Banner Health warned of a major spike of COVID-19 cases over the past few weeks in Arizona as the state opened back up and eased social distancing guidelines.
Arizona’s COVID-19 hospitalizations are rapidly increasing and raising potential capacity concerns, the system said.
“As of June 4, there were 1,234 hospitalized COVID-19 patients,” the system said in a statement. “About 50% of those patients are hospitalized in Banner Health facilities.”
Banner officials said its ICUs have gotten very busy, and the system has been transferring patients and resources to avoid putting stress on one particular hospital. Banner Health operates 28 hospitals across six states, including several hospitals in Arizona. The health system’s update comes as other hospital systems are eyeing a potential resurgence of COVID-19 cases as states reopen their economies after months of stay-at-home orders.
“If these trends continue, Banner will soon need to exercise surge planning and flex up to 125% bed capacity,” the system warned.
The number of Banner Health patients in Arizona on a ventilator has also increased over the past few weeks, from 41 on May 22 to nearly 120 on June 3.
The system also attributed the increase in COVID-19 cases to a relaxation of the state’s stay-at-home order, which expired May 15.
The cases started to spike two weeks after the end of the order, which is the likely incubation period for the virus.
Banner emphasized that the public needs to continue certain behaviors like wearing a mask in public and social distancing in order to ensure capacity isn’t overwhelmed.
Hospitals not only have to worry about the prospects of a second surge of the virus in the fall but also a wave of pent-up demand for healthcare services put off due to the pandemic.
Banner Health, like all health systems, canceled or postponed elective procedures at the onset of the pandemic back in March. But health systems are taking small steps to resume elective procedures.
Banner Health has also taken steps to preserve its personal protective equipment (PPE), which has been in short supply across the healthcare industry throughout the pandemic. Banner was one of 15 healthcare systems to buy a minority stake in PPE domestic manufacturer Prestige Ameritech in the hopes of shoring up a supply chain that is traditionally reliant on overseas manufacturers.
Geisinger Health System has inked a 10-year technology agreement with Siemens Healthineers to access diagnostic imaging equipment and artificial intelligence applications.
The Danville, Pennsylvania-based health system said the partnership will advance and support elements of its strategic priorities related to continually improving care for their patients, communities and the region.
The medical technology company will provide Geisinger access to its latest digital health innovations, diagnostic imaging equipment and on-site staff to support improvements. Education and workflow resources will also be available, which will provide Geisinger staff with the ability to efficiently make decisions and continually optimize workflows, the companies said.
Siemens provides AI-based radiology software that analyzes chest CT scans, brain MRIs and other images as well as AI-based clinical decision support tools and services to help advance digitization.
Financial terms of the deal were not disclosed.
“By expanding our relationship with Geisinger, this becomes one of the largest value partnership relationships in North America and will allow us to work together to improve the patient experience for residents of Pennsylvania and the region,” said David Pacitti, president and head of the Americas for Siemens Healthineers, in a statement.
“Making better health easier by bringing world-class care close to home is central to everything we do at Geisinger,” said Matthew Walsh, chief operating officer at Geisinger. “This partnership will allow us to continue to equip our facilities with the most advanced diagnostic imaging technology in the market to care for our patients.”
Michael Haynes, associate vice president of operations, Geisinger Radiology, said the collaboration with Siemens will enable the health system to identify and respond to health concerns more quickly.
Geisinger operates 13 hospitals across Pennsylvania and New Jersey as well as a 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine.
Partnerships between health systems and tech companies are becoming fairly common as the healthcare industry pushes forward to use data analytics, AI and machine learning to improve clinical diagnosis and better predict disease.
Mayo Clinic announced a high-profile, 10-year strategic partnership with Google in September to use advanced cloud computing, data analytics, machine learning and AI to advance the diagnosis and treatment of disease.
Providence St. Joseph Health inked a multiyear strategic alliance with Microsoft to modernize its health IT infrastructure and leverage cloud and AI technologies.
