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Hospitals face influx of patients who delayed care, revenue shortfalls

Healthcare providers transition from treating critically ill COVID patients to chronically ill patients
Hospitals are still far from normal operation, exchanging critically ill COVID-19 patients for...
Hospitals are still far from normal operation, exchanging critically ill COVID-19 patients for those who are chronically ill.(WBRC)
Updated: Jun. 17, 2021 at 6:02 PM CDT
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BIRMINGHAM, Ala. (WBRC) - For the first time in 14 months, Alabama hospitals are emerging from the COVID-19 fog.

“We’ve had a 35 percent decline in patients in hospital and our seven day average is now down to around 220 patients in hospital,” said Dr. Don Williamson, Executive Director of the Alabama Hospital Association. “That’s dramatically better than we were just a month ago.”

Hospitals are still far from normal operation, exchanging critically ill COVID-19 patients for those who are chronically ill.

“The troubling thing that we are seeing now, we’re seeing patients being admitted now with higher acuities, people who may otherwise have come in during the pandemic,” Williamson said.

Williamson said doctors are treating a wealth of patients with advanced disease, specifically heart disease, diabetes and cancer.

“One of the legacies of COVID going forward is not only going to be the loss due to COVID, but it’s going to be the more severe diseases we’re seeing as a result of deferred care or delayed care as a result of COVID,” Williamson noted. “That’s an unexpected and unfortunate corollary to the pandemic that we dealt with.”

Fiscal health is a chief concern, too. The state temporarily suspended elective procedures early in the pandemic in an effort to preserve protective medical equipment and hospital bed space. Hospitals largely depend on elective procedures to keep the doors open.

“We just know that Alabama hospitals before the pandemic, were in serious difficulty,” he stated. “With 80 percent of our rural hospitals having negative total margins and about 90 percent of them having negative operating margins. Nothing in the pandemic has really turned anything to turn that around.”

The financial uncertainty is driven by Alabama’s uncompensated care burden.

“Because of the way Alabama hospitals are paid by Medicaid by our current system, you don’t break even on your Medicaid costs or on Medicare because we have a wage index that is the lowest in the country,” Williamson added. “Most of the third party payers help with the losses on the others. But then when you’ve got 15% of your patients who are uninsured and are indigent, that’s significant portion of that you never get back.”

CARES Act funds helped fill in lost revenue gaps, still it’s too soon to know whether most hospitals will make budget this year.

“I am very worried that post-COVID we may see some of our hospitals that were struggling before COVID not make it in the post-COVID era,” said Williamson.

Among short-term needs, staffing levels are still below average.

“Our shortage of nurses and other healthcare professionals is not better, it’s worse,” admitted Williamson. “I think one of the things that we talked about as an association for next year, we’ve got to come up with a new vision for how we address workforce and find a way to encourage more people to get into healthcare.”

Williamson said the emergence of telemedicine is a positive development brought on by the pandemic.

“We know that telemedicine made a difference,” he explained. “I expect to see a world post-COVID in which you have more telemedicine visits for more appointments. For example, follow-ups are not done in the doctor’s office or in the hospital, those follow ups are now telemedicine follow-ups.”

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