COVID-19 pandemic leaves Tucson hospitals struggling financially

A pause in elective surgeries and rise in people avoiding emergency-room visits are combining to put significant financial pressure on Tucson hospitals, resulting in furloughs and cuts in work hours at the same time they respond to the coronavirus crisis, officials say.

Last month, Gov. Doug Ducey issued an executive order halting elective surgeries at Arizona hospitals to ensure there was an adequate supply of personal protective equipment (PPE) for medical facilities. But after reports that facilities across the state were experiencing financial losses of 30% to 40% a month, Ducey now says he’s looking to restore their ability to perform such surgeries soon.

At the federal level, House Democrats are pushing to set aside $100 billion of the Small Business Administration’s Paycheck Protection Program for hospitals across the country, money officials say that could help stabilize facilities here. Negotiations over the next wave of payments in the popular Paycheck Protection Program have so far stalled on Capitol Hill.

Meanwhile, local hospitals are also seeing a major decrease in patients coming through their emergency departments — another contributor to hospitals’ loss of revenue.

“We are seeing fewer patients than normal in our hospital, emergency department and across our outpatient locations and have had to reduce, reconfigure, or in some cases curtail, many of our services in accordance with state order,” Northwest Medical Center said.

At Carondelet St. Mary’s and St. Joseph’s hospitals, some hospital units not associated with critical patient care needs have been closed or ramped down. Hospital officials did not specifically identify which units were impacted by these changes, however.

“We have taken steps to divert additional resources to COVID-19 care and other urgent medical procedures that cannot be deferred,” said Carondelet Health Network’s CEO Frank Molinaro. “This includes flexing down costs and implementing furloughs for certain jobs where we need, or are required to, limit activity due to the current environment.”

Until the end of February, Tucson Medical Center was operating well within its budget, officials there say. Once the virus was identified in Pima County, however, the hospital prioritized making sure it had enough PPE and other equipment. This included $1.4 million in new operating costs in March specifically related to COVID-19. TMC spent the same amount in April.

TMC is estimating a $20 million loss in revenue for April alone. Based on the hospital’s net patient revenue last year — $615 million — this would account for nearly 40 percent of its average monthly income. The peak in the number of people hospitalized with COVID-19 is not expected until the end of April, and possibly into May.

“That is significant for a hospital like TMC,” said Julia Strange, its vice president of community benefit. “We have also seen our average daily census drop. In February and March, our average daily census was close to 500 patients a day. More recently, it’s been around 314.”

Like Carondelet and Northwest hospitals, TMC has also had to issue furloughs and decrease hours for employees in most of their departments because of lower patient volumes.

“The infrastructure that you put in place to support 500 patients is very different from what you need in place to support 300 patients,” Strange said. “So we have been flexing all of our staff, with the exception of nurses, throughout the organization to match the volumes and try to reduce expenses.”

Strange says the hospital is concerned about the well-being of its employees and is trying to support them in as many ways as possible. This includes implementing a Care Store, where employees have access to free supplies like toilet paper, disinfectant wipes and baby formula. TMC employees can also apply for a grant of up to $500 through the hospital’s economic relief fund.

“Our concern is multifaceted,” Strange said. “It’s not just the financial impact it has on the hospital, it’s also the financial impact this has on our employees who are now very unexpectedly facing challenges like everyone else in the community.”

While officials at Banner-University Medical Center declined to be interviewed about COVID-19’s financial impact, several sources have told the Arizona Daily Star that employees in several departments, including nurses, were being furloughed. Some employees said nurses at Banner clinics are having to take up to a month off without pay.

emergency rooms see fewer, sicker peopleIn the midst of Arizona’s stay-at-home order, Tucson hospitals are also dealing with a sharp decrease in patients coming through emergency departments. While this has contributed to decreased revenue, hospital officials say they are more concerned about the health of community members.

People in need of emergency hospital services are reluctant to seek care because they’ve been told to stay home or are afraid of contracting the virus, said Cynthia Carsten, associate chief nursing officer at TMC.

“Just in this last week, we’ve noticed that people are coming in so sick because they ran out of their medications. They’re waiting too long to come in and now they’re unstable,” she said. “We don’t want people to be that sick and be afraid to come in. We can keep them safe.”

On a daily basis, the emergency room at TMC will typically serve about 220 patients. Since Arizona’s stay-at-home order was issued, that number has decreased by about 100 per day.

“We do agree that people should stay home from restaurants and gyms and things like that to flatten the curve, but if someone is having signs and symptoms of a stroke, if somebody’s diabetes is not managed properly or if somebody is having signs and symptoms of a heart attack, they should absolutely seek hospital care,” Strange said. “The hospital is a safe place, and we are ready to serve.”

At TMC, patients, staff workers and visitors are being screened for COVID-19 symptoms before entering the building. Outside the emergency room, tents are set up to help triage patients and assess their symptoms before being allowed in. People who do not have coronavirus symptoms are being directed through the main lobby in the ER, where exposure to the virus is very low.

Patients who are stable and presenting with coronavirus symptoms are being directed to a negative pressure tent that is set up in the hospital’s ambulance bay. If they aren’t stable and need to be hospitalized, they are being taken through a separate lobby and admitted to a separate wing.

“In the main emergency department, we have the ability to segregate medical versus COVID-19-related symptoms.” Carsten said. “Because many of these cases are mild, most suspected COVID-19 cases aren’t even coming into the building unless they need to be hospitalized.”

Carsten said that staff members who are working with suspected positive patients are fully equipped with protective equipment, including masks, goggles, gloves, gowns, and in some cases full suits, booties and hair caps.

The hospital is also doing drills to help minimize the risk of exposure when suspected positive patients come through the emergency room. In coordination with local EMS and flight crews, the team acts out a scenario where it brings in a patient with respiratory issues. As if it had a real patient, members of the medical staff meet the EMS crew outside, where they continue compressions on the patient, drape them in a plastic covering, rush them inside to a negative-pressure room and intubate them.

In these scenarios, the EMS and medical staff are equipped with full suits. Once the patient is stable and the staff member leaves the room, an auditor watches as they remove and dispose of their protective equipment. After each drill, the staff members talk about what they could have done better and apply those lessons to the next run-through.

What will the future bring?

According to Strange, Ducey’s announcement that hospitals may soon be permitted to perform elective surgeries again will help normalize TMC’s operations and will also help decrease the number of emergency surgeries that are taking place.

“When you say elective surgeries, it sort of sounds like people don’t really need them, but these are cardiac surgeries, these are planned appendectomies, planned gallbladder removals,” she said. “An elective surgery, if delayed, can and commonly does grow into an emergency situation.”

When asked how long TMC will be able to sustain the decrease in revenue and volume through the pandemic, Strange said the hospital is prepared.

“We are in a strong financial position despite the situation created by COVID-19, and will be able to sustain through what we anticipate to be the duration of the pandemic. We are pleased to see proactive discussion about easing restrictions on elective surgeries as those are a critical part of the work we do as a community hospital.”