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Some hospitals in the U.S. are already canceling or postponing elective medical appointments and procedures as they prepare for the possibility of a surge in COVID-19 patients.
In other instances, hospitals say that patients have requested a delay in care over their own concerns about the novel coronavirus, which was first detected late last year in Wuhan, China. The outbreak has since sickened more than 121,000 people and killed at least 4,300 people. On Wednesday, the World Health Organization declared the outbreak a pandemic.
“We’re starting to create capacity by closing off certain elective surgeries, like rescheduling patients who can be rescheduled,” said Gina Intinarelli, VP of population health at UCSF Health hospital system in San Francisco.
The academic medical center is postponing up to 7,000 appointments a day, while Providence St. Joseph Health, a hospital system based in Renton, Wash., that treated the first COVID-19 patient in the U.S., said it has plans in place to examine what elective surgeries should move forward each day but it has not yet canceled any surgeries.
“We will evaluate on a day-by-day basis if that elective surgery needs to be postponed or if a person will need a skilled nursing placement,” a Providence spokesperson said. “Physical capacity and a healthy workforce are two constraints that will need evaluation continuously.”
The cancellation of procedures in the U.S. so far have been minimal, according to a Jefferies survey of 60 anesthesiologists, interventional cardiologists, and orthopedic surgeons conducted Tuesday, but those delays will likely cut into earnings for the first half of 2020, impacting the hospital companies, medical device manufacturers, and drugmakers that make money off those procedures.
“We believe delayed procedures will eventually be made up at hospitals and ambulatory surgery centers once COVID tapers,” Jefferies analysts wrote in a note. “The net impact on health care providers should be modest for FY20, barring a full-blown pandemic.”
Anthem Inc. ANTM, -1.52% CFO John Gallina told attendees at a health care investor conference on Tuesday that the insurer hasn’t yet seen any significant changes to health care utilization as a result of the outbreak. “But there’s really just not that many cases” in the U.S., he said.
There are now 1,050 cases of COVID-19 in the U.S., according to the Johns Hopkins Whiting School of Engineering’s Centers for Systems Science and Engineering. At least 29 people have died in California, Florida, New Jersey, South Dakota, and Washington state. However, as of Saturday, only about 1,500 people in the U.S. had been tested for COVID-19, and public health experts have said the size of the outbreak in the U.S. is likely much larger than what those figures demonstrate.
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Tenet Healthcare Corp. THC, -7.50%, one of the nation’s largest for-profit hospital chains, said it plans to set up triage units outside of its hospitals if COVID-19 “becomes a big deal” and will consider testing people in their cars, to keep them isolated, according to remarks made by Tenet CEO Ronald Rittenmeyer at an investor conference on March 2.
For the hospitals that operate in regions with clusters of COVID-19 infections, like King and Snohomish counties in Washington state and the counties surrounding San Francisco, some are seeing an uptick in calls and visits from people who either exhibit COVID-19 symptoms or are worried about having them.
A team of workers at UCSF is contacting patients three days before their appointments to reschedule between 4,000 and 7,500 appointments a day, according to UCSF’s Intinarelli. The aim is to limit exposure of the virus to those patients and free up clinical resources for the three respiratory care clinics that the hospital is setting up on its campuses. That includes putting up mobile tents outside of the hospital’s emergency department for people who show up with COVID-19 symptoms, in a bid to limit exposure of the virus to people visiting the emergency room for other reasons.
“The overall goal is to try and prevent patients who don’t really need to be here from coming in,” Intinarelli said, “so that reduces their risk of exposure to patients who are coming in with symptoms.”
William Rutherford, CFO of HCA Healthcare Inc. HCA, -6.91%, another publicly traded hospital operator, said at a health care conference this week that HCA hospitals “are prepared to figure out how to manage the capacity of existing scheduled business whether that be outpatient surgery cases or other kind of elective activity.”
See also: Medical device makers hurt as coronavirus slows or halts elective surgeries in China
Health insurers like Anthem and Humana Inc. HUM, -6.09% told investors they are monitoring health care utilization trends, in part by looking at what happens to elective procedures during hurricanes and polar vortex-level snowfalls. In instances like those, insurers save money when procedures are delayed or forgotten altogether. “There is a lot of evidence out there that discretionary procedures actually reduce during that time frame,” Gallina said. “While some are merely deferred until later on, other of those procedures are actually eliminated and don’t occur.”
In mainland China, which still accounts for the majority of COVID-19 cases and deaths, hospitals halted most, if not all, elective surgeries in the weeks surrounding the peak of the outbreak there, in February. Boston Scientific Corp. BSX, -3.78%, Medtronic PLC MDT, -4.09%, Smith & Nephew SN, -2.11%, and Zimmer Biomet Holdings Inc. ZBH, -6.03% each told investors that delays in elective medical procedures in China have negatively impacted their financial performance for the quarter.
In the U.S., the device manufacturers that make products used in nonelective procedures, like Edwards Lifesciences Corp. EW, -2.75%, which makes heart valves; glucose monitoring provider DexCom Inc. DXCM, -9.59%, and NovoCure Ltd. NVCR, -8.14%, used in cancer treatment, are “best positioned,” Jefferies said.
“We believe delayed procedures will eventually be made up at hospitals and ambulatory surgery centers once COVID tapers,” Jefferies analysts wrote in a note. “The net impact on health care providers should be modest for FY20, barring a full-blown pandemic.”
The Health Care Select Sector SPDR Fund XLV, -3.88% is down 6% year-to-date.
