The South Dakota-based health system has suspended talks related to its planned merger with Utah-based Intermountain Healthcare after the sudden departure of its CEO, Kelby Krabbenhoft. Sanford and its new CEO will instead focus on organizational needs, the system said.
The decision to halt merger talks comes about two weeks after Sanford Health and President and CEO Kelby Krabbenhoft mutually agreed to part ways. Krabbenhoft led the 46-hospital system for 24 years, assuming the top position in 1996. A press release noted his contributions to the Sioux Falls, South Dakota-based organization’s growth from a community hospital into a large rural nonprofit spanning 26 states.
Sanford Health did not give an official reason for Krabbenhoft’s sudden departure, but days before the announcement, CNN obtained an email sent by the former CEO to health system staff telling them that he had contracted Covid-19 and recovered. He also said he would not be wearing a mask.
Krabbenhoft said there was “growing evidence” of immunity to the new coronavirus and that wearing a mask “sends an untruthful message that I am susceptible to infection or could transmit it. I have no interest in using masks as a symbolic gesture,” CNN reported. But evidence regarding immunity after recovery from Covid-19 is still limited and some reinfections have been reported.
Bill Gassen, previously serving as chief administrative officer, succeeded Krabbenhoft as the organization’s new leader.
The health system decided to stop merger activity to address other organizational needs as Gassen takes over, according to a press release.
“With this leadership change, it’s an important time to refocus our efforts internally as we assess the future direction of our organization,” Gassen said in the press release. “We continue to prioritize taking care of our patients, our people, and the communities we serve as we look to shape our path forward.”
Sanford and Intermountain declined to comment on whether the organizations are planning to resume talks in the future.
“We are disappointed but understand the recent leadership change at Sanford Health has influenced their priorities,” said Dr. Marc Harrison, president and CEO of Salt Lake City-based Intermountain Healthcare, in the press release. “There’s much to admire about the work that Sanford Health is doing. We continue to share a strong vision for the future of healthcare.”
Had the talks continued and the merger been approved, the combined organization would have included 70 hospitals, 435 clinics and 233 senior care locations. It was expected to generate about $15 billion in total annual revenue.
Intermountain’s Harrison was slated to serve as the combined system’s leader, while Krabbenhoft was to serve as president emeritus.
They have been at this for almost a year. While politicians argued about masks, superspreader weddings made the news, a presidential election came and went, and at least 281,000 Americans died, nurses reported for work. The Post asked seven ICU nurses what it’s been like to care for the sickest covid patients. This is what they want you to know.
As of Dec. 7, Idaho has seen 110,510 total confirmed cases, 1,035 deaths, and 477 people are currently hospitalized with the virus.
Kori Albi, 31
Covid unit intensive care nurse and unit supervisor, Saint Alphonsus Regional Medical Center
Our staff are getting sick. Our physicians are getting sick. And they’re not getting it from the hospital. They’re getting it from the community. We are almost lucky to care for the covid patients because we know who they are. Anytime we go into these rooms, we know exactly what we need to do. We have all the PPE we need. And as long as we are diligent and follow all the processes that are in place, we can keep ourselves safe. That’s not what worries me at all. Going out into the community is scarier than coming into work every day. Because you don’t know who has it.
This virus has caused this feeling, this sense of isolation. The covid unit is an isolated desert. Every door is shut. Every room has negative airflow. By the time you put your N95 mask on and then your surgical mask over the top of that, then you put your isolation gown on and your face shield on top of that, you can’t tell who is who. So much of health care is about that personal touch — now, our patients can’t even see our name badges because they are on under our gowns. All they see are our eyes through our face mask.
A lot of families are hesitant to have Zoom calls with patients because it can be uncomfortable and awkward. Especially if these patients are sedated and intubated. There’s always that awkwardness of: Can they hear you? Can they not hear you? Even as nurses, we feel like we’re talking to the wall. But we talk to them just as if they were awake. Allowing families to play their music that they like or pray with them or just talk to them can absolutely help. You see vital signs change.
One patient, all she wanted to do was have her son sing her a song. I think I spent over an hour in the room listening to him play the guitar and sing her a song. He sang her mostly hymns.
Death is a very intimate event that normally involves a lot of family members that help bring closure and that helps everyone process. In normal circumstances, health care providers form these relationships with the family at the bedside. All of that has been removed. And we now have to try to form those relationships over the telephone. It’s a traumatic experience. And it’s a long drawn-out process. A lot of people don’t make it out of here. It’s a slow, lonely death.
