• As states start to reopen, hospitals are among the first services that plan to come back to provide care for noncoronavirus patients.
  • Hospitals canceled elective surgeries and postponed procedures during the coronavirus pandemic to make way for a surge in COVID-19 patients who needed hospital resources. 
  • While hard-hit areas like New York still have thousands hospitalized as part of the pandemic’s first wave, health systems across the US are planning for how they might recover and safely resume procedures that have been deferred, looking into testing and prioritizing care that can’t be delayed any longer.
  • Visit Business Insider’s homepage for more stories.

Medical procedures are among the first round of services starting up again as governors lift coronavirus lockdown orders.

Hospitals are eager to resume normal activity wherever they can, to help their patients and because the procedures generate much-needed revenue. During state lockdowns, some hospitals saw surges in coronavirus cases and became overwhelmed, even moving patients to other parts of the hospital to create more space.

But hospitals in areas of the US with few coronavirus cases became far less busy. As a result, they took a financial hit that they passed on to their workers in the form of layoffs, furloughs, and pay cuts.

The financial effects continue to be wide-reaching. One study from the consulting firm Millman projected the pandemic could reduce the amount of money we spend on healthcare by as much as $575 billion in 2020.

On top of that, patients with other medical conditions had to wait for needed care. Regular checkups, vaccines, and elective surgeries — ones that can be scheduled and aren’t emergencies — all got pushed back.

“Elective procedures aren’t just ‘people want them,'” Gregory Adams, the CEO of the health system Kaiser Permanente, said. “There are procedures that need to be done within a time frame, and if we don’t do them, they can become urgent.”

Gregory Adams, CEO of Kaiser Permanente

Gregory Adams, the CEO of Kaiser Permanente.

Courtesy of Kaiser Permanente


There’s also evidence that patients aren’t going to the hospital, even when they need help. Tom Mihaljevic, Cleveland Clinic’s president and CEO, said the hospital’s Ohio location has seen a decline in admissions for strokes, heart attacks, and newly detected cancers. 

“We know our population of patients have not become healthier over the last two months but are simply not seeking care,” he said.

Now as some patients can’t wait any longer, and the pandemic slows in parts of the US, hospitals are grappling with how and when to reopen their facilities to more patients without COVID-19, the disease caused by the coronavirus. They know that without a careful approach, they risk more patients becoming infected, running out of protective gear, or closing down again. 

For some, May is a critical month to figure out the right approach. If hospitals don’t start to reopen, the financial impact of the pandemic might push some out of business.

“If we just stay locked down in our hospitals the way we are through the end of May, there wouldn’t be much to come back to,” Rod Hochman, the CEO of Providence St. Joseph Health, said. 

Hospitals can’t resume elective care without the OK from government

Most hospitals stopped or scaled back elective medical care in March after pressure from state and federal officials. The goals were to free up space in case of a surge of coronavirus cases, conserve supplies, and protect other patients from exposure to the virus.

Since that time, President Donald Trump has signed two bills into law, with $175 billion in relief money to help healthcare providers recoup costs and cover coronavirus expenses.

Dr. Tomislav Mihaljevic, president and CEO of Cleveland Clinic

Dr. Tomislav Mihaljevic, the president and CEO of Cleveland Clinic.

Courtesy of Cleveland Clinic


On April 19, the Trump administration put out guidelines for hospitals to resume elective surgeries in parts of the US that have low numbers of coronavirus cases.

The guidelines raised several factors for hospitals to keep in mind as they decide whether to reopen, including evaluating whether they had enough staff that could rush in to mitigate a surge, how much protective equipment and supplies they had, and how well they could conduct tests. 

“This isn’t going to be like a light switch,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said during a recent White House press briefing. “It’s more like a sunrise, where it’s going to be a gradual process. And healthcare officials across the country and healthcare systems need to decide what services should be made available. And ultimately, doctors and patients need to make decisions about their healthcare services.” 

But the administration also told hospitals that they would have to work with states to figure out the exact timing and recommendations for opening up. So far, Alaska, Arkansas, California, Colorado, Indiana, Oklahoma, Texas, and Utah are allowing hospitals to resume some elective surgeries. 

Other states will be starting soon. Ohio Gov. Mike DeWine announced Monday that on May 1 the state would let all health procedures resume that can be done without an overnight stay in the hospital. 

The Cleveland Clinic team said it was implementing a phased approach in-line with what the governor’s office stipulated.

Cleveland Clinic began planning for how to resume regular activity a few weeks ago.

Mihaljevic said the health system’s Ohio hospital has been checking off the boxes it needs: waiting until the pandemic is under control in the state, making sure it has enough staff to react to a surge, and ensuring it can test, trace, and contain cases. 

Cleveland Clinic will prioritize cancer and cardiovascular screenings and care for people with neurological disorders and life-threatening conditions, Mihaljevic said. When Business Insider reached the health system for a follow-up about its testing plans, it declined to share additional details, saying they would become available later this week. 

States are all in different places when it comes to fighting the pandemic.

For instance, Janice Nevin, the president and CEO of ChristianaCare in Delaware, said discussions about resuming services were still in the early stages but would be part of the health system’s work in the coming weeks and months. 

“We’re not there yet,” Nevin said of reopening. “We are still, I would say, in the thick of things.”

How Providence is looking to restart surgeries in Washington

Providence St. Joseph Health, which runs 51 hospitals on the West Coast, has been in the coronavirus fight for three months. Its facilities in Washington were the first to treat the novel coronavirus in the US and feel the effects of the outbreak as it hit nursing homes in the area.

Now the health system has to grapple with how to restart other services.

“You’re supposed to take care of the whole public,” Hochman said. “We want to make sure we’re doing that the right way.”

His worry: People aren’t feeling well, but they’re not coming into the hospital, either because their treatments have been postponed or they fear getting exposed to the novel coronavirus.

Rod Hochman

Providence St. Joseph Health CEO Rod Hochman.

Courtesy Providence St. Joseph Health


Washington Gov. Jay Inslee has said that some restrictions in the state will start to lift on May 4. Among those services to come back online are elective surgeries, outdoor activities, and certain construction projects. Hochman said Providence has a plan in place for the first week of May. 

Providence plans to bring back surgeries based on how urgent they are. For instance, people waiting to have a biopsy done will be among the first to get care. The plan is to test patients and caregivers for the coronavirus before they go into the operating rooms.

Staying locked down isn’t an option for Hochman or other hospitals he has spoken with.

“You want to be sure you’re in your community a few years from now and be able to serve them,” Hochman said. 

Hospitals are assuming they’ll be fighting COVID-19 for years 

For Northwell Health, New York’s largest health system, the recovery may be just as challenging as fighting the coronavirus, CEO Michael Dowling said.

Northwell Health at times had 3,000 patients hospitalized with COVID-19.   

“The recovery is going to be as difficult if not more difficult than managing the crisis,” Dowling said. The health system began discussing what recovery might look like in mid-April.

One task will be communicating to patients that it’s safe to go back into a hospital. Many patients are ready to go back, while others are fearful, Dowling said. 

The discussion now is how to contain the COVID-19 cases that are in the hospital so that the rest of the space is coronavirus-free.

One of the questions that the health system is discussing now is whether there should be one hospital where all coronavirus patients go to. That way, not every hospital has to set up space to care for COVID-19 patients, ideally keeping them free of COVID-19. It might also mean certain parts of the hospital are devoted to COVID-19, Dowling said.

Even as the initial wave ebbs, there will still be patients who need to be hospitalized with the coronavirus for the foreseeable future.

“You’re going to have COVID patients for a long, long, long, long time,” Dowling said.

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