COVID-19: Q&A on managing the inpatient surge and the wave of post-pandemic care

April 10, 2020

HRI spoke with PwC principals Nikki Parham and Alex Marsden and director Uriah Melchizedek about important considerations for healthcare systems as they respond to the near-term surge of COVID-19 cases as well as the significant queue of patients that will need care post-COVID.

Health Research Institute

We’ve heard governors and states plead for additional staff in some areas. How can health systems redeploy their staff to make sure they have the right numbers to respond? 

Nikki Parham, PwC Principal

Hospital business continuity plans that have been in place really have not contemplated something like this. They should step back and think about diving into where we can use people and the skills they have, what we are ramping up and ramping down. This is fast-moving, but they should make some of those decisions with the bigger picture in mind.

Uriah Melchizedek, PwC Director

Health systems and hospitals are being very creative in pulling from wherever they can. Surgeons and other specialists are helping to manage COVID-19 patients. States are expediting licenses for physicians to come out of retirement. Several medical schools are offering early graduation to students so they can enter the workforce sooner.  

HRI: What role can business intelligence play during this outbreak?

Alex Marsden, PwC Principal

Business intelligence is going to be a key component right now and in the moderate term to minimize the disruption of care for non-COVID-19 patients who are also being severely impacted by this. There is going to be a need for analytics internally to help trace patients, caregivers and healthcare workers who are exposed to COVID-19.

There should be a focus on analytics for supply and inventory so you can model under different surge scenarios of inpatient demand and how long your existing supply or inventory of any given piece of supply can be elongated.

Nikki Parham: Some business intelligence will help you look at the ZIP code level and see the severity of the patients you’re expecting to really help you think about how to funnel different patients with different severity levels to different facilities (see more on PwC’s ZIP-code-level pandemic model for providers).

Uriah Melchizedek: Individual hospitals have bed management tools, but how can they use them as a system or a region more broadly in the context of COVID-19? That is a higher-level capability that business intelligence can help support. For example, designating certain hospitals in a health system or region for COVID-19 or non-COVID-19 patients, closely monitoring bed capacity and inventory, determining where they can transfer patients, etc.

For outpatient care, business intelligence can help identify patients you can flip to virtual visits, by designating certain appointment types and patient cohorts to switch over.

HRI: Once the US is past the COVID-19 emergent and acute surge, we expect a significant wave of patients resuming postponed outpatient care and elective procedures. What considerations should healthcare organizations keep in mind when it comes to preparing for that wave?

Alex Marsden: There will almost certainly be the largest queue of patients requiring scheduling that health systems have ever experienced. And that means automation and prioritization are going to be even more important to ensure patients can access care as quickly and efficiently as possible. Hospitals will need a massive time strategy to prioritize and reschedule patients and maximize provider time, operating rooms and ambulatory clinic time.

Nikki Parham: Many systems are not keeping track of who is getting canceled. When it’s time to get back to more normal operations, will these systems be relying on patients to call them to get back on the schedule? They should use the data available to them to develop strategies to bring those patients back in.

Hospital business continuity plans that have been in place really have not contemplated something like this. They should step back and think about diving into where we can use people and the skills they have, what we are ramping up and ramping down. This is fast-moving, but they should make some of those decisions with the bigger picture in mind.

HRI: How will the healthcare industry’s response to COVID-19 change healthcare delivery in the future?

Nikki Parham: The COVID-19 crisis has forced changes on the healthcare industry, such as the move to telehealth. We have struggled to get clinicians and patients to adopt it for years; a lot of that is because of reimbursement. Previously, clinicians were paid a lot less for telehealth visits. Now CMS has made reimbursement consistent across care settings. After the crisis passes, I would hate for telehealth payments to snap back to where they were pre-crisis.

And think of the virtual work being done by staff now. Think about the cost of space that these healthcare organizations have. Will we keep more of the virtual work environment? Will healthcare change the way it works? This is what could alter the healthcare delivery system in the future.

Alex Marsden: This crisis likely will have a profound and long-lasting impact on how care is delivered and managed. I think we are seeing new care models emerge that show—for existing patients and chronically ill patients—care can be delivered virtually in many cases. Often “virtual” means more efficient, meaning patient panels can, in some cases, be expanded to improve access for new patients into health systems.

Given the potentially significant financial pressures health systems are undertaking, we will see a significant shift toward improving “clinical time management” and efficiency, clinically and operationally.

I think there could be a shift toward creating more inpatient bed capacity instead of focusing on trying to have high occupancy at any given time. This will focus health systems to evaluate their network strategy and shift volumes to ambulatory surgical centers, for example.

Uriah Melchizedek: There are a lot of postponed elective surgeries that will need to be rescheduled, and operating room capacity is an issue for some providers. Health systems that have been reluctant to invest in ambulatory surgery centers because of lower reimbursements outside the hospital may need to do so just to serve that demand. That could accelerate the shift of care outside hospitals.

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Nikki Parham

Health Industries Advisory, Partner, PwC US

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