The amount of death with covid is profound. As nurses, we have learned to process death, but the amount of death has happened in such a short span of time — that’s what’s been overwhelming. I had a patient that we did a Zoom call with. His four-year-old granddaughter lived with him. And she brought tears to the room. The naivete of a four-year-old. Her grandfather was intubated so he couldn’t talk. But he could kind of look around the room. But the innocence of her, saying, “Come home, Pa. I miss you, Pa. I love you Pa,” all through a video screen. The 14-year-old that also lived with them couldn’t formulate words to say anything, and he didn’t know what to do or say in that video. But the four-year-old was telling Pa to come home.
JACKSON, MISS.
As of Dec. 7, Mississippi has seen 166,194 total confirmed cases, 3,961 deaths, and 1,157 people are currently hospitalized with the virus.
Catie Carrigan, 28
ICU, University of Mississippi Medical Center
There are some patients who have been in their younger 20s and their younger 30s, and I think maybe those are the hardest cases. They have families and they have kids just like I do, and it’s hard coming into work and taking care of them. Knowing they’re supposed to be going to college, they’re supposed to be getting married, they’re supposed to be having kids and, instead, they’re laying in a hospital bed on a ventilator fighting for their life.
They have their whole entire lives ahead of them, and then they get hit with this disease that everybody thinks is a hoax and then they die.
I worked in the ER a month ago, so I know exactly what’s going on down there, and now I work in the ICU, so I know exactly what’s going on on both sides of it. There are no ICU beds in the hospital. None. When there are no ICU beds, we hold them in the ER, or we hold them in the PACU (post-anesthesia care unit). The ER still has to treat our trauma patients, our car accidents, our gunshot victims. So when we have those ICU holds in the ER, it obviously makes the jobs of nurses and doctors in the ER way more difficult than it needs to be. We are treating patients in the hallway. They’re just trying to do the best they can with the resources that we have.
There is no room left, essentially, and I think that’s really what people don’t seem to understand. And I get it, when you’re not in health care you don’t really see our side of it, but we’re seeing the worst of it. It’s hard for us to convey that to the public because they don’t seem to want to take our word for it — but take our word for it. Take our word for it.
IOWA CITY
As of Dec. 7, Iowa has seen 244,844 total confirmed cases, 2,717 deaths, and 898 people are currently hospitalized with the virus.
Allison Wynes, 39
Medical intensive care unit, University of Iowa Hospitals and Clinics
I cry every day when I walk in to work, and I cry every day when I walk to my car after work.
You get it out of your system before you show up and you do your job and you’re fine. Then, you go home and you cry before you get home. And then you go home and be mom.
My 9-year-old daughter asks frequently, “Mommy, how many patients were there today? Mommy, how many sick ones were there today? Were you safe? Was everything okay? Do you have to go to work again? How many patients?” She gets it.
I think one thing that people do not appreciate is it’s not only the number or volume of patients that comes through — it’s the level of care that they require, which is so much greater than a standard patient in the ICU or a standard patient in the floor, because they can get very, very sick very quickly.
We were walking a patient who was on ECMO, which is extracorporeal membrane oxygenation, and it took five people to walk her. That’s not normal.
I work in the MICU, so it’s never like a party up in here, but it used to at least be, nine times out of ten, calm and controlled and tidy and clean. Occasionally stuff would go bad and we would all run and help, and then we would all go about our days. Now it just feels like, especially of late, there is equipment everywhere. There are gowns everywhere. There are gloves everywhere, there are people everywhere, and there are fires everywhere.
I’m actually scared, and I’ve never been scared at work before. I am scared that we will lose control.
It’s the human resources we are running low on. We can make a bed, we can find a ventilator, we have PPE. But it’s the human cost of caring for these patients that has been keeping me up at night the past couple of weeks and really making me nauseous every day.
I didn’t think it would be over by now, but I didn’t think we’d be getting hit this hard this late. I thought we’d still just be smoldering. I didn’t know that we would just be a raging fire at this point in time. We’re not prepared for that, but here we are.
After this, I’m going to take my kids to a beach or somewhere.
GLENVIEW, ILL.
As of Dec. 7, Illinois has seen 796,264 total confirmed cases, 14,216 deaths, and 5,190 people are currently hospitalized with the virus.
Luisa Alog Penepacker, 51
ICU, Glenbrook Hospital
I’ve taken care of a lot of husband-wife patients, unfortunately. One of the cases was one in which the husband had tested positive for covid first, but he was a mild case. She was a little bit more serious. She ended up on our unit.
