Executives from Northwell Health discuss the COVID-19 financial fallout and what the future might look like for theirs and other health systems.
Even the most prescient financial outlooks couldn’t have predicted the havoc that the year 2020 has brought to hospitals and health systems.
"I'm going to guess that you probably didn’t have in your capital plan building a field hospital," Sam Glick, partner, health and life sciences at Oliver Wyman said to Northwell Health executives Gerard Brogan, MD, SVP and chief revenue officer, and Rich Miller, EVP and chief business strategy officer, during a webinar yesterday.
In addition to executives from Northwell, New York's largest health system, the webinar also featured a speaker from New York's largest payer, Empire BlueCross BlueShield—Jordan Vidor, regional vice president of provider solutions and network management—and Seth Cohen, co-founder and co-CEO of OODA Health.
To call New York, and especially New York City, a COVID-19 hotspot is an understatement; it's been the epicenter of the pandemic in the United States, and Northwell Health has been engulfed by it.
"When we say we were in the hotspot," said Miller. "We [have] either tested or treated over 40,000 COVID-positive patients across our health system, including over 14,000 inpatients."
He said their peak was around April 12, with more than 3,400 inhouse COVID-positive patients across its hospitals. Things are looking better now but are still very serious.
"The COVID population in our hospitals has declined significantly although we're not yet out of the woods," Miller said. "We're at about one-third of where we were at the peak in terms of COVID-hospitalized patients."
As different areas of the country surge and peak at different times, health system financial leaders will be faced with some of the same struggles that Northwell Health has had. Here are five lessons Brogan and Miller shared.
1. Plan ahead to redeploy revenue cycle staff: With decades of experience in emergency medicine, Brogan was redeployed from his revenue cycle role and asked to help stand up a 1,000-bed field hospital alongside the Army Corp of Engineers, FEMA, the Department of Health and the National Guard.
That's only one example of Northwell's all-hands-on-deck response.
"There are literally thousands of people across our organization who were redeployed including quite a number of people who work in our revenue cycle who have clinical backgrounds; nurses and doctors who were redeployed back into the field to deal with this," Miller said.
In addition, health systems need to prepare for their employees getting sick, including those working in the revenue cycle, which is "a component that we don’t often think of," Miller said.
"We had over 100 frontline revenue cycle staff that did test COVID positive during his period," he said. "So that created tremendous challenges for us in terms of redeploying staff and taking all the steps necessary to keep people safe on the front line."
2. Prepare for long lengths of stay: Not only has Northwell been packed with inhouse COVID-positive patients across its hospitals, those patients' lengths of stay have been significantly longer than those of other patients.
"The cost to care for these patients is very significant," Miller said. "They have about 3-4 times the length of stay that we would see in a typical med-surg patient and we're incurring significant costs related to labor, supply costs, and equipment."
That also meant that the system had to take additional pains to increase bed capacity by over 50% across its hospitals.
"We even did things like take auditoriums and take all the seats out of the auditorium and stand up medical-surgical units within those auditoriums," Miller said.
The huge cost associated with caring for COVID patients is paired with the challenge that hospitals in some parts of New York State are still restricted from performing any elective or routine services as of this writing.
Other parts of the state are resuming such procedures; for instance, on May 13, Nuvance Health hospitals and ambulatory care centers in Carmel, Rhinebeck and Poughkeepsie, NY, said they are reopening for elective surgeries and endoscopy procedures.
3. Routine processes will get harder and take longer: Everything about working with COVID patients from a financial standpoint is challenging, from patient counseling to keeping up with COVID-related coding and regulatory changes. It's also challenging to manage COVID accounts alongside non-COVID accounts.
"It really involved all front, middle, and back parts of the of revenue cycle to get up to speed quickly and make sure those accounts were handled correctly while still doing whatever, quote, 'normal work' was still in existence," Brogan said.
In addition, Northwell made an early decision to "stop point-of-sale collections and then further to hold any bills to patients after we received the insurance portion of the payment," Miller said.
If there was a patient cost-sharing balance, Miller added that "we took the time to go back to all the plans to make sure their adjudication of the claims was correct. Because all of this was happening so rapidly, it was difficult for the various payers to configure their systems to eliminate the cost sharing on the COVID testing or the treatment as may have been applicable."
4. Move in the right direction before it's a scramble: Northwell had just completed its preparations to allow revenue cycle employees to work at home during hazardous weather, and that level of preparedness was more important than they could have realized pre-COVID.
"That was really critical in being able to move quickly a lot of the revenue cycle team to work from home and to still maintain almost normal productivity," Brogan said. "If we hadn’t done that it would have been a lot more scrambling and little more stress in trying to keep the revenue cycle afloat."
The same principle applies whether you're ensuring enough PPE for a surge or making your patient financial relations as frictionless as possible.
"One of the things I took away from this is whatever we can do to preserve the patient experience—clinically, administratively—will add value going forward because it's going to be a new normal for sure," Brogan said.
5. Big changes are needed (and some are here to stay):
While some COVID-related changes are temporary, others will be permanent, including telehealth, which was just ramping up at Northwell pre-pandemic.
"This has just put that program on steroids. We now are doing 4,000 telehealth visits per day across the health system," Brogan said. "I've been in practice post-residency 30 years and I've never seen anything in medicine move as quickly as telemedicine."
Northwell is also making physical changes to its locations, such as adding plexiglass barriers, spacing out chairs in waiting areas, and stocking up on PPE, said Miller.
Other changes could fundamentally remake the revenue cycle. For instance, OODA Health has been working with systems like Northwell and payers like Anthem to enable "a new type of revenue cycle arrangement" in which OODA pays the provider for the patient portion of the balance at the same time the payer sends its payment to the provider, according to Sophie Pinkard, co-founder and head of product at OODA Health.
Doing so removes the patient-as-middleman dynamic that's typical of provider-patient-payer relationships.
Alexandra Wilson Pecci is an editor for HealthLeaders.