2020 Hospital Operating Margins Down 96% Through July

Posted on by • Posted in Coronavirus, Cost Management, Cost Reduction, Economic Crisis, Economic Stimulus, Elective Procedures, Elective Surgery, Emergency Care, Expense Reduction, Health System, Hospital, Hospital Industry, Market Outlook, Market Trends, Market Uncertainty, Net Income, Nonoperating Income, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Pandemic, The CARES Act • Leave a comment

https://www.prnewswire.com/news-releases/2020-hospital-operating-margins-down-96-through-july-301116888.html

Ship in a Storm | ICOExaminer

Hospital Operating Margins have plunged 96% since the start of 2020 in comparison with the first seven months of 2019, according to a new Kaufman Hall report, as uncertainty and volatility continue in the wake of the COVID-19 pandemic.

Those results do not include federal funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Even with that aid, however, Operating Margins are down 28% year-to-date compared to January-July 2019.

Operating Margins fell 2% year-over-year in July without the CARES Act relief, according to the latest edition of Kaufman Hall’s National Hospital Flash Report. Hospitals also saw flat year-over-year gross revenue performance in July, continued high per-patient expenses, and a fifth consecutive month of volumes falling below 2019 performance and below budget.

From June to July, however, hospital Operating Margins were up 24%, likely due to a backlog in demand resulting from the shutdown of many non-urgent services in the early months of the pandemic.

“COVID-19 has created a highly volatile operating environment for our nation’s hospitals and health systems,” said Jim Blake, managing director, Kaufman Hall. “Hospitals have shown some incremental signs of potential financial recovery in recent months. Unfortunately, there is no guarantee these trends will continue, and hospitals still have a long way to go to recover from devastating losses in the early months of the pandemic.”

July volumes continued to fall year-over-year, but showed some signs of potential recovery month-over-month. Adjusted Discharges were down 7% compared to July 2019, but up 6% compared to June 2020. Adjusted Patient Days were down 4% year-over-year, but up 7% month-over-month. Adjusted Discharges are down 13% and Adjusted Patient Days are down 11% since the start of 2020, compared to the first seven months of 2019.

Hospital Emergency Department (ED) volumes have been hardest hit, falling 17% year-to-date compared to the same period in 2019, down 17% year-over-year, and 13% below budget in July. Surgery volumes saw some gains with the continued resumption of non-urgent procedures pushing Operating Room Minutes up 3% month-over-month and 4% above budget in July, but they remain down 15% year-to-date.

Not including CARES Act relief, Gross Operating Revenues were essentially flat year-over-year and 2% below budget for the month, but have fallen 8% year-to-date compared to the same period in 2019. Inpatient Revenue is down 5% year-to-date and fell 3% below budget in July, but increased 1% year-over-year. Outpatient Revenue is down 11% year-to-date, 1% year-over-year, and 2% below budget.

Hospitals nationwide also continued to see higher per-patient expenses despite having fewer patients. Total Expense per Adjusted Discharge has jumped 16% year-to-date compared to the same seven-month period in 2019, and rose 9% year-over-year and 5% above budget in July. Labor Expense per Adjusted Discharge is up 18% year-to-date and rose 9% year-over-year and 5% above budget in July. Non-Labor Expense per Adjusted Discharge has increased 15% during the first seven months of 2020 and jumped 11% year-over-year and was 5% above budget for the month.

The National Hospital Flash Report draws on data from more than 800 hospitals.

 

 

 

 

AdventHealth posts $799M operating loss in Q2

Posted on by • Posted in Elective Procedures, Elective Surgery, Health System, Hospital, Hospital Industry, Net Income, Nonoperating Income, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue • Leave a comment

https://www.beckershospitalreview.com/finance/adventhealth-posts-799m-operating-loss-in-q2.html?utm_medium=email

AdventHealth Acquires Top Cardiovascular Surgical Group - Orlando ...

AdventHealth, a 46-hospital system based in Altamonte Springs, Fla., reported a decline in revenue in the second quarter of this year and ended the period with an operating loss, according to recently released unaudited financial documents. 

