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Hospitals Create Some Momentum, but Stern Challenges Remain

By
Dr. Lynnette Watkins
Healthcare News Special Coverage

Building Blocks for the Future

Dr. Lynnette Watkins

Dr. Lynnette Watkins called 2023 a rebuilding year and a time for “getting back to basics.”

 

As she talked about the relative fiscal health of hospitals, and especially Cooley Dickinson Hospital (CDH) in Northampton, which she serves as president and CEO, and the outlook for the coming year, Dr. Lynnette Watkins looked back on 2023 and described it with phrases often reserved for struggling sports teams — yes, like the one in Foxboro.

“It’s been a very challenging year,” she told BusinessWest. “It was definitely a rebuilding year, with a lot of focus on getting back to basics, and getting to what I would call a new normal.”

While we’re used to hearing those terms in sports, they work in healthcare, and especially when it comes to hospitals, said Watkins and others we spoke with.

Indeed, hospitals are rebuilding from several years of turmoil, falling revenues, rising costs, and struggles with recruiting and retaining a workforce. Many of these issues predate the pandemic, to one extent or another, but COVID certainly exacerbated the problems.

Dr. Mark Keroack, president and CEO of the Baystate Health system, which includes four hospitals — Baystate Medical Center in Springfield, Baystate Noble Hospital in Westfield, Baystate Franklin Medical Center in Greenfield, and Baystate Wing Hospital in Palmer — put things in perspective with some eye-opening numbers.

“It’s been a very challenging year. It was definitely a rebuilding year, with a lot of focus on getting back to basics, and getting to what I would call a new normal.”

He said the Baystate system, which also includes the health insurer Health New England, a range of physician practices, and a home-health agency (a $3 billion organization), essentially lost $61 million in the fiscal year that ended on Sept. 30 — $44 million from health delivery and $17 million from the health plan, which “had a bad year.”

And that’s a significant improvement over the previous fiscal year, when it lost $177 million.

And when it comes to workforce, the Baystate system has roughly 1,400 openings across several different departments, he said, noting that, again, this is an improvement from the peak of more than 2,000 in 2022.

Spiros Hatiras

Spiros Hatiras says HMC has taken aggressive steps on the workforce front, such as large sign-on bonuses and staffing ratios for nurses.

“It’s still more than double what it used to be before the pandemic,” said Keroack, who will be retiring next summer, adding that the system has nonetheless seen progress when it comes vacancy rates, turnover rates, and overall retention through strategies including flex scheduling, workforce-safety initiatives, upward movement on salaries and benefits, wellness programs, career counseling, and more — progress he expects will continue on these and other fronts in 2024.

Dr. Robert Roose, president of Mercy Medical Center in Springfield, agreed there was some improvement in 2023 on several of the fronts on which hospitals are battling, from overall volumes in the ER and with hospital stays (sometimes for the wrong reasons) to decreased use of travel nurses and their sky-high costs.

But there are still formidable challenges in the form of higher costs for everything from labor to equipment to medication; inadequate reimbursements for care (a problem hospitals have been dealing with for decades now); and, most recently, backlogs on the patient floors and the ER resulting from a shortage of nursing-home beds.

Overall, there are still many “mismatches,” as he called them, when it comes to demand in various settings and with specific needs, such as behavioral health.

“Hospitals are at a crossroads,” Roose said, noting that the pressures currently facing them will not likely abate in the years to come. “We have to think about how we focus on three main areas — health equity, system redesign and how we can do things differently, and workforce development.”

When it comes to getting back to basics, that phrase applies to everything to improving access, through initiatives such as an expansion of the ER at CDH (more on that later), to different strategies for recruiting and retaining employees — everything from greater flexibility with hours to a concert to celebrate nurses.

In that latter realm, there is certainly room for innovation and even what amounts to risk taking, said Spiros Hatiras, president and CEO of Holyoke Medical Center and Valley Health Systems, who said he and his team have certainly done so with some aggressive initiatives with bonuses for nurses, staffing ratios, and taking on nursing students right out of college.

“Hospitals are at a crossroads. We have to think about how we focus on three main areas — health equity, system redesign and how we can do things differently, and workforce development.”

Elaborating, he said HMC took some of the federal and state money funneled to hospitals in the wake of the pandemic and “invested” in programs to bolster the workforce through initiatives such as rising pay scales and benefits, ratios, and especially bonuses for nurses, both recent graduates and those with years of experience — initiatives that have generated strong results and eliminated the need for travel nurses, as we’ll see later.

For this issue, BusinessWest talked with these hospital administrators about the various forms of progress made in 2023 — and there were several — as well as the stern challenges that remain and the expectations for the year ahead.

 

Working in Concert

They called it Nurses Rock.

That was the name attached to a concert last spring featuring the local cover band Trailer Trash, staged in the former Colony Club space in Tower Square and orchestrated by Holyoke Medical Center. And that name speaks volumes about what this different kind of event was all about.

Indeed, this was a celebration of nurses, said Hatiras, noting that nurses from across the region, not just HMC, were invited. And more than 400 turned out.

Nurses Rock II is well into the planning stage, he went on, adding that the band Aquanett has been secured, and the event has been scheduled to coincide with National Nurses Week in early May.

Dr. Mark Keroack says 2023 was another difficult year

Dr. Mark Keroack says 2023 was another difficult year for hospitals, on several fronts, but it was a vast improvement over 2022.

Nurses Rock is just one example of rebuilding, going back to basics, being innovative, and, yes, thinking outside the box when it comes to the many challenges that are still confronting hospitals, which are, in many ways, still digging out from the fiscal turmoil created by, or exacerbated by, the pandemic.

With that, Keroack returned to those numbers he referenced earlier, such as the posted losses of $61 million system-wide in FY 2023, and put them into historical perspective.

“To really understand this, you need to turn the clock back to before the pandemic,” he said. “Before the pandemic, we would routinely generate margins of 2% to 3%, and we were generally stable; we were rated A+ by Standard & Poor’s, which put us roughly in the top quartile of health systems in New England.

“In 2020 and 2021, we were propped up by some generous federal subsidies from the CARES Act,” he went on, adding that these amounted to roughly $180 million. “They papered over some serious financial problems and enabled us to post 1% to 2% margins those two years.”

But that relief went away in 2022, and the system was still left with a huge bill for contract labor and overtime pay, he continued, adding that, when it comes to that $177 million loss in FY 2022, more than 70% of that came from higher labor costs.

In 2023, Baystate was able to make about $170 million worth of margin improvement, Keroack said, adding that much of this resulted from one-time grants from FEMA and ARPA monies, as well as some revenue-enhancement initiatives, efforts to improve supply-chain expenses, and a reduction of roughly 60 positions from the executive leadership ranks.

“We’re running an extraordinarily lean organization right now,” he told BusinessWest. For example, I used to have six direct reports, and now I have 12.”

What’s more, the system “turned the tide,” as he put it, when it comes to the use of contract labor, while also embarking on a number of joint ventures, such as the new behavioral-health hospital that opened recently in Holyoke, that help avoid capital expenditures, and exiting some small lines of business such as in-vitro fertilization and urgent care, areas where Baystate either couldn’t recruit talent or determined that these areas were not the core mission and were better left to others to handle.

