A year ago, few of us would have predicted that 2020 would have gone the way it has.
While the beginning of the year had many healthcare systems focused on growth and network expansions, the outbreak in the United States put many of these initiatives on hold while health systems focused on preparing for “the surge” and reallocating resources to treat COVID-19 patients while reducing services and staff in other non-essential areas to prevent the spread of the virus.
This dramatic shift has left many facilities struggling to stay afloat financially, trying to modify their procedures to meet new COVID-19 requirements and wondering what the future of their business is going to look like.
While the pandemic presents major challenges for the U.S. economy in almost every sector, we can see health systems beginning to move into a reopening phase, hoping they will be able to rebound successfully.
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A recent report from the American Hospital Association estimated an economic impact of $202.6 billion in losses as a result of expenses and lost revenue relating to COVID-19 for the first four months of the outbreak—an average of over $50 billion in losses a month. At the same time, the report also found that costs for hospitals had increased dramatically as a result of increased supply costs, increased uninsured and publicly insured individuals due to unemployment, and high costs associated with COVID-19 treatments.
Elective surgeries are among the many things that were canceled or postponed in the height of the shelter-in-place orders. They are now being rescheduled as health systems reopen non-emergency procedures.
As hospitals look to prioritize patient backlogs and reopen departments that were on hiatus, working with ambulatory surgery centers (ASCs) as part of this strategy presents a win-win opportunity for managed care plans in the following key areas.
- Increased Patient Safety. Perhaps the most important consideration for managed care plans during this time is patient safety. Outpatient procedures performed in ASCs keep patients out of the hospital setting, protecting low-risk patients from exposure to more severe cases that may present in the hospital setting.
Surgical site infections (SSI) in the ASC setting are also lower on average (4.95 per 1,000 patients) than in the hospital setting (8.95 per 1,000), lowering the likelihood that a patient would need to return to the hospital post-surgery for additional care. Using scheduling software can further assist outpatient health settings to maintain operational efficiency while ensuring an adequate amount of time to sanitize equipment and maintain social distancing protocols as an additional level of safety.
- Reduce Elective Surgery Backlog. A patient poll by TransUnion Healthcare found that about one in four patients surveyed (27%) had an elective surgery delayed or canceled due to the COVID-19 pandemic. Nearly 50% of patients with canceled or delayed procedures indicated they would consider rescheduling those procedures only when COVID-19 was at a safe level.
Establishing a process for managing rescheduled procedures well-ahead of the surge in expected patient demand for elective procedures could help ensure that patients are able to access long-awaited procedures much more quickly. By using software to identify and prioritize patients with risk profiles appropriate for an outpatient surgery center vs. a hospital setting, health facilities can help to optimize management of the backlog in patients in the setting most appropriate for their needs.
- Carefully Managing Protective Equipment. Personal protective equipment (PPE) remains a precious commodity in the health care setting, with supply still unable to meet the demand from health facilities. The Centers of Disease Control and Prevention (CDC) currently offers resources to help healthcare facilities calculate the “burn rate,” or average consumption rate, to help with optimizing limited essential resources. ASCs using practice management software can carefully track, record and prepare for correct and compliant usage of PPE.
ASCs can further monitor changes in supply chain prices and flag potential price gouging by using tools to build and maintain optimal inventory levels.
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- Cost savings. Outpatient surgery is often more cost-effective compared to having the same procedure done in a hospital. A 2016 analysis by Healthcare Bluebook and HealthSmart found that ASCs reduce U.S. healthcare costs by $38 billion each year, with over $5 billion of that savings coming as a result of lower patient deductible and coinsurance payments.
Surgery in an ASC setting can help hospitals reduce patient backlogs efficiently, at a lower expense to the hospital. ASCs will need to ensure that coding is done properly with claims that are payer-compliant, which can easily be optimized using an ASC-specific revenue cycle management tool.
It is safe to assume that COVID-19 will not be the last time that the healthcare system will be challenged in extraordinary and unexpected ways.
But as we climb out of this unprecedented crisis, health systems can take a variety of steps to best utilize ASCs as partners in addressing the backlog of patient care efficiently and cost-effectively. This will help manage costs across the patient population, responsibly manage resources through careful planning/prioritization and tracking, and minimize patient risk exposure in hospitals.
By taking the time to identify lessons learned from the initial impact of the virus, managed care leaders can help build back a stronger, more streamlined and sustainable health system.
Tom Scott is the CFO of HST Pathways, a leader in cloud-based software solutions for outpatient surgery centers.