The husband ended up in the hospital the next day, but he was on the step-down unit. When I admitted her, she was terrified, especially knowing that her husband was upstairs in another unit. She was having a hard time breathing, and she grabbed onto my hand and looked at me. She goes, “Am I gonna die?” I mean, I didn’t know what to say. And I just told her, “Not on my watch.” So we just kept on going. But unfortunately, she got intubated the next day.
Then I was sent to work upstairs on the step-down unit. I had her husband that next day, and he was actually quite happy that I saw her. He goes, “You took care of my wife, how is she? I heard that she’s not doing well.” I didn’t know what to say to him, either. I just said, “You know, she’s in the best of care. We’ll take really good care of her.” And he looked really relieved. He goes, “I’m just so glad that someone who had seen her is here now to talk to me.” And my heart broke with that.
She ended up passing. A few days after, he went home, and I didn’t see him, so I don’t know how he took it. He wasn’t able to see her before she passed.
We wear personal air purification respirators on our heads — these big white domes over our heads with a respirator hose going to a machine strapped around our waist, and we look like astronauts walking through the unit, going in and out of patients’ rooms with our plastic gowns and gloves.
It can be frightening to family members if they’re allowed to come to visit and definitely for patients because we’re kind of scary-looking. It can be frantic at times. You walk through the hall, and you see a lot of patients on ventilators. You hear a lot of beeping. People are rounding constantly to check on patients. It’s a busy place.
You don’t know what to tell family members when you see them. What can you say? You just say, “I’m sorry.” You can’t even hug them. I used to be able to hug family members, but you can’t with all the gear.
When patients are scared, I will hold their hand even though I’m wearing gloves. I look them in the eyes as much as I can because really, that’s all you can see. You can’t see our faces. You can barely even hear past the mask. So I’ll make sure to look at them. I try to make an effort to smile with my eyes and to just hold their hand if they need it.
MURRAY, UTAH
As of Dec. 7, Utah has seen 215,407 total confirmed cases and 939 deaths.
Tammy Kocherhans, 41
Respiratory ICU, Intermountain Healthcare
These patients are different than the typical patient. They’re very complex. They can change in the blink of an eye. And it’s very hard as a nurse when you wrap your heart and soul into taking care of these patients. I started noticing that I was emotionally tired. I was physically completely exhausted. And I was beginning to question whether or not I could continue forward being a nurse at all. I was past my physical capacity.
I happened to be working a day where another health care worker who was a veteran said that this was like a combat zone, and for some reason in my head, that validated the way that I was feeling. So I reached out to one of my best friends who is a veteran, a flight medic, and he said, “I meditate and do yoga.”
Once I started doing that, I was able to handle the emotional crises, the physical pain of working so, so many long, hard hours. We do something called proning, where you take patients and flip them over onto their bellies. And that sounds really easy, but it takes a team of a minimum of five people. It is extremely taxing on your body. It hurts. And I lift weights! The meditation and yoga really has saved my life, my mental capacity, my spiritual capacity, my physical capacity, everything that is required to give to these patients.
Hopefully by 8 p.m., I’m out in the parking lot and spend a minute in my car to unload from my day. It’s all about taking a moment to breathe for myself and then going through whatever came up that day that I need to let go of. It depends on how complicated my patient was that day, whether I can let my whole day go or if I have to spend time to go through each piece and work it down to: What did I do right? Did I miss something? Sometimes I just can’t let some details go quickly, and I have to work them down to allow myself to say I did everything that I possibly could for this individual this day, in this time, in this situation. And whatever the outcome was or is, I followed protocol. I did everything that I knew how to do. And it’s going to be OK.
I find it very frustrating when I go out and about on my days off and I see people very blatantly not wearing masks or trying to tell me how come they don’t work or telling me that this pandemic isn’t real. I find it completely disrespectful to the work we do to save people’s lives, to have people think that this pandemic isn’t real, to show utter disregard for people around them, not trying to do their part.
And I really wish that I could take people on a day with me so that they can see what I see. So that they can feel your feet ache so bad that you wish they’d just fall off, because you’re on that concrete for so many hours. Your back aches because you’re wearing equipment to save your life — so that you can save somebody else’s life. And your head hurts. I’ve never had so many headaches in my life because part of the equipment sits on your head, and after 12 hours, it starts to exert so much pressure that you start to have a headache, and you’re dehydrated.
Early in the pandemic, I remember walking into this room, and this young patient was crying and asked me if they were going to die. And I’m a mom of teenagers. For me, that was awful because this patient was all alone, and we as staff were minimizing contact because we didn’t want to get the virus.