In a second round of cuts, Renton, Wash.-based Providence plans reduce the salaries of 1,200 high-paid medical providers to help offset losses from the COVID-19 pandemic, according to OregonLive.
The health system said the pay cuts will begin July 5 and will last three months. The salaries will be restored after that three-month period.
The 1,200 providers will see their salaries reduced based on their current compensation level. Providence said that providers will see 10 percent to 17.5 percent reductions, or will have the amount cut to what they were paid in 2019, according to The Lund Report.
Providence told The Lund Report that reductions will be 10 percent for those earning under $150,000; 12.5 percent for those earning $150,000 to $300,000; 15 percent for those earning $300,000 to $500,000; and 17.5 percent for those earning more than $500,000.
It is unclear how the system will decide whether pay will be cut by percentage or 2019 salary level.
The latest round of belt-tightening comes after Providence announced in May mandatory furloughs and pay cuts for 600 high-earning employees, including executives.
Continuing our series of Gist member convenings to discuss the “Brave New World” that awaits in the post-pandemic era, we brought together a group of senior human resources and nursing executives this week for a Zoom roundtable.
Several themes emerged from the discussion. First, there was general consensus that the COVID crisis exposed a workforce that had become over-specialized and inflexible. Said one chief nursing officer, “Our workforce is much more brittle than we thought.” A key lesson learned is the need for increased cross-training—especially for nurses, and especially in critical care. Systems should work now to increase the supply of nurses comfortable in an ICU environment to enable hospitals to flex staff across settings and roles to deal with future waves of the virus.
Not surprisingly, layoffs were top-of-mind for many. Executives were of one mind on the need to safeguard clinical staff as much as possible, and many systems are now considering deep cuts to management and administrative ranks: “It’s easier to stand in front of your clinical staff and be able to say you’ve stripped millions from administration before turning to clinical cuts.”
There was broad consensus for the potential for artificial intelligence and robotic process automation to enable greater reliability and productivity at lower cost in areas such as billing, coding, and even some clinical functions—and that the pandemic will accelerate plans to implement these solutions.
On a more optimistic note, one executive shared that “relationships between clinicians and administrators have never been stronger. The pandemic has forced us to have difficult and constructive conversations we would have never had the courage to have before.”
Another noted the pandemic has spotlighted new leadership talent who might otherwise have been overlooked, and plans are now in place to formally recognize and retain newly crisis-tested talent for the work of restructuring the system.
On the whole, the discussion was far more upbeat that we had expected—as difficult as the crisis has been for many teams, the opportunity to rethink old ways of doing business seems to have created renewed enthusiasm even in the face of daunting financial and operational challenges ahead.
Nurses at 15 HCA hospitals represented by National Nurses United protested last week, saying the for-profit hospital chain threatened layoffs. Nurses took to the sidewalks outside of their hospitals with signs, after they said they were told to expect cuts to benefits and staff if they didn’t give up negotiated wage increases.
In an emailed statement, HCA said it had no plans for layoffs.
“The facts are that non-represented colleagues across the HCA Healthcare enterprise are taking pay reductions and non-represented colleagues are giving up wage increases this year. HCA Healthcare has made these tough decisions in order to preserve jobs. To be equitable to all of our colleagues across the enterprise, we recently reached out to unions, with the hope that during this time of crisis, they would support the same measures for our unionized employees to minimize the impact on your compensation and employment status. … If the (National Nurses Organizing Committee) and/or (Service Employees International Union) reject our proposal, colleagues represented by these unions will no longer be eligible for continued pandemic pay, may be subject to layoffs and may face other benefit changes.”
Nurses interviewed by MedCity News said they were asked to give up other benefits.
Zoe Schmidt, a registered nurse who works at Research Medical Center in Kansas City, said they were also asked to forego their 401(k) matching for the year and shift differential pay, or increased compensation for nurses that work night and weekend shifts.
