Your checklist for resuming elective procedures

Covid-19 strategic planning survey

Now, we've created several pre-populated versions of tool, using benchmark data for four hospital types:

1. Average Hospital: National median for all hospitals
   
   
2. Rural Community Hospital: Median for 1-100 bed hospitals in rural areas
   
   
3. Large Metropolitan Hospital: Median for 500+ bed hospitals in large urban areas
   
   
4. Academic Medical Center: Median for 200+ bed major teaching hospitals.

These calculators are best used as a starting point for organizations to adjust before viewing results. This is because of the multitude of variables at play for any specific hospital type. After all, the impact of pausing electives is going to vary based on case mix, average length of stay, payer mix, the timing and length of Covid-19 peaks, added Covid-19 patient occupancy, and more.

But getting some of these inputs can be time-intensive during an evolving, urgent crisis, so how should you use these pre-populated calculators? Follow five steps to plan for upcoming Covid surges and build your continued restart strategy:

1. Identify your closest hospital cohort

While a full outline of the inputs for each calculator are included in the Sample Scenario Overview, you can identify your best baseline estimator based on four factors, ordered in terms of importance:

2. Review the most important pre-filled inputs

Some tool inputs more closely impact results, so start by checking how closely the pre-filled estimator matches your health system. We recommend reviewing three key inputs:

• ICU/CCU, non-ICU/CCU, and overall bed occupancy values (Pre-Crisis Assumptions tab)
  
  
• Operating room (OR) and procedure room (PR) utilization (Pre-Crisis Assumptions tab)
  • If either bed occupancy or OR/PR utilization rates differ significantly from the baseline values pre-calculated in the tool, we recommend increasing or decreasing the starting bed, OR, and PR counts to arrive at an occupancy that aligns with your facility.
• Added Covid-19 patient ICU/CCU and non-ICU/CCU occupancy per crisis phase (Crisis Assumptions tab)
  • Determine whether added Covid-19 patient occupancy rates correspond with what your facility experienced and update accordingly.

3. Adjust baseline pre-crisis and crisis inputs

Third, consider the maximum bed occupancy and OR and PR utilization rates you do not want your facility to exceed on the Pre-Crisis Assumptions tab. Adjust as needed based on your internal policy and any state regulations. If readily available, also update your facility's overall payer mix.

As for baseline crisis inputs, adjust the dates you started canceling elective surgeries and restarted elective surgeries on the Crisis Assumptions tab.

4. Scenario plan for different Covid crisis timeframes and cancelation scenarios¹

All pre-populated calculators assume a second Covid-19 peak in mid-October. But one of the calculators' most powerful aspects is the ability to model Covid peaks and dips on a weekly level for your facility. Use the week-by-week table on the Crisis Assumptions tab to model one or more scenarios for how Covid-19 may proceed through semi-urgent, urgent, peak, and recovery phases.

A second powerful feature is the ability to account for and strategically plan cancelations on the service-line level. On the service-specific Elective Cancelation Planning tab, check the percent of electives your hospital must cancel due to capacity. Then, based on choice and state mandates, adjust your percent of cancelations by Covid-19 crisis phase and service line to model cancelation scenarios.

5. Test restart capacity allocation strategies¹

Finally, to best estimate potential losses, you can adjust the dark grey "Percent of Available Capacity Allocated to Restarting Service" column on the Restart Planning tab in two ways:

• If you have the staffing and ability to fully prioritize target, lucrative service lines, delete the preliminary 0.4% capacity allocation percentages across all services, and proceed by allocating as much capacity as is needed to clear 100% of backlogged and new demand cases for each of your top priority services.
  
  
• If your goal is to clear volumes for as many services as possible, begin by reviewing which services shaded in green have over 100% for the "Percent of Total Volumes (Backlog + New Demand) You Can Clear Based on Capacity" column. For these services, decrease the dark grey capacity allocated percentage until the percent of total volumes cleared approaches 100%. Checking the top, red value for "Total Capacity Allocated," determine your remaining capacity and reallocate it across top priority services shaded in red, where you are not currently clearing all volumes, until you allocate 100% of capacity.

Between capacity constraints and state mandates, elective surgery cancelations have already driven substantial declines in hospital revenue. While the impact on a given hospital will vary by several factors, some inputs can be hard to acquire. By using the pre-populated calculator that best fits your hospital, you can free up time to focus on what's most important: meeting patient needs and minimizing financial losses by modeling future Covid surges and effective cancelation and restart strategies.

^{1. While steps 4 and 5 are written in terms of service line specific cancelation and restart planning, you can take a similar approach for the general cancelation and restart planning sections. Simply ignore service line specific directions and use additional time to focus on other input changes.}

Your Covid-19 service line impact guide

As elective procedures restart, you’ll need to weigh the impacts of Covid-19 on individual service lines. Different services will likely take different paths to volume recovery, face distinct challenges in clearing volume backlogs, and see some unique impacts to longer term demand.

See our take on the major implications for elective procedures within cardiovascular, orthopedics and spine, general surgery and urology, gastroenterology, imaging, oncology, and OB/GYN.

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