Dear Patient, We Want You Back for That Knee Replacement

(Bloomberg) -- An executive at a Palm Beach hospital stands between a box of surgical masks and a Purell dispenser.

“We understand you haven't been inside our hospitals for some time,” she says to the camera. The executive is delivering her line for a promotional video intended to get people back to hospitals after almost three months of avoiding the place at all costs.

Moments later, the film crew records her chatting with a vascular surgeon in an idled operating room, who soothingly reassures that a hospital is the cleanest place to be outside your home. “The hospital is safer than the grocery store,” the doctor says.

The video published on YouTube in mid-May is part of a marketing campaign by Tenet Healthcare, which operates 65 hospitals and about 250 ambulatory surgery centers. It's one attempt to solve a problem the entire health-care industry faces: Most patients vanished when Covid-19 swept the country.

Billions in Losses

Much of routine health care came to a halt in March as hospitals cleared space for an expected wave of Covid-19 patients and authorities ordered a halt to surgeries and other procedures that could be postponed. The decline in volume has clobbered hospital finances, with the industry estimating it is losing $50 billion a month.

Emergency visits dropped by 42% in four weeks in April compared to the same period last year, the Centers for Disease Control reported June 3. The number of U.S. patients getting hospital care dropped by more than half in late March and early April compared to 2019, according to data from Strata Decision Technology, which provides software to hospitals.

Some of that rebounded modestly in May as distancing rules eased, but hospital volume is nowhere near pre-Covid levels. With the pandemic ongoing and many states still confirming hundreds of new cases daily, patients are hesitating to rush back to hospitals.

“The main thing that really is a gating factor at this point is patient comfort,” Tenet President and Chief Operating Officer Saumya Sutaria said at a recent virtual conference with investors. Tenet declined interview requests.

Free Masks

To counter the public's fears, hospitals publicize what they're doing to keep patients safe. They're handing out masks at the door and spacing out chairs in waiting rooms. They're steering Covid-19 patients to dedicated sites and testing staff regularly.

Hospitals need to show patients that their facilities are safe. At Catholic hospital chain Trinity Health, that includes moving patients through “Covid-free” zones with separate doors, elevators and waiting areas.

“We can put all of the outreach and marketing in place, but it's only as effective as the people who execute those strategies,” said Julie Spencer Washington, Trinity's chief marketing and communications officer.

The question for the entire industry is how quickly patients come back. The answer will depend on a constellation of related variables, including how reluctant people are to resume care, and the course of the pandemic. Future surges could force hospitals to shut down regular care again — and spook patients further.

Hospitals and doctors are going to have to do as much as they can as fast as they can until they can't anymore,” said Lisa Bielamowicz, co-founder of consultancy Gist Healthcare.

Many patients, on the other hand, are in no rush. “They're waiting and watching rather than pulling the trigger and going to see the doctor like they would have in the past,” Bielamowicz said.

The calculation for the health-care industry is different than for many other service businesses resuming operations. A hospital procedure or even a check-up is more intimate than a meal out.

Patients are “waiting and watching rather than pulling the trigger and going to see the doctor like they would have in the past.”

For procedures that require in-patient rehab stints for recovery, the havoc Covid-19 has brought to nursing homes adds another layer of concern. “Those places seem like deathtraps now, so it's much harder to bring back those patients because you need to find an alternative way for them to rehab,” Bielamowicz said.

And the biggest consumers of health care are the elderly and the chronically ill, the very people Covid-19 most threatens. “From personal discussions with my patients, the older and more co-morbidities that any individual has, the more nervous they are about returning,” said Shauna Gulley, chief clinical officer at Centura Health, which has hospitals in Colorado and Kansas.

Patients with serious ongoing needs like cancer treatment or emergencies like heart attacks and strokes have continued to get care. And many medical problems resolve on their own. The decline in those visits – for a migraine headache, for example – reduces providers' revenue but may not harm patients in the long-term.

While people often go to the emergency room for needs better treated in other settings, now the concern is the opposite: That true medical emergencies will be neglected.

Ascension, the nation's largest Catholic hospital chain, has purchased billboards that say “Don't delay ER care.” On hospital websites and social media posts, Tenet facilities reminded patients that “Emergencies Can't wait. We're Open & Safe.”

Deferred Care

Doctors fear that some patients will defer needed care too long, allowing progressive conditions to deteriorate. Clinicians at Maimonides Medical Center in Brooklyn, New York, have seen patients arrive sicker because they didn't come earlier, said Ken Gibbs, the hospital's CEO.

“There are unmet needs, I think that's clear,” he said. “And I think the data on that will emerge, but it will take time.”

Maimonides treated 471 Covid patients at the peak on April 9, Gibbs said, and still had about 100 in late May. The hospital has applied for a waiver from New York State to resume elective surgeries, which are still on hold in New York City.

Some hospitals are preparing for a lasting dent in their revenue. For years, health economists have pointed to waste in the health-care system, with the estimated cost of unnecessary treatments in the hundreds of billions of dollars. Covid-19 may demonstrate that patients are willing to forego some of that care or opt for more conservative treatment.

People who had delayed back surgeries, for example, may now decide that doing physical therapy at home is good enough, said Marvin O'Quinn, president and chief operating officer at CommonSpirit Health, a large Catholic hospital system.

“We've all talked about too much intervention in health care in the past,” he said. “I think we'll see a new normal in terms of what patients want to do and what doctors want to do, and we will have to adjust to that.”