The health system reported revenues of $2.8 billion in the three months ended June 30, down from $2.9 billion in the same period a year earlier. The decline was attributed to lower patient volumes from mid-March through early May. On a same-facility basis, hospital admissions were down 29 percent year over year in April, and surgical volumes were down 66 percent.

Expenses climbed 2.8 percent year over year, and AdventHealth ended the second quarter of this year with an operating loss of $799 million. In the same period a year earlier, the system posted operating income of $190.9 million.

After factoring in nonoperating items, including a $291.8 million gain on investments, the system reported net income of $290.8 million in the second quarter of 2020. In the same period last year, the system posted net income of $372.8 million.

Looking at the first six months of this year, AdventHealth reported a net loss of $287.7 million on revenues of $5.8 billion. That’s compared to the first half of 2019, when the system recorded net income of $865 million on revenues of $5.9 billion.

 

 

 

The future of the ACA takes center stage yet again

Posted on by • Posted in 2020 Election Issues, ACA, Chronic Care Management, Chronic Conditions, Chronic Diseases, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Medicaid, Medicaid Expansion, Medicare, Medicare for All, Out of Pocket Expenses, Preexisting Conditions, Public Option, Supreme Court, Underinsured, Uninsured • Leave a comment

https://mailchi.mp/0e13b5a09ec5/the-weekly-gist-august-21-2020?e=d1e747d2d8

The 2020 ACA Reporting & Regulation Landscape for US Employers ...

Across four nights of a national convention that was anything but conventional, with the nominating process, acceptance speeches, and traditional pomp and circumstance forced into a virtual format due to the coronavirus pandemic, Democrats returned to the healthcare playbook widely viewed as successful in the 2018 midterm elections.

In addition to promising a more robust and concerted response to the COVID crisis gripping the nation, party leaders vowed to protect and expand the Affordable Care Act (ACA), rather than aiming to replace it with the more aggressive “Medicare for All” (M4A) approach that dominated much of the discussion during the primary campaign.

In his acceptance speech on Thursday, Democratic nominee Joseph R. Biden, Jr. promised “a healthcare system that lowers premiums, deductibles, and drug prices by building on the Affordable Care Act he’s trying to rip away,” referring to President Trump’s continued support for the full repeal of the 2010 healthcare reform law.

Earlier, progressive runner-up and vocal M4A advocate Sen. Bernie Sanders signaled a closing of the party’s ranks around Biden’s more moderate approach: “While Joe and I disagree on the best path to get to universal coverage, he has a plan that will greatly expand healthcare and cut the cost of prescription drugs. Further, he will lower the eligibility age of Medicare from 65 to 60.”

Several other speakers highlighted the need to protect the ACA’s guarantee of affordable insurance to those with preexisting conditions, most powerfully the prominent M4A crusader Ady Barkan, who suffers from amyotrophic lateral sclerosis (ALS).

“Even during this terrible crisis,” Barkan said, “Donald Trump and Republican politicians are trying to take away millions of people’s health insurance.”

 

 

 

 

The kids are not all right

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Childcare, Children's Health, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Primary Care, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Quarantine, School Reopening, Scientists, Social Distancing, Vaccination • Leave a comment

https://mailchi.mp/0e13b5a09ec5/the-weekly-gist-august-21-2020?e=d1e747d2d8

Many children heading back to school—in whichever form that that may take this fall—have skipped their annual visit to the pediatrician. The graphic above highlights the sluggish rebound in pediatric ambulatory volume. While adult primary care visits have mostly bounced back, pediatric visits are still 26 percent below pre-COVID levels.

The drop in visits early in the pandemic also impacted immunizations, with 2.5M regular childhood vaccinations missed in the US during the first quarter of 2020—and early data suggests those seem to be rebounding at a similarly anemic rate.

This lack of pediatric routine care is particularly worrisome as COVID-19 cases in children are climbing, with a 90 percent increase from July to August. Though most of the nation’s largest public school districts have opted to begin the school year with online learning, some districts have already returned to in-person classes, and, unsurprisingly, new cases are already being reported.

While COVID-19 is normally neither severe nor fatal in children, infections among school-age kids put others at risk. According to the Kaiser Family Foundation, nearly a quarter of teachers (1.5M) are considered high-risk and almost six percent of seniors (3.3M) live with school-aged children.

