remote triage capabilities and using virtual channels as a first stop, and deploying remote monitoring capabilities to care for patients. The blog post 3 ways to ramp up telehealth to deal with COVID-19 outlines these approaches and shows you how several hospitals and health systems have implemented them.

For more on telehealth, register for one of our upcoming webinars:

2. What measures should I be taking to ensure the wellness of my staff?

Some common themes can be found throughout our resources on wellness. If we had to summarize their advice we’d say: listen to your staff, show your commitment to their well-being, and communicate intentionally.

Here are a few resources to help you with that:

3. What flexible staffing strategies are other organizations using?

The COVID-19 pandemic means organizations have to get exponentially more creative in their staffing, and fast. Domestically, one strategy we’ve heard of is curating lists of recently retired physicians and nurses and preparing to rapidly reactivate them. Learn more about this and other strategies in our Q&A session, where Michael Wagner, Chief Physician Officer of Wellforce, talks about how they were able to ramp up capacity fast.

Hospitals internationally have shared strategies like halting elective surgeries and upgrading semi-intensive care beds into full intensive care. Check out our resource How Italian hospitals added 800 ICU beds in 2 weeks in response to the pandemic for the full list of approaches.

Finally, refer to this infographic for valuable ways to better utilize your advanced practice providers: Leveraging advance practice providers to supplement physician care

4. What information do you have in regards to hospitals and their care for oncology patients?

We have pulled together everything you need to know when protecting one of the populations most vulnerable to COVID 19—cancer patients. Take a look at our blog How cancer programs are protecting their patients from COVID-19, which outlines the measures cancer leaders are taking including, restricted entry, fast tracking injection patients, and separating infusion and lab appointments.

Strategies for reopening and recovery

5. When will antibody testing be available? Will it help speed the reopening of the health system?

Antibody testing is currently available, though accuracy of the tests remains variable. Only four serology tests have received emergency use authorization from the FDA as of 4/23, but FDA has also issued guidance that allows distribution of self-validated serology tests before review. Over 70 organizations have notified FDA that they have already, or are planning to introduce serology tests to commercial circulation. A running list of tests that have been deployed in the US and internationally can be found here; a running list of tests with FDA authorization can be found here.

Given lax guidelines around FDA authorization and high rates of false positives, both providers and experts across the lab industry are scrutinizing the accuracy of serology tests available on the market.

Antibody tests are best used to understand community spread and fatality rates, not to identify active cases. At this point, experts cannot confirm how producing antibodies to Covid-19 correlates to transmissibility or immunity to the virus. While understanding population immunity levels will be increasingly pertinent, widespread molecular testing remains the immediate need and priority to reopen communities.

6. How will contact tracing work in the U.S.?

Until officials outline a national or state-level strategy, methods of contact tracing will vary at the local level. According to a report released earlier this month, by the Johns Hopkins Center for Health Security, each community’s approach to contact tracing will adapt based on existing public health infrastructure. While methodology may differ across communities, success will take a combined effort of technology-based public-private partnerships and ‘boots on the ground’ public health workers.

Technology companies are already developing scalable solutions Apple and Google are partnering on a contact tracing tool that allows their users’ phones to wirelessly exchange de-identified personal testing data via Bluetooth. The app will then notify users who recently came in close proximity with Covid-19 positive cases and urge them to self-isolate.

While technology companies can help trace cases at scale, some segments of the population are most effectively communicated with through traditional, manual contact tracing. Massachusetts was the first state to train and deploy a 1,000-person contact tracing committee. Former CDC Director, Tom Frieden, suggests PeaceCorps volunteers and furloughed public employees could be trained to supplement state-level efforts but experts question the speed and efficacy of that strategy.

7. How did South Korea tamp this down so quickly?

South Korea’s approach to the pandemic relied on three priorities: proactive testing at scale, effective contact tracing, and isolation and surveillance. Access to tests and early widespread deployment allowed officials to identify, isolate and surveil infected and exposed individuals. Experts agree South Korea’s strategy has been effective in stemming the spread of Covid-19, but diverge on which specific tactics can be transferred successfully to the United States.

  • Testing: Using lessons learned from managing previous epidemics, South Korea quickly mobilized medical companies to create tests. Almost immediately, South Korea was able to test about 12,000-15,000 people per day at drive-through and walk-in testing centers. Patients were not charged for tests and received their results within 24 hours. (The Guardian)
  • Contact tracing: Fast turnaround times enabled the next piece of South Korea’s strategy: effective contact tracing. The South Korean CDC tracked mobile phone GPS data and credit card transactions of patients that tested positive to identify where they had been prior to their positive diagnosis and alert others that may have come in contact with them. For example, “after an employee at [an insurance call center in Seoul] tested positive, authorities quickly set up a tent to test everyone who worked or lived in the Koreana Building, as well those had visited the premises.” (The Guardian)
  • Isolation: Finally, isolation and surveillance. After its experience with MERS in 2015, the South Korean government was more prepared than many other nations to orchestrate an emergency response, and the public was more prepared to adhere to preventive practices like social distancing, isolation, and enhanced hygiene.

