Covid and RSV and flu (and mpox and polio and Ebola), oh my!
Not only is the “tripledemic” threat of Covid, respiratory syncytial virus (RSV), and the flu looming over health systems this winter, but cases of monkeypox (mpox) and polio are also popping up in some parts of the country.
In addition, National Nurses United, the largest nurses union in the US, started circulating a letter in early October demanding health systems share information on their care plans for patients with Ebola. The letter came in response to an Oct. 6 health alert from the US government ordering airlines to screen passengers arriving from Uganda for the virus.
With all these diseases circulating simultaneously, US health systems face a potential massive wave of hospitalizations this winter. And while most businesses expect more customers will improve their profit margins, that’s not always the case with health systems.
More viral illnesses means less time for profitable procedures
The amount of revenue a health system brings in varies widely depending on the type of service being offered, according to Matthew Weiss, managing director of EY-Parthenon’s healthcare strategy business. Elective surgeries bring in more money than treating Covid or the flu, but when there’s a surge of viral illnesses, there are fewer beds for those profitable procedures.
And it’s not just reimbursement that’s on the line this winter. There’s also revenue versus cost to consider, said Weiss. An open-heart surgery may generate $100,00–$150,000 for a hospital, but treatment for a patient with pneumonia doesn’t bring in anywhere near that amount. The pneumonia patient, however, is much costlier to treat.
With some payers, including Medicare, a hospital gets paid the same amount no matter how many days a patient is hospitalized, said Weiss. That means treating our hypothetical pneumonia patient would bring in the same amount of money, regardless if they were to use a bed—and resources like a nurse checking in on them—for three days or 14 days.
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When a hospital reaches capacity, healthcare professionals might start scrambling to care for an influx of patients. As a result, the average length of stay also tends to increase, said Weiss. Since more beds are occupied for longer periods, fewer new patients can be treated.
“You end up caring for less [patients], and so that impacts revenue,” Weiss said.
How to prepare for a big winter surge
“It’s difficult to give a recommendation that would immediately solve the problem” for how hospitals can prepare for a potential “onslaught” of hospitalizations this winter, said Jay Varma, an epidemiologist and professor at Weill Cornell Medical College.
But one thing hospitals can do is make sure they have an emergency response system, which starts with gathering data about outbreak threats in their community, he said.
“The more you understand the trajectory of the different diseases in your community, the better you’re able to prepare,” said Varma, who helped former New York City Mayor Bill de Blasio tackle the Covid crisis.
Hospital administrators should focus on keeping employees as healthy as possible, such as pushing vaccines for Covid and the flu to help lessen staff shortages, he added.
Some health systems have gotten creative and formed partnerships with skilled nursing facilities and others to open up more bed capacity ahead of hospitalization surges, said Weiss. If a nursing facility has extra space, a hospital could transfer patients who don’t require hospital resources like frequent labs or being close to an ICU, freeing up valuable bed capacity for those who do.
But, the ability of health systems to prepare for surges is “going to be significantly impaired by the fact that we’re in the third year of an all-consuming worldwide pandemic, [and] caregivers are completely exhausted,” Weiss added.
“Health systems have been facing quite adverse financial results, and morale inside [health systems is] pretty low heading into…another wave that’s gonna swamp them,” he said.