Without the traditional back-to-school push for well-child visits, sports physicals, and immunization updates, healthcare providers must think creatively about how to give children with the care they need, whether through personalized communication from pediatricians that assuages parental concerns about office safety, or through more innovative means such as drive-thru vaccination services.

 

 

 

It looks like what happens in Vegas isn’t staying in Vegas.

Posted on by • Posted in Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Economic Crisis, Economic Recovery, Economy Reopening, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, School Reopening, Scientists, Social Distancing • Leave a comment

https://www.forbes.com/sites/suzannerowankelleher/2020/08/21/las-vegas-may-be-a-superspreader-hot-spot-new-study-suggests/?utm_source=newsletter&utm_medium=email&utm_campaign=coronavirus&cdlcid=5d2c97df953109375e4d8b68#506ae817484d

Travelers returning from the Covid-19 hot spot are potentially spreading the virus to virtually every state in the nation, according to a new mobility data study conducted on behalf of the non-profit investigative news organization ProPublica.

The findings highlight the connection between travelers and the spread of the virus during the pandemic.

The ProPublica study looked at a total of 12 days of cellphone data in three batches: four days in May, when Nevada was still shut down; four days in June, just after Las Vegas reopened to tourism; and four days in mid-July. In May, travel from Las Vegas was mainly regional. But since Las Vegas reopened in early June, the mobility of smartphones leaving Las Vegas has become progressively more widespread and nationalized.

Over the final four-day period, in July, the study identified 26,000 smartphones on the Las Vegas Strip, many of which later appeared in 47 states within the same four-day period — every state in the continental United States except Maine.

“About 3,700 of the devices were spotted in Southern California in the same four days; about 2,700 in Arizona, with 740 in Phoenix; around 1,000 in Texas; more than 800 in Milwaukee, Detroit, Chicago and Cleveland; and more than 100 in the New York area,” reported ProPublica.

While the study did not determine how many of these travelers were infected with Covid-19 when they returned to their home states, it is reasonable to assume that many were. For the past several months, Las Vegas has been a hot spot for the disease.

Las Vegas is located in Clark County, Nevada, which is currently struggling with one of the highest rates of new COVID-19 infections in the country, with 26.9 new daily cases per 100,000 people tested over a rolling seven-day average, according to the Harvard Global Health Institute’s Covid-19 tracker. Any community with over 25 new daily cases is deemed to be at a tipping point where stay-at-home orders are necessary, according to Harvard researchers.

This isn’t the first data-driven study to show how travelers are spreading Covid-19 across the United States. In early July, the PolicyLab at Children’s Hospital of Philadelphia (CHOP) released research indicating that the novel coronavirus was spreading along the nation’s interstate highways.

“Travel is certainly a huge driving factor,” the researchers wrote at the time. “We see spread along I-80 between central Illinois and Iowa, as well as along the I-90 corridor across upstate New York.” They pointed to a rise in cases along the I-95 corridor and concluded that interstate travel was creating renewed risk to regions like the Northeast that had successfully flattened the curve of the novel coronavirus.

Yesterday, Clark County’s Twitter account announced a grim milestone: The number of deaths attributed to Covid-19 in the community has now topped 1,000.

 

 

 

 

Why Most Voters Oppose Schools Reopening

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Quarantine, School Reopening, Scientists, Social Distancing • Leave a comment

https://www.forbes.com/sites/williamhaseltine/2020/08/21/why-most-voters-oppose-schools-reopening/#2df43b5b1822

Why Most Voters Oppose Schools Reopening

Even as test rates hover around six to seven percent and tens of thousands of new Covid-19 cases are being reported daily, school districts across the country will continue with plans to resume operations in the coming weeks. The latest survey data shows, however, that most Americans oppose reopening K-12 education in their states.

Parents have reason to be concerned that sending their children to school could bring the virus into their homes, as well as spike positivity rates in their communities. From July 30th to August 13th, over 75,000 new child Covid-19 cases were reported, according to the American Academy of Pediatrics. The outcome would be disastrous were even one asymptomatic carrier to attend classes in the coming weeks.

