For a pandemic defined by dramatic moments, one of the most striking was the ban on elective surgeries. For many in the healthcare sector, this moment in March of 2020 was when the urgency of the situation truly gripped their staff and operations. This move freed up space and resources to press into service against the pandemic, but from a fiscal overview, it was nothing short of a catastrophe1. More than 50% of hospital revenue is generated from common inpatient procedures and banning them suddenly cast balance sheets into free fall1. Several of the top 10 procedures saw volume decreases between 79% and 99% from before the pandemic began1. Virtually overnight, many hospitals lost half of their incomes.
What Surgeries Qualify as Elective?
From a medical perspective, at first glance, this may not seem particularly dire. After all, an elective procedure isn’t medically necessary, correct? This misconception about the nature of elective surgeries helps to shroud the deeper, long-lasting impact of this directive. The effect on the patients they serve is every bit as severe, both from medical and financial perspectives.
According to Becker’s Hospital Review2, “The term "elective surgery" does not describe the acuity of the medical condition or necessity of the procedure. Rather, the use of "elective" distinguishes these surgeries that are scheduled in advance from emergency surgeries, such as trauma cases.” Therefore, elective surgery would perhaps be better classified as any surgery that is not required to save a life immediately. To drive the point home, the same article includes a tweet from N. Seth Trueger, MD, who is the assistant professor of emergency medicine at Northwestern Medicine, in which he explained that, almost unbelievably "[most] cancer and heart surgery, for example, are 'elective' in that we can schedule them for Tuesday.”2
Patient Access to Vital Care
Since elective surgeries impact vital aspects of patients’ health and can even combat life-threatening diseases, how restricted has patient access become to these levels of care?
The Healthcare Financial Management Association (HFMA) laid out the decreasing rates of the impact stating that “we see huge declines in access both for life-threatening illnesses such as congestive heart failure (-55%), heart attacks (-57%) and stroke (-56%) and for chronic diseases such as hypertension (-37%) and diabetes (-67%).”1
The Costly Reality of Delayed Treatment
For example, how does this delay in treatment affect patients with Congestive Heart Failure (CHF) (more detail on this topic can be found in our upcoming webinar)? Heart failure is one of the most expensive conditions to treat and is the illness with the highest readmission rate. According to a study, declining or delaying care for this condition ends up costing the patient an additional $8,000 yearly in medical expenses3. With the impact of COVID-induced delays for treatment, the cost of ensuring these patients receive adequate medical care can be significantly higher than that of another individual.
The Future of Elective Surgery Delays
For a while, life seemed to be inching closer to what normal used to be. However, with new variants and rising infections, many hospitals and regions are taking steps back into the days of triage and quarantine procedures. Texas has already moved to encourage hospitals to renew their postponement of elective procedures to free up space to continue the battle against COVID4. Earlier this summer, Becker’s Hospital Review published a list of 106 hospitals across the nation that have already enacted this policy5.
While this may be for the greater good and an absolute necessity from a medical and public health perspective, these decisions do not exist in a financial vacuum. For the foreseeable future, the only constant is unpredictability. Unfortunately, reduced revenues and operating constraints are here to stay for the time being.
How to Compensate and Prepare with ECLAT Health Solutions
No clever tactics or savvy financial maneuvering can completely negate the effects of coronavirus and of canceling half of an organization’s income. However, there are solutions that can ease the burden significantly. One of the most vital and timely countermeasures any healthcare revenue cycle can implement is optimizing returns on the services you are still providing. The key to achieving this goal is to utilize a coding partner like ECLAT Health Solutions who maintains the highest levels of accuracy in revenue cycle management. Further, ECLAT operates with a unique, breakthrough 3-Tier Quality Assurance process that is a proven game changer for retaining the optimal amount of revenue from providing healthcare services. With these tools in hand and a partner to secure your gains, it is possible to combat these losses, to improve your RCM and to move towards financial recovery even in the storm raging around us.
To combat losses by ensuring you’re getting the optimal reimbursement on your revenue sources:
1https://www.hfma.org/topics/financial-sustainability/article/elective-surgery-does-not-mean-optional-surgery--how-to-recover-.html | RevCycle Intelligence
2https://www.beckershospitalreview.com/hospital-physician-relationships/don-t-let-the-term-elective-fool-you-physicians-urge-the-public.html | Becker's Hospital Review
3https://www.cardiovascularbusiness.com/topics/heart-failure/16-heart-failure-patients-delay-or-skip-treatment-many-financial-reasons | Cardiovascular Business
4https://www.fiercehealthcare.com/hospitals/texas-gov-asks-hospitals-to-delay-elective-procedures-and-requests-more-out-state | Fierce Healthcare
5https://www.beckershospitalreview.com/patient-flow/8-hospitals-postponing-elective-procedures-amid-covid-19-resurgence.html | Becker's Hospital Review