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May 19, 2020: We're back with another Tuesday News Day! Our main focus this week is the idea of economic recovery after the pandemic and how this might play out in the healthcare sector. Our first piece of news we look at comes from The Economist and their article titled 'Prognosis: mixed - The pandemic will recast America’s health-care industrial complex', in which a number of high profile voices weigh in on what the world of healthcare might look like very soon. Bill then picks out some useful info from HFMA's recent webinar on recovery, a must-read for anyone in a health system at this point. From there a few listener questions are fielded on priorities and departmental alignment, strategies moving forward and the second surge. Once again Bill advises a full reevaluation of ongoing projects and some thought to be given to the idea M&As! For all of this, listen in as we share what's new in the world of health IT! 

Key Points From This Episode:

  • The possible recasting of the US healthcare industrial complex after the pandemic.
  • HFMA's Modeling and Managing the COVID 19 Recovery webinar and the findings they share.
  • Prioritizing projects according to your health system at this moment in the crisis.
  • Alignment within organizations between different departments and leaders.
  • Integrating virtual care completely and restarting primary care in the wake of COVID-19.
  • Considering the likely second surge and taking this on as a project. 
  • The final consideration that should be given attention; mergers and acquisitions moving forward.
  • A complete executive reevaluation of the projects that were on-the-go at the start of the crisis.

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Weekend Health it. It's Tuesday Newsday, where we look at the news which will impact health. It. Today we're gonna look at where we're at on the recovery and will the pandemic recast America's Healthcare Complex. That's the title from an Economist story that, uh, just ran last week, and we start to answer your questions, which I received by email on the air for the first time.

My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the c Ovid 19 series has been sponsored by Sirius Healthcare.

Uh, it is their commitment to making this content available that has made the daily episodes possible. Special thanks to Sirius for supporting the show's efforts during the crisis. A little expectation setting. Uh, we, uh, didn't drop a show on Monday. Not because we didn't have one, but because of a request from a guest.

Uh, we're going to continue to do daily shows through June and see where that takes us. I've reached out to, uh, 20 CIOs over the weekend and we started hearing back this morning. In fact, I recorded one of those shows this afternoon and look forward to airing that with, uh, Chris Ross from Mayo Clinic. Uh, we've been attempting to stay ahead of each phase of the pandemic story, uh, in order to inform health systems as they take the next steps.

Uh, we started with a series on prep, as you remember. Then we moved to solutions and then to field reports, uh, talking with people on the front lines about how they were addressing the pandemic. Uh, recently we started to hold, uh, conversations on emerging from the pandemic. And, uh, the topics are going to include things like, uh, setting priorities, opening safely, uh, second surge planning, and the, the future of work at home telehealth handling, uh, the financial challenge that we're, uh, stepping into.

So we've done about 51 episodes in nine weeks. Our hope is that this work can continue to inform current plans and act as a time capsule, if you will, for our thinking as we walk through these extraordinary events. Uh, with as little fanfare as I can possibly muster , but to keep me outta the dog house with my marketing team, uh, I need to tell you a couple things.

One is we've exceeded 250 episodes and we have over 200,000 downloads of the podcast. Uh, two today since we started the show. Uh, in the podcast world, they tell you that you are to make a really big deal of your milestones. So there it is, me making a really big deal of those milestones. We've come a long way from our first episode and the 28 downloads that it received, three of which were from my family.

Um, and we are, uh, off to the races, uh, f for our sponsors. And, uh, you know, I, I just want to thank them. I, I cherish your support. VMware, Galen Healthcare Starbridge Advisors, uh, serious healthcare and pro talent advisors. I am truly thankful that you provide the support to develop the next generation of health leaders.

If you are wondering . What we are doing with the money. Some people have asked me, uh, we are now three people. So I have a marketing intern, a researcher, and myself. Uh, we've completely revamped the website and even put a search back on there for those, uh, who have requested it, looking for an easier way to navigate the site and find the things you're looking for.

