COVID-19 Presenting New Challenges

Nearly two months into the COVID-19 outbreak in America, with 74,000 deaths recorded by the Centers for Disease Control, the Kansas City region is at an inflection point on multiple levels:

• With the finances of its health-care delivery system.
• With the risk of increased viral spread as restrictions on economic activity are lifted.
• And with significant deaths from causes unrelated to the virus as people continue to defer needed health care out of unfounded fears that hospitals could pose infection risks.

Those were key issues explored this morning in a University of Kansas Health System news briefing. Participating in the session were the system’s chief medical officer, Steven Stites; infectious-disease specialist Dana Hawkinson; chief financial officer Doug Gaston, and U.S. Sen. Jerry Moran of Kansas.

Perhaps the most significant health-care issue they discussed involved the dramatic decline in emergency-room visits, especially with anticipated numbers of people showing symptoms of heart attack or stroke.

On the health-policy side, Moran addressed the impact of federal efforts to provide financial relief to hospitals, especially those in Kansas that are community facilities owned by a county, city or public district, all of which were excluded from initial tranches of federal relief. But all, he said, are operating on thin margins that can see profitability vanish from one day to the next.

Just as important, he said, noting that he nation’s unemployment rate released today had risen to 14.7 percent, is the need for rural health care to retain employees by keeping hospital solvent. “Recruiting those workers is especially challenging in rural Kansas.”

He said recent moves from Washington to direct funding to publicly-owned community hospitals could help keep those people on hospital payrolls.

Stites note that the nation’s health-care system is normally able to shrug off economic downturns, “but now, we’re leading the recession.” But the greater risk for care delivery, he said, was the unexpected type of social distancing people are practicing with their providers.

“We closed our clinics, closed our operating rooms, thinking there would be a huge surge going to emergency rooms, but the truth is, ER volumes are down, and I think that’s the canary in the coal mine,” he said.

It makes no sense to ignore signs of medical emergency, he said. “Hospitals now can be some of the safest places to be from an infection control-standpoint. Probably safer today because of all the work that’s been done because of the virus. If people are having bad outcomes at home, that’s not the way to fight the coronavirus.”

Addressing the financial side, hospital margins tend to run about 1.7 percent, Gaston said, “and given that framework, can’t stand a big disruption. Otherwise, you wreck the finances of a hospital, and unfortunately, we’ve had a big disruption.”

From what he’s seen and heard, some hospitals and health systems have seen revenue decline by 40 percent, and some are projecting revenues will remain off by 20 percent for as long as the next 12 months.

Hawkinson presented an update on the numbers of COVID-19 cases being treated by the hospital in Wyandotte County. After seeing an uptick in hospitalizations last week, peaking at round 32 on the daily census, he said, “the number of numbers of admissions is now stable, about four or five a day, but we’ve had some discharges. So today, we have 24 patients; nine of those are in the ICU. Some have been here a long time, and that’s contributing to those numbers. We want to get those patients discharged as soon as we can, and with the economy opening up, it will be important to watch the total infection number as well as hospitalizations.”