An industry group representing the state’s hospitals is urging Gov. Jay Inslee to allow more elective health care procedures to resume, saying their facilities have plenty of capacity amid a decline in COVID-19 patients.
The Washington State Hospital Association (WSHA) sent a letter to Inslee on April 10 asking him to ease the restrictions that were intended to ensure the state’s hospitals were not overwhelmed by what public health officials worried could be a flood of COVID-19 patients. The letter also was signed by by the heads of the Washington State Medical Association and Association of Washington Healthcare Plans.
Cassie Sauer, the chief executive officer of the WSHA, said the organizations renewed its request in a Tuesday phone call with Inslee. She told The Seattle Times that many patients are suffering “while waiting to get the care they need. “
According to association surveys, the statewide average for hospital capacity is at 70%. Sauer said she is concerned about the toll on patients from delayed cancer screenings and a wide range of other procedures, as well as the financial hit on hospitals from reduced revenues.
“We are way behind other states that already have made this move in recognition that there are many more health needs than COVID,” Sauer said. “We absolutely want to restart the most pressing non-urgent procedures.”
The hospital lobbying effort comes as Inslee faces increasing pressure to loosen restrictions put in place to slow the spread of the novel coronavirus, which causes COVID-19. It’s an effort that has gained the governor some national recognition but also criticism from some in Washington who want more specifics on the timing of rollbacks.
States that have relaxed hospital elective procedure restrictions include Oregon, where Gov. Kate Brown last week lifted an order delaying nonurgent medical procedures.
Inslee on Monday said his administration was working on a “hospital-specific” plan that would allow some elective surgeries to move forward if hospitals could demonstrate they had enough personal protective equipment, adding that it would be good “from the revenue standpoint for hospitals and also for people who like to get their joints fixed.”
Sauer said that she is hopeful, after the Tuesday conversation with the governor, that there will be some action in loosening hospital restrictions in the next few days.
“We have been collaborating with WSHA and labor unions on interpretive guidelines to help hospitals understand the intent and scope of the governor’s original order,” Tara Lee, a spokeswoman for the governor said Tuesday. “We expect to have this done very soon, perhaps within a day.”
Inslee’s March 19 proclamation banning medical procedures that would not be anticipated to cause harm to the patient if delayed for three months has caused major reductions in surgical procedures, screenings and examinations. The move was impelled by the need to to conserve scarce protective gear for health care workers, and to enable hospitals to dedicate more space, staff and ventilators to the expected increase in hospitalizations due to COVID-19.
Elective procedures, along with primary care visits, are key sources of revenue for hospitals.
“That’s how the money flows into the system — through these elective surgeries, right, or through the bread-and-butter visits, and that’s gone,” said Jill Horwitz, a health policy expert and professor at the UCLA School of Law.
As hospitals incur the cost of treating COVID-19, there are financial pressures to reopen core services.
“They’re essentially businesses,” Horwitz said. “How long can those businesses survive without patients?”
Shortages of protective equipment remain a concern for the Washington State Nurses Association (WSNA).
“We’re still hearing stories from our members. They’re having to use masks for extended periods of time, some having to put masks in paper bags to reuse them,” said Sally Watkins, the executive director of the WSNA.
Watkins said nurses have been reusing disposable gear in these extraordinary times, but that the union remained worried about the practice and did not want to allow it to become normalized. Watkins added that testing capacity also needed to increase, so health care workers could be assured that patients receiving procedures were not positive for coronavirus.
Hospital administrators also remain concerned about the availability of protective gear but say declining hospitalizations have eased worries about capacity.
In the April 10 letter to Inslee, Sauer of the hospital association and Chris Bandoli of the health care plan association suggested that procedures should be approved when hospitals can show they have sufficient protective gear and other supplies to meet needs over a 30-day period.
“So long as we have adequate supplies, staff and space, allowing these procedures back will be safety for patients and staff,” the letter said.
Watkins said some hospitals were better prepared than others and the nurses’ union supported a “phasing-in” strategy for elective procedures.
Sauer and Bandoli’s letter said that the cancellation of procedures had tremendous patient impacts, both physical and psychological.
A wide range of care was put on hold with potentially serious consequences for patients. That care included mammogram and colonoscopy cancer screenings, cardiac surgeries, herniated-disc surgery and a prostate procedure to remove a catheter that posed a serious infection to an elderly patients, The Seattle Times found last month.
“The untold story is that we put the rest of the health care system on the back burner,” said Dr. Peter Benda, a Kirkland-based pathologist who said in an interview last month that the volume of his work interpreting biopsies dropped dramatically, which he attributed largely to the reduction in elective procedures
Benda recently did a tally that tracked the downturn in cancer diagnoses at the laboratory, which takes test specimens from around the state. He said the laboratory diagnosed 177 breast cancers in April, down from 285 in January. The laboratory found 21 colorectal cancers in April, compared to 38 in January and 84 prostate cancers in April compared to 189 in January.
“These are cancers that hopefully will get picked up once we reopen the system and people are unafraid to get care,” Benda said. “But the concern is, how long is that going to take.”
Sauer thinks that Inslee’s current proclamation needs to be better defined so that a wide range of procedures can move ahead without doctors fearing criminal penalties for violating the order. She said that that after the April 10 letter was sent to Inslee, she also made the request of Dr. Kathy Lofy, the state health officer, and retired Navy Vice Adm. Raquel Bono, state director for the COVID-19 Health System.
Watkins said she did not feel the proclamation restricted providers from giving care, but said now was a good time to make sure it was clear.
Sauer said it is important to move ahead soon with elective procedures. That way, if another wave of coronavirus hits later in the year, these health care needs will have been been met.
Sauer says that a hospital chief executive — whom she did not name — called her earlier this month to note that he needed a hip replacement but was not able to get it done at his own hospital. He said he was taking more opioid medications, and urged that the governor’s order be modified.
Sauer said that phone call prompted her to ask several hospitals to track opioid use, and they found a significant uptick in these pain prescriptions.
The April 10 letter also says the financial blow to hospitals and ambulatory centers “threatens the need to respond to the health needs of Washingtonians in the medium-and -long term. “
Watkins said nurses want to care for patients. Some nurses remain out of work because elective procedures have been paused.
“We’d love to get them back to work,” Watkins said, but she said the process needed careful consideration. “We don’t want to have a resurgence. It could be a further blow to the economy. We’re trying to be cautious .”