By PAULA TRACY, InDepthNH.org
CONCORD – Some of New Hampshire’s hospitals are facing a $200 million a month shortfall in revenue – about a 50 percent loss or more – and will be largely out of cash by June or July without a bailout, members of the state’s medical community told a bipartisan advisory committee on Monday.
The institutions collectively are losing several hundred million dollars each month as the COVID-19 crisis goes on due to curtailed elective surgeries, but are availing themselves of some federal and state relief that is available.
But some said it is just a drop in the bucket.
The Legislative Advisory Board of the Governor’s Office for Emergency Relief and Recovery also heard from physician practices, nursing homes, nurses and a North Country group in its afternoon fact-finding hearing. The committee is tasked with helping Gov. Chris Sununu decide how to dispurse more than $1.25 billion in federal CARES Act funding to help with recovery from the COVID-19 crisis.
Monday’s meeting was all about getting a pulse on the state’s health-care industry. The committee’s existence is being challenged by Democratic legislative leaders who contend the governor is usurping legislative power in who gets to approve and distribute federal aid.
A court hearing on that court case, Wallner V. Sununu, was heard earlier in the day and a judge has yet to rule on the governor’s motion to dismiss the lawsuit.
Officials from Concord Hospital, Huggins Hospital in Wolfeboro, and Catholic Medical Center in Manchester detailed their situations to the committee. They all curtailed elective surgeries in mid-March to deal with the impending and expected surge of COVID-19 patients, which has not yet materialized in large numbers.
But “dire” and “devastating” were the descriptions of lost revenue from elective surgeries, routine appointments and business as usual. Some hospitals have furloughed workers.
Some are asking employees to take their vacation time now rather than impose furloughs. And some are finding some grant money in a $50 million pot of state funding and others jumped on no-cost loans from the federal government.
The $1.25 billion federal money is now a source of hope.
Jerry Little, director of the GOFERR, convened the meeting by phone from its headquarters in Eagle Square in Concord.
Senate President Donna Soucy of Manchester, House Speaker Stephen Shurtleff of Concord, Senate Minority Leader Chuck Morse of Atkinson, Dick Hinch in his office in Merrimack, Sen. Lou D’Allesandro of Manchester, State Rep. Mary Jane Waller of Concord, Sen. John Reagan of Deerfield, and State Rep. Erin Hennessey of Littleton all joined in the call.
Steven Ahnen, president of the New Hospital Association, introduced members from hospitals in Concord, Manchester, and Wolfeboro who discussed the unprecedented steps taken for hospitals to prepare for the novel coronavirus, which is now a pandemic and so far has killed more than 40 state residents and sickened close to 1,400.
In addition to dealing with unsustainable financial losses, the hospitals have had to struggle with adapting for potential increased capacity, sourcing personal protective equipment, and countless other issues.
They said there is not a single source of money for solving all the financial problems and said how they get through the next 60 days will be crucial.
All three hospital executives said they went into the COVID-19 crisis in fairly good financial health, but they are now essentially in critical care.
Alex Walker, executive vice president at Catholic Medical Center, told the committee the hospital has experienced a 61 percent reduction in operating room revenue, 60 percent in primary care visits and have gone from operating a 300-bed hospital to 100 beds.
“What we have seen over the past 30 days is devastating,” Walker said, adding CMC lost about $11 million in March with a couple of weeks of normal volume and “then it fell off a cliff.”
He expects that in April and May the loss will be $20 million a month “and depending on how quickly we can start and I underline start, it will be a dimmer switch rather than a light switch” to return to normal.
“I think we did the right thing” in curtailing elective procedures following federal recommendations, “but the consequences of that are dramatic. Right now, we are waiting for a surge. We’re not sure it is going to come.” Walker said he hoped it would not, “but the longer this goes on the worse it is for hospitals.”
Scott Sloane of Concord Hospital had a similar story of impact. He is forecasting $20 million-$24 million loss each month as the crisis goes on and $40 million-$50 million for the year.
