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The Elective Surgery Business in a Pandemic – Navigating the Storm

Surgeons in an operating room getting ready to dig in

With the first wave of COVID-19 in March, healthcare systems found themselves unprepared. Coronavirus cases were soaring in many states, and ICU beds were rapidly filling to capacity. Shortages of personal protective equipment placed first-responders and healthcare workers at risk. Optimal treatment protocols had yet to be defined. Even emergent surgeries began being performed with the aid of robotics. Given the state of affairs, elective surgeries during COVID were cancelled in order to care for the urgently ill. And this took a significant toll not only in the elective surgery business but on healthcare in general.

Over the course of a few months, however, it appeared the cases of coronavirus were declining in most areas. By mid-summer, most hospitals had begun allowing some non-urgent procedures to be performed. These elective surgeries during COVID were first completed in outpatient settings. But soon, inpatient procedures were also resuming. That is until the next wave of COVID hit. Now, hospitals are again having to deal with this issue once again. Over 100 hospitals have restricted their elective surgery business within the last two weeks. This not only poses immediate issues concerning their financial health. But it also threatens patient health long-term

“Canceling elective procedures really is a last-resort option. However, in the midst of this current surge, which is the largest to date, some hospitals may have no choice.” – Jan Emerson-Shea, Vice President, California Hospital Association

Dollars and Sense of the Elective Surgery Business

Without question, elective surgery procedures are big money-makers for hospitals and healthcare systems. In fact, half the drop of the nation’s total GDP in 2020’s first quarter can be attributed to its decline. By the second quarter, a 25 percent drop in elective surgeries during COVID had occurred nationwide. As hospitals tried to adapt to managing coronavirus cases, they also had to negotiate lost revenues. Their initial strategy was to simply wait and out and hope for the best. And indeed, things appeared to look a little brighter by summer’s end.

Some surgery tools laid out for use
It may not involve a lot of “life saving”, but elective surgery is big business.

In the third quarter, the overall decline in the elective surgery business was only 12 percent below normal. Surveys of hospital administrators showed that they expected 94 percent of cancelled elective surgeries during COVID to be rescheduled. Cardiac and cancer surgeries were being addressed first, by orthopedic, urologic, and gynecologic surgeries. But a return to normalcy never completed occurred. Coronavirus cases once again surged, ICU beds began to fill, and non-urgent procedures were cancelled. Estimates now suggests that there are over a million elective surgeries for orthopedics alone backlogged.

“We’re now talking about curtailing elective procedures where you have to use an inpatient bed…We know there are downstream consequences of not doing routine health care maintenance.” – Dr. Katherine Gergen Barnett, Vice Chair of Family Medicine, Boston Medical Center

Innovative Strategies for Elective Surgeries During COVID

While coronavirus has served as a healthcare catalyst in many ways, it has been certainly detrimental in others. As the second (and now third) waves of coronavirus spikes have occurred, hospitals have been forced to adapt. Elective surgeries during COVID remain far below normal. However, the recent moratorium for non-urgent procedures have been limited to inpatient settings in most cases. Elective surgery business is being maintained in outpatient surgical centers now in an effort to maintain these revenues streams. Likewise, these strategies hope to avoid an even further increase in elective surgery backlogs. If personnel are available, and inpatient beds are affected, hospitals are trying to meet non-urgent surgery demand.

Businesses are also involved in trying to support the elective surgery business. One company, PrimaHealth Credit, now offers point-of-care lending options for those needing elective surgeries. Based in California, the company’s mobile app approves credit loans on the spot for consumers considering some elective surgeries. The most popular uses are for surgeries involving cataracts, orthodontics, dental procedures, and LASIK. Typically, consumers pay 25 percent of the fee and then finance the rest over a few months. This is particularly beneficial for those with less-than-ideal credit who need care.

“Our goal as a company is to remove barriers to patient acceptance and help people who have the means but not necessarily the credit score to get the quality care that everyone deserves.” – Brendon Kensel, Founder and CEO, PrimaHealth Credit

Challenges Ahead in Managing Elective Surgery Backlog

Notably, the most urgent challenge for hospitals in looking ahead involves managing a surging pandemic. Even with a coronavirus vaccine set to be released soon, it will be many months at best before improvements occur. But when they do, the challenge for hospitals will be catching up on the delayed elective surgeries during COVID. It won’t be as easy as simply turning the switch back “on” and getting back to normal. Healthcare systems will face many new difficulties as they try to get their elective surgery back on track.

In terms of specific hurdles, hospitals will face at least 3 major ones in trying to reduce their elective surgery business backlog. The first relates to staff fatigue. After roughly a year of dealing with pandemic stress, staff will be poorly equipped to take on extra duties. This means strict oversight will be needed to determine surgery schedules in an effort to ensure quality and safety. Secondly, surgeons will not have performed many of these procedures for extensive periods of time. Skills and techniques may be a bit rusty, and ramping up will take time also. Finally, new protocols will be in place related to COVID that weren’t before. This too will take some getting used to.

The hope for most hospitals is that a vaccine is effective and available to the public as soon as possible. This, along with continued COVID precautions, will drive case rates down and free up room for elective surgeries. In the meantime, outpatient slots will be utilized as best as possible. And they will continue to look for innovative ways to address an ever-growing number of delayed surgeries. With some good fortune, healthcare systems can hopefully navigate this COVID storm and emerge intact.


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