• Creativity, courage and commitment helped hospital staff quickly meet the equipment and floorspace challenges presented by COVID-19.
  • There is "no going back to the normal" routines that health systems and hospitals followed just three months ago. 
  • New initiatives are being established to provide COVID testing, personal protective equipment, and self-distancing guidance for hospitals.
  • Local doctors and health care providers play an important role in informing patients that hospitals are safe. 

Video Transcript

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JOHN WHYTE: You're watching Coronavirus in Context I'm Dr. John Whyte, Chief Medical Officer at WebMD. I'm joined today by Michael Dowling. He's the president and CEO of Northwell Health. And Bob Brisco, the CEO of WebMD and internet brands. Gentlemen, thanks for joining me.

MICHAEL DOWLING: Thank you so much delighted to be here. Thank you.

JOHN WHYTE: COVID-19 certainly has caused a lot of stresses and dislocations on all aspects of the health care sector, health systems, patients, physicians. Bob, I wanted to get your thoughts in terms of where you see the stressors are on the financial aspects of delivering health.

BOB BRISCO: I think there's the three aspects, right? We've got financial stress. And that stress on the HCPs. And we've got stress in the patient populations. And I thought maybe with Michael we could work through each one of those.

But Michael maybe if we started on the financial side. We know the financial pressure's huge through this because of the reasons. What are you seeing? How serious of a crisis is building here and what do we need to do as a country to get through this?

MICHAEL DOWLING: Well, there's many aspects to this. But if you take the-- you know, here in New York you have five or six very large health systems. And these are health systems that have been put together over the years. And they're relatively strong. But in our case, we are the largest one in New York.

In our case right now, we are losing because we have curtailed most of our surgery for the last five or six weeks. We are losing about $350 million a month. Um, so if when we look at the frame from when this began to when we think we can begin to get some of our original business back, we will probably have lost about a billion four.

BOB BRISCO: Oh, wow.

MICHAEL DOWLING: Now, all the other health systems are in the same position, relatively speaking, not as much as ours, because we are the biggest. And we've had the bulk of COVID patients. We've had 20% of all COVID patients in New York state in our facilities over the last five weeks.

BOB BRISCO: And I should point out, your system has been amongst the most successful, I think, in the country, if not the world in the way you've built it over a couple of decades there. So we're talking about the elite here suffering through this amongst the health systems.

So what happens? How do we put the system back together?

MICHAEL DOWLING: Well the other thing-- I want to make one other point on that. You know, we made a decision. I made a decision early on. When this happens, you put aside your concerns about the normal way you do work. You put aside your concerns about whether doing this or that is going to lose you money or gain money. You decide, do the right thing for the purpose of treating the public the right way. And then come back later and try to figure it out. Otherwise-- Because we had to expend a lot of money to prepare for the COVID crisis. We had to create 1,600 new beds on the fly.

So in answer to your question though, we are now in the process-- the beginning of the process of recovery. How do we get back? And we've got to get back slowly. So it has a whole series of initiatives, you know? How you deal with testing? What do you do with your staff that have been deployed elsewhere? How do you maintain social distancing in all of your operations? So my guess is over the next couple of weeks, we will start to bring back some of the business. But it will take months and months to get back to where we might have been before.

And also the public is very nervous. So you have to show the public that it is safe.

JOHN WHYTE: How do you show them that it's safe? Because even as the virus dissipates, the fear of the virus isn't going to dissipate.

MICHAEL DOWLING: Well, yeah, you will continue-- you'll have to communicate quite a lot to the local physicians because a lot of people would call the local physicians. So you've got to make sure the local physicians are comfortable. You've got to communicate in a major, major way which we will be doing and are doing.

But then you've got to make sure that you'll maintain PPE, your masks, your gowns, your gloves, that all staff will be maintaining the use of those for a long period of time. Social distancing will have to be continued to comply with. You can't have your waiting rooms the way they were three months ago. You're going to have social distancing in your waiting rooms. So you've got to do all of those things to make sure that you don't accelerate the transmission again.

And I think the physician community is unbelievably important here. Today we had a discussion with about 400 of our physicians just on this issue. So communication, communication, communication. But whatever you do, it will take time. And certain things take the amount of time that's necessary. And you've got to give it the amount of time that's necessary.

JOHN WHYTE: Do you think that's six months, a year, two years? What's your best estimate?

MICHAEL DOWLING: Oh, I think a year. You know, there's a lot of loyalty and trust in this-- about this organization. People believe we've handled this very, very, very well. We've acted as a real system. So we've moved patients between hospitals all over the place.

We didn't have a lot of disruption, despite the fact that we took care of the most of the patients. We didn't have the disruption that other places had because we're pretty well organized. The public respects this.

And almost every night in front of every one of our facilities we have community celebrations, celebrating the people who work in the facilities and thanking us for it. So there's a built-in good feel here which you've got to build upon. But make sure that you make the recovery transition smooth, incremental, slow when necessary, not overdo it, and not try to get back so quickly because you're so worried about getting the finances right within a month. That would be the wrong strategy.

BOB BRISCO: And Michael, I want to talk about the health care professionals. You-- you all have done maybe more than anybody. I have been looking at what you've been doing with bonuses and pay. I think you've been an exemplar around all of this. How are they doing?

MICHAEL DOWLING: They're doing extraordinarily well. I personally have been on every ICU in every hospital. I have walked every floor. And I have been doing it every week. On most days I was doing it. And being out there right on the front lines, acknowledging the staff, demonstrating gratitude to the staff is extremely important.

When I'm out there, I can tell you that the staff, their passion, their commitment, their courage, but also their sense of commitment is extraordinary. And they will actually tell you that despite how difficult this is and how fearful at times they were, it brought them all together, because the other thing was happening. You go on the floor in the ICU treating vent patients. And I had my cardiac staff under on the ICUs.

So the different disciplines came together. They didn't work in those silos that we traditionally work in. They came together. So staff will tell you, the unity around staff, committed to a focused mission, despite the difficulty, was extraordinary. So I think we've benefited from it, to be honest.

BOB BRISCO: That-- that-- that is an amazing silver lining that you're pointing to. We had on-- you know well to David Feinberg from Google. And he was at Geisinger yesterday. He talked about the adoption of digital technologies coming out of this COVID period and described that really as an inflection point, another silver lining, perhaps, coming out of this. Would you agree with that or--

MICHAEL DOWLING: I would agree. I think, despite how difficult this was-- difficult this was, this will change us all. We will operate differently going forward. There is no such thing, in my view, of going back to the normal that we had three months ago. Technology will be used a lot more.

Telemedicine was accepted during the crisis much more so than it was accepted prior. People in the past didn't want to deal with it are now dealing with it. We have 30,000 people working from home during the crisis. Many of those people will always now work at home. We found out that we can-- that people can be just as productive, in fact, in many cases more productive working from home in a lot of the revenue cycle functions, a lot of the back office functions than they did by coming into the offices. So that's another change.

We were-- we demonstrated enormous creativity during the crisis. We reconverted BIPAP machines to vents. We made our own swabs. We created at one point 200 new beds a day. A year ago, if I asked people to create 200 beds, we'd have an analysis, we'd have a plan, we'd have a business plan, we'd have discussion. It would take three months. We did it in 24 hours. So that sense of creativity and innovation is something that, hopefully, we will be able to maintain as we go forward.

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