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Coronavirus

DFW Providers Prepare for Patient Displacement

Many questions remain for those who don't have COVID-19 but need hospitalization.
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As New York copes with a lack of hospital space and ICU beds for the onslaught of COVID-19 patients, DFW providers are thinking about how to care for those who may need hospitalization for something other than the virus as the health system devotes more space to Coronavirus patients.

While many physicians are pivoting to telehealth services, some patients still need to be hospitalized, and finding a bed for them may become increasingly difficult.

Kidney disease often requires frequent hospitalizations. 

Patients with chronic kidney disease who are on dialysis are frequently hospitalized, especially if they don’t receive their regular medication. With the shelter in place order, some patients might skip dialysis or an appointment to adjust medication, which could result in them having to be hospitalized.

Patients with co-morbidities such as kidney disease are especially vulnerable to the virus, creating a Catch-22. These patients need frequent medical care to stay healthy, but risk getting a virus that may kill them if they seek it.

Dallas Nephrology Associates CEO Dr. Alexander Liang says that the COVID-19 numbers are not such yet that the practice’s patients have been displaced, but as he follows news from New York and New Orleans, he is preparing for that reality.

Liang says discussions are already underway to see what patients can be moved to other facilities, and the U.S. Army has set up a COVID-19 patient hospital in the Dallas Convention Center, with 250 beds now and a potential for 1,400.  In New York City, a convention center was converted into one of the nation’s largest hospitals in America, which will be used for non-Coronavirus patients.

As the hospitals get filled with COVID-19 patients, Liang and others are preparing to see their patients who don’t need ICU care in a variety of new settings, though the plan isn’t set just yet. “The process not quite in place, but I expect something like that to happen sometime in the next month as hospital beds become more difficult to find.”

In addition to space, Coronavirus patients take manpower away from other diseases being treated in the hospital. “There is an ever-growing number of COVID-19 positive patients, and it is taking a long time for hospital physicians to evaluate them,” Liang says. “The COVID-19 positive patients are limiting the amount of care they can provide each patient.”

Around 20 percent of those who have tested positive for the virus are healthcare providers, further depleting the number of people available to take care of patients of all kinds. “Hospital resources are very stretched from that aspect,” Liang says. “There is a shortage of manpower of staff and physicians because of potential exposure, and they could transmit it to others.”

Because of a prospective loss of manpower, Liang says partners in his practice have already received requests to treat and help with non-kidney patients, as nephrologists are also certified internal medicine physicians who are able to treat general COVID-19 patients. “We have never seen anything like this,” he says. “The community needs to come together. It doesn’t matter what specialty, practice, or group, everyone needs to roll up their sleeves and do what we can to help.”

Behavioral health patients can also hinder COVID-19 hospital response

In the behavioral health world, there are limitations on how much time a patient can spend in a psychiatric hospitals, meaning they may turn to general hospitals for mental health crises, even as those same facilities are dealing with increased COVID-19 treatment. Many with chronic illness qualify for Medicare well before they are 65, but the system will only pay for 190 lifetime psychiatric days spent at a free-standing psych facility. Dallas Behavioral Healthcare Hospital CEO Terrence O’Reilley would like to see regulations like that lifted, and the need especially acute during the possible influx of COVID-19 patients on hospitals.

For those with chronic mental illness, it can be very easy to exceed 190 days in a lifetime, leaving those patients who are covered by Medicare nowhere to go but acute care hospitals, which could be soon overrun with COVID-19 patients. Private insurance does not have a similar restriction, and a removal of the restriction would allow psych hospitals to help carry the burden and create space for more COVID-19 treatment in the general hospitals.

In addition to the questions of where the patients will go, the virus and panic that surrounds may also also create higher numbers of patients who need mental health care, spiking the number of patients at the worst time. “If you are struggling with anxiety, depression, and mental illness, that additional stressor out there is not helping anything,” O’Reilley says. 

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