Although Gov. Jay Inslee expanded the state’s “stay-home” order through May, he is allowing for incremental changes to loosen restrictions in phases and get Washington back on track.

Skagit County continues to see new positive COVID-19 cases, but Island Hospital has been working on how to ease back into full service.

The hospital is expanding services slightly, taking on what it calls “semi-urgent” surgery cases as of this week, hospital Interim COO Ann Raish said Monday.

That means cases where the patient could be harmed if surgery was postponed more than 60-90 days, she said.

Since mid-March, the hospital has been working only with urgent cases both in surgery and on the clinical side. The result is far less revenue and cuts to staffing.

To prepare for those additional cases, the hospital is making sure the environment is safe for all patients, is testing everyone who heads into the operating room for COVID-19, putting extra cleaning precautions in place and making sure it has enough personal protection equipment to last several weeks.

Many patients are waiting in their cars for their appointments, instead of sitting inside the hospital waiting room, Raish said.

The hospital is also preparing for the eventual return to elective procedures as regulations begin to ease, she said.

Hospital leadership is working with staff to decide when those who have been furloughed can return to work. Staff members have taken cuts in hours in recent months to make up for the roughly $3 million in lost revenue that came with shutting down nonessential services.

Each member of the administration team is also furloughed one day a week to save money.

The hospital saw a drastic drop in revenue since March as it had to cut off nonessential services, hospital CFO Elise Cuter said. In the first four days of May, the hospital only brought in roughly $270,000 a day, well under the $700,000 a day it would have expected.

In April, that number hovered right around $356,000 a day, or roughly half of what was budgeted.

The hospital is estimating a roughly $2.5 million loss for April alone, though the numbers are not yet final, Cutter said.

The hospital saw a $65,000 loss in March, because it was operating as normal for the first few weeks, before the COVID-19 pandemic hit.

The hospital has about 120 days of cash on hand right now, she said. Days of cash on hand equals the number of days the hospital could operate without new revenue coming in.

That number will drop in coming months, though, because the billing cycle lags behind patient visits by a month or two. April’s revenue reflects services rendered in March. With most services shut off in April, there will be far less cash coming in May, Cutter said.

Cutter said she is working with Raish and hospital CEO Charles Hall to create a model of what the financial status of the hospital will look like over the next few months as it aims to ramp up its services and open back up.

The hospital is trying to keep expenses low and seeking alternate forms of funding, Hall said at a hospital board of commissioners meeting last week.

Island Hospital received a one-time stimulus payment of about $2.1 million on April 10, but is unlikely to get more, Cutter said at the meeting.

“That’s about two weeks of revenue,” she said.

The hospital doesn’t qualify for much governmental help.

“It’s very frustrating,” Cutter said.

The hospital is fortunate to have made great financial strides early in the year, said Wes Thew, a senior manager with Wipfli LLP, who performed an audit on the hospital’s financials.

The audit was clean and everything looked good, and it compares very favorably to other hospitals, Thew said.

“A lot of hospitals didn’t have this kind of reserve built up heading into the COVID-19 situation,” he said.

Still, with revenue dropping, the hospital will take time to get back to pre-pandemic condition.

“It will take us a year or two to get back on track,” Hall said.

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