Restarting Ambulatory Care and Elective Procedures: Analytics Guide Safe, Pragmatic Decisions

Health Catalyst hosted its second in a series of COVID-focused virtual client huddles on May 21, 2020. These discussions aim to help Health Catalyst and its partners identify the data and analytics needs for understanding the pandemic, particularly as the focus shifts from initial response to recovery and rescheduling elective surgery. The second forum covered two topics: how virtual care analytics supports rapid change in ambulatory care delivery and how analytic insights help drive a COVID-19 financial recovery plan.

Restarting Ambulatory Care

The forum used a five-hospital, 1,200 employee-provider health system’s pandemic response as an example. In the wake of COVID-19, the health system shifted 80 percent of its ambulatory visits to virtual care—a significant change, as less than 1 percent of these visits were virtual before the pandemic.

The organization had partnered with Health Catalyst before COVID-19 to build a robust ambulatory management platform, which allowed them to build and scale their virtual care dashboard (Figure 1). Using the Health Catalyst® Data Operating System (DOS™) platform to perform scenario analysis, the health system can evaluate the impact of virtual care and reimbursement rate changes on financial performance.

To support the transition to a virtual ambulatory model, the health system needed the following insights to optimize its virtual program:

  • Provider productivity: Which providers were doing well, and which were struggling.
  • Backlog analysis: With many visits postponed, the organization needed to evaluate the backlog to prioritize which patients to connect with.
  • Safe restart: How can the system restart ambulatory care and elective procedures as safely as possible?

Among audience questions about the organization’s telehealth experience was the breakdown of virtual visits by video versus the phone. Of the organization’s 86 to 88 percent of primary care visits delivered via telehealth, about 50 percent were phone and 50 percent video. Appointments were initially mostly telephone based, but video was increasing.

Restarting Elective Procedures as a Step to Recovery

The organization had put 90 percent of its elective (non-urgent or emergent) procedures on hold for about six weeks, then restarted elective procedures around May 2020. It first had to identify which deferred cases to prioritize. As well, the health system’s financial leadership wanted to understand the financial impact of restarting elective surgery and create a safe restart plan, which they collaborated on with Health Catalyst.

To understand the financial, provider, and overall impact of COVID-19-related declines in elective surgeries, the health system leveraged DOS and the Health Catalyst® Financial Impact Recovery: Elective Surgery application to understand procedure trends and plan how to best meet patients’ needs and effectively recover from COVID-19 revenue loss.

Health Catalyst CEO Dan Burton asked about balancing restarting and recovery with social distancing policy—namely, with COVID-19 impacts in mind, what’s a safe, reasonable volume to aim for? The organization’s representative responded that it’s taking a conservative approach. In April 2020, for example, the health system restart elective procedures by 10 percent, 25 percent in May, and planned 50 percent in June, then likely maxing out at 80 percent by the end of 2020.

Much will depend on factors including the type of procedure, room turnover, and more. Endoscopy, for example, could get back to 100 percent, joint replacements may be back to 85 percent, while heart surgery might only return to 65 percent.

Projections for 2021

With a COVID-19 vaccine a potential for 2021, though not confirmed, healthcare organizations will have more uncertainty to navigate. To that end, Burton asked how the health system’s leadership was thinking about 2021 budgeting. Typically, the representative explained, budgeting would start in late spring/early summer and be done the following October. However, with the fluidity of the pandemic (e.g., a possible COVID-19 resurgence), the organization is looking at a 90- to 120- day budgeting process.

Health systems will need to determine new baselines for ambulatory and specialty care. For example, primary care visits will likely continue virtually. Still, organizations can’t yet project what specialty care referrals will look like, as they’re down while patients fear re-entering facilities due to COVID. For both medical and data needs, organizations will have to bucket procedure types by specialty, then by ambulatory setting, surgery setting, or inpatient setting.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

  1. Health Systems Share COVID-19 Financial Recovery Strategies in First Client Huddle
  2. Virtual Care Analytics Supports Rapid Change in Ambulatory Care Delivery
  3. Analytic Insights Help Drive COVID-19 Financial Recovery Plan
  4. Responding and Recovering in Clinic Operations with Advanced Analytics
  5. Analytics Accelerates COVID-19 Elective Surgery Restart
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