Key points to remember
- Cutting back on surgical services, even for a short time, can seriously affect a hospital’s financial security
- Maintaining access to surgical care is not just a question of income; it’s about effectively managing the needs of surgical patients
- Healthcare systems should prepare for the long term so that they can safely deliver elective surgical care during future peak COVID-19 workloads
CHICAGO: The postponement of non-essential surgeries early in the coronavirus pandemic not only disrupted surgical care in U.S. hospitals, but also wiped out a large chunk of total hospital revenues, the results of two studies show. These findings (from both studies, which took place at the University of Pennsylvania, Philadelphia, and Children’s Hospital of Philadelphia) were presented at the American College of Surgeons (ACS) Virtual Clinical Meeting 2021. .
Surgical services are generally a major financial engine for hospitals, and the results of the new study have shown that reducing surgeries for even two months can seriously affect a hospital’s financial security. Most elective and elective operations across the country shut down from mid-March to early May 2020, in an effort to conserve resources for patients with 2019 coronavirus disease (COVID-19). The results of a study found that this two-month suspension cost a single university health system 42% of its net income for five months.
Nationally, hospitals lost $ 1.53 billion just on missed elective pediatric procedures, other study investigators estimated as part of their study, for about the same time period, from March to May 2020. operations, with a median or average recovery time of one year, investigators estimated.
As COVID-19 cases are said to continue to remain high in many states, some hospitals are re-sorting cases and delaying some operations.1.2 Therefore, the researchers said their findings demonstrate the need for better long-term planning by hospitals to avoid further closures to ensure patients have access to the surgical services they need.
Reasons for not delaying surgical care
“Whenever possible, we should not delay surgical care for our patients,” said lead investigator of the first study, Daniel M. Mazzaferro, MD, MBA, plastic surgery resident at Perelman School of Medicine. the University of Pennsylvania. “Surgery is an essential asset for the survival of a health system. “
In addition, delays in surgical care can also lead to a worsening of patients’ state of health, affecting their quality of life, and sometimes even shortening it. Another result is that patients may need more treatment, which increases healthcare costs across the board, Dr Mazzaferro noted.
The pandemic has resulted in an unprecedented temporary postponement of many elective operations across the country, as recommended by the American College of Surgeons (ACS) and other organizations in March 2020 to free up hospital beds and other resources for COVID-19 patients.3 The ACS has provided advice on how hospitals could triage surgical cases, that is, select which operations to prioritize and which to postpone until the number of COVID-19 cases has declined .4
Dr Mazzaferro and colleagues calculated the net revenues of three hospitals in their healthcare system during the first wave, or ‘wave’, of COVID-19 cases from March to July 2020, compared to the same period in 2019 A total of over $ 99 million in net revenue was lost across all surgical departments and $ 58 million in the surgical department in the first wave. The researchers reported a median net loss of income of $ 636,952 per month per division for the department of surgery in the first wave, using updated data presented at the virtual clinical congress. However, the system lost significantly less money – $ 274,626 each month for each division – in a second COVID wave between October 1, 2020 and February 29, 2021.
The surgical department did not suspend elective operations during the second flare-up, said Liza Wu, MD, FACS, lead investigator of that study and professor of surgery at the Perelman School of Medicine.
“We were in a better position than the first time to pursue elective surgery,” said Dr Wu. “We had more personal protective equipment or PPE, better COVID-19 therapies and a better understanding of the virus, and we were probably able to get COVID patients out of the hospital faster. ”
Their surgical department, she added, has also started sorting elective surgical patients using a new scoring system called Medically Necessary, Time-sensitive Scoring, or MeNTS, which doctors at the University from Chicago described in the Journal of the American College of Surgeons.5
After resuming elective operations in June 2020, surgeons quickly regained their productivity, reported Dr Mazzaferro. He made this conclusion based on a measure of surgeon productivity that insurers use for reimbursement, called units of work-related value (UVR). Working UVRs decreased significantly less in the second wave of COVID-19 than in the first: 7.8 versus 13.2%.
