After the peak, tough decisions remain

On Friday, researchers at the University of Washington’s Institute for Health Metrics and Evaluation revised their closely-watched COVID-19 projections downward for the third time in a week, predicting that the peak of resource use in the U.S. would take place Saturday, April 11. 

For hospitals either coping with or preparing for a surge in patients, the continued downward trend in COVID-19 projections is surely good news. But while the surge might not be severe as projected in many locales, the financial impacts of COVID-19 continue to pose serious challenges for the foreseeable future, especially as state-mandated halts on non-urgent procedures remain in place.

The combination of rising COVID-19 expenses and reduced revenue from surgery is already taking a significant toll on hospital finances. Mayo Clinic officials announced last week that the system faces a $900 million shortfall in 2020. And for rural hospitals already grappling with tough financial times, the pandemic is posing an existential challenge.

In many instances, hospitals are redeploying and retraining staff idled by the freeze on non-urgent procedures to help manage surging COVID-19 populations. Other hospitals have been forced to furlough staff or temporarily reduce pay, both to cope with reduced revenue and to reduce the number of people in their facilities potentially exposed to the virus

Mayo Clinic, for instance, which halted elective procedures in mid-March, is currently operating at 35 percent capacity. In response, the system has instituted hiring freeze, furloughs, executive pay cuts and construction freezes to help address the gap.

While the initial peak of the COVID-19 pandemic may soon be in the rearview mirror, hospitals will be dealing with the financial shocks of the crisis for quite some time.

Building for a pandemic

Hospitals nationwide have rapidly transformed and retrofitted their facilities in recent weeks to keep staff and patients safe from exposure to COVID-19, from drive-through testing to isolating COVID-19 patients in specific wings to treating patients remotely even within their facilities. And it stands to reason that future hospitals will be built with many of the pandemic’s lessons firmly in mind.

For Rush University Medical Center in Chicago, decisions made during the hospital’s development 15 years ago have made the hospital uniquely prepared for the pandemic, the Chicago Tribune reports.  

The hospital, which opened in 2012, was designed in the wake of 9/11 with the express purpose of filling a local need for a facility that could potentially serve as a response center for a pandemic or bioterrorism. The hospital’s Center for Advanced Emergency Response houses 60 treatment bays, with a surge capacity of 133 percent. The center also houses three interconnected sections equipped for isolating patients. Every room in the hospital can be outfitted with an ICU bed, and a patient pavilion was designed to be transformed into an auxiliary emergency room. 

The hospital has also taken a series of steps to transform operations since the COVID-19 crisis began, from the formation of a command center team that meets twice a day via Zoom to shifting some NICU and endoscopy units into ICU rooms.

Since the start of the pandemic, many Illinois hospitals have transferred their COVID-19 patients to Rush, often sending along ventilators to help out with the surge. As of the publication of the story, one in 20 patients hospitalized for COVID-19 in Illinois was being treated at Rush, including 25% of all COVID-19 patients in Illinois currently on ventilators.

In Brief