If you’re interested in more detailed information, the Korean government has released a report detailing the measures it took to respond to the pandemic: Flattening the Curve on COVID-19: How Korea responded to a pandemic using ICT. (ICT = information and communications technology.)

8. How can I maximize reimbursement under Covid-19?

Maximizing reimbursement under Covid-19 requires intense focus on revenue capture, and the entire revenue cycle. It is critical to spend time developing a Covid-specific strategy, starting with updating the chargemaster, updating training on new CPT and HCSPCS codes, mitigating Covid denials, and understanding how payers have changed or altered policies around preauthorization, out of network definitions, etc. Our revenue cycle team has identified the following seven mandates for mitigating the cash crunch caused by Covid-19. Keep an eye out for a more detail on these in their upcoming research report, which should be published next week.

  1. Double down on AR
  2. Adjust the patient financial experience
  3. Reallocate revenue cycle staff
  4. Design your Covid-19 claims strategy
  5. Prioritize payment accuracy
  6. Partner with financial stakeholders
  7. Improve your debt position

Staff safety and support

9. What is the clinical risk to healthcare workers?

Healthcare workers (HCWs) are on the frontlines of Covid-19 and therefore at a much higher risk of infection. The CDC reported that 9,282 HCWs in the US were confirmed with Covid-19 between February 12th- April 9th. While most healthcare workers (90%) were not hospitalized, 27 died from the disease. The actual number of infections among HCWs is likely higher as only 16% of the total Covid-19 cases across the country included data on whether a patient was a HCW. In the states that did a better job of reporting HCW status, healthcare workers accounted for 11% of Covid-19 cases.

10. Why are so many organizations furloughing staff, when we need hospital workers? Will they return to the workforce?

Hospitals and health systems across the country are turning to staff furloughs as a result of an acute cash flow deficit. The Covid-19 pandemic has reduced revenues from elective and routine care while forcing an increase in spending on supplies like masks, ventilators and PPE. Although Congress passed several stimulus bills that will provide hospital relief, it is being distributed slowly and many have not yet received funding.

Given all of this, many hospitals have had no choice but to furlough staff that are not directly caring for Covid-19 patients. Most organizations have started by furloughing outpatient or procedural care staff, while others have focused on temporarily cutting back on administrative roles. When these steps are not enough to ease margin pressures, some hospital leaders are forced to cut back on clinician salaries or other benefits, like PTO and 401K contributions.

As hospitals begin to increase elective procedures and receive positive cash flow again, furloughed workers should slowly start to return to the workforce.

When the surge has passed...

11. What is the right discharge strategy to post-acute?

Hospital discharge strategy during the Covid-19 pandemic is heavily dependent on patient volume/availability of acute care beds and the ability of post-acute providers to safely care for confirmed or potential Covid-19+ patients. As a rule, hospitals should not discharge Covid-19 patients to a nursing facility that does not have current Covid-positive cases, unless market-level acute care bed demand makes it necessary.

Whenever possible, hospitals should discharge patients directly home. This lowers the risk of infection, prevents spread in facility-based settings, and reduces resource utilization.

For asymptomatic patients not presumed to have Covid-19, hospitals should:

  • Utilize waivers to expedite post-acute transfers.
  • Utilize LTACs as a release for stable ICU patients.

For Covid-19+ patients, hospitals should:

  • Support local post-acute providers, with education and resources to help them safely care for Covid-19 patients and prevent further spread of infection.
  • Develop new, alternate discharge sites of care. In markets where post-acute providers are not able to care for Covid patients and/or capacity is overrun, hospitals must create a discharge option for patients by converting existing facilities (eg, IRF/LTAC conversion) or refitting a hotel to serve as a recovery site.

The following resources go deeper on the strategies above:

12. What are the long-term prospects for telehealth and its reimbursement?

The future of telehealth could turn out to be the future of medicine. Given recent estimates for 1 billion telehealth visits in 2020, more consumers than ever will have had the opportunity to try telehealth for themselves. Clinicians are also getting their first experiences with telehealth: they will now have firsthand exposure and more data than ever to help them understand when telehealth is appropriate and when it isn’t. The remaining challenge is to demonstrate to payers and purchasers that telehealth is a viable alternate channel for care delivery—not merely a complement to in-person care—and worthy of reimbursement parity.

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Covid-19: What health care leaders need to know

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