“We’ve been fighting back against that. At my hospital, it does seem like they’ve backed down on wage freezes and 401(k) matching (changes),” she said.
Though Schmidt hasn’t seen any evidence of impending layoffs, she said she was worried about staffing changes that could push the number of patients past four or five per nurse for the medical surgical unit where she works.
“We’re not overstaffed by any means,” she said.
Juan Anchondo, who has worked as an RN for 16 years at Las Palmas Medical Center in El Paso, Texas, said nurses were told to expect 10% layoffs.
“The way they word it, it sounds like layoffs are imminent,” he said. “They wouldn’t be specific to which departments or which hospital.”
In the last two weeks, as the hospital started to reopen, he said his medical-surgical unit quickly expanded from 20 beds to 26 beds.
“We were barely keeping up with what we could with 20 beds available,” he said. “All of a sudden, when we had four nurses scheduled on the floor, all of a sudden four nurses, is that enough to cover 26 beds?”
Like other hospital systems, HCA has seen reduced volumes during the Covid-19 pandemic, with canceled elective procedures and patients nervous to come into the hospital.
The health system’s revenue was up during the first quarter to $12.86 billion, but its profits were down nearly 45% from the same period in 2019, for a total of $581 million.
For employees affected by low patient volumes, HCA said it had been offering them pandemic pay, giving them 70% of their base pay for hours not worked.
To offset its losses, the company cut salaries for 11,000 of its corporate staff, suspended stock buybacks and its dividend, and delayed certain capital projects.
During the company’s first quarter earnings call, CFO Bill Rutherford said the company had received $700 million in CARES Act payments, as well as roughly $4 billion in accelerated Medicare payments and $75 million per month in deferred social security payroll taxes.
In an emailed statement, HCA said the negotiations with unions had solely been about their wage increases and the health system’s pandemic pay program.
“At a time when hundreds of hospitals across the country are laying off and furloughing employees, HCA Healthcare has not laid off or furloughed a single caregiver due to the pandemic and we hope to avoid doing so in the future,” the company said in an emailed statement. “Throughout the pandemic, our goal has been to protect our colleagues’ jobs and to continue the pandemic pay program for all, including those represented by labor unions. But the unions’ rigid position on wage increases means we will likely have to make other adjustments that will affect the colleagues they represent.”
National Nurses United represents 10,000 HCA nurses across six states.
A new analysis from the CDC this week confirmed what we have been hearing anecdotally from health systems for several weeks—as the coronavirus lockdown took hold, there was a precipitous drop in visits to hospital emergency departments. According to the study, visits were down by 42 percent in the month of April compared to the previous year, and despite a rebound in May, were still 26 percent lower than a year ago. Visits in the Northeast dropped the most, as did those among women, and children under 14.
Although visits for minor ailments and symptoms declined the most, even more disconcerting was the drop in visits for chest pain, echoing the concern we’ve heard in many parts of the country that many patients may have suffered minor heart attacks without being treated, or may have waited to be seen until significant damage had been done.
As non-emergent visits have begun to return to many facilities, we continue to hear that emergency department and urgent care volume remains relatively low.
Survey data indicate that patients are fearful of becoming infected with coronavirus if they visit healthcare facilities—especially, it seems, ones where they’ll be forced to wait.
While many providers are investing in messaging campaigns to assure patients it’s safe to return, this nightmarish first-person account by one healthcare insider provides a useful cautionary tale.
Visiting a surgeon for a pre-op consult, she found the experience of visiting a COVID-era hospital downright dystopian. Simply touting safety precautions by itself won’t make patients more comfortable—they’ll need to see and feel that measures are in place to make time spent in a care setting as efficient and reassuring as possible. Otherwise, like the insider in question, they’ll take their business elsewhere. There’s work to be done.
After months of lock down, hospitals are eager to get patients back for routine care and elective procedures.
An executive at a Palm Beach hospital stands between a box of surgical masks and a Purell dispenser.
