As fear of COVID-19 surge subsides, NC hospitals resume non-urgent surgeries
Hospitals in North Carolina are beginning to reschedule surgeries and other procedures they began postponing in March to prepare for a surge in COVID-19 patients.
That surge has not arrived, and hospitals say they now have the equipment, staff and bed space to resume some non-emergency procedures. As of Tuesday morning, 463 people were hospitalized with COVID-19 statewide, with more than 6,600 hospital beds available, according to the state Department of Health and Human Services.
Duke Health, UNC Health and Charlotte-based Atrium Health began expanding the number and type of services they provide on Monday, while Novant Health and WakeMed say they’ll resume some non-urgent surgeries and procedures next week.
Hospitals say patients need this care, especially if it has been delayed for a month or more. But hospitals, clinics and physician practices also need the money these procedures generate.
Hospitals, particularly small rural ones, make most of their revenue from non-emergency procedures, and delaying them is the main reason North Carolina hospitals have lost an estimated $1 billion in the last month, says Cody Hand, senior vice president of the N.C. Healthcare Association, the trade group that represents all 130 hospitals in the state.
“That’s not a sustainable financing model,” Hand said.
Many hospitals began voluntarily postponing so-called elective procedures in mid-March. The aim was to preserve gloves, masks and other personal protective equipment as well as staff and beds for what many expected would be a wave of COVID-19 patients.
State Secretary of Health and Human Services Mandy Cohen requested that starting March 23 hospitals and ambulatory surgery centers suspend all procedures and surgeries that could be delayed four weeks without causing harm to the patient. A few days later, Gov. Roy Cooper ordered residents to stay home except to visit essential businesses, to exercise outdoors or to help a family member.
People in the hospital industry credit the governor’s order, and the public’s willingness to comply, with controlling the coronavirus outbreak in North Carolina.
“It resulted in what we wanted, which was not a lot of hospitalizations of COVID patients,” Hand said.
Dr. Joseph Rogers, chief medical officer for Duke Health, said the system’s three hospitals have seen hundreds fewer COVID-19 patients than it once expected.
“I give great credit to the public and the community for really heeding the warnings put out around shelter-in-place and social distancing,” Rogers said. “They’ve really bent the curve.”
But it has come at a cost to the economy and to hospitals themselves. Johnston UNC Health Care in Smithfield and Clayton has postponed more than 300 non-urgent procedures because of coronavirus, said Tommy Williams, the interim CEO.
“It is a significant financial hit,” Williams said. “We ... are looking at when we can start ramping up those cases. Certainly for the financial implications but also more importantly for those patients. You figure those 300 plus patients, they need that care, they need those procedures, even if they are elective.”
Cooper supports limited expansion
These first steps toward normalcy at hospitals come as the state remains under Cooper’s stay-at-home order at least through May 8. On the day last week that he and Cohen outlined the benchmarks that would have to be met before the state lifts its restrictions, Cooper spoke about the importance of the health care system getting back to treating patients.
“We need an overall strategy while we fight this battle of COVID-19 that we can keep people healthy in other ways,” Cooper said. “Because when we’re staying at home and we’re trying not to catch the virus or give it to other people, sometimes other illnesses are ignored, and we don’t want that to happen.”
Cohen said she wants to make sure hospitals can resume non-urgent procedures without depleting their supplies of personal protective equipment, or PPE. The N.C. Healthcare Association developed guidelines for hospitals as they consider performing non-urgent procedures again that include making sure they can test patients and staff for coronavirus and have enough PPE not only for now but for a potential uptick in COVID-19 patients.
After reviewing the guidelines, the state DHHS offered some suggestions but overall found them “thoughtful and constructive,” according to a spokeswoman.
Not like it was before just yet
Hospitals say they are being cautious about resuming non-emergency procedures and won’t immediately return to offering the services they did before the outbreak. The number of coronavirus cases continues to rise, and hospitals still need to be ready for an influx of COVID-19 patients, said Chuck Harr, chief medical officer for WakeMed Raleigh Campus.
“We still don’t know where our peak is going to be,” Harr said. “There could be a flareup in a nursing home or at a meatpacking plant or a prison. And we don’t want to get our hospital so full that we can’t respond to that.”
WakeMed is performing about 20% as many surgeries at its flagship hospital in Raleigh as it did before March, Harr said; starting next week it aims to increase that to about 50%. That means, for example, that patients with certain types of cancers or back injuries that were not considered critical before will now be able to receive surgery, he said.
UNC Rex has been doing less than half its usual volume of procedures and will probably increase it to 65% to 75%, said Linda Butler, the chief medical officer. Butler said even relatively minor health problems, such as a torn rotator cuff, can’t be put off forever without causing long-term damage.
“We’re more than a month out, and people’s conditions have changed or now there may be a long-term impact to the patient of delaying the procedure further,” Butler said. “We put off what we could safely put off to comply with the recommendations, but now we have to revisit those cases.”
Duke Health, which cut its surgical work in half in recent weeks, will give priority to people who need care most urgently, including some cancer and cardiac surgeries that had been postponed, said Rogers. Next week, Duke expects to reopen its ambulatory surgical centers to resume performing orthopedic and other outpatient procedures.
“We’ve begun to carefully and slowly increase our surgical volumes and make sure there are no unintended consequences,” he said.
Each hospital’s ability to expand its services will vary, depending on local situations. Janie Jaberg, president and CEO of Wayne UNC Health Care in Goldsboro, said her hospital wants to slowly bring back non-urgent procedures but remains cautious. Hundreds of inmates at Neuse Correctional Institution in Goldsboro have tested positive for coronavirus.
“We’re watching that every hour,” Jaberg said. “So we’re managing that and using that as one of the guidelines of when we can at least consider ramping back up.”
Hospitals say the cutback in services to focus on coronavirus gave them time to stockpile PPE and other equipment but also to develop the procedures to safely manage COVID-19 patients and to screen and test patients and staff. They say even when the number of new infections subsides, coronavirus will be something hospitals must guard against for the foreseeable future.
This story was originally published April 28, 2020 at 12:06 PM with the headline "As fear of COVID-19 surge subsides, NC hospitals resume non-urgent surgeries."