A recent survey conducted by the Financial Times-Peterson Foundation US Economic Monitor revealed that six in ten voters oppose reopening K-12 schools in their states, while as many as 81 percent urge the prioritization of health among students and faculty over the economy. Were children to get sick at school, not only would their health be endangered, but so would the health of their families. There would be no economy without healthy parents, which is why the vast majority of Americans urge the safety of American students over the state of the economy.

One of the more prudent concerns about the resumption of K-12 education is the social nature of a student’s daily life. School districts are assuring parents that they have put preventative measures in place, such as social distancing and classroom hybridization. But to assume students will have no interaction at all seems ludicrous. Children and teens have been out of the traditional school setting for over five months and they will be ready to interact with others. 

Despite the urge shared by parents and children alike to return to normal, the average voter realizes that the pandemic in the United States is far from over. Parents want their children to stay healthy for many reasons—to ensure the physical health and wellbeing of the family, to ensure the economic livelihood of the family, and to avoid the unknown long term health risks associated with Covid-19. Around 65 percent of voters believe social distancing requirements and non essential business restrictions should be in place for at least another three months—a sacrifice many are willing to make for the sake of their families and children.

Such statistics also show that people recognize there will be several more months of abnormality and want decision makers to take action accordingly, even if it means deprioritizing the economy. Families and individuals have been economically crippled by the pandemic and the US government’s lack of public assistance. The official unemployment rate still hovers around ten percent according to the Bureau of Labor Statistics. Low income families are struggling and eviction rates are sure to spike as rent moratoriums expire. These families have enough to worry about without the added pressure of sending their children back to school at this time.

The reopening of K-12 school districts in the coming weeks presents medical and economic challenges for families in the pandemic era, especially those already disadvantaged or experiencing hardship. Societal immunity is a long way off; as thirty five percent of voters said they would not be likely to get a COVID-19 vaccine were one approved and available by the end of the year, meaning children of those thirty five percent would also be unlikely to get vaccinated. With the inability to ensure the health and safety of students and the unknown economic future to come, schools are better off staying online for the time being.

 

 

 

 

The Science Behind Campus Coronavirus Outbreaks

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Quarantine, Respect, Responsibility, School Reopening, Scientists, Social Distancing, Virtual Work, Virtual Workforce • Leave a comment

https://www.forbes.com/sites/johndrake/2020/08/21/the-science-of-campus-outbreaks/#4c5704ae6893

LSU frat parties become coronavirus 'superspreader events ...

Colleges And Universities Reverting To Online Instruction

On August 17, seven days after the start of in-person classes, the University of North Carolina at Chapel Hill announced that, due to a dramatic increase in Covid-19 on campus, all undergraduate classes would be held online for the remainder of the fall. Ithaca College and Michigan State pulled the plug on August 18. Two days later, N.C. State joined the club. More may follow. (The Chronicle of Higher Education maintains a live update feed.) In fact, only a minority of colleges and universities are still attempting fall instruction fully or primarily in person (about 25% at this writing).

Only time will tell if these rapid course changes were warranted and, of course, the answer may not be the same everywhere. Each institution is unique with respect to size, culture, infrastructure to provide online learning, and ability to cope with transmission.

What We Know About Infectious Diseases On College Campuses

In thinking about Covid-19 transmission on campus, it may be useful to know something about the science of epidemics among college students in general. There is a small scientific literature on disease outbreaks on campus. Campuses are special for several reasons. News photos of students lounging on green quads, engaged in late night study groups, or partying into the wee hours reminds us that if college is known for anything other than studying and college sports, it might be the unique gregariousness that attaches to what many people call the “college experience.”

Although outbreaks of infectious diseases on college campuses are routinely reported, there is little evidence that they are more explosive than in the general population. Outbreaks of directly transmitted diseases like measles, mumps, and whooping cough occur with some regularity and are typically contained through isolation and other public health measures. But, no study has been done to systematically examine how the campus environment differs from community-based transmission. 

Influenza is a particularly interesting case because, like Covid-19, it is a respiratory disease transmitted directly through close contact and also has a short incubation period. The basic reproduction number (R0) is a measure of the explosiveness of an epidemic, with anything over R0 = 1 indicating the possibility of sustained transmission.