It also received about $8 million last week in federal funds and availed itself of a $57 million loan which it will have to repay.
Sloane said the hospital has asked staff to take vacation time now rather than go to furloughs.
“We feel okay for the immediate future, but everything has to be paid back,” and the impact will be felt later.
The hospital has had to mortgage the future to get through the present crisis, Sloane said.
Jeremy Roberge, president and CEO at Huggins Hospital, said the operating room has essentially closed since March 16 and it also cut back on some of the primary care services.
Though it is a much smaller facility than those in Concord or Manchester, Huggins experienced a proportional loss of $1 million in March and expects a loss of $3 million each month going forward. He expects operating cash will dry up by July.
Huggins made the difficult decision to furlough 20 percent of its workforce to slow the institutional bleeding last week, he said.
To get back to a new normal, the New Hampshire Hospital Association is just beginning to talk about a coordinated response.
Questions revolve around what surgeries require the most immediate attention, how to appropriately test for COVID-19, and whether there will be enough protective equipment to allow for various procedures.
Ahnen said it might be a regional approach.
Brendan Williams of the New Hampshire Health Care Association, which represents 80 long-term care facilities with over 7,000 licensed beds, addressed the committee.
He noted the pandemic has been particularly hard on its members from a mortality perspective, accounting for about half of the state’s COVID-19 fatalities. It is also facing a crisis in the number of available workers.
To begin with, the state has one of the oldest nursing home resident populations with an average age of 80 compared with 77 nationally.
Williams said other states have stepped up and increased their Medicaid provider rates, with the District of Columbia going to a 20 percent increase. New Hampshire has not done anything yet, but he said he is hopeful that the state is working on something now.
Recently Sununu announced a $300 a week stipend raise for long-term healthcare workers and it was great to get some positive news for workers, he said.
Williams said overall COVID-19 testing is inadequate for nursing homes in general and while “one-off testing” began Monday for nursing homes in Hillsborough and Rockingham counties – the hardest hit by COVID-19 – “it is just a snapshot. We need a motion picture. Because if you test people today, tomorrow is very different,” Williams said.
Joan Widmer, nurse and president of the New Hampshire Nurses Association, said they put out a survey to 10,000 member nurses last week and received over 800 responses.
The overwhelming first concern is having adequate protective equipment. The next most serious concern is the potential of spreading the virus and the third was adequate staffing. A fourth was adequate pay.
James Potter of the New Hampshire Medical Society presented a picture of the state’s 4,000 physician and physician practices in which some surgical practices have lost 80 percent of their revenue while many are at 50 percent.
Potter said there are some funds available but many have cut staff and have not rushed after the federal funds which have already dried up. Some cut their staffing and have no one to pursue those funds.
He said surgeries, which were not as urgent a month ago, are now becoming more urgent.
“A real question now is how we resume a soft launch of those procedures,” Potter said.
And then there is the question of how to avoid another wave of COVID-19. He said one silver lining has been the emergence of telehealth where people call or see their doctor via computer.
There has been a bit of a challenge getting people up to speed, but it has been helpful and with the governor’s emergency order allowing for it, it has also enjoyed a great deal of cooperation from insurers who are paying the same amount as a face-to-face visit.
The question is how that might be sustained going forward, he said. Federal funds and the loan programs have had a minimal impact on physician practices, Potter said. A low-cost capital access program would be beneficial, he said.
Tom Mee of the North Country Health Care Project in Coos County also addressed the GOFERR advisory board.
Mee said the project represents the critical care hospitals in the state’s poorest and most rural areas of the state, each of which represents the largest employer in its market.
The notion of furloughs and return to work in 60 days is not very realistic in the North Country as those people will have moved on by then. “I am not expecting our volume to rebound to pre-COVID levels,” Mee said. The North Country will have an increased number of people who have needs with less income and fewer with insurance, he predicted.
One area which has remained financially steady has been hospice and in-home care, he said.
On Wednesday at 1 p.m. the committee will hear from the hospitality industry, construction, car dealers and the Business and Industry Association.