With ban lifted, Indiana hospitals gear up to resume elective procedures

Indiana hospitals and clinics across Indiana are gearing up to reopen their operating rooms for elective, non-urgent procedures, now that Gov. Eric Holcomb has lifted a ban he put in place six weeks ago during the start of the COVID-19 pandemic.

Holcomb lifted the ban effective Monday, with some caveats, such as making sure that hospitals keep enough personnel and personal protective equipment on hand for COVID-19 patients.

For many hospitals, Holcomb’s decision couldn’t come soon enough. Hospitals make most of their money on elective procedures, such as hip replacements and spine surgeries.

In response to the massive drop in revenue, hundreds of hospitals around the country have furloughed or laid off staff. The Indiana Hospital Association said it was unaware of any hospitals in central Indiana that have done so.

Still, the ban has begun to sting. Last week, Indiana University Health, the state’s largest hospital system, said operating income plunged 49%, to $77.6 million, in the first quarter, as it was forced to postpone elective surgeries and inpatient procedures while paying out more money for expenses related to the COVID-19 pandemic. The number of surgeries fell by 7.5% and the number of inpatient discharges fell by 7.2% in the quarter.

Now that the ban is lifted, IU Health said it is working “toward a gradual return” to elective medical procedures. It did not say how gradually the plan would be rolled out, but said those details could be discussed in coming days.

“Every IU Health facility is ready and willing to provide safe and effective care to those who need it,” the Indianapolis-based system said in an emailed statement. “We strongly encourage Hoosiers to seek treatment not only in emergency situations, but also to diagnose serious conditions, address underlying chronic illnesses, relieve significant pain and more.”

Community Health System said today in a written statement it would resume elective surgeries “on a limited basis.” It pointed out it had continued doing urgent surgeries in recent weeks.

“It’s worth noting we never stopped doing surgeries,” said Community Health Network president and CEO Bryan Mills, in written remarks. “We never stopped caring for patients. From the beginning, we’ve been focused on the safety of our patients and our caregivers; and safety will continue to guide our pace in resuming activity. We’ll be taking it week by week.”

Franciscan Health Indianapolis said it use a “gradual, ramped-up approach” to resume elective surgeries. Dr. Christopher Doehring, vice president of medical affairs for Franciscan Health, said the first tier would include cancer or cardiac surgeries that had been classified as urgent but not essential.

The next tier will include total joint replacements, spine surgeries and other complex procedures. Also in line would be such important procedures as cataract surgeries. “You can put that off for a while, but it’s a pretty lifestyle limiting, and in some cases, somewhat debilitating type of condition that needs to be treated,” Doehring said in an interview.

The hospitals say they don’t plan to rush back into procedures, because under the state guidelines, they can’t detract from their ability to treat patients with COVID-19.

That means hospitals have to maintain an ample supply of personnel, room availability and personal protective equipment. That could be tricky, because experts have been unable to definitely say when the surge of COVID-19 patients will peak. The number of new positive cases and deaths has climbed and dropped several times in recent weeks. The Indiana State Department of Health on Monday reported 949 new positive cases, the highest ever reported in a single day and the third daily high in four days.

Last week, as the number of new cases was beginning to level off and fall, Holcomb said the surge has been lighter than expected. Much of that was due, he said, to Hoosiers practicing social distancing.

“You are, for the most part, practicing good physical distances practices,” Holcomb said. “You are slowing the surge and flattening the curve.”

He also credited hospitals for collaborating with information and supplies. Holcomb said last week that the current inventories of personal protective equipment look sufficient, but it needed to be monitored on an ongoing basis. The restrictions on elective medical procedures will be re-evaluated every seven days.

The Indiana Hospital Association said hospitals have been “nimble in expanding their capacity and redeploying staff to care for patients with COVID-19.”

“Hoosiers must know that they should seek treatment today not only in emergency situations, but also to diagnose serious conditions, address underlying chronic illnesses, relieve significant pain, and more,” the association said in a statement. “Of course, our member hospitals will continue to carefully monitor the supply of personal protective equipment and other trends related to COVID-19 in the weeks ahead.”