Still not flush with masks, Georgia hospitals ease back into surgeries



The coronavirus pandemic in Georgia is far from over: Infected patients are still flowing into hospitals, and health workers are still reusing masks to conserve supplies.

But slowly, hospitals in the state are trying to focus beyond COVID-19 and to open their doors, once again, to non-emergency patients.

For weeks, procedures that ranged from cancer surgeries to nose jobs were canceled to make way for COVID-19 patients. Now, each hospital is deciding how much it can resume doing, given the pandemic’s enormous drain on resources.

“We’re being very thoughtful, very careful,” said Dr. William Mayfield, chief surgical officer of Wellstar Health System.

“The guiding principle is we want to protect the public, and we want to protect our health-care workers, our staff.”

Wellstar is already drawing up plans to schedule non-urgent procedures, as are others, including Emory and Piedmont Healthcare. Northside Hospital already has begun.

Even Albany’s Phoebe Putney Health System, a national hotspot of the pandemic, and Gainesville’s Northeast Georgia Health System, where the number of COVID-19 cases is starting to surge, are planning to resume more procedures.

Like Mayfield, other hospital officials say they are being selective in what they start doing again and plan to closely track the course of the epidemic as they manage their growing schedules.

But, they and state officials say, it’s time — both for the sake of their bottom lines and for patients.

“Massive revenue shock”

Not all hospitals are overwhelmed with COVID-19 patients. Some have seen patient populations plummet.

And turning away surgeries means turning away money. The facilities cannot sustain forever the financial losses of keeping them at bay, state officials say.

Unlike in some states, Georgia hospitals were never ordered to stop elective surgeries. Federal officials made increasingly strong comments about such procedures before finally asking hospitals across the country to stop.

In Georgia, a few resisted the idea, at first. But, as local officials warned of an impending influx of patients and Gov. Brian Kemp declared a state of emergency, the state’s hospitals moved to postpone procedures.

When the governor announced on April 20 that it was time to begin reopening the state, he started with an invitation for hospitals to lead the way. “I believe Georgia is positioned to secure the necessary personal protective equipment for health-care facilities to resume elective surgeries deemed essential,” he said.

He added that they were losing millions of dollars.

The bond-rating agency Moody’s this week said the pandemic has darkened the financial outlook, from stable to negative, for U.S. nonprofit hospitals. The No. 1 factor, by far, was the suspension of elective procedures, the report’s lead analyst told The Atlanta Journal-Constitution.

“It’s a massive revenue shock,” said Daniel Steingart, a vice president at Moody’s. He said hospitals he sampled were generally seeing about 30% to 40% declines in revenue, which he called “brutal.” In normal times, nonprofit hospitals generally have thin profit margins: Those used in Moody’s studies averaged a 1.8% operating margin.

Yes, there’s more COVID-19 business, he added, but no one’s getting rich on it.

“Surgeries are the highest grossing, highest revenue things that hospitals do,” Steingart said. “Yeah, you got a bump from your COVID patients and extra reimbursement that Medicare provided on your COVID patients. But that doesn’t even come close to making up for the revenue that you’ve lost on surgeries on the other end.”

Not only are hospitals losing money, surgeons are. But it’s not just about the money, those interviewed said. It’s about not being able to help the people they know they can help.

Still conserving masks

There’s no universal definition of what’s elective, or even of what’s essential, the phrase Kemp used.

“Everything we do here is pretty essential,” said Dr. Robert Jansen, chief of staff at Grady Health System.

Grady and other hospitals contacted said surgery that’s purely elective is still out. But possibly coming back are things like joint replacements for people who can hardly get around on foot, and procedures to ease serious pain and discomfort.

At Wellstar, Mayfield, a thoracic surgeon, will likely resume operating on patients with ventral hernias — bulges through the abdominal wall that may form after a patient has had many surgeries, or for other reasons. They’re painful, Mayfield said, and can cause bowel obstructions and other misery that isn’t life threatening.

Lifting the suspension for those patients “will be an impactful thing,” he said. “Patients get much, much better, get back to a normal life.”

And that, Mayfield said, “just makes me smile.”

Hard-hit Northeast Georgia Medical Center is resuming surgeries that are “urgent and time-sensitive,” said Dr. Clifton Hastings, chief of medical staff there. “By performing these surgeries now,” he said, “we hope to avoid potential patient harm and future hospital admissions.”

Wellstar, Northside and other hospitals say they are taking rigorous measures with testing and patient separation to keep COVID-19 patients from infecting others. At Northeast Georgia Health System, surgery patients will need to test negative prior to their procedure. They’ll also need to acknowledge that, while all members of the medical staff have been screened for the coronavirus, they haven’t necessarily all been tested.

It helps that hospitals’ supplies of equipment have improved as they scoured the globe for sellers in recent weeks.

The Gainesville-based health system is taking donated masks and face shields from people who sew and use 3-D printers. It’s doing relatively well for face protection, but has a critical shortage of isolation gowns.

The system will monitor the situation and make decisions day-by-day.

So will Wellstar, said Mayfield: “If a wave comes on, then we know we need to slow things down again.”