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Hospitals in Quandary

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by

Dick Hall-Sizemore
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by Dick Hall-SizemoreThe Washington Posthas reported

that hospitals are struggling with their cash flow due to the coronoavirus crisis. As a result, they are asking Congress for emergency aid. The American Hospital Association is calling for $100 billion and the Federation of American Hospitals, the trade group for for-profit hospitals asked for $225 billion.

At the urging of national and health officials, hospitals are cancelling elective procedures. Those services bring in the revenue to cover a large portion of their overall operating costs. As a result, they are running low on cash.  Some are projecting they will be able to meet their payrolls only for a few weeks.

To add to these problems, vendors are requiring payment upon delivery for supplies and equipment. Some are saying they do not have the immediate cash on hand to buy the additional beds that political leaders, such as Governor Cuomo, are directing them to do. That could also be a problem in purchasing the additional ventilators that many predict will be needed.

In Virginia, the reaction of hospitals has been mixed. VCU Health, UVa Health and Bon Secours have cancelled or postponed elective procedures.  HCA Healthcare and Sentara have not changed their surgical schedules. Based on its latest COVID-19 advisory, it appears that INOVA in Northern Virginia has not changed its elective procedures schedule. Virginia Hospital Center in Arlington was one of those hospitals mentioned in a national article criticizing some hospitals for continuing to provide elective procedures. Virginia Healthcare Emergency Management Program, a partnership between the Department of Health and the Virginia Hospital and Healthcare Association, issued a statement complaining about the lack of clear national definitions and opposing “a sweeping policy” applicable to all hospitals.

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12 responses to “Hospitals in Quandary”

  1. Steve Haner Avatar
    Steve Haner

    Given Virginia reported a grand total of about 20 patients hospitalized with this as of Friday, the hospitals that pulled the plug on other procedures might have acted prematurely. Since the decision was made (or forced) to shut down the entire economy, for an unknown number of weeks or months, every industry is being crushed. Hospitals are probably better cushioned than most. Large swaths of their employees (docs and upper ranks) could take 50% pay cuts and not notice. The universities have massive resources in foundations, most from past hospital profits. It will not be possible to bail them all out, not with “real” money. Then again, in a few months there may not be any real money.

  2. sherlockj Avatar
    sherlockj

    I read the statement of the hospitals relative to elective surgeries and agree with it. There should not be a one size fits all approach. If we had far more ambulatory surgical centers, the problem would have an alternative solution. But we don’t because of COPN. I will have something to say later on the broader subject of the total lack of government oversight of the business of healthcare delivery in Virginia.

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Doctor Anthony Fauci, the American immunologist who serves as director of the National Institute of Allergy and Infectious Diseases and as a member of the White House Coronavirus Task Force said last night on national television that the federal government now is ripping into shreds COPN and other such certificate of need regimes in America.

      Given that these corrupted regimes have neutered large segments of America’s health care industries ability to counter effectively this current on-going plague, let us all thank God for that shredding.

  3. TooManyTaxes Avatar
    TooManyTaxes

    Have the hospitals cut the salaries of their presidents and other top administrators? I noticed Marriott and other hospitality companies have reduced compensation for executives? Or are we supposed to send tax and debt dollars to prop up executive compensation?

  4. LarrytheG Avatar
    LarrytheG

    This is a bit of a “duh” in a way. Hospitals have always been and now are expected to provide – as much as they are able – staff and resources in response to a national emergency.

    No one is going to be turned away from showing up – they’ll all be processed and many will then be turned away as part of triage which is not only elective procedures but even those who have conditions that would end up in admittance on a safe but sorry basis. Now, you have to have a visible life-threatening condition and even having the coronavirus may not get you admitted.

    I, like Steve have tremendous trepidation that the economic harm being done is going to be massive and long lasting and some entities will be changed forever incuding some going away.

    But I also think this is the mother of all “reboots” … think of it in terms of zero-based budgeting.. Every single industry will be forced to re-prove it’s position in the economy and if it cannot – it may go away or recede to a smaller part of the economy.

    Other new industries will pop up and survive and thrive.

    Emerging industries will accelerate – like distance education, medical, working from home, “delivery”, etc…

    In ways that none of us can fully conceive or predict.

    Of course, that might have to include Steve’s dark foreboding and that is a country that used to be number one economically, dropping down in the stack to where we might have actually been headed on a slower boat until the bottom dropped out, and we hit free fall.