This patient started physically trembling in the bed. I couldn’t take it anymore, and I went over and just held this patient because that’s what I’d want somebody to do for my children. That was my first patient that I held like that. And there have been many since.
MURRAY, UTAH
As of Dec. 7, Utah has seen 215,407 total confirmed cases and 939 deaths.
Nate Smithson, 28
Respiratory ICU, IntermountainHealthcare
A few weeks ago, my wife and I were on a date at a restaurant. And in the middle of nowhere, I had this panic attack and went and hid in the bathroom stall for half an hour. I have no idea what brought it on. I just couldn’t handle being there right then, which was weird for me. That’s the first time anything like that has happened. But since then, it’s happened multiple times, where the anxiety and stress is overwhelming, and I can’t handle it. So I have to go and excuse myself for a little bit.
Balancing work and life is something that used to seem possible. Now it doesn’t seem like there is any difference between the two. I fall asleep and I dream about my patients.
When we got our first covid patient in February in the hospital, in the ICU, we all kind of thought it was a little bit of a joke, to be honest. I had this patient, and he was sitting there with minimal amounts of oxygen in the room just watching TV. He’s like, “I’m fine. I don’t know why everyone’s freaking out about this.” And I thought the same thing. And then a few hours later, he stands to go pee, and I’m looking at his monitor. And it drops down to the low 90s. Ninety-two is about as low as you want to go. And then it starts dropping down lower, to about the 70s. Then it gets down into the 60s and 50s. And that’s dangerous territory. That’s where brain cells start dying and you start having some serious problems.
I run into the room. We get him back into bed and throw all the oxygen that we have in the room on him, crank everything up, and he’s not recovering from it. We had to intubate right then and there. And about an hour later, he finally starts recovering a little bit. But at this point, he’s sedated, he’s on the ventilator. Everything is worse. And that’s the first time where it’s like: Oh, crap, this is serious. This is something else. I’ve never seen anything like that before.
If a patient’s heart stops or if they stop breathing, we call a code blue, and that’s when the doctor, respiratory therapist, nurses, everybody comes into the room. We start chest compressions or CPR or that kind of stuff. This one patient’s heart is not working. So I call the code blue. We all get in there. We start doing the chest compressions. Five minutes later, we get the patient back. We all go back about our work. Twenty minutes later, same thing happens again. We start doing the chest compressions. We start pushing medications as fast as we can to get the patient back again.
The spouse comes into the hospital. I explain: “Just so you know, this is what happened before. It could possibly happen again. If it does, I’m going to need you to step outside of the room.” And as I’m explaining this, sure enough, it happens again. We lose the pulse. We lose the heartbeat. So I ask her to leave the room. Everyone gets in there, and we start going for it. We went for almost two hours: chest compressions, pushing medications, shocking the patient’s heart.
The doctor is ultimately the one who makes the decision about when we stop, and they call time of death. But typically in situations like that, where it’s unexpected and sudden, they want to make sure that everybody can go home that night feeling OK about what they did, knowing that they did everything. And after an hour, he stops, turns to the room and asks: Does anyone have a problem with us stopping?
I didn’t have a problem, but then as he’s saying that, I look out the window, and the patient’s wife is just watching us. She’s been sitting out there watching us for an hour, and no one’s saying anything.
And I ask them to keep going.
So we did. We went almost for another hour after that, and we didn’t get the patient back. He ended up dying.
But I think for me, that was important — to keep going. Not because we thought we would get them back, but so that his wife would know that we did everything we could.
I still go to bed with her face kind of burned into my mind, of just seeing her sitting out there watching us, and that’s what kills me.
COLUMBUS, OHIO
As of Dec. 7, Ohio has seen 475,024 total confirmed cases and 6,959 deaths.
Kahlia Anderson, 32
ICU, Ohio State University Wexner Medical Center
I graduated from nursing school in May 2019. I started here at the Wexner in August. Our orientation is a 20-week program, and so I came out on my own Jan. 12, 2020. The pandemic hit us at the end of February.
In nursing school, I think your biggest fears are making med errors, or harming your patient in some way, or just not knowing how to do everything. Did I check my patient’s blood pressure before I gave this blood pressure medication, or did I give the correct dose of a specific medication? I had heard stories about that on the unit, like make sure you’re careful with the needle stick, or make sure you’re careful with this medication. And I don’t even think about those kinds of things anymore.
Now it’s the fear of the unknown. It’s the fear that anything could happen because of this virus and my patient could die regardless of what I do.
