Hospitals across the U.S. have begun to plan how they will reopen for elective procedures. Several states, including Florida, Georgia, and Oregon, have already lifted restrictions on nonessential medical procedures.

According to a report released by accounting firm Crowe LLP, hospitals saw patient volumes decrease by 56% between March 1 and April 15, translating to an estimated decline of $1.44 billion per day for hospitals with more than 100 beds. The lifted restrictions would allow hospitals to once again offer elective procedures, such as hip replacements or cataract surgeries.

“States are reopening elective surgeries and most major systems are itching to get back open,” Ryan Zimmerman, BTIG’s managing director of equity research for medical technology, wrote in an email.

But most health systems face one major hurdle to reopening: personal protective equipment.

Faced with skyrocketing demand for masks, gowns and other equipment, hospitals have found alternative suppliers of equipment. But if health systems continue to see Covid-19 patients, masks and gowns may be diverted to those cases, serving as a potential “gating factor” to reopening, Zimmerman said.

St. Joseph’s/Candler Health System, a 636-bed hospital system in Savannah, Georgia, reopened for elective procedures in late April. The hospital’s CEO said it would start to reopen its outpatient areas, but would still screen patients at the door for Covid-19 and keep visitor restrictions in place.

Joe Loya, the director of purchasing and distribution for St. Joseph’s/Candler, said he expected to see a slow ramp-up, with patients who urgently needed a surgery coming in first. The hope is to get closer to normal volumes by July.

“I don’t think there’s going to be a mad rush at the door,” he said during a call hosted by BTIG on Friday. “For people who do have bad knee pain, or something they really want to get taken care of, it helps soothe their concerns when they hear about everything we’ve done to prepare our facility and care for our own employees. … If it’s something that truly can wait and isn’t affecting somebody’s life, those are probably patients you won’t see for a couple of months.”

So far, none of the health system’s employees have come down with Covid-19, and its two hospitals are also putting masks on patients, Loya said.

St. Joseph’s/Candler has been stocking up on protective equipment, and like many of its peers, had to look outside of its usual suppliers to purchase masks, hand sanitizer and other equipment.  But while hospitals have these relationships with distributors in place, most surgeons’ offices don’t.

“I think the PPE challenges that they’re going to have in the offices are not relieved yet. That’s going to be slow to start,” Loya said. “I’m getting calls … just saying I can’t buy masks, can’t buy gloves, can you help me out? We’re connecting them to those nontraditional vendors that we’ve used and have had success with. Those processes on their end are not as simple to get started now as you’d think.”

In the future, Loya expects to see PPE become a regular part of more procedures.

“I think everything that’s happened over the last couple of months and Covid itself has changed protocols moving forward,” he said. “Moving forward in your ICUs and EDs with any aerosol-related procedures, you’re probably going to see N95s used a lot more than they were in the past.”

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