COVID-19 Shapes the Future of Virginia Hospitals

May 20, 2020

COVID-19 remains a threat here in Virginia, but officials have told hospitals it’s okay to resume more  normal operations.  That won’t mean going back to the way things were three months ago. In fact, medical care may never be the same.

At VCU's medical center in Richmond, 40% of patients are now being seen via telemedicine.
Credit Virginia Commonwealth University Medical Center

When the new coronavirus hit, hospitals around the state moved quickly to prepare – canceling elective surgeries, tests and procedures – telling most patients to stay home.

Dr. Tracey Hoke is the Chief of Quality and Performance Improvement at the University of Virginia’s medical center.  “We basically redesigned healthcare in a matter of weeks,” she says.

While mainstream medicine had been reluctant to embrace telemedicine, that was the obvious answer to continued care during a pandemic.

At VCU’s medical center, Dr. Ron Clark said regulations pertaining to privacy were relaxed, making the transition easy.

“Concerns about HPPA and personal health information and having a secure line that you could go through -- that was, quite frankly, a big logistical hurdle for many providers.  Once that went away people adapted to the technology readily.”

Patients liked the convenience, and once Medicare and insurance companies started paying on a par with office visits, providers got on board. 

“We’re now doing roughly 1,600 telehealth visits a day, so about 40% of our prior COVID volume is now by telephone, by Zoom, but other technologies.”

Hospitals were also forced to re-think infection control. Social distancing and masks may be the new normal to protect against COVID -19 and about 200 other viruses commonly circulating thru the human population. 

At VCU, a greeter asks people if they’ve been exposed or have symptoms of the disease. Those being admitted will be tested, everyone must wear masks, and CEO Ron Clark says patients will notice a constant effort to disinfect.

“As they come in they will probably see people cleaning the environment, handrails or elevator buttons or door handles – what have you.”

At Carilion Clinic, Dr. Mike Nussbaum says they’ve rearranged the furniture to assure that seats in waiting rooms are at least six feet apart.  If they can, patients are advised to come alone.

“Whoever brings them can either wait in their car or wait close by, and we’ll call them, we’ll include them in any discussions about the procedures that they’re having, but we’re really trying to limit the number of people in our hospitals right now.”

Not only is that good medicine, but it’s good PR – doing things to reassure a nervous public told by national media about the chaos and contagion at New York City hospitals before COVID arrived here. At the Virginia Hospital and Healthcare Association – which represents 110 medical centers --  spokesman Julian Walker says people need to know it’s safe to come in.  Even at large, metropolitan hospitals there are few patients with the new coronavirus, isolated from people with other medical concerns.

"Whether it’s a surgical procedure or whether you’re an expecting family with a new baby to welcome into the world, or whether you have a health emergency, if you need medical treatment that requires a level of acute care that can only be provided in a hospital, you should seek that care, but there are some people who are still reluctant to do that our of concerns about the pandemic,” Walker says.

Reassuring those people will be key to the future of medical centers in Virginia.  The toll that COVID-19 has taken on their financial health in our next report.  I’m Sandy Hausman.

Part Two:

Confronting the COVID crisis meant big changes for Virginia hospitals -- new expenses and cancellation of elective procedures and tests.  Now, those medical centers are trying to recover even as they prepare for the future. 

The University of Virginia Medical Center has built new relationships with government and academia during the COVID crisis -- alliances that could improve future medical care.
Credit UVA Medical Center

Hospitals around the state are in line to get federal stimulus money, but administrators say it will be months before they’re seeing the number of paying patients they had before the pandemic, and Julian Walker – who speaks for the Virginia Hospital and Healthcare Association – says they’re looking at a very big budget shortfall.

“Our members lost revenue in excess of $600 million over a one- month period spanning late March through late April.  They were also investing more in supplies and equipment and adequate staffing to ensure the necessary resources to respond to this pandemic,” he explains.

At the same time, they’re obliged to pay about ten percent of the cost for Virginia to expand Medicaid – a deal they cut with Richmond two years ago.

So hospitals are reaching out through social and traditional media to tell the public it’s safe to come back. Dr. Mike Nussbaum, chief of surgery at Carilion Clinic, says his team is on the phones – booking appointments for those who were turned away when the pandemic hit.

“The leaders of all our different specialty sections are going through those lists along with each of the providers, identifying which patients really need to be addressed first."

And they’re now prepared should the state see a spike in the number of COVID cases.  They’ve built partnerships with public health experts in state and local government, according to UVA’s Dr. Tracey Hoke.

“Lots of relationships have been built across the state as we’ve all tried to pitch in and help each other figure out who’s going to serve what role,” she says. 

And they’re working closely with academic experts on infectious disease, vaccines and biomedical engineering.

“We’ve had a great collaboration with our engineering school that has built everything from testing cubicles for us to three-D printing masks to actually generating the swabs that you need for these test, which are apparently very tricky to do, and we’re in the middle of completion of an FDA trial to have approval to use those swabs,” Hoke explains. 

There’s also been greater collaboration with other hospitals. 

“Right now 75% of the patients in our ICU  are transfers,” she adds.

Hospitals have a new commitment to planning and practice, something VCU’s CEO -- Dr. Ron Clark credits for a smooth transition to pandemic care.

“One or two times a year we would drill for what are called mass casualty incidents where you have to take in a hundred or more patients at a moment’s notice, so we have a command center that we stand up during those drills, and that preparation served us very well.”

The hospital was already in the habit of getting its people together to brainstorm, so when the pandemic arrived, it was natural to collaborate and make things happen far faster than what Clark thought possible.

‘We were able to stand up clinical trials in a matter of days instead of weeks.  We converted a student dorm into a hospital within a matter of days, and then flipping from 4,000 face-to-face visits to having 40% of that volume convert to telehealth just pretty much overnight, " Clark says.

And at the Carilion Clinic, Dr. Michael Nussbaum says planning continues.

“Coronavirus isn’t going to disappear, you know, like the flu. We have an influenza vaccine, but there are years when we have a surge of influenza cases, so even after there’s a vaccine available we would still anticipate this would be one of the 200 or so viruses in circulation that will be out there.”

In the future, he adds, what hospitals have learned from COVID-19 will make them better at fighting many diseases, new and old.  

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.