Hospitals were one of the businesses that got a partial release last week from virus crisis restrictions, when Gov. Kay Ivey announced a first phase of reopening. But the change is not expected to produce a quick recovery — even though hospital capacity was not overwhelmed by the outbreak.
“We have succeeded in meeting capacity. We have not had to move patients to alternative care sites,” says Don Williamson, president and CEO of the Alabama Hospital Association. “We have never had to do that in this crisis, although there were individual hospitals that had to use additional beds for ICUs that they had not used before.”
Emergency measures, such as shutting down elective procedures, were the reason capacity was not strained, says Williamson, and caution is still called for. “It was a combination of reducing utilization and adding resources that helped us get through to this point. And if we have the second wave later in the year, we need to use this time, when the virus is low, to build up those resources for what may occur.
“We’re not where we’re going to see an on-off switch” in a return to elective procedures at hospitals, says Williamson.
The off switch did in fact work immediately, on March 13, on orders from the governor. It’s the back-on switch, started May 1, that is graduated, explains Williamson.
The return to elective surgery of most hospitals follows the guidelines of the American College of Surgeons, Williamson says. Those guidelines categorize procedures on a scale of need, from totally elective to what shouldn’t be put off. Totally elective includes such procedures as cataract surgery. In the gray area are procedures such as hip replacements. What shouldn’t be put off includes neurological and cancer surgery. Even in the later group, some cases will be assessed as more or less immediate, depending on whether they can be delayed weeks or even months.
“We could see a second wave, and the size of the second wave will depend totally on us,” says Williams, who previously served as Alabama state health officer for 23 years.
“If we maintain social distancing, the second wave will be smaller, but if people abandon precaution and start gathering together again, if that happens, there will be a large second wave and the restrictions will come back in — restrictions on social interaction, elective procedures, all those things out there are again potential interventions, if there is a second wave.”
Restraint on a return to normal hospital practices runs against great pressure on hospital finances. For most hospitals voluntary procedures “are the only things they cover that support the costs of other payers, Medicaid and Medicare, for example. They are essential,” says Williamson.
Health care is one of the largest categories of unemployment claims recorded by the Alabama Department of Labor, owing to lock down on non-virus treatments. Forcasting a $230 million budget shortfall by September, UAB Medicine announced, May 4, salary reductions in lieu of furloughs that would have cut into the return to elective treatments.
How stressed are hospital finances?
“We have not had any hospitals close since COVID-19. We certainly have had hospitals stretched, had to lay staff off, but we have not had closures. Some are in a very precarious financial state — some of the smaller, rural hospitals. Some are projecting they have lost over $1 million in revenue. UAB told the press it cost them $70 million in one month.”
Will federal relief money make up for the losses to hospitals?
“There was $100 billion in the CARES Act that was supposed to go to health care providers. Of that, $50 billion has been distributed, and less than half went to hospitals. Of the first $30 billion, $240 million went to Alabama, and of that only one third came to hospitals, physicians other medical providers.
“If you’re losing $70 million in one month and didn’t get that made up from support from the federal government, hospitals are not going to have had their losses covered. Maybe some of the larger hospitals can absorb the losses. But I worry what the health care system will like afterwards and we have to put it back together.”
