COVID-19 testing

COVID-19 testing is done at Island Hospital.

With cases of COVID-19 predicted to double this week and possibly skyrocket over the next month, hospitals are gearing up for a multifaceted problem: A steep influx of patients, stressed staff with limited resources and a severe decline in revenue.

Current predictions from the Washington State Hospital Association show that cases could double by Friday, Island Hospital CEO Charles Hall said at an emergency board meeting Monday.

Those numbers will keep climbing, he said.

Skagit Regional Health CEO Brian Ivie had a similar prediction, saying he expected this to be the worst week yet and “possibly just the beginning of things getting serious.”

That timeline depends largely on what people do with social distancing, Ivie said in an interview Monday.

Connie Davis, chief medical officer for Skagit Regional Health, said she expects the virus situation will continue through summer, based on information health officials are receiving from epidemiologists and the state Department of Health.

The good news, according to both Ivie and Davis, is Skagit County has yet to experienced the spike seen in Snohomish and King counties, possibly because more people are heeding advice about hygiene and keeping a safe distance from others.

Financial impact

As they work to care for the public’s health, hospital administrators also have to protect the financial health of the hospitals.

To prepare for a growing stream of patients with COVID-19, the hospitals have had to reduce and delay nonemergency services, including some of their biggest revenue producers.

Emergency care is not among the services that keep the hospitals financially afloat. Outpatient service volume and privately insured patients do that.

“We are self-funding in all that we do, and we need to keep that going,” Ivie said.

The current payer mix for Skagit Regional is 75% government reimbursement via Medicare and Medicaid, and 25% private insurance. The government reimbursement doesn’t even cover the hard costs, Ivie said. Therefore, cutting back on outpatient and nonemergency services comes with a price.

Hall said he worries there will be a long-term impact if Island Hospital cannot keep enough cash on hand to quickly bring back the services it had to reduce. Without those services, the hospital will lose half its revenue even as expenses increase, he said.

Predictive models indicate Island Hospital could lose $3.8 million per month in this current situation, Hall said. To protect its viability, the hospital will need to find $725,000 per month in reductions, divided between staffing and operational costs, Hall told commissioners Monday.

“This will change the face of medicine as we know it,” he said. “Who we were yesterday is not who we’re going to be tomorrow.”

Currently, Island Hospital has 100 days’ worth of cash on hand. That’s the number of days the hospital could afford to stay open without additional revenue, Hall has said.

Skagit Regional has 134, according to Ivie.

Ivie said that when services begin to return, there will be some backlog in demand from patients that will help rebuild depleted funds.

“I think Skagit Regional will absolutely rebound,” he said.

Island Hospital, which is smaller, has been actively working with congressional representatives and state lawmakers to get relief funding in place.

Island Hospital CFO Elise Cutter said the hospital wants officials to understand that even as the crisis subsides, expenses will hit faster than revenue returns.

“This is not the time the federal government wants to see rural hospitals fail,” she said.

In addition to government relief, the Island Hospital Foundation has set up a relief fund for community members to help.

Staff concerns

Officials at both hospitals must consider not only the impacts on public health but also the effects on their staff.

A major concern is that hospitals will be overwhelmed with more patients than they can handle. There is also concern that personal protective equipment (PPEs) will run short. Lack of equipment puts employees, their families and other patients at risk.

“We’re really in uncharted waters here,” Ivie said. “I think our employees are scared. These are uncertain times.”

Balancing work life with their home life creates stress as health care workers and other hospital staff worry about patients, themselves and their families, he said.

“We’re all in this together and trying to work together,” Ivie said.

Part of the problem is not knowing how long the crisis will last, Hall said.

However, in this time of uncertainty, there is something everyone can do.

“People need to stay home and wash their hands — literally,” Ivie said.

— Editor’s note: PeaceHealth United General Medical Center officials were not immediately available for comment for this story.

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