Becker's Hospital Review

63 FINANCE CMO / CARE DELIVERY 14 hospital leaders on the toughest thing about resuming elective surgeries By Molly Gamble F ourteen hospital and health system leaders shared the most chal- lenging aspects of resuming elective surgeries, the first steps they are taking to reschedule elective procedures that were canceled in March, and how they are collaborating with health officials. All respondents shared their insights with Becker's via email April 20- 22. Responses were lightly edited for clarity and length. ey are pre- sented alphabetically. What is most challenging about deciding when to resume or ramp up in-person care? Kathy Bailey, President and CEO, Carolinas HealthCare System Blue Ridge (Morganton, N.C.) We want to make absolutely sure that we ramp up in-person care at the right time — early enough to start getting people seen again, but late enough to prevent a second surge of COVID-19 cases. We will need to rely on trending data to help drive that decision, which should be compiled based on testing data. Peter Banko, President and CEO, Centura Health (Centennial, Colo.) e biggest challenge in deciding when to resume or ramp up in-per- son care is the willingness of our communities to come back in per- son. Our neighbors now know that touching things, being with other people and breathing the air in an enclosed space can be risky. And they have been purposely avoiding hospitals and other care settings to, in turn, avoid the virus. For example, a recent article in e New York Times reported that cardiologists across the country are seeing a 40 to 60 percent reduction in admissions for heart attacks. We need to be able to assure our communities we are doing everything we possibly can to keep them safe. Paul Beaupre, MD, CEO, St. John's Health (Jackson, Wyo.) I think restarting elective procedures is actually simple, however it is predicated on our ability to obtain the appropriate amount of rapid COVID-19 RT-PCR testing. If we had the appropriate amount of test kits, we would test everyone who is scheduled for an elective procedure on the day of their procedure. If the test is negative, they could come in and be treated like any patient prior to the COVID-19 outbreak. If they tested positive, we would inform public health and quarantine them for 14 days and then retest and provide the elective procedure. Without testing availability, we will go through inordinate amounts of PPE. Ralph Castillo, CEO, Morgan Medical Center (Madison, Ga.) Probably the most challenging thing is getting people to trust seeking care in the ED again (understanding that they will not catch COVID-19 by seeking ER care). e second is the mitigation steps that have been put in place. When is it time to start phasing them out? Michael Dorsey, CEO, Johnson Regional Medical Center (Clarks- ville, Ark.) It is challenging coordinating with local, state and federal guidelines. ere are differences at each level, and not all the guidelines make sense, like antibody testing, when they are not reliable. Steve Edwards, President and CEO, CoxHealth (Springfield, Mo.) e variables and risk factors of this decision are well beyond our nor- mal margin of error. It is a calculus that requires factoring in perceived versus real burn rate, the R0 [reproduction ratio] versus the impacted R0 due to social distancing, and any political adjustments to social dis- tancing, the gradual effect of civil disobedience, the financial impact and the risk of life and limb. It becomes a decision that must be based upon our highest ethical thinking. Will Ferniany, PhD, CEO, UAB Medicine (Birmingham, Ala.) What makes this challenging are changes to governor's order and all hospitals in the area working in concert. Kiley Floyd, CEO, Nemaha Valley Community Hospital (Seneca, Kan.) As of April 20, we have not had any cases in our county (yet). It is hard to sit by and wait, knowing it is the right decision to protect our staff and conserve PPE, while our cash is drained. Steve Goeser, President and CEO, Nebraska Methodist Health Sys- tem (Omaha, Neb.) I am not concerned about the safety of elective procedures and our ability to test patients prior to surgery. e rub is that there is not enough PPE in the supply chain, and we are now getting about 30 percent of our propofol and fentanyl supplies. If we open up to all the private ASCs and GI labs, we could quickly create an unsafe environ- ment if there is a second wave. We have plans on how and who would be brought back, but the supply chain is the key! Ken Johnson, President and CEO, Hutchinson (Kan.) Regional Medical Center e toughest part is making decisions with conflicting medical advice on the national front as well as locally. Some experts say it is still too soon to reopen significant avenues to surgical care, while others ad- vise that we are simply not going to see the large influx that everyone feared. Also, Kansas has not received needed test kits to do widespread test- ing, which will allow us more confidence in opening up the clinic and hospital to needed healthcare services that are building up rapidly due to COVID-19. e shortfall is not in the diligent effort to advocate and solicit needed testing kits, it's in the number supplied to Kansas as a whole and the dismal amount of supplies that reach us in Hutchinson. We are poised to have a significant impact on the testing shortfall in Kansas. We are fortunate to have robust labs, experienced staff and capacity to meet a significant need. We just need testing kits. Michael Layfield, Interim CEO, Carlinville (Ill.) Area Hospital Two things are most challenging about deciding when to resume or ramp up in-person care: 1) e recommendation of social distancing and knowing the only way to stop coronavirus conversion is stay at home. 2) Testing of patients. ere is no way to test for those who have the virus but show no symptoms yet. Robb Linafelter, CEO, Lincoln (Neb.) Surgical Hospital Our biggest concern is making sure we have enough PPE to meet the demand going forward with the increased need to meet additional

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