In 2014, CDC and academic scientists compiled a list of all estimates of R0 for influenza. While most estimates for the 2009 pandemic were between 1 and 2, estimates from some schools (not necessarily colleges or universities) were noticeably higher (2.3 for a school in Japan and 3.3 for a school in the United States), although other cases (Iran and the United Kingdom) were similar to the rest of the population.

Perhaps more importantly, a study in Pullman, Washington (home to Washington State University) estimated R0 of the 2009 pandemic flu to be around 6, which is two to four times larger than most other estimates. So there is some evidence that campus contagions may be more prone to outbreak than other places.

Since Covid-19 is typically much less severe in young adults than in older adults, another question that seems particularly important now is whether transmission among students remains primarily within the student population or readily spreads to the rest of the community. 

In a measles outbreak at a university in China, the fraction of staff who were infected was not statistically different from the fraction of students. The total number of staff infected — three — was small, however, and it seems unlikely that this is the usual pattern.

A study of the 2009 influenza pandemic at the University of Delaware found that the risk of infection for people older than 30 was roughly half the risk of those that were 18 to 29.

An even more interesting aspect of the University of Delaware study is the association with student activities. Reports of influenza-like illness among students at a nearby emergency health center remained stable for almost a month after spring break. But cases increased almost five-fold following “Greek week”. In the final analysis, belonging to a fraternity or sorority doubled a student’s chances of being infected.

What’s Happening Now

This is concerning now as cases of Covid-19 are rising among college students nationwide. College leaders such as Penn State president Eric Barron, University of Kansas chancellor Douglas Girod, and University of Tennessee chancellor Donde Plowman have reproached students, especially fraternities and sororities, for ignoring guidance to avoid large gatherings.

Yesterday, J. Michael Haynie, Vice Chancellor for Strategic Initiatives and Innovation publicly excoriated students at Syracuse University for “selfishly jeopardizing” the possibility of in-person instruction this fall. “Make no mistake,” he wrote, “there was not a single student who gathered on the Quad last night who did not know and understand that it was wrong to do so.”

The science of Covid-19 tells us that students are vulnerable, just like everyone else. Although the evidence is somewhat thin, what there is points only in one direction: because of their specific social structure, college campuses are especially prone to outbreaks of infectious diseases. As in the rest of society, the only way to slow down the Covid-19 pandemic on college campuses is to reduce the rate of infectious contacts. There is too much value in the college experience to reduce it to partying, and it should not be squandered altogether for the sake of the party experience.

 

 

 

 

Sutter posts $857M loss in H1 on investment, operational declines

Posted on by • Posted in Antitrust, Cash, Cash Management, Cash Reserves, Coronavirus, Credit Quality, Credit Ratings, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Health System, Hospital, Hospital Industry, Lawsuit Settlement, Liquidity, Market Outlook, Market Trends, Market Uncertainty, Net Income, Nonoperating Income, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Pandemic, The CARES Act • Leave a comment

https://www.healthcaredive.com/news/sutter-posts-857m-loss-in-h1-on-investment-operational-declines/583910/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-08-21%20Healthcare%20Dive%20%5Bissue:29231%5D&utm_term=Healthcare%20Dive

California's Sutter Health reaps rewards from investments in ...

Dive Brief:

  • Sutter Health had a staggering loss of $857 million in the first half of the year as the Northern California health was bruised by the pandemic. That’s almost a $1.4 billion drop in income compared to the first half of last year, a plummet Sutter management largely blamed on investment and operational losses in its latest financial filing posted Thursday.
  • The virus shuttered operations for a period of time, driving Sutter’s revenue down 8% to $6.1 billion during the first half of the year. Expenses climbed nearly 2%, contributing to an operating loss of $557 million.
  • Still, the nonprofit noted it did experience a significant rebound in its investments in the second quarter after weathering the devastating effects of the first quarter.

Dive Insight:

Sutter joins other major nonprofit health systems in posting net losses for the first half of the year despite receiving hundreds of millions in federal grants to help offset headwinds brought on by the pandemic.

Recently, both Renton, Washington-based Providence and Arizona-based Banner Health posted losses for the first half of the year — $538 million and $267 million, respectively. Dampened revenue and downturns in investments contributed to their losses.

