Hospitals and Health Systems in the Coronavirus Crisis


Health systems all across the United States are reeling from a once-in-a-working-lifetime crisis brought about by the COVID-19 epidemic.  Hospitals, care systems and physician practices are hemorrhaging cash in the face of an expected oncoming flood of COVID patients.  Like the prelude to a tsunami, where the tide goes out a half mile, health system revenues have fallen 25-40% month over month, as normal patient care operations have receded. 

Patients have been reluctant to use hospitals over concern about their infection risk, and fresh worries about their ability to pay their share of the cost.   It is likely that the earnings impact will be much worse, since cases being cancelled are relatively high margin elective cases from patients with private insurance coverage that pays more than it costs to take care of them. 

Even with recent increases in Medicare payment rates for care for the COVID cohort, and an increase in federal Medicaid match to support state payments for the indigent and “differently abled”,  hospitals and the health systems will come tens of billions short.

Balancing hospitals’  safety net function of hospitals with their routine care mission is always tricky, particularly in communities with no public hospitals.   The United States commits less than 3% of total health spending on public health, and has chronically underinvested in mental health, infectious disease surveillance and disaster preparedness. 

Continue reading

Coronavirus-like Symptoms


My first possible COVID-19 case came nearly three weeks ago, before there were any cases in our city. He was a healthcare professional who presented with fever, sore throat, and cough. We did the usual strep and influenza testing, both negative, but I thought that he looked different. He had some diarrhea, stomach pain, and a different look to his face that I couldn’t place.

“You might have it,” I said. “You might have coronavirus.”

He looked at me nervously, obviously having thought the same thing. “Is there anything I can do about it? Can you test me?”

No, there were no tests anywhere at that point. Few states had access to any testing, so I knew all we could do was to wait. I sent him home and told him to go to the hospital if he developed shortness of breath, and that we’d get him tested as soon as possible. That seemed to be a short time, as my nurses contacted the national lab we work with and they told us that collection kits for COVID-19 were “on the way” and would get to us in 1-4 days. Perfect.

That was the start of a long odyssey of growing frustration, helplessness, and anger at the testing for this deadly disease. Those kits never showed up. By the time we had local access to testing, the patient had gotten completely better and was asking to go back to work. He works around very vulnerable patients and we told him to let his employer know about my suspicions and to get him tested. We never heard anything.

Of course, since then every cough has been a worry to my patients. Fevers are watched with dread. We have been directing people to contact our local academic hospital to be triaged for COVID-19 testing. A couple of them have been accepted, none has tested positive. Some of them have seemed suspicious to me, but the lack of adequate testing has the triage center restricting tests to the very vulnerable or the obviously sick.

Continue reading

Time to Have an Idea


What are the most important pieces of professional advice you’ve ever received?

I remember one of mine clearly: It was in late 2004, and my colleague Bill told me that it was “time to have an idea.”

I had hired in as the first employee at a small consulting company in early summer. The founders had been handing me pre-specified projects for a few months. These early projects appeared on my desk ready-made, with the Statement Of Work (SOW) already written, the scope negotiated, and the customer interested mostly in when the resource (me) could be scheduled.

Now it was fall, and it was time for me step up my game and spec my own work. I realize now that they were tired of carrying me.

In the spirit of “learn by doing,” they dumped me on the phone with a prospective customer, the IT department for Stanford.

That, in itself, was an incredible opportunity.

Rookies look down on “sales.” I know now about the grinding work that leads to calls like that. The series of interactions with gatekeepers whose only options are to say “no” or else to continue the conversation. The people on the other end of this call could say “yes.”

Continue reading