When I got my first covid-positive patient, I remember thinking: Somebody did the assignment wrong because there’s no way that they believe that I should be taking care of this patient. I can remember the feeling. I can remember the day. It was a weekend. I was on a day shift. And I was thinking to myself: Who trusted me, the new nurse to take care of a covid-positive patient? How am I going to do this? How am I going to keep this patient safe? How am I going to keep myself safe? Am I safe? Wait, who cares about me? Let’s get back to the patient. What do they need?
At the time, I didn’t even understand some of the ventilator settings because I was still that new, and it was still that fresh to me. And I thought: This machine is doing that much work for them, and I don’t know enough about it, but I’m going to make sure that I get it done and I’m going to figure it out today to make sure that this patient gets everything that they need. And I’m going to call their family and double check with them and check in with them and call them.
That patient is alive. That patient is no longer in the hospital. As far as I know, that patient is home and safe with family.
I would feel like: There’s someone more experienced. There’s someone more adequate to deal with this. And I was like — oh, it’s me. This is me, I’m doing this, and I’ve been doing it ever since.
I saw new nurses come out of orientation, and I saw the type of assignments that they would get. So my mind fixated on like: I’m going to get patients that are ready to transfer out. They can talk, they can eat. They’re just waiting for a bed on another unit. Or maybe it’s a patient who needs long-term care. So they’re waiting to go to a facility to be discharged. And so I was thinking to myself: I’m going to get my feet wet. It’s going to be great. I’m going to build up this experience, and then I’m going to start getting sicker patients, and I’m going to be ready.
Once covid hit, there was no room for those types of patients anymore. Everyone had covid, everyone was sick, everyone was intubated or approaching intubation.
And for me, I just wanted my first experience. I wanted to have the simple experience of building and getting better. But that’s not what was in store. And I can’t say that I’m upset about it today. I’m grateful for this experience. I don’t wish this pandemic on anyone. I wish it was not here. I wish that it was different. But as a nurse, as a new nurse, these experiences are unique to me. It’s making me a better nurse. It’s made me a better person, and I can only continue to just be.
We did cry in the beginning, and now not so much. I think we all struggled when we had a young death. Someone in their 20s was very difficult for us. Because you think: That was a young life. What a young life that was, and they’re not here anymore. Because of a virus. That’s hard. It’s very hard.
Hospitals across the country are reaching their breaking point on ICU and bed capacity as COVID surges, forcing many health systems to begin diverting patients from emergency rooms and ration care, Axios’ Orion Rummler reports.
What’s happening:
Pennsylvania: “Most hospitals in Montgomery County are at or near capacity,” county commissioners’ chair Valerie Arkoosh said in Norristown, Pennsylvania, last Wednesday.
Georgia: Major hospitals, including Grady Memorial and Emory University, have had to turn away patients brought in ambulances, the Atlanta-Journal Constitution reports.
South Dakota: The Monument Health Rapid City Hospital and Sanford USD Medical Center — some of the biggest in the state — say they have no more ICU beds, the Mitchell Republic reports.
Colorado: More than a third of hospitals across the state said in a survey they expect staffing shortages this week, Colorado Public Radio reports.
Context:White House coronavirus task force coordinator Deborah Birx noted on Sunday’s “Meet the Press” that U.S. hospitals are usually anywhere from 80 to 90% full in the fall and winter — and “when you add 10, 15, 20% COVID-19 patients on top of that, that’s what puts them at the breaking point.”
That brings the total number of enrollees to 2.9 million, a slight jump over last year but with more days to sign up over 2019.
During the fourth week of the 2020 open enrollment period, from November 22-28, 523,020 people selected plans using the HealthCare.gov platform.
That brings the total number of enrollees to 2,903,547 after the first four weeks of open enrollment. That’s an increase of 523,020 people from last year, which saw 2,380,527 consumers sign up for plans after the first four weeks.
It’s important to note, however, that in 2020 there were more days in this four-week period than last year, since the Centers for Medicare and Medicaid Services measures enrollment Sunday through Saturday. Nov. 1 was on a Sunday this year and on a Friday in 2019, so the first week of 2019 had only three days, while the first week this year measured a full seven.
The numbers are a dip from the third week of open enrollment, during which 758,421 signed up for coverage.
The HealthCare.gov platform is used by the federally facilitated exchange and some state-based exchanges. Notably, New Jersey and Pennsylvania transitioned to their own platforms for 2021, and due to this they’re absent from HealthCare.gov for 2021 coverage. Those two states accounted for 578,251 plan selections last year, 7% of all plan selections. These enrollees’ selections will not appear in CMS’ figures until it announces the state-based marketplace plan selections.
