Healthcare leaders said in a Perimeter Center discussion that they expect the disparity of care for minority and rural residents to get worse, but they see an opportunity to use what they have learned during the COVID-19 pandemic to make positive changes.
Dr. Kathleen Funk of Northside Hospital; Heather Dexter, CEO of Emory Saint Joseph’s Hospital; and Brian M. Rivers, director of the Cancer Health Equity Institute at Morehouse College took part in the Dunwoody Perimeter Chamber of Commerce’s “Return to the Perimeter” virtual panel on June 9.
COVID-19 safety measures increased costs, cut revenue
All three of the panelists said the additional health safety measures required because of the coronavirus have increased the cost of providing the same care.
Elective procedures at Emory St. Joseph’s and Northside were stopped at the start of the pandemic to keep personal protective equipment available for working with coronavirus patients.
“We went from our normal volume down to about 20% of normal,” Dexter said.
Emergency Department and inpatient visits dropped 50%. If it had continued through August, Emory would have suffered a $660 million loss of revenue, she said. In May, Emory Healthcare announced furloughs or hour cuts for many employees. Reopening plans didn’t change based on projected and realized losses, said Dexter.
By the end of May and June some procedures resumed and for the past few weeks Emory St. Joseph’s was at 75% of its normal volume.
For inpatient care, Dexter said the hospital had to “assure the safety of our patients but also assure the supplies were available for the personal protective equipment necessary for our staff.”
Times became difficult right away.
“We couldn’t find PPE so we had to start looking for alternatives. Then we asked our staff to reuse items not designed for reuse,” Dexter said.
Testing capacity wasn’t available for a long time. Once testing was available, results took a long time to come back.
Rivers said Morehouse School of Medicine made the decision to transition the platform of classroom work more toward a virtual setting early in spring.
Research came with other difficulties. If a researcher is not at the bench, most research can’t continue. They had to create novel pathways and approaches to continue their research.
A lot of the patient population has been clinical based, Rivers said. Many processes could be converted to a virtual platform. He said it took some adjustment to move from the clinical setting while offering the same level of integrity.
From a clinical point of view, Funk said COVID-19 is nothing like any other virus they’ve seen in their lifetimes — not only for its mortality, but also in the challenge in finding the different ways the illness can present.
Northside’s staff canvassed across the nation and the world, reaching out to colleagues to learn more about the coronavirus. One board member had a contact that provided the hospital system with an early copy of the manual written by Chinese scientists on how they were managing things.
In addition to postponing elective cases, the panelists’ institutions took many other steps to try to control the spread of the coronavirus at their facilities. Visitors were limited and only in special situations were allowed. Everyone coming into the hospitals gets screened.
“I think unique for Morehouse School of Medicine is that we have returned to campus,” Rivers said.
It took a lot of preventive measures to realize that, he said. “Everyone has to be tested. We tested our entire workforce.”
Fear has people waiting too long to come to the emergency department, Funk said.
“We worked really, really hard to make people safe when coming into our hospital,” she said.
Funk and Dexter both said the cleaning and disinfecting process makes it almost an hour to turn over a room between patients. Employees and patients must wear face masks. Dexter said furniture has been removed to help assure social distancing.
Outside of the hospitals, Funk said not a lot of people are wearing masks. To those people who find wearing a face mask uncomfortable, she said, it is less so than being put on a ventilator for COVID-19 treatment.
Opportunity to change healthcare model
The healthcare leaders said with the practices that became necessary with the coronavirus, an opportunity has been created to change the face of healthcare.
“Even in the midst of this pandemic we realized that some individuals or families have it much worse than others,” Rivers said.
African American, Hispanic and rural communities suffered more for various reasons, he said. Poverty and densely populated areas make social distancing ineffective. The pandemic helped magnify the healthcare disparity on a national level, Rivers said. He said we can’t go back to business as usual with how we structure healthcare.
“But we have to make change to be sure we are… meeting the needs of all,” he said.
Funk said they continue to seek partners in rural communities to arrange for specialists to visit these communities to increase the availability of care.
“Telehealth can inexpensively bring quality care to those communities,” she said.
Northside completed more than 70,000 telehealth sessions. Those included follow-ups from the emergency department and surgery. The primary care clinic took the lead, calling COVID-19 patients who were discharged from the emergency department.
Emory St. Joseph’s has been working with telehealth for about 10 years, Dexter said.
“We feel like we made more progress in 10 weeks than in the 10 years previous,” she said.
Rivers said Morehouse found some people were having a difficult time understanding the health guidelines being issued. People were gathering in churches, choirs and barbershops when they needed social distancing.
“But we knew that message needed to be clarified,” he said.