05.04.2020

Hospitals Exceed ICU Capacity

More Funding Expected, but Mass. Hospitals Losing $1.4B Month

U.S. Health & Human Services (HHS) announced on Friday that it is distributing another $12 billion to U.S. hospitals, but as of Sunday the initial explanation of how HHS was parceling out the money was removed from its website.

 

The department's original announcement indicated it was sending money through a “High-Impact Allocation” formula to areas most affected by COVID-19. In addition, HHS had announced distribution of another $10 billion to rural providers, including rural acute care general hospitals and critical access hospitals, rural health clinics, and community health centers located in rural areas.

 

HHS based its distribution on an April 10 cutoff date for counting COVID-19 patients. That date disadvantaged Massachusetts, which saw its surge in patients in the weeks following that date. The formula also does not recognize smaller hospitals facing the same major financial challenges of the COVID-19 emergency, with all hospitals ceasing elective surgeries and experiencing reduced outpatient visits.

 

Friday’s funding announcement was the latest distribution from the $100 billion contained in the CARES Act for healthcare providers. Previously, $50 billion had been distributed with only about 43% of that amount going to frontline hospitals (of which approximately $550 million came to Massachusetts). MHA is engaged with the state’s supportive Congressional delegation and has advocated for the need for additional financial relief for hospitals like those in Massachusetts that are facing a more extreme, direct, and prolonged effect of the COVID-19 pandemic.

 

As Congress continues discussion of the next financial relief bill – a so-called 4.0 relief package – MHA has been in contact with the state’s Congressional delegation urging help for sorely pressed hospitals.

 

In a letter to each member of the Massachusetts Congressional delegation, MHA President & CEO Steve Walsh wrote, “Our most recent, conservative estimates show that due to the curtailment of elective surgeries and other non-COVID-19 care, Massachusetts acute care hospital revenue losses are approximately $1.1 billion per month. Hospital-affiliated physician organization revenue losses are estimated to be more than $280 million per month.” In addition, hospitals are spending enormous sums to reconfigure spaces for ICU care, buy marked-up supplies and PPE, provide child care and hotel rooms for workers, support skilled nursing functions – and much, much more. “While the relief packages from Capitol Hill are greatly appreciated and necessary, the wide dispersal of funding to all Medicare providers has not recognized the central role hospitals play – especially those in COVID-19 ‘hot spots’ such as Massachusetts,” Walsh wrote.

 

Walsh called on Congress to ensure that future funding distributions from the Provider Relief Fund or any other source are “proportionally directed to hospitals where COVID-19 is having the most negative effect.” MHA then laid out a series of specific funding ideas to be included in the 4.0 bill.

 

The American Hospital Association (AHA) weighed in with its own letter. AHA wrote: “[H]ospitals and health systems that are supporting the nurses and physicians to care for patients, building new sites of care to minimize the spread of the virus, and purchasing the ventilators, drugs, and supplies to care for the critically ill, received less than a fair share given their role. We would appreciate that HHS better target funding for hospitals and health systems, which serve as the nation’s primary source of COVID-19 testing and treatment.” The AHA noted that hospitals stopped non-emergency procedures at the government’s request and lost 40-70% of their revenue in doing so.

Data to Consider While Pondering a "Re-Open" Date

While the healthcare community has a good boots-on-the-ground perspective of what is happening in Massachusetts hospitals, the general public may not. The public may be lulled by assurances that Massachusetts is “staying ahead of the curve” or because there aren’t news photos of ill people lining up on sidewalks outside of hospitals. The data, however, paints a different picture. It shows the difference between what is occurring now and what might have occurred if the commonwealth did not prepare. And that data could be instrumental in reaching decisions about when to “re-open” the state.

 

The following graphic derived from daily hospital reporting, shows that as of yesterday, 64% of the ICU beds in the state were occupied. However, the words above the statewide data column – “Non-Surge Only: 114%” – tell a different story. The 114% means that if one eliminates the ICU beds that were created to deal with COVID-19 – hospitals spaces that were repurposed or created at great expense – then the system would be 14% over capacity. As you can see, Metro Boston is 30% over regular ICU capacity. If the hospital community had not prepared, every ICU bed today would be filled and there would be tragedies unfolding outside of facilities and within their corridors.

