Why the “Missing Domino” Matters So Much

Right now, those of us working in the hospital industry feel like we are in the middle of a series of biblical plagues: the COVID-19 financial disaster caused by pausing elective surgeries, COVID-19’s impending second wave, and now, consumer anxieties about returning to a hospital or physician’s office. It feels like hospitals have faced locusts, frogs, and water turning to blood.

Yet we are learning more every day about the new healthcare economy, and how consumers are choosing to access care under certain circumstances and delay care under many others. A few months ago, we were early in sounding the alarm about the need for Rapid Recovery for elective surgery volumes and high-margin services. Many hospitals are in the middle of that process now, and patterns are emerging in the data and consumer interactions that we must carefully analyze and then adjust course.

Rapid Recovery is the immediate and urgent imperative, and we know rebuilding surgical volume is the only solution an individual hospital or health system can own and control. That’s why first movers were quick to plan and restart in the post-COVID-19 world, or at least the post-COVID-19 first wave world.


Is This Enough?

Another huge problem revealed by early returns from Rapid Recovery information is the diminished patient volumes and consumer anxiety. Many hospitals have celebrated the return of volumes at 60% or 80% of pre-COVID-19 levels. But the big questions are: Is this enough? And: How long will it last?

Most hospitals need all of the delayed patients to reschedule PLUS the patients who were already scheduled for the summer. Hospitals need 120% or 130% of normal volume for a period of time. Without those volumes, the losses generated during the first wave of the COVID-19 crisis are simply locked in, and 2020 is a guaranteed financial disaster. So, is it enough? Absolutely not.

“During the first week of May, half of hospital administrators surveyed by healthcare consulting firm LEK said they’d resumed procedures at lowered volumes. By the end of last week, more than 70% said they’d reopened for elective care at reduced volumes.

‘We’re seeing inpatient orthopedics, cardiovascular and oncology — the three big surgeries that have the greatest level of acuity associated with them — they are working through their backlog,’ said Christopher Kerns, vice president at health care consulting firm Advisory Board, but he adds the outlook for new surgeries looks more uncertain.

‘What health system leaders are telling us is that they’re feeling good about right now [but] they’re concerned about 60 days from now,’ Kerns said.” (CNBC, May 22, 2020)

That’s the “missing domino” — the problem we will face in roughly 60 to 90 days unless we take immediate action.


How Long Will It Last?

How long will it last? We must move through the backlog from March, April, and May while also keeping all the previously scheduled patients on the schedule as planned. Yet we know some percentage of the backlog is not returning — some estimates are as high as 40-50%. We should assume some portion of the patients scheduled for the summer will be similarly unavailable or reticent about returning to a hospital. This means volumes may be impacted through the fall without serious marketing and physician intervention.

Yet this problem could last much longer unless we find a way to replace “the missing domino.” What’s missing are all the patients who would normally have been moving through the system – physician appointments, diagnostic tests, imaging, and all the steps necessary before surgery or treatment plan. Other than in emergent situations, all those preventative and diagnostic dominos need to fall before there can be surgical volumes. Remove or delay any one of them, and you remove or delay the surgical procedures. ED volume has the same dynamic with 50% lower volume translating to lower admissions from the ED, diagnostics, and surgical volume.

Hospitals have been starved of these “top of the funnel” encounters since early March, and many have deprioritized them during Rapid Recovery to focus on today’s surgical volume. But the implications could be significant and long-lasting. If we don’t find a way to replace this “missing domino,” surgical volumes could drop off even more significantly after the summer Rapid Recovery period. Once pent up demand and currently scheduled summer procedures are completed, what patients will be queued up next?

We were worried about Rapid Recovery, but this is perhaps a more existential and long-term problem. And we aren’t the only industry watchers and experts worried about this situation.

“Scheduling for new elective procedures usually happens about a month or two ahead of time. Executives are worried that the pipeline for new surgical referrals may not bounce back as quickly as rescheduled procedures, in part because some patients may continue to put off care due to fear… Another concern is that specialist practices, which refer patients for diagnostic screening and surgery, are themselves reopening with lower patient volumes. An analysis by the Commonwealth Foundation found that patient visits at surgical and orthopedic practices have recovered this month, but are down more than 30% from normal volumes. Like hospitals, physician practices and diagnostic screening facilities now have to take extra safety precautions which could mean that they won’t be able to see the same volume of patients for surgical consultations as they did before the pandemic.” (CNBC, May 22, 2020)


Replace the “Missing Domino” ASAP

When we connect all these dots, it seems clear that “the missing domino” could have long-term consequences if we don’t correct the problem. That will require aggressive communication by (and to) physicians, aggressive marketing to consumers, personalized marketing to Rapid Recovery patients, and significant operational changes to accommodate restrictions on throughput. This will require our focus and attention to solve and restore our hospitals to long-term financial stability and sustainability.

With all these competing priorities, what should we focus on right now?

  1. Drive aggressive Rapid Recovery marketing, paired seamlessly with the operational changes necessary to make it happen.
  2. Start marketing and physician relations to restore “the missing domino” – getting patients back in physicians’ offices and diagnostic services.
  3. Begin communications planning for the fall/winter return of COVID-19 and the seasonal flu.



May 27, 2020
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