Overall, volumes returned in 2023 across the board, Keroack said, meaning in the ER, surgeries, and discharges. But hospital stays or ‘days’ were considerably over budget because length of stay has increased, often because it’s more difficult to discharge a patient to a nursing home or home care.

“Hospitals are at a crossroads. We have to think about how we focus on three main areas — health equity, system redesign and how we can do things differently, and workforce development.”

“It’s causing a traffic jam,” he explained. “And it results in dozens and dozens of patients being stuck, waiting for a discharge to happen; that jams up the in-patient unit, causes backup in the emergency room, long waits, etc. It’s been stressful, but we’re beginning to get some progress on that.”

Watkins agreed, noting that more progress is needed in 2024 and beyond because there are many consequences as hospital stays lengthen, everything from greater potential for hospital-acquired infections and patient falls to further financial hardship for hospitals because insurers will not reimburse for those longer stays.

Much of the problem results from workforce issues, she went on, noting that “workforce drives access — access to our acute-care facilities, access to our ambulatory clinics, access to our VNA and hospice — and it really drives the value and quality of service that we offer.”

 

Work in Progress

Overall, there has been even more progress on the workforce front, although considerable challenges remain, said all those we spoke with.

Due to a heightened focus on various strategies regarding recruitment and retention, hospitals have greatly reduced their dependence on travel, or contract, nurses, who are paid at rates at least double what staff nurses receive, Watkins said.

At HMC, use of travel nurses has been eliminated altogether, said Hatiras, with a discernable dose of pride in his voice, noting that this was achieved through some rather aggressive risk-taking.

And, overall, the hospital has made itself a good place to work, he said, making it easier to recruit not only nurses but also doctors and other providers as well.

“The main theme in 2023 for us was to really leverage many, many years of work to create a great culture here,” he said. “That work, that culture, enabled us to attract physicians here where otherwise, we would have no shot. And it has essentially enabled us to solve our staffing problem. We have solved it for now — knock on wood.”

The most significant progress has come with attracting and retaining nurses and thus eliminating dependence on travel nurses, he went on, adding this has been accomplished through creation of that culture, but also through large bonuses and staffing ratios, initiatives launched in the early stages of the pandemic that are paying real dividends now.

“We gave the nurses something that no one else wanted to give them — something they really wanted, and something we fought for years not to give them: ratios,” he said. “None of my colleagues like my answer, but it has worked for us.”

Elaborating, Hatiras said that, pre-pandemic, his hospital, and all hospitals, fought hard against ratios demanded by nurses unions, primarily because there was no flexibility built into the equation, and penalties were imposed upon those who did not comply. HMC has injected some flexibility, keeping a 5-to-1 ratio whenever possible.

Meanwhile, rather than spend pandemic-related state and federal assistance on the “middleman,” meaning agency nurses for which the hospital paid $200 per hour, the hospital opted to put it toward retention bonuses and other initiatives for nurses and other providers of care.

“We basically said, ‘you’re here, and you work for us; we don’t want you to leave — so we’re going to pay you $20,000 over the next four years as a bonus, just to stay,’” he said, adding that very few nurses who accepted those terms have left.

Meanwhile, more recently, the hospital decided to make some additional investments, this time in recent college graduates, at a time when fewer hospitals were taking on such inexperienced individuals because of the high cost of training them. HMC offered them the chance to join the staff in May, after graduating, but not take on a full patient load until October.

On top of that, it offered something most “couldn’t say no to” — a $50,000 sign-on bonus for a commitment to stay five years.

“We said, ‘listen, we’ll cut you a check so long as you sign a note that says you’ll come and work for us,’” he said, adding that these bonuses were larger than most being offered and upfront in nature.

And they have worked, with many recent graduates signing on. And while many of his colleagues have questioned his math, Hatiras has told them, as he told BusinessWest, that, in the long run, it’s more cost-effective to incentivize nurses to stay in this aggressive fashion than it is to replace them when they leave. And that same guiding philosophy prompted him to put in place a similar program for experienced nurses, one that offers them $40,000 bonuses if they stay three years.

 

Reality Check

While there has been progress on workforce issues and other fronts, there are still a large number of pain points for hospitals, said Roose, adding that these will certainly continue in 2024.

“The pressures on hospitals have been increasing; they’ve been changing, and the needs of our community have been changing over the past several years, but the pressures have not relented,” he said, noting that the pandemic exacerbated the workforce crisis and compounded a financial crisis for hospitals across the country.

“Those various elements lead to pressures on everything from access to care for patients through traditional models that we’ve had for the past several decades, to having enough colleagues to provide care to meet the demands in different kinds of settings, to how to continue to invest in resources to innovate and grow to where healthcare is going.”

Moving forward, he said the healthcare system must continue to evolve to meet the changing needs of the public and continue to provide access to care, especially amid an ongoing shift toward more care being provided in outpatient settings.

“Hospitals and healthcare systems are evolving, but perhaps not quick enough to best meet those needs,” he went on. “We need to provide access points of care that are the most convenient, that are readily available, at the right level of care when needed, and with a high level of excellence.”

Watkins agreed, but noted that, while 2023 was certainly a time of ongoing challenge and duress for hospitals, it was also a period for rebuilding and, at CDH, celebrating such things as the 10th anniversary of the hospital’s partnership with Mass General Brigham, an expansion and renovation of the hospital’s labor and delivery suites, and the advancement of plans for expanding the ER, a project that will greatly enhance the delivery of care in that unit.

Ground will be broken on the new facility shortly, she said, adding that work to enlarge and redesign the ER brings into focus many of the pressing issues in healthcare today — everything from access to care to workplace conditions to retention of talent.

All are addressed in a design that adds 7,000 square feet of space but also improves safety through an overall configuration that enhances lines of sight while also improving staff satisfaction.

“They want to be in an environment that is pleasing to them, that they can move around in, because we spend a lot of the day at work,” Watkins said. “All of these things come back to workforce, which is going to be the key driver as we move into 2024.”

 

Bottom Line

As he talked briefly about his pending retirement and tenure at Baystate, Keroack joked that it has “never been dull.”

That’s an understatement and a rather polite way of summing up the past few years in particular.

It’s been a time of extreme challenge, but also intriguing and sometimes even exhilarating work to confront those challenges and find solutions.

As for what is to come and the outlook for 2024, hospitals will continue to rebuild and stress the basics. And, like any struggling sports team, they’ll look forward to the new year with optimism.

That’s the best you can do when you’re at a crossroads.

Hospitals Challenged by Rising Costs, Falling Revenues

By
Health Care Special Coverage

Critical Condition

 

 

An “inflection point.” 

That’s what Dr. Robert Roose says hospitals have reached when it comes to their bottom lines and the ongoing challenge of making ends meet at a time when revenues continue to fall and expenses continue to rise. 

Hospitals have perpetually struggled from a fiscal standpoint amid continually rising prices, the need to constantly upgrade technology and innovate, and reimbursement rates from payers that have historically been below 80 cents on the dollar, Roose said. But trends and conditions that existed before the pandemic have only been exacerbated over the past three years, and now, hospitals are at a critical, and extremely challenging, crossroads. 

