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Thursday, May 26, 2022

Post-Pandemic Hospitals

Since the onset of coronavirus, hospitals and clinics have faced a monumental task of caring for patients while controlling a microscopic enemy amid evolving legal and regulations protocols. Navigating this challenge required nimbleness – a trait not usually associated with the health care industry – and now it appears some of those quick changes may stick around long term, according to industry leaders.Virtual visits, for one, will be more of a fixture in the industry. Facility design may change, including a phasing out of waiting rooms, and operational processes and infection control practices are expected to evolve as doctors and administration look back on data compiled over the past year.Consolidation is expected in the coming years too, with standalone hospitals coming into 2021 barely standing.“It’s very difficult to survive as a standalone hospital. About 40 percent of the hospitals were in the red prior to the pandemic and post pandemic, it’s up to 60 percent of hospitals in California,” said Dr. Bernie Klein, chief executive of Providence Holy Cross Medical Center in Mission Hills, No. 2 on the Business Journal’s list of hospitals by beds. Klein, who is also on the board of directors for the Hospital Association of Southern California, received statistics from the organization.

A report released by the association in April added that hospitals in the state lost more than $14 billion last year due to the pandemic; with financial support from the CARES Act included, that number was reduced to $8 billion.California hospitals are expected to lose an additional $600 million to $2 billion this year, depending on vaccination rates and the path of the virus.“These findings suggest broad and serious challenges for California’s hospitals,” the report stated. “Not only could many hospitals struggle to maintain pre-pandemic service levels, a significant number run the risk of defaulting on bond covenants, losing their ability to function as independent entities and/or closing.”Klein said he also expects medical groups and clinics to consolidate into larger entities, but not to the extent of hospitals.“Clinics can survive a little better on their own than hospitals because (a clinic) doesn’t have the regulations hospitals have and it doesn’t require the intensive capital that hospitals require,” said Klein. “We’re still going to see independent clinics and small group clinics, clusters of clinics joining together like we’re seeing now.”Dr. Nancy Gin, regional medical director of quality and clinical analysis for Kaiser Permanente Southern California, said she expects consolidation, or at least affiliation with a larger system, so providers have access to resources and technology.Kaiser Permanente has hospitals in Woodland Hills and Panorama City that rank 19 and 20 on the Business Journal’s list by bed count respectively.Virtual visitsTelemedicine access is a major reason providers consider consolidation or affiliation, Gin continued.“As the industry either develops its own system within the larger health care delivery systems like ours, and there are others that are doing the same, or developing alliances to be able to provide those services to patients, I think those are the changes we can expect for the future,” Gin added. “It would be difficult for a solo practice, or even a small group practice, to be able to develop that mechanism.”Some practices might affiliate with organizations that solely focus on telehealth technology to remain more autonomous, she added.During to the pandemic, Kaiser Permanente Southern California went from a 20 percent telehealth presence to more than 80 percent during the height of surges. Gin said usage will settle somewhere between those two figures; organization leaders will have a better idea in six to 12 months as more people get vaccinated.“There is an increasing demand for face-to-face visits. We are seeing increases in scheduling for procedures and surgeries,” explained Gin. “That’s what is making planning a challenge right now, when you’re talking about capital planning because we don’t actually know.”An increase in telehealth long term will have a lasting impact on workflow for doctors and nurses, affecting work hours, building use and even the construction of health care facilities in the future.“Some of the physicians have days of nothing but virtual visits,” explained Gin. “It also means we’re expanding the hours that people want to access their care, because that’s also a convenience, so that’s changing as well. The old days of Monday through Friday, 8 a.m. to 5 p.m., are really disappearing. Our patients everywhere want access to their care on weekends, evenings – the times when they are able to come in and seek help. The industry is working hard to accommodate that.”But telehealth accommodation doesn’t necessarily mean longer hours, Gin said, just different, staggered schedules for staff. It also means a closer look at which visits need to be in-person and what could be virtual.