The federal government has funneled billions of dollars to providers across the country in an attempt to help them weather the downturn in patient volumes. Sutter noted in its filing that it’s received $400 million in federal relief funds so far, though that wasn’t enough to push the health system back into the black. Sutter operates 29 hospitals and enjoys a large presence in Northern California.

Sutter reported fewer admissions and emergency room visits in the second quarter compared to the prior-year period, down about 10% and 19%, respectively.

The pandemic was quick to wreak havoc on Sutter’s finances during the first quarter, in which the system reported an operating loss of $236 million and a net loss of almost $1.1 billion.

The coronavirus is also serving as a drag on its ratings. In April, two of the three big ratings agencies downgraded Sutter Health’s rating.

In part, Moody’s attributed the downgrade to Sutter’s weaker profitability profile. In its rationale, Moody’s said, “Following a second year of weaker results, margins in 2020 are likely to remain under pressure due to COVID-19 related disruptions, ongoing performance challenges at some of Sutter’s facilities, and continued reimbursement pressure.”

Also weighing on Moody’s rating is the $575 million settlement expected to be paid this year to resolve antitrust issues. Last year, the health system averted a trial over antitrust concerns after agreeing to a settlement with California regulators. Sutter agreed it would end any contracts that require all of its facilities to be in-network or none of them and cap out-of-network charges, among other stipulations.

 

 

 

 

Revenues and volumes have fallen ‘off a cliff’ hospital executives tell American Hospital Association

Posted on by • Posted in American Hospital Association (AHA), American Medical Association (AMA), American Nurses Association, Cash, Cash Management, Coronavirus, Deferred Healthcare, Economic Crisis, Economic Stimulus, Elective Procedures, Elective Surgery, Emergency Care, Health System, Hospital, Hospital Industry, Liquidity, Net Income, Nonoperating Income, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, The CARES Act • Leave a comment

https://www.healthcarefinancenews.com/news/aha-releases-case-studies-us-hospitals-and-health-systems-highlighting-financial-challenges

Revenues and volumes have fallen 'off a cliff' hospital executives ...

Eight health systems in AHA case study are asking Congress for more relief funding.

The American Hospital Association has released eight case studies from hospitals and health systems across the country that highlight how systems of different shapes and sizes are reacting to the financial challenges posed by COVID-19.

The case studies include Kindred Healthcare and TIRR Memorial Hermann in Houston; AdventHealth Central Florida Division in Orlando, Florida; the Loretto Hospital in Chicago; Kittitas Valley Healthcare in Ellensburg, Washington; Washington Regional Medical Center in Fayetteville, Arkansas; Banner Health in Phoenix; UR Medicine Thompson Health in Canandaigua, New York; and the Queen’s Health Systems and the Queen’s Medical Center in Honolulu.

Across the board, every case study revealed that hospitals and health systems are asking Congress for more relief funding.

“We are begging for more assistance and more help because we can’t keep moving forward,” said Michael Stapleton, the president and CEO of UR Medicine Thompson Health in New York.

WHAT’S THE IMPACT?

In Texas, the state with the third most COVID-19 cases, Kindred Healthcare and TIRR Memorial Hermann have begun to rely on inpatient rehabilitation facilities and long-term acute care hospitals to treat COVID-19-positive and medically complex recovering COVID-19 patients.

“In particular, as communities and hospitals struggled to meet ICU capacity needs, these hospitals stepped forward to take care of COVID-19-positive patients and others to help provide beds for more COVID-19-positive patients,” the case study said.

However, even with assistance from local facilities, post-acute care providers have incurred increased costs to prepare for and treat COVID-19-positive patients and complex post-COVID-19 patients.

“When you look at lost revenue and volumes, and the additional costs of ramping up to prepare for COVID-19, whether it’s personal protective equipment, respiratory systems, medications or facility infrastructure changes, there are significant dollars associated with that,” said Jerry Ashworth, the senior vice president and CEO at TIRR Memorial Hermann.

AdventHealth in Florida has taken financial hits from declining elective procedures and purchasing personal protective equipment. The company says it has lost $263 million since the start of the pandemic and has spent $254 million sourcing PPE.