“There’s no way to sugarcoat it — hospitals and health systems across Massachusetts, and across the majority of the country, are finding themselves struggling in many regards, and at an inflection point where there are going to need to be continued efforts to support hospitals, or there will continue to be systems and hospitals that remain in distress,” said Roose, chief administrative officer at Mercy Medical Center in Springfield, part of Trinity Health Of New England. 

He quantified the situation by noting that Mercy is on a path to lose roughly $25 million for the fiscal year that will end in June, about the same amount as last year. 

“There’s no way to sugarcoat it — hospitals and health systems across Massachusetts, and across the majority of the country, are finding themselves struggling in many regards, and at an inflection point where there are going to need to be continued efforts to support hospitals, or there will continue to be systems and hospitals that remain in distress.”

Dr. Robert Roose

Dr. Robert Roose

“It will be challenging to persist with the current models that are in place in the same ways that we have in the past,” Roose went on. There are a multitude of reasons for that, but the challenges remain significant, and the pathways forward are going to require multiple initiatives and ongoing support from a variety of different angles. 

Dr. Lynette Watkins, president and CEO of Cooley Dickinson Hospital, an affiliate of Mass General Brigham, agreed, noting that COVID put the challenges that all hospitals are facing under a brighter spotlight. 

“The past three years have been particularly challenging,” she said, citing everything from staffing issues to the aging of the population and the pressures they put on hospitals. “What COVID laid bare is that all of these issues are there, and that it’s incumbent on us to be creative, accelerate the solutions, and leverage a lot of the tools that we were in many ways reticent to use, such as telehealth and virtual visits. 

“While this situation has challenged us, it has also provided us with an opportunity to think differently, to treat patients differently, to engage differently — with our patients and with the community,” Watkins went on, adding that she and her team at CDH are working to taking full advantage of that opportunity. 

Spiras Hatiras, president and CEO on Holyoke Medical Center (HMC), concurred. In remarks made to BusinessWest for its annual Economic Outlook, he spoke of both challenge and opportunity, on several fronts, but especially when it comes to workforce issues. 

The ongoing workforce crisis, while it has impacted all sectors, has put healthcare providers, and especially hospitals, at an extreme disadvantage, especially when it comes to nursing and the need to fill vacancies with contract or ‘travel’ nurses, which can cost two or three times what a staff nurse might, Hatiras noted. 

“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,” he said. “To put things in perspective, we have about 20 nurses on temporary staff that we get through agencies. Those 20 nurses, on an annual basis, cost us $5 million; each nurse costs us $250,000 because the rates are exorbitant — the nurses get a lot of money, but there’s also a middleman that makes untold amounts of money from this crisis. 

“As a nation, the federal government is doing a lot of things — they did some things with railroad workers, they’re helping Ukraine, they’re talking about a lot of things. They should have stepped in and regulated this and said, ‘the pandemic created a tremendous amount of shortage; we cannot allow private companies to go out and profit from that shortage of staffing and bring hospitals to their knees.’ With all this, it’s going to be very difficult for hospitals to cope, and that’s why all our strategy centers around finding a way to attract nurses here.” 

For this issue, BusinessWest takes an in-depth look at the fiscal challenges facing hospitals today, and what must happen for these institutions to weather this severe storm. 

 

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 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. 

“What COVID laid bare is that all of these issues are there, and that it’s incumbent on us to be creative, accelerate the solutions, and leverage a lot of the tools that we were in many ways reticent to use, such as telehealth and virtual visits.”

Dr. Lynette Watkins

Dr. Lynette Watkins

“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, including 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. 

“So, the pandemic caused a significant challenge amidst what was already 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 surgeries 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. 

“With that, inpatient volume was beginning to decline by a few percentage points,” Roose said, adding that those shifts were beginning to accelerate 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 already 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.” 

 

Work in Progress 

One of the factors greatly impacting hospital finances is the ongoing workforce crisis, which has certainly increased the cost of providing care. Roose told BusinessWest that, while Mercy’s overall workforce is down perhaps 20%, due to a variety of factors, its workforce costs are still 7% to 8% higher than before the pandemic. 

Indeed, with many positions, not just nurses, hospitals have had to rely on contract employees, which are considerably more expensive than those on staff. 

“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.”

Spiros Hatiras

Spiros Hatiras

But there are other factors as well, said Watkins, including additional overtime, bonuses needed to attract job candidates, shift bonuses, and more. 

“It’s a huge challenge, and it significantly affected our financial performance, as well as that of other systems in the Commonwealth and across the country,” she said. “And we have to make sure that we are staffed to take care of the patients here that are sicker and that are staying longer.” 

Elaborating, she explained that Cooley Dickinson used very few contract nurses prior to the pandemic, but the need for such personnel has risen dramatically due to retirements, burnout, and individuals simply leaving the profession to do something else. 

These forces have left hospitals to fill the gaps as best they can and, for the long term, focus energies — or even more energies, as the case may be — on attracting and retaining personnel across the board. 

Indeed, Hatiras told BusinessWest that closing the staffing gap is critical because it will bring down the overall cost of doing business and help hospitals cope with lower amounts of COVID relief and revenue levels still below those from before the pandemic. 

“With ARPA funds drying up, we’re going to have pull ourselves up by our bootstraps. So our emphasis is on closing the staffing gap,” he said. “If we can do that, and not bleed money on the expense side, I think we’ll be OK; I think we’re poised to have a good year, as long as we’re able to attract nurses here.” 

Elaborating, he said closing this gap involves making HMC a preferred place to work, one where applicants with choices will want to go — and hopefully stay, thus reducing the high cost of continually filling vacancies. 

“We’re doing OK because we had to respond to what was going on in the market by creating even more attractive reasons for coming here — we raised our rates, we’re enhancing benefits, and at the same time, we’re looking at economic assistance for the lower-earning employees,” he said. “Where it’s more difficult is with the professionals because the dollars are significantly more, so competing just on price is difficult. The key for success — what keeps people here and makes them come here — is the culture of the place, so we put a tremendous amount of effort in the 10 years I’ve been here on creating a good culture. Now, it’s become a differentiator, and we’re pushing it even more. We’re an employer that listens to employees, responds to their needs, and cares. That’s what people want.” 

Roose concurred, and told BusinessWest that the recent challenges that hospitals have faced have put even more emphasis on the importance of people in the overriding task of providing quality care to patients — and the overall success of a provider. 

“Never has it been more apparent, and critical, to realize that people are the vehicles through which we deliver healthcare,” he said. “We do not deliver services that can be provided by machines; we’re reliant upon the great skills of care providers — and we don’t take that lightly.” 

 

Bottom Line 

Moving forward, Roose said, as hospitals cope with these various challenges — and, again, there are many of them — state and federal governments need to step up and continue to provide needed support. 

“The ARPA funding and other sources of relief through the pandemic and beyond, which is greatly appreciated, is not enough to close the gap from the challenges that we have encountered,” he noted. “The cost structure for delivering care has increased so dramatically, the models for fee-for-service care have not shifted quick enough, and the rates from commercial and other payers has not kept up with inflation. 