Uh, we're developing, uh, uh, some video training I'm excited about, and that's what I'm doing in the background, uh, on topics like governance, architecture, and digital strategy. Um. You know, why are we doing that? Because, you know, the next generation of health leaders needs something more pragmatic than what we already have out there, to be honest with you.

So, uh, more ways, uh, I'm looking for more ways for you to interact with me and, uh, we're looking to develop a new, uh, community framework for you to interact with each other. I'd love to do more, but we are being responsible with the money that we've been entrusted with. Uh, we grow as our sponsors come alongside of us.

Uh, so if you wanna support the work, drop us a line at sponsor at this week in health Okay. Now phone, uh, let's get to the news. Prognosis mixed. The pandemic will recast America's Healthcare Industrial Complex. This is from, uh, the Economist's story. May 9th. Here's some of the things I had to say.

Doctors and nurses at Northwell Health have treated nearly 40,000 c Ovid, 19 cases more than any other American provider. Uh, but Michael Dowling, who runs New York State's largest hospital firm, is not triumphant. This crisis has humbled us. He says the same goes for much of America's $4 trillion healthcare sector.

Um, skip a little here. Uh. Let's see why, why is he there? Reduced spending on healthcare accounted for nearly half of the half, uh, 1.2% quarter on quarter drop in GDP in the first three months of the year, things could get worse. The American Hospital Association, a trade body estimates that members will lose more than $50 billion a month between March and June.

Tim Van Beason. Of Bain, a consultancy notes that the procedures like hip replacements and heart and brain surgery, which make the most money for hospitals are down by 65 to 80% strata decision technology, which, which makes software for hospitals estimates that hospitals revenues have dropped by 90 billion a month.

Uh, Mr. Dowling says, Northwell with annual revenues of 14 million, made a loss of 350 million to 400 million in the past month. HCA, the biggest listed hospital chain scrapped its annual guidance, citing uncertainty. Uh, it goes on. Let's see, uh, the pain extends beyond clinics. Medtronic a medical device giant, admitted its weekly revenues in America fell.

By 60% year on year, uh, even big pharma, uh, is not immune. Merck, a large drug maker, as you know, said it expected a $2.1 billion hit on sales this year 'cause patients sheltering at home are not consuming Physician administered drugs. It goes on to say, America's health business faces two questions. How quickly can hospitals return to normal-ish and with them spending on ailments other than the coronavirus?

Uh. And with them spending on ailments other than coronavirus. And will the crisis reshape the industry which is bigger and more Byzantine than in other rich countries? Uh, let's see, two more paragraphs. Sorry. Uh, the answer of the first question is not as fast as markets seem to assume. Robert Fields of Mount Sinai Health Partners, which has 4,000 doctors, expect normal services to resume slowly.

With built-in inefficiencies arising, arriving from continued social distancing and other administrators. . Concur. Uh, same Glick of Oliver Wyman. A consultancy says that the new sa, that with new SUP safety protocols, extended hours, virtual appointments, and the like non covid therapies and, uh, income, uh, could nearly be back to pre covid levels within two months of the outbreaks peak in a given region without such measures, he says income might be 35%.

Lower, uh, by that same timeframe. So you have sort of the mix that people are talking about. Some are saying, Hey, can you come back quick if we do the right things? Of course this is a consultancy talking. I mean, you have to take that into account, uh, because a consultancy makes money when you say, well, I want, I wanna make sure we're doing the things right.

Are we doing the things right? And then they come in and tell you whether you're doing things right. Uh, but generally speaking, the things he's talking about are what we're hearing. Safety protocols need to be in place. You can't have people coming to the hospital without covid and leaving with Covid.

That would be problematic. So the safety protocols are important. Extending the hours to capture, uh, some of that lost revenue is important as well. Virtual appointments, uh, continue to maximize virtual appointments, uh, is significant. And, uh, some of the other things that he talks about. Uh, actually some good insight there.

Health insurers look least vulnerable in the near term. Most have big enough buffers to withstand even a severe scenario for Covid 19 in which 130 million Americans are infected and four to 5 million need intensive care, uh, reckon credit raters at Moody's. The collapse in claims for non covid procedures has reduced insurers overall costs.