“We understand you haven’t been inside our hospitals for some time,” she says to the camera. The executive is delivering her line for a promotional video intended to get people back to hospitals after almost three months of avoiding the place at all costs.
Moments later, the film crew records her chatting with a vascular surgeon in an idled operating room, who soothingly reassures that a hospital is the cleanest place to be outside your home. “The hospital is safer than the grocery store,” the doctor says.
The video published on YouTube in mid-May is part of a marketing campaign by Tenet Healthcare, which operates 65 hospitals and about 250 ambulatory surgery centers. It’s one attempt to solve a problem the entire health-care industry faces: Most patients vanished when Covid-19 swept the country.
Billions in Losses
Much of routine health care came to a halt in March as hospitals cleared space for an expected wave of Covid-19 patients and authorities ordered a halt to surgeries and other procedures that could be postponed. The decline in volume has clobbered hospital finances, with the industry estimating it is losing $50 billion a month.
Emergency visits dropped by 42% in four weeks in April compared to the same period last year, the Centers for Disease Control reported June 3. The number of U.S. patients getting hospital care dropped by more than half in late March and early April compared to 2019, according to data from Strata Decision Technology, which provides software to hospitals.
Some of that rebounded modestly in May as distancing rules eased, but hospital volume is nowhere near pre-Covid levels. With the pandemic ongoing and many states still confirming hundreds of new cases daily, patients are hesitating to rush back to hospitals.
“The main thing that really is a gating factor at this point is patient comfort,” Tenet President and Chief Operating Officer Saumya Sutaria said at a recent virtual conference with investors. Tenet declined interview requests.
Free Masks
To counter the public’s fears, hospitals publicize what they’re doing to keep patients safe. They’re handing out masks at the door and spacing out chairs in waiting rooms. They’re steering Covid-19 patients to dedicated sites and testing staff regularly.
Hospitals need to show patients that their facilities are safe. At Catholic hospital chain Trinity Health, that includes moving patients through “Covid-free” zones with separate doors, elevators and waiting areas.
“We can put all of the outreach and marketing in place, but it’s only as effective as the people who execute those strategies,” said Julie Spencer Washington, Trinity’s chief marketing and communications officer.
The question for the entire industry is how quickly patients come back. The answer will depend on a constellation of related variables, including how reluctant people are to resume care, and the course of the pandemic. Future surges could force hospitals to shut down regular care again — and spook patients further.
Hospitals and doctors are going to have to do as much as they can as fast as they can until they can’t anymore,” said Lisa Bielamowicz, co-founder of consultancy Gist Healthcare.
Many patients, on the other hand, are in no rush. “They’re waiting and watching rather than pulling the trigger and going to see the doctor like they would have in the past,” Bielamowicz said.
The calculation for the health-care industry is different than for many other service businesses resuming operations. A hospital procedure or even a check-up is more intimate than a meal out.
For procedures that require in-patient rehab stints for recovery, the havoc Covid-19 has brought to nursing homes adds another layer of concern. “Those places seem like deathtraps now, so it’s much harder to bring back those patients because you need to find an alternative way for them to rehab,” Bielamowicz said.
And the biggest consumers of health care are the elderly and the chronically ill, the very people Covid-19 most threatens. “From personal discussions with my patients, the older and more co-morbidities that any individual has, the more nervous they are about returning,” said Shauna Gulley, chief clinical officer at Centura Health, which has hospitals in Colorado and Kansas.
Patients with serious ongoing needs like cancer treatment or emergencies like heart attacks and strokes have continued to get care. And many medical problems resolve on their own. The decline in those visits – for a migraine headache, for example – reduces providers’ revenue but may not harm patients in the long-term.
While people often go to the emergency room for needs better treated in other settings, now the concern is the opposite: That true medical emergencies will be neglected.
Ascension, the nation’s largest Catholic hospital chain, has purchased billboards that say “Don’t delay ER care.” On hospital websites and social media posts, Tenet facilities reminded patients that “Emergencies Can’t wait. We’re Open & Safe.”