Open enrollment lasts six weeks and ends on December 14. Those who sign up within that time frame will see their coverage begin January 1, 2021.
WHAT’S THE IMPACT
This is the fourth snapshot of open enrollment figures by CMS during this sign-up period.
Of those selecting plans, 138,183 were new consumers, while 384,837 were renewing coverage. This brings the total number of new consumers to 659,455 since the beginning of open enrollment, while the tally for those renewing coverage now stands at 2,244,092. More than 4,386,530 consumers have been on the applications submitted to date.
A consumer is considered to be a new consumer if they did not have 2020 exchange coverage through Dec. 31 of this year and had a 2021 plan selection. They’re considered a renewing consumer if they have 2020 exchange coverage through Dec. 31 and actively select either the same plan or a new plan for 2021.
The numbers represent those who have submitted an application and selected a plan, net of any cancellations from a consumer, or cancellations from an insurer. The weekly metric represents the net change in the number of uncanceled plan sections over a given period.
Plan selections will not include those consumers who are automatically re-enrolled into a plan. To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. CMS did not report the number of effectuated enrollments.
In all, there were 1,749,555 HealthCare.gov users recorded during the fourth week, and 57,502 of the Spanish-speaking equivalent, CuidadoDeSalud.gov, bringing the four-week totals to 9,582,790 and 317,487, respectively.
To date, Florida tops in the number of plan selections over the first four weeks with 871,361 sign-ups, followed by Texas (471,849) and Georgia (198,090).
THE LARGER TREND
President-elect Joe Biden has said he is favorable to strengthening and expanding the Affordable Care Act, and favors a government-run public option to run parallel with private offerings.
But prior to Biden’s inauguration on Jan. 20, 2021, CMS may release a final rule based on a proposed rule it released late on Thanksgiving Eve to allow states to implement Section 1332 waivers to waive certain ACA requirements. This allows states to decentralize enrollment through insurers and web brokers. Opponents have said this will expose consumers to junk plans.
Georgia has already been approved for such a waiver.
According to a recent report from the Kaiser Family Foundation, insurer participation in the ACA marketplace in 2021 is seeing a third straight year of growth as several insurers are entering the market or expanding their service area.
For 2021, 30 insurers are entering the individual market, and an additional 61 are expanding their service area within states.
Despite taking a huge volume hit in Q2, most hospitals have managed to maintain positive operating margins—largely thanks to a $100B cash infusion from the federal government via the Coronavirus Aid, Relief and Economic Security (CARES) Act.
According to Kaufman Hall’s most recent National Hospital Flash Report, based on data from over 900 hospitals of all sizes nationwide, hospitals would have been operating at a significant loss without federal aid. As the graphic above shows, the average hospital operating margin without CARES Act relief funds would have been negative eight percent in April—and would still be in the red as of October, despite much of the cancelled elective business returning across the summer and early fall.
However, with the aid, hospitals operating margins only turned negative in April and May. When compared to the same time period last year, year-to-date (YTD) gross revenue is down almost five percent, though net patient service revenue per discharge is up—the result of longer lengths of stay, the 20 percent Medicare reimbursement bump for COVID-19 patients, and suspension of the two percent sequestration adjustment on Medicare fee-for-service payments. Yet hospital expenses per discharge are also up 13.5 percent, dampening profitability.
Though the CARES Act has been a stopgap solution for the vast majority of hospitals, a handful, most notably HCA Healthcare, have proactively returned the money. While motivations for doing so are varied, we’ve been hearing that the ever-changing reporting and spending requirements associated with CARES Act funding have many hospital leaders concerned about possible future claw-backs.
With COVID-19 hospitalizations now reaching record-breaking highs, potentially forcing another round of shut-downs, and with little movement on another round of federal relief, hospitals may be on their own for the time being—and the greatest hit to health system finances may still be yet to come.
Dallas-based Baylor Scott & White Health said it will lay off 102 employees in finance and accounting roles as part of an effort to reshape operations and reduce costs, according to The Dallas Morning News.
The duties of the affected workers will be outsourced to a third-party vendor in India. About 18 of the affected Baylor employees will be offered positions with the vendor, according to the report.
A spokesperson for Baylor Scott & White told Becker’s Hospital Review that the system will retain about two-thirds of its corporate finance department.
“Our system is continuously looking for ways to reduce costs and improve our ability to provide affordable and quality healthcare for our patients and members. As part of this, we are transforming the way we deliver our corporate finance services,” the nonprofit health system wrote in a statement obtained by Becker’s.
