By Maria Romano, MPH, BS, RN, Global Clinical Executive, TeleTracking Technologies
The ongoing fragile health of our nation’s safety net hospitals, which are required by law to provide healthcare services to anyone regardless of whether they have medical insurance coverage, has been challenged even further in the aftermath of the COVID pandemic. These hospitals, which always faced obstacles even before there was ever a public health crisis, were impacted more acutely than the broader hospital and health ecosystem on several levels by the pandemic, most importantly in their ability to deliver care to the most vulnerable patient populations they serve. That is why efficiency – which can seem like a cold word – needs to have a renewed focus at these critically important healthcare institutions, so their patients never have to worry about receiving delayed care or no care at all, and their operations can be sustained into the future.
The COVID pandemic kept many safety net hospital community patients isolated for a number of years for fear of contracting the virus. As a result, their already chronic health conditions dramatically worsened, and in many cases, led to their death. While financial pressures may have eased a bit during the pandemic for safety net hospitals, those pressures are once again at higher levels as a pent-up flow of sicker patients urgently seeking care have started to flood back into these hospitals. At the same time, the largely government-driven and public insurance payments channels to fund the patient care and operating costs of safety net hospitals has not changed. The care and treatment costs for patients going to safety net hospitals are also typically substantially higher as they may receive care for multiple chronic conditions and diseases as well as for underlying behavioral and psychiatric conditions that can contribute to their declining health.
Sinai Chicago is one safety net hospital that has experienced the lingering financial and patient care aftereffects of the COVID-19 pandemic. Dr. Olusegun Ishmael, formerly their Medical Director, relates that while reimbursements levels were impacted during the pandemic, the near sudden stoppage of all surgical procedures was something that had never happened at the hospital and created the biggest concerns about its financial picture. "Our overall payments didn't necessarily get affected, but our revenues for high-margin procedures that were cancelled had virtually disappeared," said Dr. Ishmael. "While we continued to get compensated through a number of federally-financed processes to get us through the COVID drought, a lot of that money still had to be paid back and payments we usually received from managed care or patient preventative care services like cholesterol checks, mammograms or colonoscopies were even delayed," he added. Today, those surgical disruptions, which interrupted patient flow, have also created a level of uncertainty over how the hospital can effectively load balance its patient flow going forward.
As this precarious dynamic facing safety net hospitals will likely not change any time soon, what can these institutions do to have better control over their patient flow and discharge processes to reduce their costs while also ensuring optimal care for their patient populations and minimize the risk of hospital readmissions?
As the volume of high-vulnerability patients continues to rise in underserved areas, every safety net hospital across the country will at some point hit a capacity roadblock, with some already even unable to handle patient overflow in their communities.
However, what every safety net hospital must come to realize is that they aren’t on their own. There are likely one or more other safety net institutions within their immediate geographical areas facing the same capacity concerns, so what if they can solve their common load balancing challenges together? That’s exactly the vision Dr. Ishmael had for Sinai Chicago – to connect the hospital to all the other safety Net designated hospitals in the Chicago area to mutually work together to identify open beds across their facilities and get their patients in them to be treated as quickly as possible. Creating a safety net hospital network in Chicago will enable every hospital in that network to manage patient flow and patient revenue forecasting more efficiently, and in the end, each of their anticipated respective reimbursement payment streams to remain financially sustainable.
The question is what the most efficient path for is making such a network work successfully and that is where technology comes in - specifically cloud-based operational software technology that many commercial hospitals are using now to create master Command Centers. These Command Centers are allowing them to see what their bed capacity looks like at any given time and transfer patients to other hospitals when it can be determined they will receive more optimized care based on their condition.
"Very often my hospital, for example, may be bursting at the seams with patients but there may be a sister safety net hospital a few blocks away that has two or three extra available beds that we aren’t aware of," said Dr. Ishmael. "This kind of advanced operational software technology can give us that real-time view across all the safety net hospitals in the Chicago area and even beyond and help us accelerate the transfer process between us. Even if one of our hospitals doesn't have a specialty a patient needs like cardiology or pulmonology, the technology can also help us leverage telehealth-based physician consults across such a connected safety net health system, which can be critically urgent for the patients we serve," explains Dr. Ishmael.
Dr. Ishmael's vision of a connected system of Safety net hospitals collaborating with each other instead of competing for patients can be an efficient solution for load balancing and bolstering the financial security for all these facilities, with Command Center technology enabling it to happen. That’s a noble vision for improving vulnerable patient health and outcomes via a Chicago safety net health system, and a national safety net health system.
Dr. Olusegun Ishmael, MD, MBA recently left Sinai Chicago and is the new Chief Operating Officer/President of the Hospital Division at MetroHealth, another safety net hospital health system.
Maria Romano is Global Clinical Executive for TeleTracking Technologies. Maria has been a Registered Nurse for over 30 years. Before TeleTracking Maria worked in leadership at St. Peter’s Healthcare in Albany, NY as the Operations Manager of the Patient Logistics Center which centralized all of the logistics around Transfer Center and Patient Placement. This love for efficiency with patient placement came from her experience in the Emergency Department at St. Peter’s Healthcare where she co-developed, maintained, and monitored operations of an Express Admitting Unit. Her favorite things in life are spending time with her family and serving her community.