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Thursday, May 19, 2022

Surge Or Slowdown?

 More than seven months into the pandemic, Valley hospitals have spent millions of dollars on preparations for a surge that never developed, while seeing overall patient volume drop off. That has resulted in long-term impacts on health providers’ finances and operations.Non-COVID patients have slowly been trickling back into area hospitals for surgeries and preventative care, but revenue is still not back to where it was in prior years, officials said.Pacifica Hospital of the Valley, which serves the area’s most vulnerable population, spent $6.5 million on its surge plan, according to Chief Executive Precious Mayes.“For Sun Valley and the other over 12 ZIP codes that we actually service … we surged over 40 beds, three different units, plus we surged 17 beds for subacute,” said Mayes. “We had a total of over 60 surge beds.”Money was spent on travel nurses too, Mayes said, along with negative pressure rooms, ventilators and overpriced personal protective equipment.“At the front part of the pandemic, staff was afraid. They called off sick; they were afraid to come into work, even nurses, doctors were afraid,” Mayes said, referring to the reason travel workers were brought in.Pacifica got $2.4 million in federal funding from the CARES Act, while payroll was $4 million for July alone — Pacifica saw its worst surge in patients that month, but fortunately influx still fell within surge capacity.“We were seeing sick, sick patients and because of that, I was getting concerned that we were not going to be able to handle capacity,” Mayes said. “I’m not part of a chain. I am a safety net hospital and I serve the most vulnerable population that there is.”Pacifica had patients come all the way from El Centro and Imperial Valley in the early months — sick ICU patients transported when there were no other beds available near the Mexican border.Other area hospitals echoed the same sentiments — an exorbitant surge plan price tag with little assistance from government. Larry Kidd, chief clinical officer at Valencia’s Henry Mayo Newhall Hospital, said medication assistance dried up within months. “Initially, the government was subsidizing the cost of medications for COVID patients, like remdesivir,” said Kidd. “Now, it’s no longer free. We’re having to pay for those drugs and they’re very expensive and of course there’s competition for them.”Hospitals are required to provide drugs such as remdesivir to a COVID patient that meets certain criteria, Kidd said, meaning the institution must foot the bill. Staffing and COVID treatment is another cost contributor, with more specialists needed for COVID patients in the ICU. “To take care of a COVID patient, it costs twice as much,” Kidd said. Nurses, doctors, respiratory therapists and specialty physicians might be called in to treat one COVID patient.With no cure, hospitals have no choice but to just treat the symptoms, which drives up cost per patient, Kidd said.Henry Mayo’s new six-story patient tower opened at the end of last year, making social distancing and triage easier for the Santa Clarita Valley hospital.“We had all these additional beds that we vacated, we moved people from the older part of the hospital into the new tower, so come spring when we needed additional beds, we had these units that were already in play that we could staff up to meet the requirements for a surge,” explained Kidd. “We were able to create a designated unit, and at one point we had two units where we could house COVID patients.”Marketing and lobbyingHenry Mayo saw 30 to 40 COVID-related hospitalizations daily in March and April; that has reduced to 12 to 15 daily, Kidd said. Those admitted are less sick too, he reported, and the length of their stay is shorter.Now, hospital officials point to delayed care, a result of mistrust among consumers and state mandates halting certain surgeries in March and April. The result is peril for patients.Providence Saint Joseph Hospital in Burbank saw a decline of nearly 40 percent in admissions, 80 percent in outpatient surgeries, and its emergency department volume was down 55 percent since April, Chief Executive Kelly Linden told the Business Journal.“We’ve seen a pretty significant recovery; we’ve spent a lot of energy educating our community so that people know we’re safe,” said Linden, referring to townhalls and other community outreach. “Providence hospitals as well as other health systems, we rolled out an extensive marketing campaign to educate the public about the safety of our hospitals.”Providence, along with UCLA Health, Keck Medicine of USC, Kaiser Permanente, Dignity Health and Cedars-Sinai formed the “Better Together Health” initiative in June involving billboards, television spots and print advertisements ensuring hospital safety.Henry Mayo’s “Safe in Our Care” campaign, separate from the initiative Providence is part of, ranges from video clips showing examples of what one might expect during a hospital visit to a podcast, newspaper advertisements and a hotline for further questions.“We got a lot of calls for several weeks,” Kidd said of the hotline. “That was letting us know people were aware of what we were doing, and they had more questions that they wanted answers to. Gradually, over the past month, we’ve seen an uptick in almost every area of adult care.”West Hills Hospital, owned by HCA Healthcare in Tennessee, has produced a series of testimonials about the facility’s safety.“We felt that hearing from the physicians directly was important,” said Mark Miller, chief executive of West Hills Hospital. Videos featuring the hospital’s doctors walks the viewer through screening procedures, separation of patients with the virus, and sanitation protocols for waiting rooms and elevators.Still, volume is down 20 percent overall for West Hills compared to last year, Miller said.“It’s interesting where (volume) is coming back, so much of it is physician driven, if a physician’s practice is back open. Some specialties are being put off,” added Miller. Aimee Bennett, director of marketing for West Hills, shared a story about a patient experiencing symptoms of cardiovascular disease — when the man finally called 911, he was put on a transplant list.“Had he received care early, we would have been able to do a stent or something similar. A lot of surgeons are saying that,” Bennett said, referring to a higher degree of urgency when patients come in. For safety net hospitals such as Pacifica, lobbying efforts and consumer outreach have slowly brought volume back up; emergency room volume dropped 75 percent initially, and visits are just now starting to reach “a little over 50 percent,” Mayes said.“Politically, I’m being as active as I can to get more federal funds, or state funds. They asked us to surge and to spend; they knew it was going to cost us these dollars, and I did it on a very slim margin, but I need my money back,” Mayes explained. “I also need my volume back. When you spend that kind of money and you don’t have the volume coming in, you’re talking millions of dollars in losses.”Legacy of COVIDHospital administrators expect a continuation of trends propelled by the pandemic, including telehealth’s increased use, a push for outpatient services and a change in the layout of hospital facilities.“We had to modify some of our entrancing and the way we triage patients during the course of this circumstance, and we looked at our facilities moving forward,” said Linden, referring to Providence Burbank’s new emergency department and urgent care center currently in development. It’s set to open in 2022 and fundraising efforts have garnered $65 million of a $78 million campaign, Linden added.“We were in a really good circumstance that we were just finalizing our design and we were able to make those modifications to further enhance that care we’re providing,” continued Linden. Specifically, the building incorporates different entrances to the ER, depending on whether the patient comes via ambulance or a walk-in.Kidd hopes to see more planning for disasters and coordination between hospitals. “We’ve learned a lot. We initially had a lot of touch-and-go situations with PPE; many didn’t have what they needed. We need more coordination on who has what, and sharing of that, a system of knowing where everything is so it can be dispersed equitably,” he said.“At a minimum this is going to challenge every health care organization to ensure that we are easily accessible,” added Miller at West Hills Hospital. “We will need to make sure patients will be able to access us the traditional way, with the hospital, and through telemedicine, remote services. … Every health care entity will have to be much more nimble.”

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