For the second study, researchers led by Sourav Bose, MD, MBA, MSc, then a postdoctoral researcher at Children’s Hospital of Philadelphia, assessed the financial impact of cancellations of pediatric procedures related to COVID. To project lost surgical revenue, they used the 2016 Children’s Inpatient Database, which accounts for about 80% of pediatric hospital admissions nationwide.
Dr Bose, a general surgery resident at Brigham and Women’s Hospital in Boston, said children’s hospitals across the country have delayed or canceled about 51,000 elective procedures from March to May 2020.
“Our message is not just about income. It’s about effectively managing the needs of surgical patients, ”said Dr. Bose. “Hospital systems need to evaluate their operation management strategies to optimize the availability of surgical resources for the patients who need them most. “
He proposed that hospitals optimize any excess resource capacity that existed before the pandemic or increase their capacity to perform procedures according to their resources, such as extending operating hours.
Dr Mazzaferro also recommended that health systems prepare for the long term so that they can safely provide elective surgical care during future peaks in COVID-19 cases. He suggested the following:
- Increase the capacity of hospital beds and resources through alternative solutions, such as sending an overflow of surgical patients to other patient care units or facilities that can accommodate them.
- Appropriately sort elective operations according to ACS guidelines4 and other published surgical triage tools.
- Ensure sufficient PPE for healthcare workers and patients.
- Help keep staff healthy by requiring COVID-19 vaccines or testing them frequently for the virus.
The researchers of Dr Mazzaferro and Dr Wu at the University of Pennsylvania were Viren Patel, Nelson Asport, MSHI, CPC, Robert L. Stetson, MHA, David Okawa, MBA, Deborah Rose, MBA, Natalie M. Plana, MD, Joseph M. Serletti, MD, FACS, and Ronald DeMatteo, MD.
Quote: Mazzaferro, DM, et al. The financial impact of Covid-19 on a surgical department: the effects of surgical stops and the impact on a health system. Presentation of the Scientific Forum. American College of Surgeons Clinical Congress 2021.
Dr. Bose’s co-investigators were Serena Dasani, MD, MBA, Brandon White, MSE, Nick S. Adzick, MD, FACS, and William H. Peranteau, MD, FACS, all of Children’s Hospital of Philadelphia.
Quote: Sourav B, et al. Hospital financial risk due to procedural cancellations during the Covid-19 pandemic. Presentation of the Scientific Forum. American College of Surgeons Clinical Congress 2021.
“FACS” means that a surgeon is a member of the American College of Surgeons.
The authors do not report any relevant disclosures.
1 Advisory board. Hospitals are again delaying elective surgeries. But this time, they do it differently. Daily briefing. https://www.advisory.com/daily-briefing/2021/08/18/elective-surgeries. August 18, 2021. Accessed September 29, 2021.
2 Paavola A. 106 hospitals postponing elective procedures amid COVID-19 resurgence. Beckers Hosp Rev. June 1, 2021. Accessed September 29, 2021.
3 American College of Surgeons. COVID-19: Recommendations for the management of elective surgical procedures. https://www.facs.org/covid-19/clinical-guidance/elective-surgery. March 13, 2020. Accessed September 20, 2021.
4 American College of Surgeons. COVID-19: Guidelines for triage of elective surgical procedures. https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage. March 17, 2020. Accessed September 20, 2021.
5 Prachand VN, Milner R, Angelos P, et al. Medically Necessary and Urgent Procedures: Scoring System to Ethically and Effectively Manage Scarcity of Resources and Supplier Risk During the COVID-19 Pandemic. J Coll Am Surg. 2020; 231 (2): 281-288.
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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. His accomplishments have greatly influenced the course of scientific surgery in America and made him a major advocate for all surgical patients. The College has over 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.