Oregon’s health care system is reeling.
Hospital revenues have plummeted and providers worry they are not getting enough federal relief funding. On the front lines, nurses, technicians and emergency room physicians are concerned about a lack of adequate personal protective equipment and want the state to better coordinate those efforts so all providers have equal access.
Those are some of the messages expressed Friday in a hearing of the House Health Care Committee about the state’s response to COVID-19 and its impact on the industry. Hospitals lost more than $600 million in March and April, with a 41% drop in inpatient revenues, according to the Oregon Association of Hospitals and Health Systems. Rural hospital faced even steeper losses with a 73% drop in inpatient revenues.
“No one has a roadmap for a once in a lifetime pandemic,” said Becky Hultberg, CEO and president of the association.
Hospitals have received $270 million from the federal Coronavirus Aid, Relief and Economic Security Act, called CARES. That’s less than one month of financial losses, Hultberg said. Oregon rural hospitals received another $172 million in federal money earmarked for small providers.
Even so, hospitals face a long recovery. Staffing is down by nearly 1,100 employees statewide, a 2.6% reduction. Hospitals have put employees on furloughs, enacted layoffs and slashed salaries. It may not be enough.
“It is critical to protect our frontline caregivers, but absent additional financial assistance or improvements in revenue, this may not be possible over the long term,” Hultberg said.
Melissa Damm, chief financial officer of Providence Health & Services, said federal relief helps, but has not covered the losses.
Revenue at Providence is down $163 million and the system has received $29 million in federal relief money, Damm said. The system anticipates another $150 million drop through July, with another $30 million in federal aid.
Groups representing hospital workers are concerned about the economic outlook and the lack of uniform standards for personal protective equipment.
“What we hear from the frontline’s is a lack of clarity about how much PPE any specific facility has, and concerns about rationing,” said Sarah Laslett, executive director of the Oregon Nurses Association, which represents nearly 15,000 nursing professionals.
Nurses often received reassignments in March to keep their jobs, though providers are increasingly turning to layoffs, Laslett said.
Health care workers still have concerns about personal protective equipment, even though providers say they have an adequate supply, said Dr. Chris Strear, president-elect of the Oregon Chapter of the American College of Emergency Physicians.
Hospitals must have an adequate 30-day supply of personal protective equipment in order for counties to reopen. Most counties have received the green light to reopen from the state.
“Some providers have to reuse masks for up to a week at a time, and we have even heard of physicians sterilizing their N95s in a crock pot,” Strear said. “These standards are not safe, often fall short of even the CDC’s crisis capacity requirements, and seem in direct conflict with some hospitals’ attestations that they have sufficient PPE supply.”
In a survey of emergency room workers, the organization found only 23.6% of them believed they are as safe as they can be during a shift. Just 18.9% felt safe when returning home to their families.
Health care workers stay in trailers, sleep in basements and otherwise avoid contact with family members to prevent infections. The group wants hospitals to coordinate PPE sharing so there are no disparities among providers.
Oregon Health Authority Director Patrick Allen told lawmakers that one goal he has is to modernize the state’s stockpile of personal protective equipment for the future, noting the difficulties with supply chains and the federal stockpile.
The pandemic forced rapid technology changes. The health care industry expanded telehealth services so patients could avoid clinic visits.
Dr. Jim Polo, executive medical director for Cambia Health Solutions, told lawmakers the change will be long-term, especially as technology advances.
“COVID was the perfect storm to really drive change in our delivery system,” Polo said.
In the long run, challenges remain on the behavioral health front. More people will face behavioral health challenges from chronic stress and job losses than the people who needed medical treatment from the virus, he said.
“We are by no means out of the woods,” he said.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.
