How Front-Line Healthcare Leaders are Strategically Managing Resource Challenges During the COVID-19 Crisis
In April 2020, Ingenious Med CEO Nimesh Shah and Founder/Chief Medical Officer Steve Liu, MD, convened a group of healthcare leaders who are members of our advisory board to understand the key challenges they’re facing during the COVID-19 pandemic – and share their innovative approaches to overcoming them.
Part 1 of this blog series covered how they are addressing key financial challenges. Part 2 focuses on how they are managing resources strategically to provide effective care in a rapidly changing environment.
Right-sizing clinical resources across states, specialties and facilities
The pandemic has created a major imbalance in healthcare resources. On one hand, many facilities struggle to staff sufficiently for large numbers of COVID-19 patients. Many areas don’t have enough healthcare providers to treat them. Meanwhile, the near-total loss of elective procedures and fewer visits for other conditions has emptied other facilities and caused staff layoffs and furloughs.
That imbalance has worsened as more staff become sick themselves. Hospitalist companies usually staffed for a normal census quickly found themselves overwhelmed as physicians became quarantined. At one point, a large hospitalist group had over 60 of its physicians in quarantine. In some cases, they worked with their hospital partners to reverse unnecessary quarantines. But experiencing their first physician death from COVID-19 was a grim reminder of the risks for clinicians.
Proactive surge planning
The challenge lies in right-sizing clinical resources across different specialties, facilities and states. That’s especially critical when revenues have dropped dramatically and many patients have lost their commercial health insurance along with their jobs. Organizations with multiple locations have risen to the challenge with redistribution plans that move clinicians from areas with lower COVID-19 volumes to those experiencing a surge. One physician practice rolled out a comprehensive surge plan that enabled it to augment its New Jersey staff when it faced five times its normal census. It supplemented staffing with its own clinicians wherever possible, but eventually had to hire clinicians from other facilities to meet the demand.
Although New York and New Jersey made it easier to bring in outside staff by relaxing licensing requirements, leaders still needed to expedite enrollment and credentialing. They had clinicians sign PRN (as needed) contracts, and then worked with each individual hospital to expedite the process.
Coordinating from the ED to post-acute care
Advisory board members underscored the importance of collaborating with ED/admissions teams and post-acute facilities. As one participant shared, “We’re using a prioritization matrix to triage which patients should be tested or admitted, and coordinating with SNFs and post-acute networks. The entire healthcare system agreed not to transfer patients for insurance reasons to reduce viral spread. In post-acute environments, we’re looking at dedicated COVID-19 sites to keep SNFs virus-free.”
A West Coast health system observed a growing number of discharge planning backups as many SNFs refused to accept COVID-positive patients. To address this, some groups are working with SNFs proactively to develop transfer plans or creating dedicated COVID-19 sites so that other SNFs remain COVID-free. They’re also ramping up efforts to connect patients with home-based care.
Redeploying administrators and different specialists
A southeastern-based hospitalist group helped solve its clinical staff shortage by reassigning qualified administrators to clinical roles and flying in volunteer providers from less-affected states. Some are seeing patients transferred from one overwhelmed hospital to another with lower census, noting that “we’re doing whatever’s needed to take care of our patients.”
“Many underemployed specialists and other physicians have said, ‘I can do procedures, I can do airways; let me help with critical care.’ So we brought them in, matching their skill sets with the facility’s needs.”
– Advisory Board Member
One group is working closely with its carriers to ensure that providers have appropriate malpractice coverage, as well as planning ahead for a potential combined flu season and second wave of COVID-19. It wants to be highly proactive and project staffing needs for a variety of possible future scenarios.
Desperate need for PPE
It’s no secret that healthcare providers are struggling to fill the desperate need for PPE. All advisory board members face these issues and are being forced to go outside of usual supply channels.
A California health system reduced its PPE issues by cohorting all inpatients into COVID units to conserve critical supplies and fostering collaboration among pulmonary critical care teams. A Mid-Atlantic hospitalist company said it was ordering its own PPE directly rather than relying on hospital partners, and using connections with import/exporters to secure N95 masks.
“We’re trying to figure out where we can get PPE, to the point that friends and local schools are 3D printing face shields for us. It’s a hodgepodge.”
– Advisory Board Member
Dr. Liu cautioned that quality among PPE suppliers can vary widely, noting, “You have to be careful about the fit of some mask brands because they don’t have the same tight fit as N95s from 3M. You need to ensure they don’t leak.”
Using Ingenious Med flags and analytics to optimize resources and revenues
To help our customers better predict and track surges to ramp up staffing, Ingenious Med developed COVID-19 reports and flags that can support staffing decisions and predict where surges are about to occur. The new tools are facilitating diagnosis capture for virus-related codes and telemedicine coding on superbills. They also provide reports and dashboards to interpret the incoming data.
One participant noted that Ingenious Med’s COVID flags and reports have enabled their organization to readily obtain a daily view of these volumes across sites, so it can spot trends and help providers anticipate pockets of growing demand.
The West Coast health system has used Ingenious Med to isolate pandemic-related data from its normal run rates. It was already in renegotiations with its health system partners about managing finances in a period where it had to ramp up staff. It’s using Ingenious Med to identify patterns and respond proactively.
“We want to define the worst period in this crisis and know when to declare it over. We’ve isolated those analytics from our regular run rates because we’re already negotiating renewals with clients.”
– Advisory Board Member
A second participant added that their group is using the notes section in the COVID flags on all the therapeutic modalities it’s using, such as noninvasive ventilation and proning (a potential coronavirus treatment), or to track results of different treatments like hydroxychloroquine, remdesivir and IL-6 inhibitors.
Ingenious Med has also developed resources to help users optimally capture telemedicine revenue, including a new telemedicine modifier that enables providers to correctly code these encounters and an optional new superbill specifically for telemedicine.
Sharing lessons learned from the crisis
Ingenious Med data may serve yet another role in this pandemic. The group discussed using information captured through the platform to conduct a HIPAA-compliant study of outcomes as cases progress, or to assist with clinical studies on the efficacy of various medications. Sharing this data weekly would enable users to create a powerful method of tracking the usage and efficacy of different therapies. That would represent an exciting – and unanticipated – way for our solution to serve its customers.