When the coronavirus slammed into Westchester last March, local hospitals scrambled to find enough beds, expert medical personnel, and the necessary equipment and medications to meet the surging demand. They were tested in ways never imagined as they rushed to take care of desperately ill and dying patients while keeping their staffs and non-COVID patients disease-free.
Today, as local hospitals and other healthcare institutions begin to emerge from the worst days of the coronavirus, they are coming up for air and looking around at the new normal of patient care and the business of running a medical facility in the aftermath of a watershed event. What worked, and what didn’t? What innovations and lessons learned can be carried forward? Is telemedicine here to stay? And yes, despite the utter horror of the pandemic and the hundreds of thousands of lives lost, some positive changes, for both patients and the healthcare industry, have begun to emerge.
“The pandemic has taken an incredible toll on our society and on our lives, so we need to take everything positive from it that we can,” says Jeff Short, vice president and chief of staff of the Bronx-based Montefiore Health System, which includes Montefiore New Rochelle Hospital, Montefiore Mount Vernon Hospital, Burke Rehabilitation Hospital, and White Plains Hospital within its network.
COVID-19 has forced hospitals to adjust and readjust quickly and often, adds Josh Ratner, executive vice president and chief strategy officer for the Westchester Medical Center Health Network (WMCHealth), which is headquartered in Valhalla. “The new normal comes in almost quarterly intervals now,” Ratner says.
Tracy Feiertag, deputy executive director of Phelps Hospital Northwell Health, in Sleepy Hollow, agrees. “The biggest difference is our need to be nimble, by making significant business decisions in short order, without necessarily having as much information as we normally have available,” she says. “The business of healthcare is extremely complex, and we have a historic culture of careful analysis and planning. Today, we make fairly impactful decisions — temporarily halting services, moving patients throughout the hospital to make sure we are emphasizing safety, purchasing equipment and supply, and redeploying staff — almost on a daily basis.”
“We’ve had 10 years of innovation in 12 months. We went from a purely in-person business model to a mixed in-person and virtual business model.”
—Jeff Short, Vice President & Chief of Staff, Montefiore Health System
Perhaps the most important change to come out of the pandemic is the explosion of new technology in the field of telemedicine and virtual healthcare.
“We’ve had 10 years of innovation in 12 months,” says Short. “We went from a purely in-person business model to a mixed in-person and virtual business model. COVID disrupted the normal flow of how patients sought out services. Many patients were afraid to enter an emergency room and sought care at a physician’s office.”
Some patients delayed care. Others were able to avoid an initial in-person visit altogether. If you injured your arm, for example, the normal treat-and-release model would have you go to the emergency department and be treated and sent home that day; then you would make an appointment to see an orthopedist in the next few days. With all these changes, those treat-and-release numbers are “down 30 percent system-wide for us over the previous year,” Short explains. Even with the arrival of widespread COVID vaccinations, “that is never going back to what it was.”
Even with the COVID volume, “we had fewer patients in the hospital,” adds Short. “We saw a definite reduction in the number of patients sitting in hospital beds. Something fundamental has changed in the way patients are seeking care. Many now have more options; they can access their physicians virtually. We’ll have to wait and see if these changes are permanent.”
Even though the first two months of 2020 were pre-COVID, “if you exclude the fields of radiology and pathology, which tend to require in-person visits, we had a 31 percent virtual visit rate for the year,” Short says.
In all of 2019, Montefiore had just five telehealth visits. In 2020, that number skyrocketed, to nearly 700,000. “Because of the pandemic, both physicians and patients were willing to try something new,” Short says.
Other healthcare facilities saw similar numbers. At the height of the pandemic, “we were doing 35,000 to 40,000 virtual visits a month,” says Dr. Scott Hayworth, president and CEO of CareMount Medical and president of Optum Tri-State. CareMount has 45 offices throughout the region. The company expanded and broadened its virtual visit platform in a week and a half in March 2020.
Today, telehealth remains popular. “We’re hovering around 15 percent,” says Michael J. Fosina, FACHE, president of NewYork-Presbyterian Lawrence Hospital, in Bronxville. Meanwhile, at White Plains Hospital, telehealth “represented eight percent of our visits for the month of January,” says Susan Fox, the hospital’s president and CEO.
“We are very bullish on telehealth, and we will continue to look at new ways to utilize it,” Ratner says. Patients and their families like it, and “we have specialists here who may not be available to patients at community hospitals.” Insurers have also bought into telehealth, he adds: “In reality, it has improved access to better healthcare for patients, at no new costs.”
Virtual medicine during the pandemic was particularly good for patients with chronic conditions who couldn’t make it into clinics, as well as for those who needed mental health care, says Anthony Viceroy, CEO of Westmed Medical Group, which has 13 offices in Westchester and Fairfield County. “Our patients over 60 were our biggest users for telehealth, since they were most at-risk during the pandemic. They adapted to it right away.”