For Ricky Gold Wasser of Morgan Stanley, an investment banker. Thinks that big ones like Humana and Anthem could see profits rise 4% and 15% respectively in 2020. Another Centene has just hired a thousand new workers. However, it's not all rosy for the insurance carriers. Next year may be, uh, tougher for insurers.

Oliver Wyman estimates that six months after an outbreak starts in a region, they will see a large and substantial rebound in costs as patients seek elective treatments. Meanwhile, Greg Bloch. Of Georgetown University and Daniel Wickler of Harvard find that insurers and self-insured firms could face a bill next year of over 650.

Billion, uh, for covid related expenses. So I wanted to give you guys a picture of, uh, right now, uh, things are not coalescing around, uh, how we are doing. It's mixed, you know, we are starting to recover, but we have this, um, this gap. I mean, we essentially had three months of almost no revenue. The. The, uh, uh, elective procedures went away and the covid patients in a lot of regions did not show up.

And so the revenue, uh, the revenue just evaporated for not only healthcare providers, but also for, uh, other people that rely on the healthcare complex, as they call it, uh, healthcare industrial complex as they call it, uh, to, uh, continue. So, um, we are, we are moving from . You know, the covid crisis into a fin, a time of financial uncertainty is what it looks like.

So, um, at times where we're talking about finance, I look at, uh, there's a couple of organizations within healthcare that are really good and HFMA is one of those, and they have been having a series of webinars. And last week, May 12th, they did one called modeling and managing the c Ovid 19 Recovery. And, um, it was really good.

It was sponsored by, uh, ensemble Health Partners and the SSI group, and it was on Tuesday, May 12th. And the questions they tried to answer were how steep and far reaching was the decline. Uh, what is the current status, uh, and what may recovery look like and what do claims revenues and schedule data tell us, and how can we leverage this information?

Uh, so again, it's based on claims data. And scheduling data. And, um, I, gosh, they have a whole bunch of information on, on the data itself. If you're interested, you can go out to, put in your email and download a, a great presentation. By the way. Uh, what they're seeing is the decline, uh, modeling the decline, 40 to 50% decline in overall net revenue and patient volume, uh, during the, uh, timeframe that they took a look at.

So, um, and that was just in 30 days timeframe is roughly, gotta read that. Uh, March through April 15th. April 15th. , well, it's mapped through the end of April, but the decline was mainly through April 15th, about a 50% decrease in overall revenue, uh, eligibility volume down 58% over that same, same timeframe.

They took a look at if shelter versus non shelter, uh, states, uh, impacted the declines. And I would say, you know, roughly, you know, a delta of about, uh, 10%. Between shelter and non shelter, um, uh, impacting the, the volumes. Um, they go on. I'm gonna skip a couple of these slides. You can, uh, download it and I highly, uh, highly recommend this, uh, presentation is pretty good.

So the decline, health systems revenue about 27% in inpatient, 58% in outpatient, 53, 3% in emergency. And that would, um, coincide with a lot of the other stuff that I'm reading. So they start to talk about the recovery, and there are some factors you have to take into account, uh, uh, account, uh, in terms of the recovery, the internal factors, location, market share, patient mix, case mix, patient access, hos, hospital capacity, those kind of things.

External factors are gonna be, uh, the covid spread and decline rates, shelter in place, regulations, state regulations. Uh, you get the picture. There's some hospitals that still cannot do, uh, some of the procedures based on state. Um. State regulations that are in place, regulations, are they laws, regulations, suggestions?

I'm not sure what they are. Um, but the emergency situation that they have set up in the states, so I. But the good news is we are seeing an uptick, a little bit of recovery. So accelerated growth of, uh, 19% has started to show in moving average claim volume data. So recovery since four 17 is about 19%, 18.6% actually, um, the, uh, Monday claims trend is up as well, week over week eligibility volume is up as well, pretty significantly.