Deferred Care
Doctors fear that some patients will defer needed care too long, allowing progressive conditions to deteriorate. Clinicians at Maimonides Medical Center in Brooklyn, New York, have seen patients arrive sicker because they didn’t come earlier, said Ken Gibbs, the hospital’s CEO.
“There are unmet needs, I think that’s clear,” he said. “And I think the data on that will emerge, but it will take time.”
Maimonides treated 471 Covid patients at the peak on April 9, Gibbs said, and still had about 100 in late May. The hospital has applied for a waiver from New York State to resume elective surgeries, which are still on hold in New York City.
Some hospitals are preparing for a lasting dent in their revenue. For years, health economists have pointed to waste in the health-care system, with the estimated cost of unnecessary treatments in the hundreds of billions of dollars. Covid-19 may demonstrate that patients are willing to forego some of that care or opt for more conservative treatment.
People who had delayed back surgeries, for example, may now decide that doing physical therapy at home is good enough, said Marvin O’Quinn, president and chief operating officer at CommonSpirit Health, a large Catholic hospital system.
“We’ve all talked about too much intervention in health care in the past,” he said. “I think we’ll see a new normal in terms of what patients want to do and what doctors want to do, and we will have to adjust to that.”
Lucy Dadayan of the Urban-Brookings Tax Policy Center breaks down the good, the bad and the ugly of the fiscal crisis facing states as the coronavirus pandemic crushes revenues and raises costs.
“Prior to the onset of the COVID-19 pandemic, most states were generating solid revenue growth. And many built up robust rainy day funds. But the pandemic has largely wiped out earlier revenue gains and most states now anticipate substantial revenue shortfalls for the current fiscal year and for fiscal year 2021,” she writes.
The good: Preliminary April tax revenue data show a steep drop in estimated and final annual tax payments as the tax-filing deadline got pushed back from April 15 to July 15. But taxes withheld from paychecks grew in 17 states compared to April 2019. “Tax withholding is usually a better indicator of the current strength of the economy and of the path for personal income tax revenue because it comes largely from current wages,” Dadayen explains. On the other hand, 16 states reported declines of less than 10%, while five states posted double-digits drops, so the bright spots are limited.
The bad: “Declines in sales tax revenues have been fast, steep, and widespread across the states,” Dadayen writes. How steep? April sales tax revenues fell by 16% across 42 states for which the Tax Policy Center has complete data. Twenty-three states reported double-digit declines, while just five states reported year-over-year growth. And since the April data mostly reflect March sales, the May numbers are likely to be even worse.
The ugly: For the fiscal year so far, total state tax revenue has fallen sharply — and next year is expected to be worse. “With two months remaining in the fiscal year for 46 states, total state tax revenues are now down about $57 billion, compared to last year,” Dadayen writes.
After the sharp pandemic-related plunge in April, tax revenues have fallen in 34 states compared to 2019 and risen in 12. (NewYork, the state hit hardest by the virus, is surprisingly among those dozen, but Dadayen says that’s only because its fiscal year 2020 ended in March, so April’s devastation isn’t reflected in the data. The state reported that net taxes and fees collected in April, the first month of its new fiscal year, fell by 69% compared with April 2019.)
At least 13 hospitals in Oklahoma have closed or experienced added financial distress under the management of private companies. Some companies charged hefty management fees, promising to infuse millions of dollars that never materialized.
Revenues soared at some rural hospitals after management companies introduced laboratory services programs, but those gains quickly vanished when insurers accused them of gaming reimbursement rates and halted payments. Some companies charged hefty management fees, promising to infuse millions of dollars but never investing. In other cases, companies simply didn’t have the hospital management experience they trumpeted.
Click on link above for examples of rural hospitals that pinned their hopes on private management companies that left them deeper in debt. They are based on interviews, public records and financial information from the Centers for Medicare and Medicaid Services and the American Hospital Directory.
HENRY KOTULA 