The cuts follow a larger round of layoffs and furloughs announced in May, which affected about 1,200 employees, or 3 percent of its workforce.
The health system said it is working to be more efficient and intentional in how resources are used. It is working to add front-line caregivers and has more than 2,000 open clinical jobs, a spokesperson told Becker’s.
“We care deeply about all our colleagues and are committed to supporting them through this process,” the statement read.
Roommates Madilyn Dennington, Bailey Mills and Olivia Noe, all 23, were issued misdemeanor citations in connection with an Oct. 31 football watch party at their East Nashville home on the 1200 block of Boscobel Street south of Fatherland Street.
Police spokesman Don Aaron said the women were served with court summonses on Monday and are slated to appear on the charges Dec. 16.
According to an arrest affidavit, officers responded about 6:30 p.m. to a complaint about a loud party at the home, heard music blaring and saw several people in the yard. In all, police said they found more than 100 people inside and outside the home.
When officers spoke to Dennington, Mills and Noe outside, they told police they had organized a watch party at their home for a football game, the affidavit states. The officers told the women that at that time, no more than 25 people were permitted to gather in Davidson County unless the gathering was approved by the city.
The women then went inside and told everyone to leave, police reported.
Police then alerted Metro Health officials about the party. Hugh Atkins, Metro Health’s environmental health services director, confirmed the Health Department did not receive an event application for the gathering.
On Tuesday, Davidson County reportedan increase of 851 cases in 24 hours — the second-highest ever daily increase. So far 369 people in Nashville have died from the virus.
Dennington is a registered nurse at TriStar Skyline Medical Center, authorities said.
It was not immediately known whether the hospital had taken any disciplinary action against Dennington. She did not return an immediate request for comment and blocked her Facebook page from a Tennessean reporter shortly after being contacted.
“Properly following pandemic regulations is extremely important to help reduce the spread of COVID-19,” Anna-Lee Cockrill, a spokeswoman for TriStar, said regarding the party. “We are looking into this further.”
According to their social media pages, all three roommates formerly attended the University of Mississippi before moving to Nashville, and Dennington and Noe both graduated from the University of Mississippi Medical Center.
Noe and Mills also could not immediately be reached for comment.
More than 50 arrests, 315 citations
Police data shows at least 50 people have been arrested and more than 315 have been cited under local emergency health orders that went into effect earlier this year.
As of Tuesday, only one of the arrested defendants had pleaded guilty: Jeffrey Mathews, a 36-year-old Goodlettsville dentist arrested for throwing an Aug. 1 house party on Fern Avenue in East Nashville. He was one of two men criminally charged for the party that drew hundreds.
Many hospitals are temporarily or permanently reducing the size of their workforce as they grapple with depleted revenues and the thorny question of when they can return to normal operating capacity. Here’s a tracker to follow the latest updates.
Hospitals across the country, financially battered as they face the dual challenges of sick COVID-19 patients and a precipitous decline in patient volume, are struggling to balance quickly shifting staffing needs. While some face and others brace for intense demand, many have announced furloughs of specialists and others that work in elective surgeries that have been drastically scaled back.
Thousands of healthcare workers at hospitals big and small have been asked not to return to work, and it’s still unclear how soon non-essential services will return. While some governors announce plans to reopen businesses, others have extended stay-at-home orders.
Most recent data from the U.S Bureau of Labor doesn’t cover the second half of March or early April, but during the first half of March, the healthcare industry shed 43,000 jobs — reversing a decade of growth in the sector. According to BLS data, the industry added 49,000 jobs in March 2019.
“Even our emergency room has seen a significant drop in patients coming in,” Sue Philips, an ICU nurse at Palomar Pomerado Health in Northern San Diego, told Healthcare Dive.
Phillips is a spokesperson with National Nurses United, the country’s largest nurses union.Palomar Health, which runs three medical centers in northern San Diego County, recently instituted 21-day temporary layoffs of 221 employees.
On April 28, Palomar announced that most of those layoffs were becoming permanent. The system laid off 5% of its workforce, eliminating 317 positions. Fifty of those employees were clinical RNs, mostly in part-time positions, and the rest spread across the organization ranging from clerical staff to technicians.
Due to a 50% decrease in patient volumes, Palomar lost $10 million in revenue in March alone, according to a statement. In April the system said it stands to lose $20 million or more.
“I’m an ICU nurse, so my job is pretty much protected,” Phillips said. “But you didn’t think you were expendable until you became expendable, and that’s a hard pill for nurses and caregivers to swallow.”