“So even with all that support, hospitals like Mercy Medical Center are expected to lose about $25 million this year, which is very similar to what it was the year before, and Trinity Health Of New England lost $65 million in fiscal 2022 from operations,” he went on. “And that puts incredible stress on hospitals.” 

Indeed, it does, and these losses, and the forces behind them, explain why hospitals are at an inflection point, and why change is needed if they are to move from critical condition fiscally to something far more sustainable.

New Inpatient Beds Will Meet a Long-time Regional Need

By
Health Care

Mental Block

The health anxieties, economic stresses, substance abuse, and feelings of isolation exacerbated by COVID-19 aren’t exactly new, Dr. Barry Sarvet says. And they won’t fade when the pandemic does.

“Prior to the pandemic — and it’s easy to forget this now — we had an enormous amount of stress in our communities related to poverty, homelessness, economic struggles … people just facing an enormous amount of stress in their lives,” said the chair of Psychiatry at Baystate Health. “We had underemployment, unemployment, an opioid epidemic. It’s a very distressed community with a lot of long-term struggles, a lot of psychosocial stress. Every psychiatric disorder is influenced by environmental stresses, and those aren’t getting better. We need to pay more attention to them after the pandemic.”

Well before COVID-19, Sarvet noted, the region’s mental-health needs laid bare a shortage of inpatient beds for patients who need more help than outpatient visits can provide. It’s why Baystate announced a joint venture with Kindred Behavioral Health last summer to build and operate a $43 million behavioral-health hospital for the region, set to open in 2022. The hospital will be located on the former Holyoke Geriatric Authority site on Lower Westfield Road in Holyoke.

Dr. Barry Sarvet

“Every psychiatric disorder is influenced by environmental stresses, and those aren’t getting better.”

Holyoke Medical Center (HMC) had revealed a similar proposal in March 2020 to build a $40.6 million, 84-bed behavioral-health facility on its campus. But when Baystate’s plans came online, and the threatened closure of 74 inpatient beds at Providence Behavioral Health Hospital were saved by a change in ownership, HMC reverted to an earlier plan, to repurpose two of its existing units for behavioral health.

“We were concerned about providing a solution to get beds online as the state was developing guidelines for all hospitals to incentivize an increase in behavioral-health beds,” said Spiros Hatiras, president and CEO of HMC and Valley Health Systems.

The process of converting two units to behavioral health — an adult unit and one with a likely geriatric focus — began in October and will be finished by late April, and will add 34 new beds to the existing 20 at the hospital, more than doubling the total to 54. In doing so, it provides a more immediate solution to regional bed shortages, avoiding the need for a lengthy construction period (HMC’s new hospital was also expected to open in late 2022).

The internal repurposing of units had been conceived as a stopgap measure, but when Trinity Health announced the sale of Providence to Health Partners New England (HPNE), which committed to keeping inpatient beds open — and Baystate moved forward with its project — the stopgap made sense as a longer-term solution, although HMC could revisit a standalone behavioral-health hospital at some point in the future, Hatiras said.

Baystate’s project, meanwhile, will include 150 beds — 120 of them part of the original plan. The system has also contracted with the state Department of Mental Health to operate a 30-bed, long-term continuing-care unit for chronically mentally ill people who need a longer time in the hospital to stabilize before returning to the community, Sarvet explained.

This state-funded program, not accessible to regular referrals, was launched after the closures of Northampton State Hospital and other facilities like it. “Some patients need longer-term care, and this offers a length of stay to support people who don’t benefit from short-term hospitalization,” Sarvet said, adding that the DMH unit will be physically connected to the new hospital, but offer its own unique resources.

“New beds will be needed over the long term,” he said, speaking of the project as a whole. “We have had quite a shortage for many years, prior to the potential closure of Providence and prior to the pandemic. This substantial increase in needs is reflected in emergency-room visits from patients with a mental-health crisis. And we certainly see evidence that this isn’t a short-term blip, but part of a longer-term trend that predated the pandemic.”

 

Multiple Pivots

The prospect of any additional behavioral-health beds in the region is certainly a turnaround from a year ago, when Trinity Health announced it would close 74 inpatient beds at Providence Behavioral Health Hospital.

However, two months ago, the health system sold Providence to HPNE, which provided some management services at the facility from 2011 to 2014, and will operate the facility under the name MiraVista Behavioral Health. In doing so, it will resume operations of numerous outpatient programs, as well as including up to 84 inpatient psychiatric beds.

Spiros Hatiras

Spiros Hatiras

“We were concerned about providing a solution to get beds online as the state was developing guidelines for all hospitals to incentivize an increase in behavioral-health beds.”

“At the time we put forth the plan to build a new behavioral-health hospital, everyone else had pretty much abandoned any behavioral-health expansion,” Hatiras told BusinessWest. “People were shrinking programs; Providence was closing down their campus, and Baystate had put their plans on hold indefinitely. We decided we needed to do something to service the region. Since then, Baystate resurrected their plan to develop the old Geriatric Authority site.”

The recent moves come as no surprise at a time when state health officials have been incentivizing hospitals to open up behavioral-health beds in the wake of a sharp increase in cases due partly to the pandemic.

However, “we had a concern that what seemed like no beds could potentally become too many beds,” Hatiras explained. He disagrees with Marylou Sudders, secretary of Health and Human Services for the Commonwealth, who has said there can never be too many beds because the state has so many needs. Rather, he noted, “demand may be greater now than it will be a year from now as we move away from the pandemic spike; we might see demand go down.”

Two other factors, both geographic, also played into the decision to scale down HMC’s behavioral-health expansion. One is that HMC, Baystate, and Providence would have been providing around 225 beds within a three-mile radius of each other, and though the need for services is great statewide, there’s only so far patients and families will be willing or able to go to seek access to treatment — not to mention the difficulty of recruiting more physicians, nurses, and ancillary staff to such a concentrated area.

“We might find ourselves very quickly in a situation where we might not be able to staff those beds. Can we attract staff to this area? That’s always been difficult for Western Mass.,” Hatiras said, another reason why a smaller-scale project makes sense right now.

“I’m optimistic about the units we’re building coming online quickly and providing some relief,” he said. “It’s a good project, and we have a good track record in behavioral health. We know we can run it well, and the state has been very enthusiastic about it. I think we’re in really good shape.”

While the standalone hospital proposal is ‘parked’ for the moment, not abandoned completely, HMC has to be sure something of that scale would be both necessary and practical before moving forward, Hatiras added. “We’re a small community hospital. A project can’t be something that may or may not succeed financially; we can’t take a $45 million risk.”

Baystate currently has 69 behavioral-health beds at three of its affiliate locations: 27 at Baystate Wing Hospital, 22 at Baystate Franklin Medical Center, and 20 at Baystate Noble Hospital. When the new facility opens next fall, these three locations will close. A fourth location, the Adult Psychiatric Treatment Unit at Baystate Medical Center (BMC), which accommodates up to 28 medically complex behavioral-health patients, will remain open. Kindred Healthcare will manage the day-to-day operations of the behavioral hospital.

