Election 2020 Politics

The Health 202: Hospitals still anticipating coronavirus surge are bleeding revenue

THE PROGNOSIS

Congress assembled its enormous stimulus package so quickly it didn’t specify how $100 billion will be allocated to the nation’s hospitals caring for covid-19 patients. 

The bill the Senate passed late last night says the funds will be provided through “the most efficient systems practicable to provide emergency payment.” That essentially leaves it up to Health and Human Services Secretary Alex Azar to decide how to divvy up the pot – and get the money out the door as soon as possible.  

And hospitals hope the decisions will be fast. Facilities where cases are already surging are already struggling. And those still preparing for a surge say they’re stuck between a rock and a hard place. 

“Unlike any other business, we’re at the point we have to maintain our capacity, given we don’t know if the surge is coming,” Charlie Shields, CEO of Truman Medical Centers in Kansas City, Mo., told me over the phone yesterday.

These hospitals are bringing in a fraction of their usual revenue, forced to cancel non-urgent surgeries and procedures as officials keep communities locked down. But they can’t lay off doctors and nurses, at the risk of suddenly finding themselves with a rash of new patients.

“We can’t lay off or furlough our employees because, frankly, we could need all of them,” Shields said.

Shields and other hospital advocates say they need the federal money rapidly. Yet accessing federal grants can often be a clunky process that takes six weeks or more.

Tom Nickels, executive vice president of government relations for the American Hospital Association, said that “we do worry” about getting the funds fast enough. But he said he feels confident that the HHS is “bound and determined to get this money out as quickly as possible.”

“Sometimes government moves slowly, but I think the will is there,” Nickels told me.

The Senate unanimously approved 96 to 0 the largest financial relief bill by far in U.S. history, which would send checks to more than 150 million American households, set up enormous loan programs for businesses large and small, pump billions of dollars into unemployment insurance programs and much more, The Post’s Erica Werner, Mike DeBonis and Paul Kane report. The House will convene Friday to pass the legislation by “voice vote.” 

“The Senate’s most liberal and conservative members joined together to support the mammoth spending bill, illustrating how concerned policymakers have become about the health care strains and financial pain the country now faces,” they write.

The United States is now on course to have the worst coronavirus outbreak of any country. Wednesday was the deadliest day thus far, with 200 deaths reported. In New York City, which has become the epicenter with cases doubling every three days, workers are scrambling to convert the 1.8 million-square-foot Jacob K. Javits Convention Center into a hospital.

“The president says it’s a war,” New York Gov. Andrew Cuomo (D) said at a news conference at the conference center. “Well then act like it’s a war!”

Mark MacKinnon, correspondent for the Globe and Mail:

Infections are also spreading rapidly in Louisiana, a state that was slower to adopt quarantine measures. Nearly 1,800 Louisianans have tested positive for the virus and at least 65 have died, Gov. John Bel Edwards (R) announced. While the state has dispensed ventilators to New Orleans hospitals, Edwards said the supply of ventilators could run short by the first week of April.

The mounting cases have prompted a mad scramble for masks, gowns and ventilators, pitting states against one another and driving up prices, my Post colleagues Jeanne Whalen, Tony Romm, Aaron Gregg and Tom Hamburger report.

“The market for medical supplies has descended into chaos,” they write. “They are begging the federal government to use a wartime law to bring order and ensure the United States has the gear it needs to battle the coronavirus. So far, the Trump administration has declined.”

“Some hard-hit parts of the country are receiving fresh supplies of N95 masks, but others are still out of stock. Hospitals are requesting donations of masks and gloves from construction companies, nail salons and tattoo parlors, and considering using ventilators designed for large animals because they cannot find the kind made for people.”

Yet in parts of the country where cases haven’t yet surged, hospitals are experiencing exactly the opposite problem: a dramatically reduced demand for their services. 

It’s been 11 days since Truman Medical Centers, which operates two teaching hospitals mainly serving low-income people, announced it would postpone elective services as people started social distancing to reduce the spread of the virus. Patients are no longer getting knee replacements or preventive procedures such as colonoscopies and mammograms unless there’s an immediate medical need. 

The hospitals have cut their outpatient and elective surgical procedures to about 25 percent of their normal operations, Shields said. And because they operate on a 1.5 to 2 percent margin as safety-net providers, he’s concerned about his ability to keep paying staff members unless more revenue starts coming in.

He’s faced with tough questions that are virtually unanswerable at the moment — such as how long the quarantine measures will last and how many covid-19 cases his facilities will encounter.

“It’s very challenging because you don’t know the timing on this,” he said.

AHH, OOF and OUCH

AHH: The price tag for the relief package rose from $850 billion to $2.2 trillion in just a matter of days, as lawmakers and the White House were bombarded with lobbyists and special-interest groups seeking assistance – including for a grab bag of provisions having little to do with the coronavirus.

The bill includes $13 million for Howard University, $25 million for Washington’s Kennedy Center for the Performing Arts and $75 million for the National Endowment for the Humanities. “Senate aides said those allocations and others were justified to help the institutions prepare for and respond to the coronavirus outbreak,” our colleagues report.

Trump said yesterday he approved of the Kennedy Center funding, even as Republicans chided the inclusion of such aide. 

— Politico Magazine’s Michael Grunwald writes that an earlier bill proposal from House Democrats – which included things like overtime pay for TSA employees and funding for “bio-surveillance of wildlife” — was a sign of what’s ahead as Congress is expected to pass more stimulus bills in the coming months.

