HJAR Mar/Apr 2021

16 MAR / APR 2021 I  HEALTHCARE JOURNAL OF ARKANSAS STATE OF ARKANSAS’ HOSPITALS As we look back on the past year, all the de- scriptions —many now overused by news me- dia — are entirely applicable: unprecedented, never before seen, a “new normal.” We all remember where we were as our state began reacting to the arrival of COVID-19 last March, and we are all individually conducting our own personal and professional reviews, one year into the pandemic, as we consider our prospects for the coming year. 2020 presented healthcare providers with an array of challenges and opportunities for growth. The following is a review of the most prominent stress and growth points for hospitals during the pandemic. ELECTIVE/NONEMERGENT SURGERIES One of the first measures the state took to brace for the impact of COVID-19 was to issue a directive to healthcare providers to cease per- forming elective or nonemergent procedures April 3, 2020. The directive was motivated by the perceived need, at the time, to preserve personal protective equipment (PPE) and hos- pital bed capacity. Looking back, there is no doubt that healthcare providers were experi- encing extreme shortages of all types of PPE at the time, but what was unknown was how quickly — and what types of — hospital bed space would be needed. The restrictions on elective procedures emp- tied out our hospitals. We heard frommany hos- pital administrators that their halls were quiet for the first time in memory. The silence in the building replaced the usual hustle and bustle of providing healthcare. As we saw more evidence of the impact of this directive, hospitals were allowed to resume these procedures for patients who tested nega- tive for COVID-19 within 48 hours prior. The major challenge was finding testing labs that could turn around a result in that timeframe. This proved challenging for larger hospitals, some of which had significant lab capacity themselves, but it was next to impossible for smaller facilities and those located in more ru- ral areas of the state. This was then adjusted to 72 hours and eventually extended to 120 hours (five days). We have certainly learned a lot about the effectiveness of ceasing so-called elective procedures. It is a misperception that most procedures in a hospital are elective. Stopping elective procedures does not stop car wrecks, heart attacks or strokes. Other procedures of- ten grouped in the elective category are non- emergent only with regard to timing but are absolutely necessary. Experience has taught us that the directive only delayed these proce- dures, and this deferred care filled hospitals in later months and exacerbated some patients’ conditions. HOSPITAL FINANCES The directive’s reduction in procedures creat- ed significant financial stress for hospitals. AHA surveyed its membership in April to attempt to project the financial impact of COVID-19 in just the first couple of months. At that time, hos- pitals had seen outpatient procedure volume drop by 35%, and emergency department visits were 45% lower. These decreases in volume caused net pa- tient revenues to decrease by an estimated $54,600,000 in March and $271,080,000 in April. This is an extreme negative financial impact for every hospital in Arkansas, the likes of which HOSPITALIZED COVID-19 PATIENTS IN ARKANSAS 4/9/20 - 2/03/21