“Florida is in the middle of the crisis,” said Todd Goodman, division chief financial officer of AdventHealth. “Our current COVID numbers are four times higher than the peak that we had back in April. We are bringing in higher-priced nurses and staff from other parts of the nation, because of a rapid increase in inpatient census. We are in a different place today than we were even six weeks ago.”

COVID-19 has disproportionately affected communities of color across the country, but especially in Chicago, where 30% of the population is Black. Forty-six percent of all COVID-19 cases and 57% of all deaths are Black people.

Despite having 70% of its admissions being related to COVID-19, the Loretto Hospital in Chicago has not received any funds from the Coronavirus Aid, Relief, and Economic Security Act hot spot distribution.

“Our COVID-19 unit is full and has been for the last three months; we’re now at 296 COVID-19 patients [on July 16] and yet we’ve not received any of the COVID-19 high impact ‘hot spot’ payments,” said George Miller, the president and CEO of the Loretto Hospital. “We got the Small Business Administration loan to help keep our team members employed.”

Kittitas Valley Healthcare in Washington was among the first in the country to feel the impact of COVID-19. The rural delivery system and its critical access hospital postponed elective surgeries and many other nonessential services in response.

“Our revenues and volumes fell off a cliff,” said Julie Petersen, the CEO of Kittitas Valley Healthcare. “Our orthopedics programs, our GI [gastrointestinal] programs and cataract surgeries evaporated.”

Now, the hospital is off its original 2020 net revenue projections by $8.4 million.

After seeing a 12% rise in COVID-19 cases over a two-week period in Fayetteville, Arkansas, the Washington Regional Medical Center had 96% of its 40 intensive care unit beds occupied, a 20-bed COVID-19 ICU was completely full, and 298 of the facility’s 315 adult beds were occupied.

Taking care of these patients put the health system in a financial crisis. Its net patient revenue declined by $14 million in April. It furloughed 350 of its 3,300 employees and reduced the hours of 360 full-time workers, according to Larry Shackelford, the president and CEO of Washington Regional Medical Center.

On July 12, Banner Health in Arizona had more than 1,500 inpatients who either tested COVID-positive or are suspected of having COVID-19, representing 45% of the COVID-19 inpatient hospitalizations in the state, according to Dr. Marjorie Bessel, the chief clinical officer at Banner Health.

Banner expects operating losses of $500 million for 2020, compared to its initial expectations, with expected revenue losses approaching $1 billion for the year, according to the case study.

By mid-March, New York had 15 times more COVID-19 cases than any other state, according to the case study. Like the rest of the state, UR Medicine Thompson Health shut down many of its services, resulting in “insurmountable” financial losses and staff furloughs.

“Our first projection was a $17 million loss through the year-end,” Stapleton said. “We lost half of March, all of April and half of May. The hospital has received only $3.1 million from the CARES Act tranche payments.”

Although the Queen’s Health Systems and the Queen’s Medical Center in Hawaii are starting to reschedule appointments, surgeries and procedures that had been delayed by COVID-19, patients aren’t coming back as anticipated.

“Even with the pent-up demand for elective procedures, minimally invasive and even short-stay procedures are still down by about 18%. We are seeing our in-person clinic visits down by about 14%, and the emergency department (ED) is the one that surprised us the most – down by 38%,” said Jason Chang, president of the Queen’s Medical Center and chief operating officer of the Queen’s Health Systems and the Queen’s Medical Center.

The systems lost $127 million between March and May, according to Chang. He says the projected losses are about $60 million for 2021, but could reach $300 million if Hawaii experiences a second wave of COVID-19.

THE LARGER TREND

The AHA has cited $323 billion in losses industry-wide due to the ongoing COVID-19 pandemic, with U.S. hospitals anticipating about $120 billion in losses from July to December alone.

It was joined by the American Nurses Association and the American Medical Association to ask Congress to provide additional funding to the original $100 billion from the CARES Act. In a letter sent in July, the organizations asked for “at least an additional $100 billion to the emergency relief fund to provide direct funding to front line health care personnel and providers, including nurses, doctors, hospitals and health systems, to continue to respond to this pandemic.”