Remote patient care, a natural outgrowth of virtual phone calls with doctors, is now becoming a reality in the wake of COVID. “We can now track specific conditions using integrated devices in real time to monitor and identify any cause for concern early,” Fox says. “For patients with pacemakers, we have the ability to track their heartbeat, generating reports and potential red flags that are reviewed by a clinician.” Further, she says, “We will soon be administering home-monitoring kits to select patients, so they can measure their blood pressure, oxygen levels, and lung capacity at home and share data with their physicians.”
For now, the revenue stream for virtual care is smaller, but that will change as the technology gets better and more healthcare is delivered virtually, Short says. “Per a transaction basis, the revenue-per-visit is lower because you can’t do certain things via telehealth.
“We have a problem in healthcare with no-shows,” he adds. It’s like empty seats on a plane, he explains: You want them full before you take off. “With in-person [appointments], we have a pretty high no-show rate. With telehealth, we can go to you, and you can do your appointment from your living-room couch.”
Virtual care has the potential to improve access to care and the quality of care, Short says, and it “grows the pie for the healthcare industry. That has real value. Technology creates all sorts of opportunities to create value. It’s a really exciting time.”
“Now, we are on the front lines of innovation like never before. COVID made us look at things like cost structure and capturing greater efficiencies and greater evolution in consumer demand.”
—Anthony Viceroy, CEO, Westmed Medical Group
Viceroy sees telehealth as part of a broader push for improved innovation and technology brought on by the pandemic, as well as a new age of consumerism. “When I came into this industry, nine years ago, healthcare was the slowest to adopt new technology,” he says. “Now, we are on the front lines of innovation like never before. COVID made us look at things like cost structure and capturing greater efficiencies and greater evolution in consumer demand.”
It also brought about some hard looks at healthcare institutions’ finances and long-range planning. No one had the COVID playbook. They know now that this may be the first of many new pandemics in the future. Also, healthcare institutions must have the ability to make fast decisions and remain both agile and viable.
The healthcare industry has learned the importance of maintaining a very strong balance sheet, with healthy access to capital, and to focus on managing the unpredictable.
Seeing what was happening with the virus in Europe in February 2020, for instance, Viceroy quickly shored up his cash position by securing liquidity through his bank’s credit facility. He also knew that once the pandemic entered the U.S., banks would be more challenged in their lending.
Government help became available, but Viceroy says he didn’t know what to expect in way of stimulus in the early days of the pandemic. The company needed to have cash flow to survive; he made sure the company had working capital on hand to cover the organization for a full year.
Fosina, of NewYork-Presbyterian Lawrence Hospital, faced similar issues. “The pandemic really devastated the hospital’s finances, and that was true across the country,” he says. Hospitals had to expand their intensive care units on a moment’s notice and shut down elective surgeries and outpatient offices for months at a time. “We added four ICUs overnight and then another 20 over a weekend,” he remembers. “The nonclinical staff worked hard and were here 18 to 20 hours a day, and staff didn’t want to leave. We housed staff in local hotels and provided them with three meals a day.”
“When you’ve been in the trenches together, there is a tremendous trust that develops — and that remains.”
—Dr. Mark Silberman, Physician-in-Chief, Symphony Medical Group, at St. John’s Riverside Hospital
Being part of a large healthcare network was necessary, Fosina adds. “We were able to monitor the whole NewYork-Presbyterian Lawrence Hospital system and place resources such as physicians, staff, equipment, and PPE in the surging locations as needed. We always had the resources we needed.”
Most hospitals “cross-subsidize” their businesses with different services, such as complex medical cases versus elective surgeries. “Each affects the bottom line in different ways,” says WMCHealth’s Ratner.
Not doing elective surgeries and other non-urgent care for several weeks was a big hit on CareMount’s bottom line, as well, Hayworth says, and he still worries about patients who are putting off colonoscopies, mammograms, and other screening procedures. “We want our patients to come back. The last thing we want is to lose people to cancer who may be worried about COVID,” he says. “We have COVID completely under control in an office environment.”
With memories of pandemic-related severe shortages of PPE and critical-care medications and machines fresh in their minds, local healthcare institutions have also gotten good at long-range purchasing. NewYork-Presbyterian Lawrence Hospital now uses a warehouse to store a three-month supply of everything needed for the hospital. The goal is to never run out and to be prepared for any sort of future emergency or shortage of equipment.
At the height of the pandemic, “we were paying $125,000 a week in PPE, just to keep staff and patients protected,” says CareMount’s Hayworth. At Westmed, “we took out 18 months of supply of PPE last April,” Viceroy says. “It was a huge investment we made, but we didn’t know if there would be a second wave, or a third wave, or a new strain. It was a smart bet on our end.”
