With elective procedures on hold, there has been a significant reduction in revenue, health system executives said, while fewer patients are seeking hospital care because of fear of contracting COVID-19.

As the coronavirus continues to alter almost every aspect of life in Delaware, health care is no exception.

Hospitals have reported significant financial losses. Practitioners are using telemedicine more than ever. And fewer patients are seeking health care.

"Financially, yes it is a challenge," Dr. David Tam, CEO of Beebe Healthcare told Delaware Online in April. "We continue to do well in terms of staying above water. And we intend to be here for the next 100 years."

But what will those years look like?

Show me the money

Since hospitals temporarily suspended elective procedures, there has been a significant reduction in revenue, health system executives said. Fewer patients are also seeking necessary care because many are afraid to go to hospitals out of fear of contracting the virus.

The increased need – and sometimes higher prices – for personal protective equipment and testing supplies has also burdened hospital budgets.

In April, hospitals across the country received $50 billion in funding aid relief from Congress. The money is intended to help cover expenses and loss of revenue. The American Hospital Association estimates that hospital are losing about $50 billion a month.

This has led to the furloughing or layoff off of health care workers. Trinity Health Mid-Atlantic, which owns Saint Francis Healthcare, announced in April it will furlough some employees and reduce executives' salaries.

A hospital spokesman declined to say how many employees have been furloughed at Saint Francis.

And though Delaware acute hospitals received about $85 million in aid, this money covers only about two weeks of losses, hospital executives say.

"I have incredible anxiety about some of our members being able to exist ... absent of financial support," said Wayne Smith, president and CEO of the Delaware Healthcare Association, which represents all the acute care hospitals in the state.

Depending on the amount of money hospitals receive in aid, Smith said health systems may have to raise its prices in order to remain financially stable.

The doctor will see you now – on your phone

Like many practices in Delaware, First State Orthopaedics' waiting room used to be bustling. Dr. Joseph Straight was in the office five days a week, treating dozens of patients.

Now, he and his colleagues are seeing between 20 to 30% of their normal volume. Most of the appointments are done via telemedicine.

This has become the new normal for primary care physicians and specialists. For Straight, relying on telemedicine these past few months has made him realize what can be done via FaceTime – and what can't.

"I do believe that we will see the increase in utilization of telemedicine going forward, even after COVID-19," said Straight, the president of the Medical Society of Delaware. "It it will be used differently among specialties. In orthopedics, you're going to see post-op checks and follow-ups on wounds through the phone."

In the midst of the pandemic, regulations around telemedicine – and its reimbursement by insurers – has loosened. While Straight believes most of the regulations will return, he hopes some of the rules will continued to be relaxed.

Straight said telemedicine has allowed provides to give patients the care they need "at the right time," instead of appointments being delayed or avoided because of the pandemic.

Telemedicine also allowed his practice to conserve personal protective equipment and keep health workers safe, by avoiding an influx of patients coming into the office.

But there's only so much telemedicine can do.

It will never take away the importance of an in-person, physical examination, he said.

"There is some concern in the medical community," he said, "that if you're not touching somebody, listening to their heartbeat, making a diagnosis is difficult. We're always worried about the liabilities."

Back to the future

Even before the pandemic hit Delaware, some independent practitioners struggled to keep their businesses open – overhead costs were high and reimbursement rates were low.

Now as Delaware begins to reopen its economy, it raises the question of if these practices will still be able to remain open, or if health systems will continue to dominate the health care landscape in the state.

Patrick Harker, president and CEO of the Federal Reserve Bank of Philadelphia, said in early May that the Federal Reserve is "thinking carefully about setting up facilities that can provide direct lending to colleges, universities, and nonprofit medical institutions."

Harker said this is "crucial" for Delaware because of how essential educational institutions and hospitals are to the state's economy, making up about 17.4% of the workforce.

Straight, the president of the medical society, believes social distancing requirements will change how doctors' offices are managed, especially since people will likely be nervous to go to a medical facility for the coming months.

And these precautions will cost money.

"It's very tough to be in private practice," he said. "The landscape of medicine – it's tough for everybody."

"Do I think the pandemic is going to change things? Yes."