“Hospitals are here 365 days, 24/7; our lights never shut off,” said Kevin Nokels, CEO of St. Luke’s in Duluth. “At a time like this we are privileged to take on this role.”
But these days, trying to forecast timelines and needed resources can be like standing on the brink of a valley. “We can’t see across the valley, how deep or wide it is,” he said, and it’s important that “we are still strong when we get to the other side of the valley and still strong to serve our communities.”
Staying strong is hard. Since March 16, St. Luke’s has averaged a $4 million loss per week. Hospitals have had to outlay funds for supplies, to convert facilities and maintain a skilled workforce … all while losing revenue, said Todd Christensen, director of finance at Grand Itasca Clinic and Hospital in Grand Rapids. To protect workers and patients, and to conserve supplies for COVID-19 patients, elective procedures and patient visits from surgery to physical therapy have been postponed.
“We’ve told our main source of revenue to stay at home,” said Jean MacDonell, president and CEO of GICH, “which was the right thing to do.” As a result, GICH is losing 40 percent of its total operating revenue on a weekly basis.
In a letter to its congressional delegation, the Minnesota Hospital Association estimated hospitals statewide were losing $31 million in revenues daily, from a 55 percent to 70 percent drop for smaller hospitals. All of its member hospitals are in “a pretty dire financial situation,” according to an MHA spokesperson.
State and federal grants addresses some shortfalls. A short-term emergency fund of $50 million distributed grants from Minnesota to healthcare organizations in early April and $150 million more became available in mid-April. In general, the grants cover supply expenditures.
Hospitals received money from the CARES Act. GICH said its check will cover one month of lost revenues. Medicare providers have several funding sources, from advance payment loans from the Centers for Medicare and Medicaid Services to increased reimbursements and relaxed regulations. A bill in Congress co-sponsored by Rep. Pete Stauber (Immediate Relief for Rural Facilities and Providers Act of 2020) will target rural and critical access hospitals and other providers for grants and loans.
It’s a challenge to gear up for adequate supplies and facilities when the exact need is uncertain. Traditional supply-chain ordering isn’t possible, and some deliveries are pushed into summer. Fortunately, regional hospitals have been sharing resources for over 20 years through the Northeast Healthcare Preparedness Coalition, one of eight emergency preparedness regions in Minnesota.
But if there aren’t enough supplies in the region or from manufacturers, where do you find them? “In a time when access to these resources is very limited, our community is innovating, transitioning their operations and supporting the needs of those on the front line,” said Adam Shadiow, NHPC regional coordinator.
His alternative sources have been surprising. Cirrus, the aircraft manufacturer, and Frost River Trading, which does industrial sewing, have partnered and retooled to produce over 30,000 disposable face shields. The companies are also working on powered air purifying respirators. Duluth Pack brought workers back to sew hospital gowns along with Stormy Kromer, a cap maker from Ironwood, Mich. Wintergreen Northernwear of Ely is making masks. A Proctor High School industrial arts teacher is using his home 3D printer to make ventilator splitters so one ventilator can serve two to four patients. He’s using the project to teach his students online.
“I’m not aware of an effort like this since World War II,” said Shadiow. “It’s remarkable, to say the least.”
More supplies and equipment are costly. For St. Luke’s it’s about $2.5 million, plus planning and training, with labor adding as much as $4 million. A smaller hospital like GICH estimates expenditures of $50,000 to $100,000 on supplies such as PPE.
Hospitals also have altered facilities to make them more relevant to a contagious respiratory illness like COVID-19. St. Luke’s converted regular hospital rooms to intensive care-ready rooms, going from 25 to 81 ICU-level beds. Those modification costs include more information technology, wiring, monitors and such. GICH has gone from 3 to 19 ICU-level beds. Critical access hospital Bigfork Valley has repurposed its day surgery rooms to create isolation rooms.
With fewer patients, staffing has been decreased through furloughs, vacation or leave time, reduction in hours, cross-training and layoffs. “We’re confident we can bring everybody back,” said MacDonell, “but we don’t know the time frame.”
So how wide is the valley? When will these resources be needed in northeastern Minnesota? Estimates put a surge in patients from mid-June to mid-July, depending on to the model used.
Meanwhile, hospitals continue to gather supplies, furloughed healthcare workers are waiting, and rooms sit empty. Fortunately, even as the hospitals are committed to their communities, the reverse has proven true. There’s been an outpouring of support, said Nokels, and donations are still welcome. Donations are handled through the hospital or community foundations, with drop-off locations for hand-sewn masks, gloves and other supplies. Donating blood also helps. Local blood donation drive sites can be found on the Memorial Blood Centers website, mbc.org.
“We’re in a bit of a holding pattern,” said Shadiow. “It’s important for us to maintain the course.”