And, uh, we're starting to see it. . Bounce back. Uh, they also talk about the different regions and how they've, uh, been impacted. To be honest with you, there's not much difference. It's interesting to look at the data and again, uh, hfm download the, uh, presentations worth it. Uh, they took a take a look at the West, south, Midwest, and Northeast.

Uh, I wish they'd broken it down by, um, urban and rural. That would've been more interesting, uh, number for me, I think. Um, but anyway. Uh, roughly the same. Uh, decrease across the board, roughly the same uptick and increase across the board as well. It looks like the west is actually, uh, was hit hardest going in and is popping back quicker, uh, than others.

So, uh, I'm gonna skip that, skip that. Uh, they talk about a lot of recovery scenarios. Again, these are scenarios based on what they're seeing, and there's a, and none of the scenarios actually bounce this back to a hundred percent. It bounces it back to about 85%. Uh, I don't, they don't cover it in here, and I did not get to listen to the entire presentation, so I.

I'm not sure why they think we're going back to 85%. Uh, but there's a delta I can presume that, uh, you know, there's gonna be some inefficiencies as we talked about in the previous article built in, um, you know, we're, we are not going social distancing, uh, new scheduling scenarios. We're, we're, there's just gonna be, uh, a host of things that are gonna keep us from getting back to that a hundred percent.

There's a whole bunch of people that still have fear, uh, of uh. You know, again, we told them not to go to the hospital and uh, we gave them good reasons, you know, that, you know, waiting rooms are bad places to catch disease and whatnot. So we educated them and now they're sort of, uh, listening to us and, uh, potentially staying away.

So, um, again, great presentation. They actually go on to talk about, uh, how to use ai. I think one of these companies, I don't know, which. Uh, SSI or Ensemble, uh, probably does the same AI work and they talk about the AI work around, um, some of the, uh, some of the key areas. Schedule optimization, DRG validation, charge capture, payer yield, ar follow-up, payer updates.

Um. You know what's interesting is, you know, one of the questions I've been getting over and over again and I wanted to get into your questions, uh, and I appreciate everyone who's sending me, uh, emails with questions that you have right now. I really appreciate it, bill, at this weekend, health I haven't determined if I'm going to attribute the question yet or not.

I'm probably gonna have to get ahead of this a little bit more and send you an email and ask you if I can attribute the question. But, uh, somebody asked me a question around what types of projects should we be . Prioritizing right now. And, uh, interestingly enough, you know, from where I sit, the uh, uh, the question around that becomes, it, it really depends on your, uh, health system and, uh, where you're at and what, how you experienced.

I. Uh, C Ovid 19. That's what I find to be the most important thing. I don't think we can give a blanket answer as to, Hey, your priority should be telehealth. Your priority should be work from home. Your priority should be, I, I think it's impossible to do that. Everything's gonna depend on, um, your balance sheet.

It's gonna depend on your market. It's gonna depend on, uh, how much revenue you lost. It's gonna depend on, uh, just so many different factors. , and this is why a, a recent post that I put out on LinkedIn, I said, you know, the, the C-E-O-C-F-O and chief uh, strategy Officer and CIO, so the C-E-O-C-F-O. Chief Strategy Officer and CIO strategies should be in perfect alignment right now.

Uh, CIO shouldn't be offsetting stra setting, uh, priorities. Security officers shouldn't be setting priorities. Nobody can work in a vacuum right now. It has to be one system looking at all the factors, and there is a certain amount of crisis management that is still going on. That needs to be taken into consideration.

You just left a covid crisis and you set up command centers and all sorts of other things, uh, and the CEO was heavily involved. The CFO, everyone was talking about these things all at once. Well, that didn't end. We just entered a financial crisis and the C-E-O-C-F-O security officer. Uh, medical officer, CIO, uh, need to be in perfect alignment on what its strategy is.

And again, if you're small, rural, it could be a sort of a survival tactic. We just lost a lot of revenue. We don't know how much, uh, we don't have much to sort of fall back on. Uh, that's a, that's a different set of strategies. You could be a very healthy balance sheet, uh, organization, in which case, uh, you should be considering how you're gonna take advantage of the situation.