After coming within a few days of running out of PPE and ventilators, St. John’s Riverside Hospital, in Yonkers, now has a “three-month supply of everything we need,” says Dr. Mark Silberman, physician-in-chief for the Symphony Medical Group, which oversees doctors at the hospital. The hospital now has more than 80 ventilators, compared with 20 before the pandemic. They typically cost in excess of $40,000 each.
“We were within a day or two of running out of ventilators,” Silberman remembers. “Doctors considered the possibility that they might reach a place where they couldn’t keep every critically ill patient alive.”
The pandemic has also brought changes to the physical spaces within healthcare systems. Pretty much gone, at least for now, are waiting rooms and other pre-care preliminary steps.
“How we move people through the hospital has changed,” says Fosina of NewYork-Presbyterian Lawrence Hospital. “Everything is much more streamlined. You come in directly now, and everybody has your information in our electronic system; it is now all collected online, while you are home.” There are no more registration clipboards. “If you’re having surgery, for example, we move you right up to a preoperative area, then to the operating room,” he notes.
“Our physical environment is one of the biggest changes for us,” says Phelps’ Feiertag. “We went from having 12 negative-pressure rooms to over 100,” she says, describing an engineered air-flow system that pulls air into a room as opposed to pushing air out. “This air-flow mechanism provides a much safer way to manage infection control in the hospital, keeping our patients and staff members much more protected from infection transmission.”
During the pandemic, most back-office employees worked from home, says Hayworth, who says, “I think that will continue, and we won’t need as much commercial real estate anymore.”
Recognizing the COVID-driven need for patients and their families to feel safe and secure in a hospital setting, the new 16,000 sq. ft. Maternal & Newborn Care Unit at NewYork-Presbyterian Hudson Valley Hospital, in Cortlandt Manor, will have enlarged rooms and pods for privacy.
“From the start, the unit was designed in a family-focused way so that families would have everything they need within their own private rooms, including spacious bathrooms and showers, and comfortable sleeper beds for partners,” says hospital president Stacey Petrower. “This detail is especially important with COVID, when families are looking for options that are safer and more secure for the whole family — especially for their newest additions.”
Interestingly, Petrower also says that the hospital has seen an “intermittent surge in deliveries over the past year, due to many families moving to the Hudson Valley.” Based on the trend of newly pregnant patients Petrower is seeing in their medical offices, she expects that trend to continue.
Many of the COVID-related protocols for testing and cleaning in healthcare facilities will likely be part of the new normal for some time to come.
“One of the things I think the community learned from COVID-19 was just how important it is to have quality healthcare nearby.… Your local hospital needs to be equipped to handle everything from the routine to the complex.”
—Susan Fox, President & CEO, White Plains Hospital
“Screening protocols are here to stay,” Viceroy says. “All of our medical facilities have developed triage workflows to isolate and treat sick patients.” There are also extensive new cleaning protocols, “so that all examination equipment is always available,” he adds. “We’re always disinfecting everything.”
Beyond the physical changes, there are many intangibles brought about by the pandemic. “We learned the importance of communication,” says Hayworth. “We increased the number of group-wide phone calls at night with different groups of providers. We also did frequent email blasts to patients to keep them informed.”
Silberman says that he and other St. John’s doctors “were in communication with doctors in Italy, doctors in China,” to figure out how best to care for patients and what drugs worked.
Post-COVID, Ratner, of WMCHealth, expects to “continue an enormous amount of collaboration between providers and health systems. This has real value for the public and the community. Further, the overall emergency preparedness of healthcare institutions has been greatly enhanced,” he says. “We now have preparedness and procedures in place for future pandemics or emergencies.”
There is also a newfound appreciation for suburban hospitals and close-at-hand healthcare, both for emergencies and routine care. “In 2020, the American public learned that healthcare is part of the fabric and infrastructure of the community,” Fosina says.
Fox agrees. “One of the things I think the community learned from COVID-19 was just how important it is to have quality healthcare nearby,” she says. “With healthcare needs constantly evolving, your local hospital needs to be equipped to handle everything from the routine to the complex.” To further its efforts in that cause, White Plains Hospital in June is opening a state-of-the-art Center for Advanced Medicine and Surgery for outpatient care.
Meanwhile, COVID-stressed and overworked healthcare personnel formed bonds with each other and their communities that will likely last for years to come. “It was really very special to see how much the staff and the administration stepped up in this crisis, to see the camaraderie, the teamwork, the collegiality, the motivation,” says Silberman. “It was very moving to be a part of that. When you’ve been in the trenches together, there is a tremendous trust that develops — and that remains.”