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Colleagues,
From the very early days of the U.S. COVID-19 response, ACHE leaders have been on the front lines. New York has frequently been called the U.S. epicenter of the COVID-19 pandemic. Some of the first people with COVID-19 in the state were treated at NewYork-Presbyterian hospitals, and the system has weathered a massive surge in patients since.
Two of the system’s top leaders—Steven J. Corwin, MD, president and CEO, NewYork-Presbyterian; and ACHE Chairman Michael J. Fosina, FACHE, president, NewYork-Presbyterian Lawrence Hospital, Bronxville, N.Y., and senior vice president, NewYork-Presbyterian, New York—recently shared some insights about how their organization has been navigating the coronavirus crisis, as well as plans and strategies to reopen, on a free webinar.
Corwin talked extensively about the considerations healthcare leaders must take to reopen and restart elective procedures and surgeries safely. According to him, that means understanding that workflows must change to accommodate social distancing and solutions such as telemedicine.
“We want the ‘new normal’ to be a better normal, and that means you can’t wish for what we had before, pre-COVID,” said Corwin.
Watch the full webinar here for more insights from Corwin and Fosina. If you are interested in learning more about strategies for restarting and expanding elective surgeries after COVID-10, you can also watch our Special ASA/ACHE Joint Webinar.
Editor’s Note: Are you interested in being featured as our Member Profile subject in an upcoming issue of the Physician Executive Newsletter? If so, email Shannon Barnet, content marketing strategist, at sbarnet@ache.org.
Global Pandemic Impact on Behavioral Health Delivery
By Leslie S. Zun, MD, FAAEM; Howard J. Gershon, LFACHE; and Stephen M. Merz, FACHE
Ensuring access to and allocating adequate resources for behavioral healthcare was a challenge before the COVID-19 pandemic, and it’s only become more challenging since. According to a recent report from the Kaiser Family Foundation, prior to the COVID-19 pandemic, nearly one in five of U.S. adults (47 million) reported having a mental illness in the past year. The report goes on to say, “During this unprecedented time of uncertainty and fear, it is likely that mental health issues and substance use disorders among people with these conditions will be exacerbated. In addition, epidemics have been shown to induce general stress across a population and may lead to new mental health and substance use issues.”
The pandemic has changed the mental healthcare landscape in the short term and will likely continue to change this area of care for years to come.
From emergency departments to inpatient units and residential and community programs across the country, the pandemic is exposing huge gaps in behavioral health. Here are a few key areas that have seen the biggest change in how behavioral healthcare is delivered:
Emergency Department
Pre-COVID, approximately 15 percent of all ED visits were for people in crisis or seeking mental healthcare. Now, fear of COVID-19 exposure has reduced many ED volumes. In fact, some organizations have seen ED visits decreased by nearly 50 percent. Most EDs have taken the steps to help ensure patient safety and some have even mounted a public education campaign to encourage patients to get care in a safe environment. It’s important for hospitals to communicate to the community that anyone facing a mental or behavioral health emergency should seek immediate care, and they are safe to do so through the ED.
Crisis Care
Although crisis care continues as before with telephonic communications, the ability to offer walk-in services at crisis care facilities has been severely curtailed. Fortunately, audio and video platforms have allowed many crisis centers to provide in-person-like services. These services have expanded access to care in many markets.
Inpatient Care
Inpatient psychiatric units have struggled considerably during COVID-19. Many have had to scramble to create single-occupancy rooms and help patients deal with isolation resulting from restricting outside visitors. Additionally, intermediate services are lacking in many local communities and, in some cases, patients stay longer in inpatient psychiatric facilities simply because there is nowhere to go upon discharge. Inpatient psychiatric unit volume is generally down across the board but not to the extent seen in EDs. That said, inpatient units have been given some direction now on how to modify care to account for patients with COVID-19. Many states are issuing guidelines for the management of suspected and confirmed COVID+ psychiatric patients. Accrediting bodies, including The Joint Commission and DNV GL Healthcare, have also created resources to help navigate new challenges.
Residential Programs
Residential and other congregate care programs are essential to a well-functioning behavioral healthcare system. They provide structure, stable housing, socialization and access to other services. These programs have all but closed during COVID-19 due to fears of community-acquired infection risks. Restoring capacity for these organizations moving forward is essential.