Sarvet firmly believes Baystate will able to fully staff the new venture.

“We do have a nursing shortage, so this will present a challenge, but I don’t think it’s insurmountable,” he told BusinessWest. “We’ll work very hard to include people from the region and hire locally, but we might need a wider net to bring people in. We are very confident we’ll be able to be successful.”

 

Not Waiting Around

In fact, all the local players in the inpatient realm of behavioral health need to be successful, Sarvet noted. For example, suicide rates are increasing, as are instances of anxiety and depression, including in young people (see story on page 4). Meanwhile, the workforce of psychotherapists and clinicians in outpatient settings haven’t been operating at full capacity — again, partly due to the pandemic and the shift to remote treatment settings.

Like HMC, Baystate isn’t waiting for a new building to expand certain aspects of behavioral care. It will open a 12-bed child unit at Baystate later this month, which will expand to a 24-bed unit in the new hospital next year, in response to a shortage of beds specifically for that population. “We see a large number of kids taken care of on medical floors, waiting for beds, up to several weeks,” Sarvet said.

All this movement is positive, Hatiras noted, though he does wish that leadership from HMC, Baystate, and Providence had engaged in deeper conversations about the region’s long-term behavioral-health needs and how to meet them before the recent rush of project launches and changes, bed closings, and ownership transitions.

“Let’s talk as a regional team and determine what makes sense for the region,” he said. “That still has purpose now. Let’s decide what makes sense in these areas before we build 250 beds and can’t staff them, or half of them sit empty.”

For his part, Sarvet agrees that the meeting the region’s inpatient behavioral-health needs is not a solo effort. “We don’t want to win the battle; we want all hospitals to be staffed. We’re in a friendly competition, and we want everyone to win.”

 

Joseph Bednar can be reached at [email protected]

Beset by Wasteful Spending, American Healthcare Needs an Overhaul

By Contributor
Health Care

What’s Next for Hospitals

By Spiros Hatiras

The year is 2020, in the midst of an unprecedented pandemic, and the subject is the U.S. healthcare system — more specifically, the average U.S. hospital. Is it alive and well, or is it ailing?

I will argue that all is not well with our healthcare system, and that the average U.S. hospital is facing tremendous challenges now and for the foreseeable future.

It is important to establish that, while the healthcare-delivery model has been shifting to less hospital-centric models, the acute-care hospital remains solidly in the center of our delivery system and, in my opinion, will continue to do so. Any notion of a more decentralized model with less emphasis on hospitals has been pushed many years into the future, in part as a result of the COVID-19 pandemic. Despite the accelerated growth of telemedicine during the pandemic, the need for hospital bed capacity, specialized equipment, and personnel — including the ability to ‘surge’ when needed — has all but ensured that the trend toward a smaller hospital footprint will slow down if not entirely reverse.

Shouldn’t that be good news for the future of hospitals? Well, not quite. While we may have a new appreciation for the need of readily available inpatient hospital care, we have also not solved any of the problems that hospitals have been facing for many years. In fact, the pandemic laid bare one of the most fundamental problems facing the industry, especially for smaller community hospitals. At the very onset of the pandemic, it was immediately clear that many hospitals, suffering from years of underfunding, faced immediate financial threat and would not be able to survive without a financial bailout, while private insurance companies reported record profits.

“I will argue that all is not well with our healthcare system, and that the average U.S. hospital is facing tremendous challenges now and for the foreseeable future.”

Why is this the case in a country where healthcare demands the highest per-capita expenditure of all developed countries? According to a study published in January 2019 by the Johns Hopkins Bloomberg School of Public Health, the U.S. topped the ranking of healthcare spending among developed countries in 2016 at $9,982 per capita per year, a figure that is more than double the median of $4,033.

The reason for this disconnect is that most of that money is spent not on actual care, but on administrative costs. A recent study by the Center for Medicare and Medicaid Services found that, of the $3.5 trillion spent on healthcare in 2017, 33%, or $1.1 trillion, was paid to hospitals. Unfortunately, a significant portion of that money covered unnecessary costs to process bills and get paid by insurance companies, meaning the total spent on actual hospital care was far less. The same is also true for doctors’ offices.

In a study published in 2017 in Annals of Internal Medicine, Steffie Woolhandler and David Himmelstiein noted that the administrative cost of our healthcare system was estimated to be $1.1 trillion, of which the vast majority is excess and unnecessary spending. We are spending vast sums of money on a deliberately confusing and complex insurance system.

Trying to navigate the onerous billing requirements, denied-claims management, pre-authorization requirements, and a host of other administrative hurdles unique to the U.S. healthcare system is wasteful and frustrating to hospitals, doctors, and patients alike. We spend more money administering the system than we spend on care. This should alarm each and every one of us and prompt us to look a little more carefully at proposals for a single-payer system.

It is time to ignore private insurers who portray a single-payer system as the boogeyman, or the end of healthcare as we know it, and recognize their argument for what it really is: a reluctance to part with huge profits being made from a broken system at the expense of our health.

 

Spiros Hatiras is president and CEO of Holyoke Medical Center.

Hospitals Bleed Millions in Revenue from Lost Volume During Pandemic

By
Guy DiStefano
Health Care Special Coverage

Critical Condition

Guy DiStefano

Guy DiStefano says the non-urgent procedures that were shut down in March typically support the rest of what hospitals do, leading to major revenue shortfalls this spring.

Back in March, when COVID-19 was just starting to crest, hospitals took steps to brace for a potential surge of patients. But while COVID-19 surged, revenues slowed to a trickle.

“Early on, we realized we needed to build capacity for a surge of patients so we didn’t get overwhelmed like they did in New York City, so we shut things down early in March — which blew a hole in everybody’s finances,” said Mark Keroack, president and CEO of Baystate Health. “We’ve been gradually returning to prior operations. We always remained open, of course, but it was only a week or two ago that we resumed more elective kinds of cases.”

Many hospitals are doing the same, but the overall losses to the state’s hospital industry are, as Keroack put it, “staggering” — expected to total between $5 billion and $6 billion by the end of the fiscal year on Sept. 30. “It’s a big stress test, if you will, for hospitals. And some have been hit more than others.”

All area hospitals have taken a financial blow.

“This has been very challenging, with the reduction in services,” said Guy DiStefano, vice president of Finance at Mercy Medical Center. “All our outpatient services — what are termed non-urgent cases, which usually help feed and support what a hospital does in its normal, day-to-day business — has been shorted, leaving us with a great revenue shortfall.”

At the same time, he added, “we still have all our expenses in place, just like any other business. Look at restaurants — the doors were closed, but they still had rent, utilities, all the other expenses, and the employees.”

Through May, Mercy saw a $25 million reduction in revenues due to pandemic-related reductions in services — and plummeting volume in the ER, a development that surprised hospital officials nationwide. At Mercy, daily Emergency Department cases dropped from a typical average of between 225 and 250 to around 100 to 120.

“Those slowly crept back up — we’re at 150 to 180 on a daily basis, so we’re not at full capacity, and there’s a lot of pent-up demand. Our business is coming back, but we lost a lot of revenues.”

