At the Helm

How long is your organization's road to recovery? Consider these 4 factors.

by Colin Gelbaugh and Anna Yakovenko

By some estimates, most providers across the United States are now past the peak of their Covid-19 epidemic curve. However, a month of postponing medically necessary, but elective procedures and visits, has left providers in dire financial situations, with an average drop in revenue of 55%, by some reports.

Your top resources for Covid-19 readiness

While not everyone is on the downslope of their epidemic curves, now is the time to start thinking about when to resume postponed services, how to prioritize backlogged procedures, and how long it may take your organization to return to pre-pandemic levels of utilization. Here are four factors to consider when determining the timing and pace of your recovery.

The four factors impacting your demand curve post-Covid

For any service, the time when you can start recapturing and serving deferred demand depends on these four factors:

Exogenous factors: Do federal and state guidelines permit you to resume non-urgent, elective services? Is it safe to fully open given your position on the Covid-19 curve?

Supply availability: Do you have the right type and amount of supplies to open and still handle a potential second wave of Covid-19 patients? Do you have sufficient staff available to meet demand?

Volume backlog: How much deferred demand do you actually have waiting? How much volume will be lost to competitors?

Future demand: To what extent will future demand change? Will Covid-19 permanently reshape demand or result in shifts in care site for certain services?

What services should you prioritize?

Despite external constraints, such as state guidelines recommending postponement of electives, providers may consider resuming some postponed services that are medically necessary, safe to perform, and time sensitive. University of Chicago surgeons recently released their Medically Necessary Time-Sensitive (MeNTS) scoring system to help prioritize which procedures to perform. 

The MeNTS scoring system considers 21 factors that are scored on a scale of 1 to 5 for each case. A higher score indicates that the procedure would pose greater risk to the patient, utilize more resources, and have a higher chance of exposing health care personnel to the virus. Factors they consider include:

  • Anticipated length of stay;

  • Time required in the operating room;

  • Size of the surgical team;

  • Probability of needing intubation to perform the procedure;

  • Effectiveness of non-operative treatment;

  • Impact of two week delay on disease outcome and surgical difficulty/risk;

  • Impact of six week delay on disease outcome and surgical difficulty/risk;

  • Age of the patient; and

  • Presence of comorbidities (lung disease, CV disease, diabetes, immunocompromised)

Those with processes in place to continually evaluate medical necessity and safety can ensure that delays aren't negatively impacting patient health outcomes. After medical necessity, providers may consider additional factors such as revenue and margin in the prioritization process. Those that are laggards in beginning to perform elective procedures may lose market share to competitors.

Can you return to pre-Covid-19 (or close to pre-Covid-19) utilization levels?

Planners should consider medium and long-term factors that would slow down or speed up recovery on the road to pre-Covid-19 levels of utilization. Even though many postponed services can likely be recouped, the speed of recovery (and the provider that recoups the volumes) will be dependent on both the organization's supply (facility, staff, and supplies) constraints and new demand coming out of the recovery. Here are high, medium, and low-impact factors—many of which will differ from organization-to-organization and market-to-market—to consider when assessing the timeframe for getting back to normal utilization.

Factors with high impact:

  • Supply constraints:
    • Bed, OR, and staff capacity constraints (i.e. availability and willingness of staff to work longer hours, weekends), potentially shifting cases to competitors with shorter wait times; and
    • Availability of PPE, testing, and supplies (blood, IV bags and pumps etc.) that comfortably meet demand—and reinforce safety among patients and staff.
  • Demand drivers:
    • Lingering consumer anxiety/fear of exposure to infection may result in site of care shifts or absolute reductions in use (availability of therapeutics, vaccines, and tests will likely determine the magnitude of impact);
    • Loss of insurance and/or job may result in patients delaying or canceling care and shift payer mix to lower reimbursed Medicaid; and
    • Patients opt for non-surgical treatment options, or choose to not reschedule their postponed visit (may be dependent on the extent to which organizations proactively reach out to patients to reschedule appointments and effectively communicate regarding safety).

Factors with medium impact:

  • Supply constraints:
    • Loss of workers who were furloughed, laid off, or quit and how quickly organizations can regain this staff;
    • Status of ambulatory sites, which can reduce or delay downstream referrals for procedures; and
    • Organizational readiness of using telehealth for upstream services.
  • Demand drivers:
    • Delays in care, leading to exacerbation of health issues and longer lengths of stay, especially for medical cases; and
    • Reduced demand for price sensitive services due to employer increases in cost sharing in next year's benefit year.

Factors with low impact:

  • Supply constraints:
    • Time off or reduced hours/productivity of staff involved in managing Covid-19 care; and
    • Lasting negative stigma of SNF sites leading to longer LOS, less bed turnover (and potentially greater home health use).
  • Demand drivers:
    • Prolonged social distancing guidelines and permanent lifestyle changes (e.g., people continuing to work from home) which may continue to reduce travel and result in less accident-induced trauma; and
    • Mortalities in highly affected regions that reduces demand.

As you model out the road to recovery for your organization, recognize that there are still unknown variables that could impact the time and pace of recovery. We suggest planning for several scenarios and revisiting assumptions on a regular basis to account for different paths forward.

Your top resources for Covid-19 readiness

You're no doubt being inundated with a ton of information on how to prepare for possible patients with the 2019 coronavirus (COVID-19). To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.

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