Health providers look to get back on their feet and back in business

After a six-week ban on elective procedures, many Florida health-care providers are back in business.

But it’s not yet clear whether residents are ready to become health-care consumers, even with additional safety measures put in place as hospitals and other medical centers were allowed to resume providing elective procedures Monday following a halt because of the coronavirus.

Doctors and other people in the health-care industry have openly expressed fears that some patients have been forgoing needed medical attention.

“There’s been a lot of folks who are putting off going to see their doctor during the ‘Safer at Home’ order and the ban on elective procedures. Some of these patients were patients who really needed to be seen,” Florida Medical Association General Counsel Jeff Scott said, referring to a coronavirus order issued by Gov. Ron DeSantis. “Doctors’ offices have obviously issued some safety precautions to make sure their offices are safe. You’ll see people wearing masks, and you’ll see people coming in for their appointment from their automobile rather than sitting in the waiting room. They will be doing different things. So it’s not going to be 100 percent back to normal, but the care is there. The doctors are available.”

Health providers across the state are authorized to provide elective services after DeSantis last week issued an executive order that began the process of reopening businesses that had shut down or scaled back because of the coronavirus pandemic. The executive order was loosely based on recommendations compiled by a DeSantis-created task force and recommendations issued by the Trump administration.

“I know this is going to help the health of a lot of people in the state of Florida as well as help hospitals function,” DeSantis said Sunday at a press event at Halifax Health in Daytona Beach. “This will allow kind of the system to start running again like it should, and obviously it will be good for people’s health.”

Red Hills Surgical Center in Tallahassee will reopen next Monday and has 25 scheduled surgeries, said David Shapiro, an anesthesiologist and risk manager for the facility. As part of the planning, Shapiro met with top medical staff to discuss new safety procedures because of COVID-19, the respiratory disease caused by the coronavirus.

Chief among the changes is a requirement for all patients to be tested for COVID-19 before surgical procedures, Shapiro said.

“That’s going to be our biggest challenge, I think,” Shapiro said of the new policies and procedures that the ambulatory surgical center will follow. “We are doing that to protect not only the patient but all the other patients, surgical, medical staff and employees.”

Patients, he said, can be tested for COVID-19 at their referring physicians’ offices or at Tallahassee Memorial Hospital, which co-owns the surgical center.

Red Hills also is waiting on its own supply of COVID-19 tests and will have capability to test for the virus, Shapiro said.

“We are not  going to be mandating that they get a test at a certain place, but we are going to require that they do have that test done,” he said, adding that the goal is to administer the tests about two days out from scheduled surgeries.

“We want to keep time frames short. They cannot get tested two weeks out,” Shapiro said.

Most of the other changes taking place at Red Hills affect the environment. Visitation of patients will be “strictly, strictly,”  limited, Shapiro said. Moreover, anxious visitors in waiting rooms will no longer have access to refreshments, magazines or even the television remote control.

“It will look a little less friendly, but will really be more safe,” Shapiro said.

Shapiro said the surgical center has been closed since DeSantis issued his initial executive order in March. DeSantis said he instituted the ban on elective procedures to conserve necessary personal protective equipment and hospital space as the state prepared for a surge in COVID-19 patients. But despite national models that predicted demand for health care would outpace capacity, that has not occurred to date.

The downside is that Florida providers say the ban has wreaked havoc on their financial health.

Brandon-based dentist Rudy Liddell did not completely shutter his two office locations, but he pared his hours of operations to about 20 hours a week across a four-day period. Liddell said billing for the dental offices during the six weeks dipped by 70 percent.

He has avoided laying off staff because he was able to tap into the payroll-protection program for small businesses that was included in a federal stimulus law.

Scott, of the Florida Medical Association, said his physicians’ association conducted a survey of its members that showed 42 percent of the respondents had laid off staff and 55  percent had applied for loans. Four percent of the survey respondents said they permanently or indefinitely have closed their businesses.

Safety Net Hospital Alliance of Florida CEO Justin Senior estimated his 14 member hospitals are losing about $175 million in revenue each week, most of which has been attributable to the ban on elective surgical procedures.

Unlike guidelines issued by the Trump administration, which initially backed elective surgeries on an outpatient basis only, DeSantis’s order last week also allows hospitals to admit new patients, a move Senior applauded.

“I think that is a better approach for Florida,” Senior said, noting that adequate bed capacity for a COVID-19 surge has not been an issue in Florida. “Given the situation in Florida where you had so many vacant beds and so many available ventilators, I think they (hospitals) would have been really distressed if this had dragged on even further.”

To offer elective surgeries, hospitals must have enough bed capacity to respond to a potential COVID-19 surge. Additionally, all providers offering elective procedures must maintain an adequate supply of personal protective equipment, commonly referred to as PPE. The supply must be obtained from the private sector and cannot be obtained from the government.

The Agency for Health Care Administration told the News Service that it has the capability to monitor bed capacity and that the state Emergency Operations Center can track which providers are getting government-issued PPE.

The agency, though, did not directly answer how the state plans to ensure that adequate PPE supplies are maintained.

Liddell, who has been a dentist in Brandon for 37 years, said PPE may eventually become an issue for dentists because they are not considered front-line first responders and are not given priority status when ordering the supplies.

Scott said the Florida Medical Association would have preferred that the DeSantis order not include the caveat that PPE cannot be obtained from the government.

“I think (doctors) would like to see the ability to receive assistance from the state or federal government,” Scott said. “The whole world is competing for PPE, and trying to obtain these supplies is hard.”