Congress has attempted to financially support struggling hospitals through ongoing coronavirus relief legislation, approving some $175 billion thus far. But without knowing what will come next, hospitals are attempting to remain nimble while reining in one of their most costly expenses — paying employees.
The following information is based on publicly reported data, along with interviews with hospital representatives and union members.
It’s not an exhaustive list, but features nonprofit and for-profit hospital systems that reported revenue above $10 billion in 2019. It also takes a look at smaller, more regionally based systems that have announced similar cutbacks.
Use the dropdown to find a company (Click on link above to access layoff tracker)
The Federal Trade Commission is revamping a key tool in its arsenal to police competition across a plethora of industries, a development that could have direct implications for future healthcare deals.
In September, the FTC said it was expanding its retrospective merger program to consider new questions and areas of study that the bureau previously has not researched extensively.
One avenue it will zero in on is labor markets, including workers and their wages, and how mergers may ultimately affect them.
It’s an area that could be ripe for scrutinizing healthcare deals, and the FTC has already begun to use this argument to bolster its case against anticompetitive tie-ups. Prior to this new argument, the antitrust agency — in its legal challenges and research — has primarily focused on how healthcare mergers affect prices.
The retrospective program is hugely important to the FTC as it is a way to examine past mergers and produce research that can be used as evidence in legal challenges to block future anticompetitive deals or even challenge already consummated deals.
“I do suspect that healthcare is a significant concern underlying why they decided to expand this program,” Bill Horton, an attorney with Jones Walker LLP, said.
So far this year, the FTC has tried to block two proposed hospital mergers. The agency sued to stop a proposed tie-up in Philadelphia in February between Jefferson Health and Albert Einstein Healthcare Network.
In both cases, the agency alleges the deals will end the robust competition that exists and harm consumers in the form of higher prices, including steeper insurance premiums, and diminished quality of services.
The agency has long leaned on the price argument (and its evidence) to challenge proposed transactions. However, recent actions signal the FTC will include a new argument: depressed wages, particularly those of nurses.
In a letter to Texas regulators in September, the FTC warned that if the state allowed a health system to acquire its only other competitor in rural West Texas, it would lead to limited wage growth among registered nurses as an already consolidated market compresses further.
Last year, the agency sent orders to five health insurance companies and two health systems to provide information so it could further study the affect COPAs, or Certificates of Public Advantage, have on price and quality. The FTC also noted it was planning to study the impact on wages.
FTC turned to review after string of defeats
A number of losses in the 1990s led the agency to conduct a hospital merger retrospective, Chris Garmon, a former economist with the FTC, said. Garmon has helped conduct and author retrospective reviews.
Between 1994 and 2000, there were about 900 hospital mergers by the U.S Department of Justice’s count. The bureau lost all seven of the cases they attempted to litigate in that time period, according to the DOJ.
The defendants in those cases succeeded by employing two types of defenses. The nonprofit hospitals would argue they would not charge higher prices because as nonprofits they had the best interests of the community in mind. Second, hospitals tried to argue that their markets were much larger than the FTC’s definition, and that they compete with hospitals many miles away.
Retrospective studies found evidence that undermined these claims. That’s why the studies are so important, Garmon said.
“It really is to better understand what happens after mergers,” Garmon said. It’s an evaluation exercise, given many transaction occur prospectively or before a deal is consummated. So the reviews help the FTC answer questions like: “Did we get it right? Or did we let any mergers we shouldn’t let through?”
The Federal Trade Commission is suing to block New Jersey’s largest health system, Hackensack Meridian Health, from acquiring a close competitor, Englewood Health. That system operates Englewood Hospital, an independent hospital and one of the last in the area, according to the Star-Ledger.
After the tie-up, Hackensack would control three of the six acute care hospitals in Bergen County, the most populated county in the state.
The loss of competition between the two would leave insurers with few options and would allow Hackensack to obtain higher prices from insurers, leading to higher premiums and higher out-of-pocket costs for consumers, the FTC alleged in a statement Thursday.
In each case, the FTC has argued the deals would eliminate close competitors and lead to higher costs and lower quality of care.
At the time, Hackensack said Englewood would become a tertiary hub for Hackensack with a focus on a slew of services lines including cardiovascular care, neurosciences and oncology. Englewood said it would also benefit from the affiliations Hackensack enjoyed with Memorial Sloan Kettering Cancer Center.
As part of the announcement, Hackensack committed to invest $400 million in Englewood Health.
Hackensack operates its flagship hospital, Hackensack University Medical Center, and partially owns Pascack Valley Medical Center, which are both within 10 miles of Englewood Hospital, according to the FTC.
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HENRY KOTULA 