“We are trying to ensure we have the same levels of quality and safety and outcomes in telehealth,” she added. “It is a question that is on the minds nationally for groups like (the National Committee for Quality Assurance). Accrediting, regulatory bodies want to know how we can ensure safety and quality.”Interior designHospital layout had already started to change prior to the pandemic. For example, a shift to single patient rooms, was already underway and proved a boon for doctors and other hospital staff trying to keep the virus under control.Kaiser Permanente started this shift about 14 years ago. Henry Mayo Newhall Hospital’s new patient tower opened in October 2019 with single rooms, and Providence Cedars-Sinai Tarzana Medical Center’s patient tower, currently under construction, will offer single rooms as well.The next change is a possible phasing out of the waiting room, officials said, or repurposing it to separate infectious and noninfectious people.“We shouldn’t have people waiting in waiting rooms so much anymore,” said Kaiser Permanente’s Gin. “The process for them should be, they can wait, they call and in many cases they can walk around and just like a restaurant, you get a text message when we’re ready for you. That makes it easier and you’re not made to sit in one area with other people.”Some hospitals, including Providence Holy Cross, still have a tent outside where nurses triage patients before they even step into the building, which is a way to limit potentially infectious patients to the correct ward.Gin said doctors will try to do more in the exam room, instead of in a public setting. That could inlcude filling out intake forms – the multi-page packet usually accompanying you to your seat in the waiting room – to reading vital signs, checking blood pressure and body temperature.“If we can do those types of things in the room rather than out in the more general space, it provides less potential exposure,” Gin noted. “Those are the kinds of workflows that will be much more common in other systems as well, as people will no longer be terribly interested in congregating in waiting spaces.”However, given the familiarity of waiting rooms and the costs of altering the interior design of hospitals, the direction forward is far from clear.“I think it’s going to be difficult to phase out a waiting room,” said Klein at Providence. “Kaiser is kind of ahead of the game on this in that they eliminated the reception desk. I think more things are going to be handled electronically. You know how you have to come in and register at a hospital before you get admitted, or at a clinic you have to check in at the front desk? All that can be done electronically and I do think we’ll continue to move in that direction.”“The way our workflows work currently, it would be hard to conceive of how you can make that work,” added Dr. Jeff Borenstein, clinic director at UCLA Health with an office at UCLA’s Porter Ranch location. “I think using existing spaces differently is definitely something that will happen. What that will look like I’m not really clear on, but it seems highly likely we’ll pay more attention to that.”In the Valley region, UCLA Health also has clinics in Burbank, Woodland Hills, Panorama City, Encino, West Hills, Calabasas, Simi Valley, Westlake Village and Thousand Oaks.Working through dataBorenstein said operational practices and infection control procedures may look different than what we’ve seen the past year or even pre-pandemic, but how exactly these processes change will be based on data compiled last year.“Just think about the things we tell people to do, the frequent hand washing, the social distancing, the double mask wearing,” said Borenstein. “Which contributes the most? Are they all necessary? We think they’re all necessary, but do we really know? Do we really understand completely how much each one contributes and if there’s a better thing, something we should be doing or not doing?”The UCLA doctor gave mask wearing during the early days of the pandemic as an example. Public figures in the medical world, even Dr. Anthony Fauci, said initially masks wouldn’t help contain the virus, but then had to walk back previous statements to better align with data indications.Added Borenstein: “The pandemic has provided us with this huge amount of data and information, and we’re still processing it. It kind of reminds me of a space mission, where they send something up that takes data, and then for the next decade they’re processing the data to figure out what it means. … Although we may jump largely to a prior state with some exceptions, the questions will remain for a long time.”Kaiser PermanenteHEADQUARTERS: OaklandCEO: Greg AdamsBUSINESS: Nonprofit health care systemOPERATING REVENUE: $88.7 billionVALLEY LOCATIONS: Woodland Hills, Panorama CityEMPLOYEES: 216,766Providence Health and ServicesHEADQUARTERS: Renton, Wash.CEO: Dr. Rod HochmanBUSINESS: Nonprofit health care systemOPERATING REVENUE: $25.6 billion in 2019VALLEY LOCATIONS: Burbank, Mission Hills, TarzanaEMPLOYEES: 120,000UCLA HealthHEADQUARTERS: Los AngelesCEO: Dr. John MazziottaBUSINESS: Nonprofit health organizationOPERATING REVENUE: $6.8 billionNUMBER OF LOCATIONS: 215EMPLOYEES: 32,000 

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