Indiana-ACC Virtual Forum: Re-Starting CV Practice Post-Covid-19
COVID-19: “Road to Recovery” Resuming Planned Care IN-ACC COVID-19 Webinar Series April 27, 2020
IN-ACC
COVID-19: “Road to Recovery” - Resuming Planned Care • Welcome
• Don Westerhausen
• Background • Ed Fry
• Panel Discussion • • • • • • •
Mike GeRue Dick Kovacs Chandra Kumbar Joel Sauer Doug Segar Saeed Shaikh Ram Yeleti
• Q&A
Ready to Re-Start
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COVID-19 Pandemic Recovery: Background • Not “Post-COVID” • ”We live in a COVID world now” – Cardiologist, Wuhan, China
• Non-COVID in-patient care reduced 50-90% during the Surge • Hospital revenues down (IU 49% - IBJ) • Lay-offs, furloughs, pay cuts (Mayo -10% physician salary reduction)
• Harder to restart than to shut down • “Breaking up is hard to do” – Neil Sedaka. Restating much harder
• Non-COVID Acute and chronic illnesses continue (progress, worsen) • STEMI and CVA presentations down – MI deaths at home up • ”Unexplained” deaths increased – NYC, Detroit, NOLA
• Healthcare Disparities – Death = 3x for Black vs White
COVID-19 in IN: Timeline
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March 2020
Jan. 2020
Cases Deaths
1 0
30 1
May 2020
14,395 785
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COVID-19 Pandemic: Phases Cases/Hospitalizations/Deaths
Preparation
Acute Care
Recovery
Transformation
Surge
Non-COVID Care:
Cancel March
Defer April
Resume
May/June
ongoing
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“Resume” Planned Care
Surge Time
Risks from Non-COVID Illness
Risk of COVID complications
COVID-19 Pandemic Recovery: Timing
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COVID-19 Pandemic: When to “Re-start” Planned Care • Gov. Holcomb: “Resume ‘Elective’ procedures effective 4/21/20” • Local disease prevalence and trajectory • Declining number of COVID in-patients, ICU use, retain surge capability • Balance risk of COVID infection/complications vs Risks of delayed care • Public Health and Economic decision • Don’t want to be first and be wrong, Don’t want to be right and be last
• Ascension: National Framework, Local Specifics • “As standardized as possible, as different as needed” • Timing and ramp-up dictated by local factors
COVID-19 Pandemic: Patients will determine the recovery Patients deferring care:
What are patients looking for:
• Fear of infection • Messaging from healthcare systems – “stay away” • Financial concerns:
• “A trusted hand to lead them through uncertain times” • Access to care when needed • Only the care they need • A safe care environment • Transparency • Trusted information
• ~20% unemployed • Loss of insurance, • Co-pays/Deductibles
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Questions • • • • • • • • • •
What will “recovery” or “re-start” look like? What are the metrics you will measure to describe success? What is the role of patient/staff testing as your ramp back up? How will you prioritize patients to resume “planned care”? What changes do you foresee in your office and hospital practices? What is the new normal going to look like in terms of volumes and the way we practice? What will be the main concerns from a staff and physician standpoint? What concerns exist due to mismatch of state gov. actions vs. healthcare response? What do you perceive the patients’/public’s pent-up need/hesitancy to be? Financial issues: What are realistic expectations?