Page 7 - Healthcare News Jan/Feb 2023

Michael Barbara-Jean James Michael Henry “Hank” Joe Doug Lynch DeLoria Montemayor Davey Downey Kulig Gilbert
We listen more than we talk.
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Hospitals
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Dollars and Sense
When asked how hospitals arrived at this inflection point, as he called it, Roose said it was a combination of factors, but, as he and others noted earlier, it comes
“In healthcare, there is a great deal of concern, and the most concerning part is the continuing shortage of personnel, which has created this market for temporary staffing at rates that are truly outrageous.”
down to an exacerbation of, to borrow an industry term, some pre-existing conditions.
These include a trend toward outpatient, rather than inpatient, care, which certainly impacts overall revenues, and also shortages on the workforce front, which increase the cost of doing business in many ways, and sharp rises in prices of ... well, just about everything, from medications to PPE.
“We’ve been dealing with the aftershocks of one of
the most significant public-health crises of our time,” Roose explained. “And it occurred at a point where many shifts in healthcare were already underway, in- cluding a shift from inpatient care toward the delivery of care in a lower-cost outpatient, ambulatory setting where the trends of consumers, our patients, were beginning to change, but where the reimbursement for those services had not been able to keep up with those changes. This was layered on top of an existing healthcare-workforce shortage.
“With that, inpatient volume was beginning to decline by a few percentage points,” Roose said, adding that those shifts were beginning to acceler- ate when the pandemic hit. Overall, there has been movement away from the fee-for-service model that had dominated healthcare delivery for decades and
a shift toward promoting wellness, he explained, but not enough movement to shelter hospitals, especially smaller community hospitals, from those headwinds he described earlier.
“It has certainly not kept pace with the dramatic impact on volume and the lack of reimbursement for fee-for-service care that has occurred to make up that gap,” he went on, adding that staffing shortages al- ready existed before the pandemic, but they, too, were exacerbated by COVID and its many side effects. Watkins agreed, and, like others we spoke with, she said revenues have certainly improved since the depths of the pandemic, but they are still not at pre- COVID levels.
And there are many other forces at play that are challenging hospitals, she added, including a shortage of workers at post-acute facilities such as nursing homes, which often leaves patients who are otherwise ready for discharge with no place to go, putting more pressure on hospitals.
“We have two, three, or sometimes more patients who are ready for medical discharge, but when we don’t have a place to send those patients, so they stay with us,” Watkins said. “And that means that some patients who need to in an acute-care facility are in the emergency room or cannot get in; that’s been a huge, huge challenge.”
SPIROS HATIRAS
“So, the pandemic caused a significant chal- lenge amidst what was al- ready several headwinds that were providing stiff challenges for smaller hospitals across the country to overcome,” he went on, “forcing them to transform, to look differently, to meet those challenges and the needs of our community.”
Elaborating, he turned the clock back to late
2019 for perspective. He said that there was already significant movement in how healthcare was being delivered. More services were being provided in settings outside hospitals, he explained, with surger- ies taking place in outpatient, ambulatory settings. Meanwhile, insurance companies were adjusting as well, covering certain types of procedures, such as joint replacements, only if they took place in those lower-cost settings.