Health care leaders share their Covid-19 outlook

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COVID-19 has shown the region’s health care organizations to be resourceful and clinically resilient but financially fragile, says Mark Taubman, University of Rochester Medical Center CEO.

Taubman was one of three upstate health system leaders who spoke Thursday to virtual attendees of “Rebuild Upstate—The Outlook for Healthcare,” Upstate Venture Connect and Rochester Beacon’s online forum on what the future holds for regional health care organizations threading their way through a pandemic whose end date cannot be predicted. Rochester Beacon publisher Alex Zapesochny served as moderator for the event, which drew nearly 200 attendees. 

The other panelists were William Streck M.D., president and CEO of the Bassett Healthcare System in Cooperstown, and Kim Townsend, president and CEO of Loretto, a Syracuse-based multilevel, multifacility senior care organization serving some 10,000 Central New York residents.

Upstate health care organizations adapted quickly and efficiently to a crisis that came upon them suddenly, nearly overwhelming available resources, Streck says. 

The other panelists concurred. All cited their facilities’ quick adoption and rapid ramping up of technological aids like telemedicine as well as quick deployment of measures like social distancing, use of special equipment like ventilators and fast calculation of how to best allocate hospital beds.

URMC clinicians, for example, learned quickly how to best triage COVID-19 patients, ascertaining which patients needed to be put on ventilators and which didn’t as well as who needed be immediately hospitalized and who could be sent home, and so were able to efficiently allocate the medical center’s suddenly strained resources, Taubman said.

At the early height of the coronavirus pandemic, URMC’s telemedicine visits surged to 6,000 virtually overnight, he said. Their numbers have since declined, plateauing at some 2,000 patients per day. 

But Taubman does not see the system’s share of telemedicine consults falling to previous levels anytime soon. Social-distancing requirements will indefinitely cap the number of in-person interactions clinicians will be able to manage for some time to come, he predicted.

Greater reliance on such technology will permanently alter the way health care is delivered regionally and across the United States, in many ways improving it, the health care leaders said. 

With greater deployment of telemedicine, URMC doctors are seeing fewer no-shows, Taubman said. Patients from outlying districts find keeping a telehealth appointment easier than a 20- or 30-mile drive capped by a search for a parking space.

A pervasive deployment of telemedicine will have a positive effect on facilities’ bottom lines because as telehealth ramps up, fewer physical locations will be required, Streck predicted.

Still, area health care organizations’ financial future looks far from rosy, the CEOs agreed.

Loretto’s Townsend called the pandemic’s financial fallout “an extinction event” for the state’s long-term care facilities.

COVID-19 brought a lot of unanticipated expenses as nursing homes and senior living facilities suddenly had to search for and acquire personal protective gear and expensive equipment like ventilators at a time when short supply drove prices sky high.

Dependence on Medicaid meant that senior care facilities’ finances were already stretched to the limit, she added. Medicaid pays the bills for 63 percent of nursing home residents and New York’s Medicaid payments fall $70 short of each patient’s daily costs, Townsend explained.  

A government-financed insurance program for the poor, Medicaid is jointly financed by the federal government and states. Staying within guidelines set by the federal Center for Medicare and Medicaid Services, each state creates and runs its own Medicaid program. Before cutting nursing home reimbursements 1.5 percent this year, New York had not raised rates for 12 years. 

Pandemic-induced strains on the state’s budget could presage further cuts, Townsend fears. Federal financing will be needed, she said.

Federal aid so far has been some help but falls far short of what’s needed, Streck and Taubman said. 

A two-month ban on elective surgeries imposed by the state to ensure adequate space to accommodate COVID-19 patients resulted in reams of red ink for all New York hospitals. Electives are now allowed, but few hospitals if any are making up the losses, Streck said.

Putting URMC’s shortfall as of June 30 at roughly $250 million, Taubman does not disagree. Serving as a stress test for the nation’s health care financing mechanisms, the pandemic has showed the U.S. medical reimbursement system to be “fragile” and in need of an immediate redesign, Taubman said. Government and private insurers all need to take a fresh look at how they pay, he believes.  

In creating a new system, Taubman said, “people need to look at what care costs.” 

Will Astor is Rochester Beacon senior writer. All coronavirus articles are collected here.

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