A decision by a major company in Birmingham’s healthcare landscape illustrates one of the many strange ironies of the coronavirus pandemic.

Tenet Health, which operates Brookwood Baptist Health, Princeton Baptist Medical Center, Shelby Baptist Hospital and Walker Baptist Hospital among other facilities, informed employees it would postpone contributions to their 401(k) plans.

“We are facing a growing demand,” the company told employees, “which is difficult to fully estimate given the changes we see daily.”

Tenet is just one facet in an industry coping with the massive demand for services related to the COVID-19 outbreak. At the same time hospitals are focusing on backbreaking care for those affected by the pandemic, other outlets - family doctors, dentists, eye care, specialists, elective procedures - are almost totally squeezed out by the sheltering requirements in place to stem the pandemic.

Tenet, responding to questions about the 401(k) announcement, reiterated that the move was a postponement until a later time this year, not a cut, cancellation, or elimination.

“Our most important mission right now is to provide the best possible support for our hospitals and other care facilities so they can continue to deliver life-saving treatment to fight COVID-19 and many other illnesses and conditions,” the company stated. “Every effort is being made to help bring us all through this crisis, and we have made the decision to direct additional resources to meet the increased demand for healthcare services, address evolving patient needs in our hospitals and protect front-line staff."

That’s one company illustrating the business problems healthcare companies are facing right now.

Sam Pierce is the immediate past president of the American Optometric Association and practices in Trussville. Like others, he is navigating the shutdown from his own offices while watching what is happening around him.

“The economics at every level of this has yet to be felt,” he said. “Everyone wants to be back to normal as soon as possible. I’m not sure everything will ever be normal again.”

As Pierce explained, a lot of the healthcare industry includes providers doing routine or specialized care that has been put on an indefinite hold. That affects not only the provider, but the people who work with them. It affects private, corporate and commercial practices, all around Alabama and beyond.

“If you’re a plastic surgeon and 90 percent of what you do is elective – you’re on hold. The hospitals won’t give you access to the operating rooms. That trickles down to every single person in your practice, including the one answering the phone," Pierce said.

More than 10,000 communities around the U.S. have at least one doctor of optometry, he said.

Karen Vanoy, an optometrist at Eyecare Associates in Homewood, would typically see as many as 20 patients a day before the outbreak. Now, like other specialists, she comes into the office for three hours a day on weekdays in case any patients need urgent care - something that could be potentially sight threatening. Last week, she saw two people. For the first time, she wore a mask during an exam.

As she explained, the pressure she feels comes from several directions. There is no way to generate revenue other than emergency procedures. There are the patients she isn’t seeing now, and the rescheduling of potentially hundreds of patients over the coming months, once restrictions are lifted. Finding a routine in all of that will be difficult.

And while she isn’t working with patients struggling to breathe from COVID-19, she is a healthcare provider “on the front lines.”

“You can’t do eye care six feet away from someone,” she said.

Some companies are adapting through telemedicine. Vanoy, for example, said her company is using a secure app to see some patients. Blue Cross and Blue Shield of Alabama, the state’s largest insurer, has expanded its telehealth benefit, while Aetna also announced it will offer zero co-pay telemedicine visits nationally for any reason through June for all commercial plans. United Healthcare offers telemedicine through its mobile app.

But Pierce said there is no template for what is happening to the business of healthcare right now. After the housing crash at the beginning of the 2008 recession, he remembers 30 to 40 patients a month cancelling appointments due to their financial situations. That was different from the current situation with virtually no patients.

“It’s quite frightening,” he said. “The average eye doctor’s office typically has enough cash flow in reserves to sustain itself for two to three weeks. Now you’re talking about four, six, eight weeks.”

The stress is similar to other businesses. Mortgage or rent payments come due. Utility payments. Lab bills. Payroll and payroll taxes, insurance for employees, 401(k) contributions all are due.

“I’m already seeing large numbers of offices that are having to furlough their staffs and say, 'I’ll hire you as soon as we have patients coming in, because there’s no way to cover that,” Pierce said. And as Vanoy said, doctors can’t make money without staff.

“The staff makes everything go,” she said.

But the stress extends even to large hospitals. A primary reason for the extreme coronavirus sheltering procedures that have shut off large patches of the economy is the need to relieve stress on overtaxed hospitals. Flattening the curve, though, also flattens the amount of revenue coming in from elective procedures - basically, the lifeblood.

That’s why part of last week’s $2 trillion stimulus package signed into law included more than $100 billion in emergency funds for hospitals and health care providers for lost revenue.

Monica Aswani, assistant professor in UAB’s School of Health Professions, said healthcare companies are making hard choices at a time when they are “massively hemorrhaging money that would be coming in.” The choices right now may be between delaying 401(k) contributions and furloughs.

But at the same time, Aswani said, there is something good about that.

“To hospitals’ credit, across the nation, they’re weighing the trade-off between losing significant reimbursement versus how to take care of the country during an unprecedented pandemic, and they’re choosing the latter over their own profit,” she said. “They recognize the moral imperative to contain coronavirus, which is notable since many organizations may only be able to sustain their current operations for a few weeks.”

There will be many other business issues going forward, once restrictions are relaxed. Will patients feel safe immediately going to practices for care, or will they wait and see? Will the country still be dealing with mass unemployment into the coming months, with patients foregoing care without insurance or in attempt to save money?

“If all those people are still unemployed, the last thing they’re going to think about is routine healthcare,” Pierce said. “A lot of normal things are going to be put aside until everything feels back to normal.”