“All our outpatient services — what are termed non-urgent cases, which usually help feed and support what a hospital does in its normal, day-to-day business — has been shorted, leaving us with a great revenue shortfall.”

Joanne Marqusee, president and CEO of Cooley Dickinson Hospital, said the hit has been significant. Through May, the facility recorded a loss of $18 million, partly due to COVID-related costs, but mostly because of lost volume. That number would be worse if not for $5.5 million in federal support.

“But that in no way covers our losses,” she added, noting that Cooley Dickinson Health Care could see a revenue shortfall of well above $30 million for the fiscal year ending on Sept. 30.

“We’re now planning for a fiscal-year 2021 budget and considering a number of measures to mitigate some of this — things like hiring freezes and reducing a lot of discretionary expenses. Everywhere we can hold off on spending, we have,” she went on, noting that service hours could be temporarily curtailed in some services, while employees making more than $26.50 per hour will forgo raises for the time being.

While that move shaves some costs while protecting lower-paid employees, it doesn’t make nearly enough of a dent, Marqusee noted. “So we’re looking at ways to further reduce expenses. But the work we’re doing already will certainly have an impact.”

DiStefano said Mercy has also had to take steps like furloughs and reducing hours to mitigate the losses. “We did everything we could to help employees keep their benefits in place. But employees are the number-one cost of a typical hospital — about 50% to 60% of the cost structure.”

Holyoke Medical Center has been losing roughly $6.5 million per month since services were curtailed back in March, President and CEO Spiros Hatiras said. But the community hospital did take some steps early on to gird against the damage.

“We were probably the first hospital in the area to furlough folks; we didn’t hold off because we saw it was absolutely important to be financially viable because we don’t have a parent company to spot us money,” he told BusinessWest, adding that many furloughed employees took advantage of the $600 federal boost in unemployment and wound up bringing in more than they did while working.

Joanne Marqusee says she hopes patient volume returns

Joanne Marqusee says she hopes patient volume returns not because of the revenue issue, but because patients shouldn’t forgo necessary care.

“That helped reduce expenses significantly,” he added, noting that almost 170 of 250 furloughed employees were back at the start of July, with another 80 to 90 expecting to return at month’s end. “Then MassHealth stepped in and allocated $11.8 million over four months to cover some of the losses, and we got a one-time payment from the feds of about $3 million. Add it all up, and through May, our losses were roughly $3 million — not insignificant, but we were able to survive it.”

Dollars and Sense

Baystate is surviving, too, Keroack said, emphasizing the importance the health system has not only on its 12,000 employees, but on the region, where it has an annual economic impact of some $4.2 billion.

When the fiscal year ends on Sept. 30, he expects Baystate to have lost about $160 million in revenues due to volume losses, but the system was able to secure about $75 million in federal relief and another $23 million state aid.

“The rest of that will likely be covered by reserves,” he added, noting that Baystate is fortunate to have both reserve funds and a broad service model.

“The smaller hospitals that have cash-flow problems got hit very hard because they didn’t have much in the way of reserves, but the other group is bigger hospitals that are highly specialized, like Mass General, where their revenues really depend on that elective surgical volume. Hospitals that are jacks of all trades and have good size, like Baystate, were hit less hard. Not to say it was pleasant what we’ve been through.”

Calling a $160 million revenue loss a ‘less hard’ hit may speak in some ways to the financial clout of the healthcare industry as a whole; it’s certainly one of the Commonwealth’s key economic drivers. And as patient volume continues to ramp back up, hospitals will be on safer ground when it comes to budgeting.

“At Baystate Medical Center, we’re at 80% to 90% capacity, so I would say people are mostly back.” Keroack said, noting that, while patients are returning gradually for routine care and procedures, current volume is still affected by social-distancing and sanitization measures that have slowed the pace of treatment. “In the community hospitals, they’re a bit further behind — more like 60% of former volume.

“In the long run, the question is, will volumes be permanently depressed?” he went on. “We’ve tried to convince people you really don’t want to put off stuff you know is worthwhile — you don’t want to ignore symptoms that might be serious. We have seen a number of people lately whose illness is much more serious than it would have been in pre-COVID days.”

Cooley Dickinson Hospital’s Emergency Department has seen a 100% increase from its COVID lows, during the height of the pandemic locally, when it was handling 35 to 45 patients per day. Now, ED providers are seeing 70 to 80 patients per day, which is still about 20% below the organization’s typical ED volume.

“We are seeing people with chronic illness who have waited too long to seek medical attention and are sick,” Emergency Department Nurse Director Sara McKeown said. “We have also seen an uptick in people seeking mental healthcare; patients presenting with substance-use issues and trauma are also increasing.”

Patient volume is bouncing back at Holyoke Medical Center and its community-based practices, but ED visits still lag, Hatiras said. “Anecdotally, we’ve heard of people putting off heart conditions and other things, and that can lead to bad outcomes. People shouldn’t stay home with serious conditions.”

That said, “I don’t blame the government for being overly cautious with closing down elective surgeries,” he added, noting that the elimination of many procedures over the past two months was, more than anything else, about preserving beds to treat an unpredictable pandemic.

“We’re now planning for a fiscal-year 2021 budget and considering a number of measures to mitigate some of this — things like hiring freezes and reducing a lot of discretionary expenses. Everywhere we can hold off on spending, we have.”

Now that the infection rate is being effectively controlled, he explained, hospitals are trying to communicate the message that they are safe places to visit — with plenty of strict protocols in place, from masking to social distancing to constant sanitizing — for patients who need to be seen.

DiStefano said the challenge has been ramping services back up — and bringing back furloughed workers — to match what is proving to be pent-up demand, but in a measured way. “It’s a delicate balance — how do we do this to best serve the community?”

It’s a long road back from the volume lows of the spring, when physician revenue dropped by 50. They’re now back around 65%, and inpatient beds are at about 80% of capacity. But people with serious health concerns should not put off care, he stressed, especially since the hospital has been diligent about infection protocols and keeping COVID-suspected patients separated from the rest.

“We take great pains to keep this environment safe,” he said. “The message to the community is, ‘if you are hurt, if you have a condition, this is a safe place to come.’” It helps, he added, to be affiliated with a larger system, Trinity Health, and while Mercy has rarely seen the kind of financial deficit it faced this spring, its leaders are still doing what they can to meet community health needs.

“We are the fabric of the community; there are no concerns about Mercy’s future,” DiStefano told BusinessWest. “We are going to be here for many years to come. Fortunately, we have the backing of a larger organization, and that helps a lot.”

Distance Learning

If there is an upside to navigating the pandemic, he said it might be the growing importance of telehealth, which became not just a convenient tool for providers and patients over the past few months, but a critical one — and one that seems to be on track to be covered by insurance payers in the future much more consistently than before.

“This has become more of a platform that allows us to reach out to patients,” said DiStefano, whose background in telemedicine goes back to the 1990s. “I hope it’s a bigger part of healthcare going forward. Obviously, you have to do some testing in the office, but you can do preliminary or follow-up appointments with telehealth, and that reduces the volume of patients in the waiting room and the physical office, which allows us to have a much cleaner, COVID-free environment to keep those people safe.”

