by ALEXANDRA RETTER
Primary and specialty care services are starting to open back up at Winona Health. With some services discontinued and others reduced due to COVID-19, Winona Health, like other hospitals across the country, is facing financial hardships due to weeks of major sections of its offerings shuttered due to the pandemic.
The American Hospital Association (AHA) recently analyzed and reported on the impact of COVID-19 hospitalizations on hospital costs, the impact on hospital revenue of services cancelled due to COVID-19, extra costs tied to buying more personal protective equipment (PPE) and costs associated with some hospitals providing additional support for their employees.
Having completed the analysis, the AHA estimates that from March 1 to June 30, U.S. hospitals and health systems will lose $202.6 billion, an average of $50.7 billion each month.
Winona Health President/CEO Rachelle Schultz said the hospital has faced extra costs to prepare for COVID-19, including purchasing extra supplies and equipment, coupled with a loss of revenue due to non-essential health services closed during the height of Minnesota's shutdown. “So from that standpoint, as soon as the governor had his announcement or executive order that eliminated any type of elective procedures, surgeries, that was a huge financial impact,” Schultz stated. “And that wasn’t specific to Winona. That was across the country, really.”
Schultz explained that operating costs have placed pressure on hospitals over the past few years as well. In December 2017, Winona Health laid off 17 employees and made other staffing reductions to try to reduce costs. Along with the layoffs, 25 positions that were vacant at the time were eliminated, some employees who were about to retire were not replaced and hours for other positions underwent changes. Winona Health leaders said at the time that reimbursement rate reductions, demographic changes and insurance pressures were factors that led to costs needing to be reduced.
“Health care organizations across the country are facing similar financial pressures and many are reducing costs,” Winona Health officials wrote at the time.
Returns on stock market investments that provided some financial buffer also decreased when the market dropped, Schultz noted.
Schultz shared that state and national legislative bodies may consider assisting hospitals during this time. “We’ve never had a situation like this,” Schultz said. “It’s really challenging, because we don’t know how long it’s going to go on. And it’s hard on people. I do want to acknowledge that as we looked at cost reductions, we couldn’t leave things as they were. We had to, across the board, with everyone in the organization, ask people to take time off … furlough hours.”
Schultz explained that it is difficult to model the financial future for Winona Health at the moment, as the organization will have to be flexible with balancing its services, from surgery to clinic appointments, as well as PPE and bed availability, and recognize that if a spike in COVID-19 cases were to occur, services may be reduced once more.
Some services had been discontinued at Winona Health completely, Schultz stated. For instance, athletic training halted. Other services had been discontinued at a rate of 50 to 80 percent, she said. Schultz shared that services such as surgery and imaging had been open for emergency and high-risk health situations.
“We’re thrilled this didn’t go on for five months,” Schultz noted. “That would’ve been really disastrous. I think as we open back up, we’re really looking at doing this really thoughtfully and methodically, because COVID is still here. It’s not resolved. We don’t want any outbreaks … we do want to protect people, our workers as well as patients.”
Primary care services from check-ups for babies to Medicare wellness visits are now available. Patients may choose for their appointments to take place over the phone, via virtual meeting or in-person.
Patients who choose face-to-face appointments are screened for COVID-19. When they enter, they are asked several questions centered on respiratory health. Next, they are given a mask if they do not have one, and their temperature is taken.
During in-person appointments, staff members wear eye protection and a mask. If a patient has COVID-19 symptoms, staff members also wear an isolation gown and head covering.
Exam rooms are cleaned between appointments, and common area surfaces are disinfected. Social distancing occurs as patients enter the building, sit in waiting rooms and exit the space. Visual marks on the floor serve as social distancing guides.
Specialty care services are also available now. These services include eye care, podiatry, dermatology and women’s health.
Chief Operating Officer for Specialty Services and Chief Nursing Officer Sara Gabrick said that while telehealth options are appropriate for some specialty service areas, other health assessments made in specialty service areas, such as eye exams, are best done in-person.
“It was really great to have services be able to open up, and now we are building that back up, but it’s not back at 100 percent … we have to manage the environment to make sure we have social distancing and infection prevention,” Schultz shared.
Elective surgeries recently began being offered again in a limited capacity. The capacity will gradually expand over time, Gabrick stated. Prior to surgery, patients are tested for COVID-19.
Schultz said procedures and surgeries that had been postponed are being incorporated into the schedule now, and the aim is to complete them all by early fall.
Chief Operating Officer for Hospital and Primary Care Services Robin Hoeg shared that Winona Health is contacting patients whose appointments were postponed. “We just don’t want people to delay too long on chronic care management,” Hoeg said.
Gabrick explained that some health issues may become harder to treat they longer a patient has to wait for care. “Wherever there’s a concern, we’re here to … address that concern, come up with a treatment plan and move forward with the patient with treatment,” Gabrick said.
More information about Winona Health may be found at https://www.winonahealth.org/.