Geriatric Care
Elderly and senior care psychiatric populations are among the most at-risk for COVID-19. These individuals frequently lack access to transportation and other resources. That said, these populations are more vulnerable to isolation, anxiety and depression than the general population. Those 65 or older are among the most vulnerable for COVID exposure, so their needs are even greater.
The good news is, many healthcare organizations are developing alternative models of care where telehealth is not possible, including drive-in clinics. Seniors can remain in their vehicle and receive individual treatment services. Tablets and smartphones can also serve as portals for seniors in long-term care facilities, and modified group therapy programs with three to five patients can provide care while promoting social distancing.
Telehealth
Regardless of the treatment setting, to safely retain access to services, telehealth has evolved as a primary service delivery technology. In fact, an April 2020 survey conducted by the Coalition for Behavioral Health in New York reported that, on average, 82 percent of the programs offered by its member organizations were being delivered by telehealth. From telepsychiatry in EDs and inpatient units, to Zoom meetings for families and group therapy to a variety of apps for outpatient services, telehealth has become a key tool for providers.
Final Thoughts
It is difficult to say what our “new normal” will be. Many programs will most likely return to their pre-COVID, in-person configurations and overall behavioral healthcare utilization is likely to increase in the coming years. In fact, many are predicting a COVID-related behavioral healthcare surge. Many of the evolving models of care and tools that have been used to enhance access to care may continue well beyond this pandemic. These will likely include telehealth, home care and residential care options and services for at-risk populations, particularly youth and the elderly. To stay ahead of the curve, healthcare organizations should evaluate how they can improve and expand coordination for such services.
Leslie S. Zun, MD, FAAEM (leszun@lakecountyil.gov); Howard J. Gershon, LFACHE, (howard@reach-newheights.com); and Stephen M. Merz, FACHE, (stevemerz01@gmail.com); co-present, “Behavioral Health Challenges, Strategies and Solutions: The Business Case for Meeting Community Needs.”
ACHE understands the COVID-19 pandemic has impacted healthcare professionals across the globe. To help healthcare leaders continue to grow and learn, we are offering a 25 percent discount on the registration fees for all paid live webinars, webinar recordings and online seminars now through Dec. 31, 2020. Learn more here.
Save an Additional 20% on HAP Books and Self-Study Courses
Looking to add to your healthcare management library? Right now is the perfect time to shop—save big with our annual HAP Summer Sale. Now through Sept. 30, get an additional 20 percent off the already discounted member price on books or self-study courses purchased directly from us. Use the promo code SUMMER20 at checkout to take advantage of these savings.
Learn more about our management books and textbooks. Browse new releases and books by topic, such as strategic planning, career development, patient safety, and leadership development. The discount excludes any already discounted bundles, Futurescan 15-packs, and the Board of Governors Exam Study Set and Flashcards.
Order and save today by visiting ache.org/HAP or calling (800) 888-4741.
Upcoming Webinar on Conducting COVID-19 Trials
The COVID-19 pandemic catapulted clinical research into the forefront of healthcare because the trials are becoming sought-after patient care options.
Register today the free webinar, “What Healthcare Executives Need to Know About Conducting COVID-19 Trials and the Changing Landscape of Conducting Clinical Research,” July 24, 1–2 p.m. Central time. During the webinar, Tampa General Hospital’s CMO and a clinical research administration expert from Huron Consulting Group will share experiences of rapidly adapting the clinical research operation in light of the pandemic while expediting the launch of COVID-19 trials.
This webinar is free and eligible for 1 ACHE Qualified Education credit.
Advance Your Career With ACHE Resources
ACHE is committed to supporting our clinicians and physicians transitioning to healthcare executive roles. We invite you to explore our resources for physician executives, available to support the unique career development needs of members with clinician and physician backgrounds. Resources include articles, books, assessments and more.
Joint Accreditation for ACHE Education Programming
ACHE has your education needs covered. In addition to offering continuing medical education (CME) for physicians, ACHE also offers contact hours for continuing nursing education, continuing pharmacy education credit and physician assistant continuing education. All in-person events, online seminars and live webinars are approved for Joint Accreditation.
Please visit the continuing education information page on ache.orgto learn more.
Connect With Forum Members
Looking to connect with your Forum colleagues? You can locate them at the ACHE Member Directory. Scroll down to the "CEO Circle/Forums" drop-down menu in the directory, select "Physician Executives Forum" and look for the "PE" icon beside their names.
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Please note any views or opinions presented in this online newsletter are solely those of the author and do not necessarily represent those of ACHE.