Ballad Health hospitals postpone elective procedures amid COVID-19 surge


Rural hospital chain Ballad Health is poised to postpone elective procedures at three of its Tennessee hospitals following a spike in COVID-19 cases.

Ballad on Monday began deferring up to 25% of scheduled, non-emergency services at Holston Valley Medical Center in Kingsport, Tenn. In a few days, it will do the same at its hospitals in Johnson City and Bristol. Ballad was treating 166 COVID-19 patients, and most of the cases are at these three facilities.

Meanwhile, Maury Regional Medical Center in Columbia, Tenn., which is not part of Ballad, on Monday began suspending elective procedures requiring an overnight hospital stay after receiving an influx of coronavirus-stricken patients. The hospital was treating 50 COVID-19 inpatients, including 20 in the hospital’s 26-bed intensive-care unit.

Alan Levine, CEO of Ballad, which operates 21 hospitals in four states, explained that the three hospitals are postponing some non-emergency procedures so they can ensure they have enough staff to take care of patients with emergencies and avoid putting too much strain on nurses.

“You want to make sure you’re not stretching the nursing staff too thin and the most logical place to reduce your volume is with these elective procedures, and so that’s where we start. We started by deferring 25%. That number will go up if we see COVID cases continue to climb,” Levine said in an interview Monday.

At least fifty Ballad nurses were out sick with COVID-19, and because demand for labor is so high, the hourly rate for some contract nurses is north of $120 per hour—about double what it normally is, Levine said. He expects to see COVID-19 cases continue to surge in the state, based on Ballad’s predictive modeling.

“With a very high level of confidence, we can predict two weeks out and we believe we’re going to see a continued increase in the inpatient COVID cases, and we’re at a point where we just cannot ask more of our nurses than we already have,” he said.

Not all Tennessee hospitals are postponing procedures. Vanderbilt University Medical Center in Nashville and Erlanger Health System in Chattanooga both said they have not recently and do not plan to postpone scheduled procedures. As of Oct. 23, VUMC had 51 COVID-19 patients in its hospitals, which is less than the number of coronavirus inpatients it has had in the past.

“In no way have we dropped our guard and continue to prepare for what could be very challenging months ahead,” a spokesman said.

Nationally, health systems are also taking different approaches. The Wall Street Journal reported Monday that for-profit chain HCA Healthcare last week postponed some surgeries in El Paso, Texas, amid a surge in COVID cases. Dallas-based Tenet Healthcare Corp., meanwhile, has not deferred elective procedures.

In the early months of the pandemic, hospitals nationwide postponed elective procedures to comply with governors’ orders and federal guidance. The deferrals were meant to help conserve hospital beds, personal protective equipment and other resources in case of a surge of coronavirus patients.

COVID-19 cases spiked in different areas of the country at different times, and so while some hospitals were full of coronavirus patients, others saw few cases. Their revenue dried up as patient visits plummeted.

Since the country-wide shutdown in March and April, hospitals and other healthcare providers have generally avoided canceling non-essential services, save for a few exceptions. Many hospitals continued providing elective services when COVID-19 cases increased in some states in July, arguing that they better understood how to treat the disease, prevent its spread, and conserve equipment and other resources.

Today, decisions to postpone elective procedures are likely to be made on a hospital-by-hospital basis, rather than a in compliance with a state order.

“There are implications for patients when you do this. How we’re doing it now is appropriate and safe, but to just do a blanket ban on elective procedures and diagnostics the way it was done before, there were a lot of patients with early-stage cancer that didn’t come get their diagnostics,” Levine said. “This really does have to be community by community based on our assessment of what community needs are.”

COVID-19 cases are on the rise again throughout the country. In Tennessee, there were 3,500 new cases and 31 additional deaths on Sunday, according to the Tennessee Department of Health. In total, roughly 247,600 COVID-19 cases have been confirmed, and more than 3,100 people have died from the disease in the state.

Nationally, at least 59,691 cases and 339 deaths were reported on Oct. 25, according to the New York Times database. Roughly 8.7 million people have been infected by COVID-19 and 225,000 have died since the start of the pandemic.

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