“The House proposal still bears a very close look as a preview of how Democrats plan to use their leverage,” Michael writes. “It also gives Republicans some talking points about the random taxpayer-funded goodies their opponents are pushing during a crisis.”

— Three members of Congress have tested positive for the coronavirus and more than two dozen members of Congress have self-quarantined because of a brush with the virus, Amber Phillips reports. 

Reps. Seth Moulton (D-Mass.) and Katie Porter (D-Calif.) were two of the latest to announce they had some coronavirus-like symptoms and were quarantining at home. Porter said she was awaiting the results of a coronavirus test, and Moulton said his doctor told him he doesn’t quality.

“People with symptoms should be tested, and the fact that tests are not available for Liz and me and far too many other Americans, a month after I wrote to the Vice President demanding more widespread testing, is a major failure of the Administration that I will continue fighting to fix,” Moulton said in a statement.

OOF: Economic forecasters say as many as 3 million Americans filed for unemployment benefits last week as employers facing deep uncertainty about when they can reopen businesses were forced to lay off staff in massive numbers, NPR reports.

If those numbers bear out, unemployment filings would be considerably higher than during the 2007-2009 economic recession. Layoffs are rampant in the energy, travel, transportation, hotel and restaurant sectors.

The economic disaster has prompted a furious public debate over when Americans should be able to ease off on social distancing measures, as President Trump says he wants it to end by Easter. 

Conservatives, noting the disastrous economic ripple effects, have argued it can’t go on indefinitely. Liberals have accused them of prioritizing economic interests over the lives of older and sicker Americans who are more vulnerable to the virus.

Conservative radio host Glenn Beck suggested he would be willing to sacrifice his own health and other older Americans’ lives to save the American economy. 

“I would rather have my children stay home and have all of us who are over 50 go in and keep this economy going and working,” Beck said. “Even if we all get sick, I’d rather die than kill the country. Because it’s not the economy that’s dying, it’s the country.”

— Some Republican lawmakers are balking at the president’s push to reopen parts of the country by Easter, in just 17 days. 

Instead, governors are “following the advice of public health experts and embracing coronavirus lockdowns and business closings,” Politico’s Brianna Ehley reports

“You can’t put a time frame on saving people’s lives. We’re going to make decisions based on the scientists and the facts,” Maryland Gov. Larry Hogan (R) said. 

Gov. Mike DeWine (R) said he is expecting Ohio’s infections to peak around May 1: 

— Trump won’t have the final say on this because it’s state governors who are ordering people to stay at home.

“Already, 19 have ordered or announced that they’re about to order residents to stay at home,” our colleague Amber writes. ”Even Republican governors, like Greg Abbott in Texas, aren’t inclined to open up their economies now.”

“If the goal is to get the economy going, the best thing we can do to get the economy going is to get covid-19 behind us,” Abbott said.

And in many states, schools, day-care centers and shops are closed. “So even if people want to get back to work, a lot wouldn’t be able to,” Amber writes. “Parents wouldn’t have child care, and governors in a number of states have ordered nonessential businesses closed, so workers in, say, a boutique wouldn’t be able to go back to work.”

OUCH: Hospitals on the front lines are discussing a gut-wrenching calculation: whether to resuscitate a dying coronavirus patient if doing so may expose those health-care workers to infection.

“Northwestern Memorial Hospital in Chicago has been discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members,” our Post colleague Ariana Eunjung Cha reports.

When a patient’s heart or breathing stops, typically available personnel perhaps between eight and 30 people rush into the room to start live-saving procedures. 

“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” one ICU physician in the Midwest explained.

R. Alta Charo, a University of Wisconsin-Madison bioethicist, acknowledged the prospect of withholding such care is unsettling but pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.”

— In New York City, hospitals are facing disturbing spikes in cases. 

Over 24 hours, New York City’s public hospital system said, 13 people died at Elmhurst Hospital Center, a 545-bed hospital in Queens. Outside, a refrigerated truck held the bodies. 

“Across the city, which has become the epicenter of the coronavirus outbreak in the United States, hospitals are beginning to confront the kind of harrowing surge in cases that has overwhelmed health care systems in China, Italy and other countries,” the New York Times’s Michael Rothfield, Somini Sengupta, Joseph Goldstein and Brian M. Rosenthal report. “… Gov. Andrew M. Cuomo on Wednesday offered a glimmer of hope that social-distancing measures were starting to slow the growth in hospitalizations. Still, hospitals are preparing for a major influx.”

Our colleague Philip Bump:

— Catch up on more coronavirus-related developments below (but if you can, don’t forget to take a moment later today to take a break from all the news):

On the front lines:

The administration’s response: 

  • A 69-page National Security Council “pandemic playbook” finished by the Obama administration in 2016 has been essentially ignored by the Trump administration, Politico’s Dan Diamond and Nahal Toosi report. 

Response from the states:

  • Experts are split over how contain the virus from spreading from New York, where cases are spreading, to new areas, our colleagues Shayna Jacobs, Ben Guarino and Tim Craig report.
  • A group of Texas abortion providers are suing top state officials over an order to halt abortions during the pandemic, the Texas Tribune’s Raga Justin reports.

More in troubling news:

  • The chief scientific consultant who worked the film “Contagion,” has tested positive for the coronavirus.

SUGAR RUSH

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