In short, it’s a way to boost volume — and revenues — while making patients who do go to the hospital feel more secure.

Hatiras agreed. “We had to switch on the fly to do more telehealth, but what we saw was care being delivered even more efficiently,” he said. “We saw no-show rates completely drop. So it’s an effective way to provide care, and there will certainly be more pressure on insurers to reimburse appropriately for telehealth.”

Indeed, Marqusee added, “what has been stopping us from doing more telehealth has been reimbursement; I hope we never go back to the days when we were so underpaid for telehealth. It has been a terrific model.”

In the meantime, she sees volume slowly returning to Cooley Dickinson — perhaps reaching 90% of a typical season come October. “But the reason we welcome those numbers is because people need to get care — it’s not because we need the volume. We know from national studies and anecdotally that people have been afraid, and they’re forgoing care, and that can really have health impacts for people.”

That’s why her facility, like the others BusinessWest spoke with, is not only maintaining strict protocols around infection control, but is communicating what it’s doing with the community.

“People have to believe that and feel confident. It’s really important that people don’t stay home in pain with issues that will just get worse. People aren’t coming with heart attacks, or appendicitis, or they power through a head injury, and it turns out they had a brain bleed. People need to come for care, and they should know this is a place they can come and feel comfortable.”

Not so comfortable, however, that they neglect the behaviors that have reduced infection rates in Western Mass. and allowed hospitals to increase their non-COVID-19 services.

“We’re in a good place; there isn’t a high level of COVID in our community. But that can change quickly,” Marqusee said. “I want people to always remember the reason we have low levels of COVID is because of the efforts everyone is making to social distance, wear masks, and practice hand hygiene. We shouldn’t take the reopening as a sign they we don’t need to do those things, but to do it even more. That allows us to provide needed care to all our communities.”

Keroack says he expects some patients to enthusiastically return to care providers, while others will be stragglers who need more convincing — while others will continue to embrace telehealth as the best option.

“We may not return to our former volumes until we have a vaccine and everyone feels totally comfortable,” he told BusinessWest. “I think it’s going to be a process.”

Joseph Bednar can be reached at [email protected]

Hospitals Gird for a Potential COVID-19 Surge

By
Dr. Andrew Artenstein
Health Care

Life on the Front Lines

Dr. Andrew Artenstein

Dr. Andrew Artenstein, chief physician executive and chief academic officer for Baystate Health.
Photo courtesy of Baystate Health

Dr. Andrew Artenstein isn’t the first to notice the lack of cars on the roads, but he’s certainly among those most invested in those open roads.

“When I leave work, I’m used to traffic, and there’s no traffic,” said the chief physician executive and chief academic officer at Baystate Health. “Every day feels like Sunday out there. The streets are a lot quieter. Hospitals don’t have visitors, so the hallways are quieter.”

Fewer people out and about means the social-distancing movement has largely taken hold in Western Mass., meaning fewer transmissions of the novel coronavirus and fewer cases of COVID-19 than would be present if people weren’t staying home. The question is, how much difference will it make in the end?

“I can tell you that I don’t know the effect, but I do know anything will help,” Artenstein told BusinessWest. “It’s the right thing to do, and it will hopefully blunt the peak. It will not prevent it totally, but if you can blunt the peak, flatten the curve, we can possibly manage the surge.”

What that surge will represent wasn’t clear at press time, when the state had tallied close to 17,000 cases of COVID-19 — a number that may be much higher as you’re reading this.

Based on expert estimates, Gov. Charlie Baker said Thursday that coronavirus hospitalizations in the state will likely peak between April 10 and April 20, with the total estimate of coronavirus cases in the state ranging from 47,000 to 172,000 over the course of the epidemic, or about 0.7% to 2.5% of the population.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital,” Artenstein went on. “People still need other types of care; people still have cardiac issues or lung issues or kidney issues. That’s not going to stop. But people who don’t need emergency or hospital-level care, for the most part, are finding care in other ways, which is what they’re being told to do. That keeps people from transmitting infection in hospitals, and keeps them away from other patients who might be sick.”

That means patient volume for non-urgent matters is indeed down at Baystate, with some of that work being moved to telephone or telehealth platforms (more on that later), as well as outpatient clinics and urgent-care centers, all of which are also trying to enforce social distancing as best they can.

What is on the rise in the emergency room are cases of respiratory illness, fevers, and coughs, with many of those being admitted and testing positive for coronavirus.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital.”

“There’s clearly a lot of transmission going on in the community, which is exactly what you’d expect from a pandemic,” he said. “If you look at the data, the vast majority of people [with the virus] are not sick enough to need to go to the hospital, but they’re still infectious and potentially transmitting it if they’re not isolating themselves.”

Artenstein should know all about the effects of isolation on pandemics. He founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, so “I have a fair amount of experience with these things. But this is a unique experience … a 100-year event.”

It’s an event that has seen Mercy Medical Center, like Baystate, shift from a strategy prioritizing preventive wellness to one that focuses on readiness and the immediate response to coronavirus — and an expansion of capacity where possible, said Dr. Robert Roose, the hospital’s chief medical officer.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase,” he told BusinessWest.

That increase in the number of patients requiring hospitalization reflects what Mercy’s leaders are tracking on a national level, and he expects the trend to increase over the coming weeks.

HCC Police Captain Dale Brown stacks boxes

HCC Police Captain Dale Brown stacks boxes of personal protection equipment for delivery to area hospitals.

“In regard to our local preparedness, we have a robust surge plan that identifies three different levels of escalation to increase our capacity to treat increasing numbers of patients,” he explained. “We’re also coordinating with other local and regional hospitals on a surge-capacity plan in the event we need to share resources among different hospitals in the region.”

Testing, Testing

What would help predict and manage the coming surge is a more robust array of testing resources, but local hospitals are still hampered by a limit on how much is available at the state level.

“At the present moment, we’re prioritizing testing patients who are symptomatic and in need of care in the Emergency Department, as well as healthcare workers and first responders,” Roose said. “We’re prioritizing those groups per the CDC, and as testing capacity increases, then we’ll be able to offer more testing as it becomes more readily available.”

Artenstein reported the same protocol for priority test groups: patients hospitalized with symptoms, employees showing symptoms, and some first responders who are symptomatic. “We know it’s not in our control; it’s a national issue, and we’ve been severely limited in our ability to test. It’s starting to improve because of a tremendous effort by people at Baystate and some of our government officials to help us get more testing and more capacity and more rapid turnaround time. We’re starting to see an improvement, but it’s still not where it needs to be.”

As for the coming surge, Baystate began preparing for that in a number of ways over the past few weeks, including the construction of a rapid-response triage facility just outside the entrance to the ER. It holds around 40 chairs — each of them six feet apart — for individuals entering the ER.

“There’s community transmission of the virus at this point,” said Dr. Niels Rathlev, chair of the Department of Emergency Medicine, when the project was announced last month. “And we really are preparing for more patients showing up for screening. This is not to expand testing; the real issue is to try to keep patients that don’t require admission to the hospital — acute emergency care — and screen them rapidly out here.”

