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Ask the Expert: Healthcare During the Pandemic

April 6, 2020 | Crain's New York Business
The coronavirus crisis has upended life and business as we know it. No organizations are feeling the impact more than those in health care. They have been under intense pressure to treat the mounting number of cases.

The unprecedented situation has required leaders of many health care organizations to think about everything from staffing to delivering health care in new ways. The situation has opened the door to greater use of technology, such as telemedicine.

For insight into the trends, Crain’s Content Studio recently spoke with Joseph Tomaino, chief executive officer of Grassi Healthcare Advisors LLC.

CRAIN’S: What are the added challenges health care organizations face during the pandemic?

TOMAINO: The immense scope of Covid-19–with 20% of infected patients requiring hospitalization–is straining the capacity of facilities that were already stretched thin by flu season. Add the demand for testing, respiratory issues from seasonal allergies, and increased measures to protect staff and patients, and it’s not hard to see why hospitals and residential facilities are struggling.

At the same time, many health care practices are having the opposite problem. They are
seeing decreased volumes of 33% or more as patients defer nonessential appointments. Their challenges are compounded by excess staff capacity as well as the unpredictability of when the cash-flow impact will hit.

Mental health providers will face increased demand, with many people looking for assistance in dealing with social isolation, unemployment and lack of recreational activities.

CRAIN’S: How do you anticipate these challenges evolving, once the virus peaks?

TOMAINO: Judging from what we’ve seen in other countries, social isolation measures should reduce the number of people affected and flatten the rate of infection, relieving hospitals and other resources from being totally overwhelmed.

My concern is for the community-based medical providers, clinics, mental health programs, substance use disorder programs, home care agencies and hospices that are all going to feel the brunt of the peak, and likely for months to come. So much attention has been placed on the acute needs of the 20% who are hospitalized that we may be overlooking vulnerabilities in our ability to respond appropriately to the 80% who are not.

CRAIN’S:What best practices and strategies can health care organizations deploy to get through this and other emergencies?

TOMAINO: Every organization should have an emergency preparedness plan that now includes pandemics. Organizations will deploy their plans’ strategies for command and control, communications, staffing, equipment and supplies, safety and clinical operations.

Thanks to some relaxed regulation and rapid innovation, I am receiving many requests to help clients implement telemedicine as a strategy for continuity of care in the safety of the patients’ own homes.

Plans for coordination of care personnel from other states, retired staff, volunteers, the
Federal Emergency Management Agency, the military and others will need to be expedited. As part of this, health care organizations should think outside of the box. I have been working with some organizations to begin recruiting and training displaced restaurant workers to help augment staffing in whatever appropriate ways they can.

CRAIN’S: How can health care organizations use these best practices within a value-based reimbursement model?

TOMAINO: Value-based reimbursement is based on improved outcomes, with lower costs and positive patient engagement. During a pandemic, this model is on pause. Compare it to what we are doing now—practically putting the entire economy on hold.

The cost is enormous, but so too is the value of saving lives.

Science may prove to be the catalyst to getting the tremendous cost of acute care and the economic burden of business closures under control. If drugs can be proved effective at treating Covid-19, that would lead to less mortality and shorter hospital stays.

Science has demonstrated incredible speed in genetically replicating the virus in the lab and developing vaccines. Even at this pace, however, mass immunization is a year away, at best.

CRAIN’S: What have we learned so far from the coronavirus that health care leaders can apply to their organizations?

TOMAINO: In this crisis, organizations have learned to be nimbler and more innovative. Consider the tremendous expansion of telemedicine. This change was poised to occur, but attitudinal and regulatory barriers were holding it back. I think this shift is here to stay as providers and patients realize its effectiveness.
Things like encouraging good hygiene practices for employees and better sanitizing of public and office spaces are basic infection-control practices that shouldn’t be reserved for a pandemic. I read in Crain’s that the Metropolitan Transportation Authority stepped up subway car cleaning to every three days. In South Korea, they stepped it up to three times a day!

Some would say it’s too expensive to sanitize our public transportation so frequently, but Covid-19 demonstrates the costs of not doing it.

CRAIN’S: Looking beyond the immediate situation, what trends will ultimately shape the future of health care in New York City? How can health care organizations prepare?

TOMAINO: We’ll need to focus on getting back to basics with hygiene awareness and infection control. We need to reduce the number of ill people coming to work by providing better sick leave and work-at-home policies. We tolerate tremendous levels of illness and death from influenza, much of which might be avoided in these basic ways.

We need to address critical-care capacity for surges, perhaps repurposing portions of closed or downsized hospitals that can be mothballed for emergency use. Scientific research at academic and biotech centers will grow, along with our capacity to use genetics to develop medications and immunizations quickly.

Elder care trends will shift toward innovative care models, allowing more patients to receive care at home instead of in large institutions.

These efforts will not only address our pandemic readiness but save thousands of lives and lost work dollars related to all contagious diseases.

This article originally appeared in the April 6, 2020 issue of Crain's New York Business. Click here to download a PDF reprint.