    But back to Dick’s observations.

    I cannot imagine a world where hospitals turn folks away because they do not have beds or staff or critical resources.. they really can’t help you – all you can do is go home and home you get over it – or just die.

    That’s a world we ought to be able to see – like Dick has.

    And if you really think about it – this is a reality for more than half the worlds population right now – in 3rd world countries. If you get sick, even from a curable disease in other countries – one may end up permanently disfigured or just die.

    We are so spoiled in this country.. super critical of any flaw or shortcoming and take so much for granted.

    https://natgeo.imgix.net/factsheets/thumbnails/BEE160829_SCREENING_JULIEN_PAT0385_TB0003_WEB.jpg?auto=compress,format&w=1600&h=900&fit=crop

  5. sherlockj Avatar
    sherlockj

    To provide more clarity, a key reason I agree with the hospitals statement on elective surgeries is that, even if some might think such things should be regulated by the state, and I don’t, it is far too late for intervention in a matter that the state is not set up to oversee.

  6. TooManyTaxes Avatar
    TooManyTaxes

    “But I also think this is the mother of all ‘reboots’ … think of it in terms of zero-based budgeting.. Every single industry will be forced to re-prove it’s position in the economy and if it cannot – it may go away or recede to a smaller part of the economy.”

    Very profound!!!

    As people do with less or even without, what will bring them back to making the same types of purchases, purchases at the same level and purchases from the same providers when the crisis has past and the economy growing again? Every business manager better be thinking about this.

    Can’t resist this one? Does American want 24/7 “news” and “pseudo news” that caters to the news presenters? Might we see a wonderful downsizing of the MSM? Might those who remain think more about the audience than their chance to expound their personal views?

    On a positive note, the speed and distance of the economic contraction could well be followed by a period of extremely high growth but that may not bring us back to where we were. Further, the stock market was more than due for a correction, albeit smaller than we’ve seen.

    This would also be a good time for governments to reexamine what they do. What programs are critical to have? What programs keep being funded to keep the workers working? What programs are nothing more than crony capitalism? What programs are heavily subsidized to benefit special interests and/or the providers? What programs are more effective and efficient than other programs? Can governments continue to close their eyes to unsustainable pension programs that are much more generous than those covering most taxpayers?

    If the economic drop is a big as some predict, some governments may just need to do some of this.

  7. LarrytheG Avatar
    LarrytheG

    MSM has “demand” as they say. Ask FOX!

    Also – think of this time as the mother of all dot-coms… and remember –
    dot-com was not a fail and it went away, it was a speed-bump and
    afterwards – thousands and thousands of things did change to an online world.

    1. TooManyTaxes Avatar
      TooManyTaxes

      Where did I exempt Fox News? I don’t sit down to watch the 24/7 TV news. Sometimes others have a channel on and might watch for a bit. There isn’t enough new news to warrant this type of coverage. There isn’t sufficient news makers to warrant this type of coverage. So they sit around and treat other news people and hangers on from nonprofits as if they actually could add something of value.

      Right now, I’m thinking of how I can provide valuable legal services to be a survivor.

  8. James A. Bacon Avatar
    James A. Bacon

    It’s a good thing for Virginia hospitals to being canceling/rescheduling elective surgery. Far be it for me to tell them how to do their business, but there’s a right way and a wrong way to go about it — and in the prevailing hysteria, I don’t know which way they have chosen.

    At this point in time, the number of hospitalizations is small, and the number will continue to be manageable for a week or two. There is no reason to cancel elective surgeries until there are bed shortages. Hopefully, hospitals will continue to provide elective surgeries until the beds are needed. If hospitals are facing massive revenue shortfalls, they should be allowed to continue generating revenue as long as they can. Of course, all elective surgery patients should be warned that their surgery may be canceled without notice as the COVID-19 emergency develops and hospital priorities change.

  9. MrMat Avatar
    MrMat

    Elective surgeries use up valuable PPE. There probably is a fraction of elective surgeries that end up with ICU stays and ventilator usage. If a hurricane is on the horizon, do you carry on as normal until it starts to rain or do you batten down the hatches and prepare for the worst?

    1. LarrytheG Avatar
      LarrytheG

      Yep. Agree.. If you’re a hospital and you doubt an ability to get re-supplied and you’re looking at this going on – in my mind – You’d be irresponsible not to conserve… (that used to be a Philosophy… 😉 ).

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