Because I guarantee you, there are organizations right now who are gonna take advantage of the situation. They're going to expand, they're going to, uh, take on, uh, new, uh, service lines. They're going to, um, acquire medical groups. They're gonna do all those things. So, um. in this post, I, I just, I sort of went to, uh, uh, taking a look at, you know, what, what should the priorities be?

And, you know, clearly integrating virtual care, uh, completely throughout your system should be something that you're focused in on. But, uh, you know, a handful of priorities for me are restarting primary care. Primary care didn't go fall by the wayside, but it did not do well during the covid crisis. And we need to restart that increasing volume of elective surgeries.

Um, again, from that last, uh. Uh, presentation f Uh, with those two companies, they talked about using AI around scheduling. You have to optimize those rooms, optimize those procedures, optimize the time, um, and, uh, you know, there are a lot of really great technology tools that enable that to happen.

So, uh, keep those volumes up. Keep the, uh, elective surgeries, uh, going through the system. Uh, I, it's a good time for, I think that regardless of your size to look at revenue cycle projects, uh, given the economic hit that's happened. Uh, and it's, I think it's really important to do that. Uh, I think it's also, you know, you can't, you can't shift too quickly.

So I think we have to consider the second surge and second surge readiness should be a project, uh, all rooms and all units. Uh, you know, as we transition them back to doing what we normally do, we've gotta be able to transition them back in case of a second surge almost instantaneously, I mean, within 24 hours at at the least.

So do you have cameras in all those rooms? Do you have the ability, uh, to make them . Uh, you know, MedSurg, you know, trans transform everything into MedSurg. You have all the codes already in your system. So just consider from a facility standpoint how you're gonna maintain that high level in case of a second surge, if that comes back.

Um, and then, uh, you know, finally. And then for the , for the healthy select few, uh, polishing the m and a playbook is also top of mind. Uh, for those with healthy balance sheets, uh, just something to consider as you, uh, . You know, as you're, as you are looking at this and as you are, uh, trying to move through it, um, again, that's, you know, answering one of the questions, what priorities would I be looking at?

I'm, I'm really focused in on, uh, the, the crisis and being able to make sure that you, uh, handle the transition well and make sure that you provide a safe environment that has to be top of, uh, top of mind and be able to transition back to, um, . To the type of facility you need to be in case of a second surge, obviously that needs to be top.

But then I almost immediately dropped to things around efficiency and financial impact. And the reason for that is because, uh, we've got a financial hold to dig out of and, um. I, to be honest, I don't think you go back to the same set of projects that you came into this with and just try to get back to doing the same old, same old that would be, uh, problematic because the, uh, the environment where you made the decision to do all those projects.

Um, and you said, Hey, here are the assumptions we're gonna do these projects. If you were to, if you were to take today's environment, today's assumptions, um, I guarantee you they're not the same as when you made the decision to do all these projects. I would evaluate every project again, I. And say, is this worth doing?

Is this, I, I would reprioritize 'em, is this top of mind and I wouldn't prioritize 'em with your normal governance. I would put this straight up to the, uh, executive team, uh, to the, you know, the executives team at this time is to lead it is to make decisions around, uh, the allocation of resources, allocation of finances, um, the allocation of priorities.

This is what leaders do in a time of crisis. I think this, um. Just goes e, e, e, especially if your governance is not that great, I would go straight to the executive team and put this in front of 'em and say, we need a set of priorities. So that's my first attempt at answering your questions. I'll get better at that.

We will, uh, we will create a process where, uh, we reach back to you and ask if it's okay to use your name. So I'll say. This person asked this question and I want to answer it. So, uh, we're gonna keep doing that on a weekly basis. So if you have a question you want me to try to answer, please send it along, bill, at this week in health

That's all for the news this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, pro talent advisors. And, uh, who am I missing, Sirius Healthcare for choosing to invest in developing the next generation of health leaders. This show is a production of this week in Health It.

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