Construction of the triage center is a step that mirrors what is happening in other parts of the country, Rathlev noted, adding that some areas, such as the state of Washington, established such centers weeks ago in anticipation of a surge in visits to the ER and the critical need to triage those coming in. Meanwhile, field hospitals are being created at sites like Worcester’s DCU Center and the Boston Convention and Exposition Center.

Capacity concerns also cross over into the realm of protective equipment like masks and gloves. Roose said Mercy is working aggressively with suppliers to make sure it has what it needs. “I will say we have supplies, but I don’t think any hospital around here feels particularly comfortable with the amount they have because there may be a large influx of patients at any time.”

It’s a problem that has required some creativity. Earlier this month, Patriots owner Robert Kraft sent a team plane to China to pick up 1.2 million N95 masks. In all, Kraft partnered with the state to purchase 1.4 million masks for Massachusetts, and purchased another 300,000 protective masks for New York.

Locally, institutions have stepped up enthusiastically to meet the need. Springfield Technical Community College’s (STCC) School of Health and Patient Simulation donated personal protective equipment — including surgical masks, isolation gowns, and exam gloves — to Baystate Medical Center, Mercy Medical Center, Holyoke Medical Center, and Cooley Dickinson Hospital, in addition to emergency medical services personnel in the West Springfield Fire Department.

“We recognize there is a critical need for personal protective equipment at hospitals and medical centers,” said Christopher Scott, dean of the School of Health and Patient Simulation at STCC. “By donating our supplies, we are doing what we can to protect the healthcare workers who are running short on masks and other protective equipment. The community needs to work together to ensure we defeat this pandemic.”

Holyoke Community College donated similar equipment from its health-science programs to area hospitals. HCC Police Captain Dale Brown spent a day last month conducting an inventory of collected supplies — including boxes of isolation gowns, exam gloves, masks, goggles, hand sanitizer, and microbial wipes — at the Campus Police station. A representative from the Massachusetts Emergency Management Agency picked everything up to coordinate delivery to area hospitals.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase.”

Even Dakin Humane Society pitched in, donating its in-house supply of disposable surgical gowns and booties, along with other personal protective equipment, to Baystate.

“We’ve seen news stories about the need for protective equipment being faced by those in human healthcare, so we reached out to Baystate Medical Center because they’re local,” said Karina King, Dakin’s director of Operations. “We anticipated that human health workers would need these supplies soon, so we recently stopped using disposable items at Dakin and found alternative equipment, including smocks that could be laundered and re-used instead of being disposed of.”

A researcher from UMass Amherst contributed in a different way, with a dose of data. Richard Peltier, a professor in the university’s School of Public Health and Health Sciences, partnered with Dr. Brian Hollenbeck, chief of Infectious Disease at New England Baptist Hospital in Boston, to test in his lab whether used N95 facemasks were still effective at blocking infectious particles after sterilization. They determined that, yes, masks could be safely sterilized and reused.

“While these are ordinarily disposable protective devices for medical workers, these are not ordinary times,” Peltier said, “and this science shows that sterilized face masks will protect our healthcare providers who are working under extraordinary conditions.”

Across the Distance

In short, there’s a lot going on to both help hospitals prepare for the surge and to reduce non-critical traffic as much as possible. To that end, a number of institutions have stepped up their telehealth efforts, including Valley Health Systems, which includes Holyoke Medical Center, Holyoke Medical Group, and River Valley Counseling Center.

“We are expanding our capabilities to meet the needs of our patients, especially those with ongoing health concerns that need to be treated and in contact with their healthcare providers,” said Spiros Hatiras, president and CEO of HMC. “It is important for everyone to maintain their health and safety regarding pre-existing conditions, as much as it is to protect from COVID-19.”

Behavioral Health Network (BHN) introduced a new program, BHNTeleCare, that allows individuals to continue counseling sessions with their therapists from the safety of their own homes.

According to Katherine Wilson, president and CEO of BHN, “this innovation in the way we provide therapy and counseling services is groundbreaking and allows us to render services where people are. This is particularly critical as a result of the needs that have emerged due to the spread of COVID-19. It allows a counseling avenue for those suffering anxiety and in need of support during this time of crisis affecting individuals and families.”

Meanwhile, MHA also introduced its new TeleWell virtual service delivery, which allows mental-health clinicians and their clients make virtual connections using a smartphone, tablet, or computer.

“With social distancing now part of daily life, people who receive therapy for emotional support, or who would like to, may experience uncertainty when it comes to making and keeping office-based appointments,” said Sara Kendall, vice president of Clinical Operations for MHA. “TeleWell provides another option by enabling people to keep their appointments virtually. Every day, more BestLife clients are using this option.”

All these efforts — including simply staying at home to avoid transmission — are helping, Roose said.

“I cannot stress enough how important the efforts of the community are in ensuring that our healthcare providers and resources adequately meet the needs of this crisis,” he said. “Physical distancing, diligent hand washing, isolating and quarantines when appropriate — those are the efforts that will flatten the curve and lessen the impact of this disease, and ensure that our healthcare providers have what they need to provide the care the community needs.

Meanwhile, Mercy’s incident command center continues to keep in contact with the entire Trinity Health system every day. “And every single day, I stress the importance of efforts we can all take to impact this disease. It’s something we all have the power to impact if we take proper precautions and follow the guidelines around physical distancing and quarantines. I can’t stress that enough.”

Those community efforts don’t guarantee Massachusetts won’t become as strained as New York City, Artenstein said, but they help.

“My feeling is that April is going to be very challenging in Western Massachusetts, and after that, I don’t know,” he told BusinessWest. “It quite possibly could extend well into May. I don’t think we’ll be completely out of the woods, and I do think, if you look at epidemics and pandemics, there are second and third waves sometimes.”

For example, he explained, the Spanish flu of 1918 saw a second wave late that year, and an even worse third wave arrived the following spring. COVID-19 has the potential of following a similar track because it’s new, and people haven’t built up the blanket of underlying immunity that keeps seasonal flu, while dangerous as well, under control.

“With each passing day, it becomes clearer we’re living in an unprecedented time, and with that comes uncertainty,” Roose added. “As this pandemic evolves, we are all called upon to learn quickly, work collaboratively, and constantly change how we do things. This is a community crisis, and it takes involvement and the efforts and support of everyone in our community.”

Ready for the Surge

Roose emphasized that he greatly appreciates those efforts, not just in the community, but from the selfless healthcare workers on the front lines.

“I could not be more inspired and impressed by our teams of providers, clinicians, nurses, everyone showing a commitment to putting patients first and responding to the needs of the community,” he said. “In a crisis like this, people show their true character, and it’s clear to me we’re much stronger together, and our teams are rising to this challenge.”

Artenstein agreed.

“I’ve never seen a group of more dedicated, committed, and compassionate people than I’ve seen here,” he said. “They’re working hard in adverse conditions.”

At the same time, he added, “they’re nervous, scared for their familes, and scared for themselves — and they have the right to be scared. But our people are true to their mission to provide excellent, compassionate care.”

No matter what form the April surge may take.

“This is a very unique point in our history — one that, hopefully, we’ll look back on and not have to relive.”

Joseph Bednar can be reached at [email protected]

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