Hospitals expand services

Dr. Juan Ortega examines a CT scan in the Diagnostic Imaging Department at the Bayhealth Campus in Dover on Thursday. Delaware State News/Marc Clery

Delaware’s COVID-19 concerns remain but some dramatic fears have at least diminished.

Thus, health care professionals agree it’s time to resume elective procedures and primary care services.

On Tuesday, state officials announced expanded opportunity for surgeries, preventive care and wellness visits. The services were allowed to return on Wednesday.

Much needed colonoscopies, hip and knee replacements and mammograms can proceed, along with pediatric vaccinations, cancer screenings, and management of chronic diseases such as diabetes or hypertension.

That doesn’t necessarily mean an immediate surge in hospital visits are coming, however.

Bayhealth President and CEO Terry M. Murphy said he hopes for a return to full operations in July, as the system takes a “measured approach” to the added services.

Last week’s expansion, however “at least shows there’s light at the end of the tunnel,” Mr. Murphy said.

Nanticoke Memorial Hospital plans to ease into newly available care as well.

“We’re going to start with surgeries where the patients don’t have to stay the night,” President Penny Short said.

“It will be outpatient surgeries initially. We’ll do that for a week, and then we’ll start those patients that need to stay in the hospital less than a day — we call them 23-hour-a-day patients,” said Ms. Short.

Then, starting around June 8 Nanticoke’s plan expands to include patients that require overnight stay.

“It is a fine balance to make that we’re continually looking at making sure we have enough testing, because some of these patients will need to be tested before they come to the hospital,” Ms. Short said.

“Also, we’re making sure we have the right amount of supplies that can care for everybody.”

Describing the process as “methodical,” Beebe Healthcare President and CEO Dr. David Tam said the Lewes-based hospital system will begin offering more appointments on June 1.

First, Dr. Tam said, Beebe will work to make sure all support systems are in place, from pre-screenings and evaluations to post-visit followups.

Patient conditions may have changed since originally scheduled pre-pandemic, and Beebe aims to conduct physical examinations, new blood tests, X-rays, imaging and more while opening up clinics and laboratories. Rehabilitation, occupational and physical therapy units are gearing up for returns as well.

Dr. Tam said Tuesday’s announcement came after collaborative communications with Delaware’s healthcare providers and state officials.
“This wasn’t a surprise and we’ve been planning for fully reopening for a good while now,” he said.

Still, the official go-ahead was a morale booster for health care providers inching back toward their pre-coronavirus mission.

“Clearly it’s important to have expectations for the staff that on June 1 we will pivot to the recovery stage instead of the surge stage,” Dr. Tam said. “A lot of people have been waiting to see their doctor, so we are reaching out to provide assurance that we’ll be fully prepared to address all their medical needs in a safe, healthy environment.

“We will return to a normal volume over a period of a few weeks.”

The medical community that promoted preventive care pre-coronavirus was placed on hold for weeks, increasing the odds for morbidity and mortality.

Extensive sanitation measures continue at Nanticoke Memorial Hospital, which last week announced plans to resume some outpatient surgeries and other procedures in its phased plan. Submitted photo/Nanticoke Memorial Hospital

“Hospitals are telling us a lot of patients (have been) showing up at Emergency Departments who have waited too long for medical care,” Division of Public Health Director Dr. Karyl Rattay said when the increased services were publicly announced this week.

At Bayhealth on Wednesday, some surgical procedures included cardiac catheterizations as well as some elective orthopedic, podiatry, ENT surgeries, and simple neurosurgical procedures.

The diagnostic imaging department is also resuming elective screenings that had been postponed, spokeswoman Pam Marecki said.

The OK to return comes with stipulations — proper social distancing and face coverings are a must, along with all-inclusive screenings for COVID-19 symptoms upon arrival for work shift or patient visit, among others.

Also, according to Bayhealth, telehealth and phone pre-registration and check-in processes will increase safety, visitation restrictions continue, along with continuing enhanced cleaning and disinfection procedures.

Nanticoke is utilizing two floors for segregation — one for patients who potentially or do have the virus, and the other specific for those who would be having surgery.

“We continue to make sure that we are not cohorting patients that potentially would have COVID with patients that don’t,” said Ms. Short.

A well-stocked amount of PPE allayed concerns about seeing more patients at Georgetown Medical Associates. Now, however, “We have enough for a month and a half even if we don’t get any from now until then,” internal medicine physician Dr. Beshara Helou said.

Steep financial losses

Financial fallout from the medical limitations have been enormous, and $85 million in federal relief to First State hospitals did little to slow losses of about $5.6 million daily and $170 million monthly.

Statewide, behavioral health and rehabilitation facilities have lost $2 million to $3 million a month since the pandemic’s arrival, Delaware Healthcare Association President and CEO Wayne Smith said last week.

Recovery will be slow, Mr. Smith said, and the additional procedures and visits “will certainly help but there’s a long road ahead with many financial potholes.”

From Nanticoke, Ms. Short said, “I can attest that the financial struggles from all of this is tremendous,” and added from a statewide call last week the impact is “amount of losses for hospitals total within the state is tremendous.

“We’re a smaller community, rural hospital, and it doesn’t take much to really impact our care. We’re trying our best to work with the legislators in trying to get funding, but right now there is funding that doesn’t match with the losses … not close at all.”

Dover neurologist Dr. Robert H. Varipapa said that “while we’ve had a marked reduction in revenue with less patients and less revenue, we need to be able to take care of patients and not worry about money.”

The reality of “no margin, no mission” applies, though, Mr. Smith said.

“A hospital needs to cover costs with a little bit left in reserve or it will lose the ability to help anyone at all and eventually cease to exist,” he said.

According to one survey, Delaware’s hospitals had at least contained expenses for a 10-year-span prior to COVID-19.

On Friday, the Delaware Healthcare Association touted the state’s No. 3 national ranking for the lowest increase in hospital expenses per visit from 2009-2018. The ranking was released by the QuoteWizard Insurance News.

The ranking was generated after analysis of American Hospital Association data via the Kaiser Family Foundation, according to a news release.

While hospitals nationally saw a 36% increase in visit costs, Delaware facilities’ incurred expenses rose just 5%, with an average of $2,062 per visit in 2018, according to the report.

Average visit costs rose an average of around $100 since 2009. The First State ranked No. 20 nationally for the lowest average hospital expenses per visit, the analysis found.

“By making substantial investments in the health of our community beyond the hospital walls, delivering care in the right setting at the right time, and entering into new payment and reimbursement models that prioritize quality over quantity, Delaware hospitals are successfully working to mitigate the total cost of health care delivery through value-based care,” Mr. Smith said.

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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