Back to Health: While Munson ramps up operations, patient numbers remain low

Socially distanced waiting rooms, telehealth visits and detailed patient pre-screenings are just a few ways Munson Healthcare is keeping patients, staff and visitors safe.

Despite the precautions, the healthcare system is in a sort of limbo at the moment, with many potential patients unwilling to come in for care or services, according to Laura Glenn, Munson Healthcare’s director of physician network and president of ambulatory services and value-based care.


“We are having some patients who are refusing to reschedule care or services that were either delayed or cancelled due to COVID-19,” Glenn explained, citing a mid-March executive order that limited healthcare organizations in their ability to offer so-called “non-essential medical procedures.”

That executive order was officially lifted statewide on May 29, but patient traffic at Munson system hospitals and outlying clinics still has not returned to pre-COVID-19 levels.

“We know that this issue is not unique to Munson Healthcare,” Glenn said. “We’ve connected with our colleagues and other health systems across the state, and others are experiencing a similar phenomenon. But we are trying to take every opportunity we can to make sure people understand that they can safely receive care in our facilities.”

A decreased patient census includes typical medical emergencies, said Dr. Christine Nefcy, Munson Healthcare’s chief medical officer.

“…(W)e have seen less volume in some of the things we would have thought wouldn’t have changed at all, like strokes or heart attacks. We’ve certainly seen a reduction in the number of people coming in for what we would call routine health maintenance or preventive care,” she said.

Other areas are also down, Nefcy said.


“Childhood immunizations are a concern for us, because those numbers are down,” she said. “And then preventive care, like getting a mammogram or a colonoscopy, those are down as well.”

The smaller number of people coming in for preventive health screenings has created a domino effect within Munson that has been detrimental to the healthcare system’s traffic.

Nefcy notes that these types of screenings “drive other volumes” within the system, since they help identify health concerns that demand further evaluation or treatment. With those numbers down, not only are potentially serious health problems going undiagnosed in the community, but Munson’s revenues are down, too.

Prior to the pandemic, the consulting firm Guidehouse released a study claiming that a quarter of rural hospitals in the United States were “at a high risk of closing” due to their financial situations. COVID-19 was expected to worsen the situation significantly.

While Glenn declined to share specific revenue figures for Munson Healthcare, she confirmed that COVID-19 “definitely had a very significant impact” on the revenues for the healthcare system. Munson hospitals were “at half capacity or less” during the stay-at-home order, and some services were completely shut down.

However, Glenn also says Munson’s hospitals are not in immediate jeopardy, in part because the system has been aggressive in pursuing funding through the Coronavirus Aid, Relief, and Economic Security Act Act and numerous federal and state grant programs.

“We’ve left no stone unturned as it relates to applying for any grants or other funding that might be available through those multiple sources,” Glenn said. “And that has helped us stay stabilized in the short-term and make up for at least some of the losses that we’ve experienced, given a dramatic decrease in volume.”

The next step is getting patients back into system hospitals and clinics – a process of building trust throughout the local community that both Nefcy and Glenn acknowledge will likely take time.

Safety protocols throughout the Munson system are aimed in part at establishing that trust. At hospitals, Nefcy says Munson is requiring masks for all, limiting common-touch items (such as coffee makers), removing some furniture from waiting rooms to enforce social distancing, installing plexiglass shields at check-in and check-out points, and reducing the number of entrances to allow for easier screening of all patients and visitors who come through the door.

Munson has also purchased 90 iPads, which it is using to coordinate care across the system and to allow patients who are cut off from their families to visit with them virtually via video chat.

At outpatient clinics, the focus has been on increasing telehealth services. In any given week, Glenn says that Munson’s clinics have been doing between 1,600 and 1,800 virtual visits. Those numbers represent a significant increase in telemedicine for Munson, which at the beginning of the year counted 20 visits a week as “a lot,” Glenn said.

“We had an implementation plan in place for virtual care that was nine months in length, but when the pandemic hit, we set up a full platform in two weeks,” Glenn said. “So we have tremendously enhanced our capabilities and shifted to telehealth throughout COVID.”

When asked how long-term some of these changes might be, Nefcy says there is no way of knowing for sure what the next chapter of COVID-19 looks like.

However, she’s hopeful that patients won’t continue deferring care – not only because the pandemic could prove to be a long haul, but also because the risk of catching the disease in a hospital or clinic are relatively low.

“The reality is that we haven’t had a positive patient in any of our hospitals for awhile,” Nefcy said. “We’re doing pretty well up here in northern Michigan, and I’d say our hospitals are very safe.

“We just need to get people confident enough in the safety measures we’ve put in place so that they feel comfortable coming back in to get the care they need, whether it’s acute care or preventive care.”