by Tom Robertson
Executive Director, Vizient Research Institute
04/22/20

In the second half of the 1960s, the same company that brought us the Frisbee and the Hula Hoop introduced a new toy and the simple act of bouncing a ball would never be the same. If you drop a baseball on the floor, it barely bounces at all. Drop a tennis ball from the same height and it bounces higher. But the Super Ball, by Wham-O, bounced higher than anything we had ever seen. What made the Super Ball special was its elasticity. By adding sulphur to the synthetic rubber, the resiliency increased and the ball rebounded to a height just short of that from which it had been dropped. Elasticity, the ability of an object or material to resume its normal shape after being stretched or compressed, is the key to how far and how fast something will bounce back. As health care providers look ahead to the other side of the pandemic, elasticity will be a critical variable in their economic recovery.

A byproduct of the virus outbreak that’s catching physicians by surprise is the disappearance of heart attacks and strokes from hospital emergency rooms. As reported in a number of national publications, hospitals in New York City, Detroit, Atlanta and Boston have seen the number of heart attacks being treated fall by as much as 90%. Neurologists report treating fewer than 50% of the stroke cases they would normally see. In the absence of any known link between the virus and a reduced risk for heart attack or stroke, the best explanation is behavioral. Concern is high that patients with life-threatening cardiovascular conditions are avoiding treatment out of fear of viral transmission. To the extent that the precipitous drop in heart attack and stroke cases is in part attributable to fear of exposure, the pace at which that fear dissipates may be a leading indicator with respect to the eventual rebound of demand for discretionary and elective services.

As health systems prepare for a return to normalcy – whatever the new normal may be – a confounding unknown is the rate at which demand for services that were postponed or suspended during the pandemic will return. It is reasonable to assume that demand for discretionary services will rebound no more quickly (and perhaps more slowly) than the return of life-threatening cases like heart attacks and strokes. The return of demand for elective services may be even slower yet.

Planners might consider using the rate at which heart attacks and strokes return to pre-pandemic levels as an upper limit on the expected pace of a rebound of demand for discretionary and elective services. By modeling multiple scenarios in which the projected rate of change in demand for elective procedures is related to the observed rate of change in heart attack and stroke volumes, it may be possible to estimate a range of expected volumes for discretionary and elective services and to prepare accordingly.

Released at almost the same time as the emergence of the Super Ball was a popular song written by Paul Simon, “Red Rubber Ball.” A portion of the lyrics from that song have an element of poignancy in the current environment:

And I think it’s gonna be alright/ Yeah, the worst is over now/ The mornin’ sun is shinin’ like a red rubber ball

It’s hard to know when the worst will have passed, but we all hang on to the expectation that it will eventually be alright. How fast and how far things bounce back remains to be seen.

About the author and the Vizient Research Institute. As executive director of the Vizient Research Institute, Tom Robertson and his team have conducted strategic research on clinical enterprise challenges for 20 years. The groundbreaking work at the Vizient Research Institute drives exceptional member value using a systematic, integrated approach. The investigations quickly uncover practical, tested results that lead to measurable improvement in clinical and economic performance.