Two caveats to the data: first, in some parts of the state and in some hospitals, the number of COVID-19 cases is small; some hospitals have excess capacity even at a time such as last Thursday when the state recorded its largest ever one-day COVID-19 death toll. Second, however the state re-opens – either across the board or in regional pockets – there’s a great likelihood that the second wave of the virus in the fall or winter (or sooner) could be much worse.

Explaining ESP Options to Behavioral Health Patients

As hospitals remind the public that their EDs are safe and should be used without delay for non-COVID-19 emergency care, the behavioral health community is using the opportunity to re-educate patients about community-based care alternatives. Beacon Health Options and the Massachusetts Behavioral Health Partnership have created two flyers (in  and ) to help explain the community-based options. The statewide Emergency Services Program (ESP) provides 24/7/365 crisis help – without people having to go to a hospital ED. Services are provided at no cost to those with MassHealth, Medicare, or people without health insurance. Some people with commercial insurance can also take advantage of these services. The statewide Emergency Services Program line that anyone can call (1-877-382-1609) allows people to enter their zip code and be directed to their local ESP.

Competition for Masks and Other PPE

When the economy re-opens, it’s a sure bet that business will have to assure the public that their spaces are safe. Expect your local fitness club, mall, or restaurant to offer personal protective equipment at the door in the form of masks, hand sanitizers, or more. Of course, the shortage of PPE will not have evaporated overnight. Care facilities that today are still struggling to provide enough masks, gowns, face shields, cleaning supplies, and sanitizers – and which are paying exorbitant prices for the scarce supplies – will still face the shortages when they are competing with private companies for the goods after any potential re-opening. And when or if the virus re-appears with added force later in the year, the PPE shortages will be even worse – and potentially more lethal.

Monday, May 11: Major Innovation Forum on COVID-19

The World Medical Innovation Forum – a multi-hour event featuring experts on COVID-19 – will take place on Monday, May 11. The virtual event will include top industry leader panel discussions, CEO fireside chats, and a live Q & A opportunity. The event features Harvard infectious disease experts discussing the crisis and the new technology used to combat it, as well as what is under development. .

Transitions

Congratulations to Jack Barry, the American Hospital Association’s Region 1 Executive, who has retired after decades of service to the nation’s hospital community. For the last 38 years, Jack kept an office at MHA in Burlington as he travelled the six New England states advocating for the region’s hospitals and patients. We’ll miss Jack’s friendship and good humor as much as his work on behalf of MHA’s membership, and MHA wishes him the best.

Errol R. Norwitz, M.D., has been named president of Newton-Wellesley Hospital (NWH), effective July 1. Norwitz is currently Chief Scientific Officer at Tufts Medical Center and the Louis E. Phaneuf Professor and Chair of the Department of Obstetrics & Gynecology at Tufts Medical Center and Tufts University School of Medicine. He also has been a member of the executive leadership team of Tufts Medical Center/Wellforce since 2016. Previously, he held executive leadership positions at Yale-New Haven Hospital and was Professor of Ob/Gyn at Yale University School of Medicine. Norwitz will be returning to Newton-Wellesley, where he was on the medical staff from 1997-2002. A native of South Africa, Norwitz completed his medical training at the University of Cape Town, his PhD at Oxford University, as a Rhodes Scholar, and his Ob/Gyn residency and Maternal-Fetal Medicine fellowship at Harvard, with clinical training at Brigham and Women’s Hospital and Massachusetts General Hospital. He earned an MBA from the Questrom School of Business at Boston University. Norwitz succeeds Michael R. Jaff, DO, who joined Boston Scientific in January, and Interim NWH President Gregg Meyer, M.D., Partners HealthCare’s Chief Clinical Officer, who has led the organization during the search process.

WEBINAR: COVID-19 and the Rise of Telemedicine
Wednesday, May 6; 12:30 to 1 p.m. EST

MHA is presenting a webinar series on the expanded opportunities for Massachusetts providers to treat patients via telemedicine during the COVID-19 pandemic.  for Part 1 of this multi-webinar series, which will provide a high-level overview of the federal and state waivers that have enabled providers to increase their utilization of telemedicine, the “nuts and bolts” of the telehealth regulatory landscape, and best practices when building a telemedicine program.  for more information on upcoming COVID-19 related webinars, plus recordings of past webinars.

John LoDico, Editor