Hospitals Steel for Possible Virus Resurgence, Unsure of Their Financial Future
Private health care networks treated most COVID-19 patients, but lost dollars could yield cuts to services even as they brace for a second wave.
Images of New Yorkers lining up around the block at Elmhurst Hospital in Queens, part of the public hospitals system, became an emblem in March of a city under siege by the coronavirus.
Yet statistics recently released by the Cuomo administration show that privately run medical centers took on the vast majority of the nearly 60,000 patients treated for COVID-19 in New York City through mid June — at a price still unknown to the hospitals and those who rely on them.
Meanwhile, even amid fear of another coronavirus wave, a hospital trade group warns that cutbacks in services could be in store if non-COVID-19 patients keep staying away, avoiding elective surgery and other visits that help pay the bills.
The so-called voluntary hospitals admitted 84% of coronavirus patients in the five boroughs, the records show — slightly more than their usual share of New York City hospital beds, where they run about four out of every five.
Those that absorbed the most patients activated sprawling regional networks amassed through mergers to meet overwhelming demand and keep staff supplied with protective gear.
‘Turning Over Quickly’
Dr. Melissa Baldwin, a vascular surgeon at Mount Sinai Brooklyn, in Midwood, described an inundation of patients from nursing homes in nearby neighborhoods, with as many as 27 deaths a day.
“Things were turning over quickly,” Baldwin said of the small 212-bed private community hospital.
Stabilized patients ended up at other Mount Sinai facilities, especially those in less-inundated Manhattan — like its Upper East Side flagship, Mount Sinai West (formerly Roosevelt Hospital) and Beth Israel.
In all, Mount Sinai hospitals hospitalized 7,398 inpatients, the new state numbers show.
A similar pattern played out for Long Island Jewish Medical Center at the eastern edge of Queens.
The Floral Park facility, run by Northwell Health, usually steps up when the network’s Forest Hills hospital or a Long Island facility needs to transfer patients, said Dr. Richard Schwarz, the medical director at LIJ Medical Center.
Normally, LIJ has 583 licensed beds, and at the peak of its patient load in April was treating nearly twice as many people, Schwarz told THE CITY. Even then, it wasn’t enough — so the hospital sent patients to other Northwell facilities across the region, from Manhattan (Lenox Hill) to eastern Long Island (Peconic).
“As we became inundated, we were able to take fewer and fewer of their patients so they wind up going as far as Lenox Hill in one direction and Peconic in the other direction,” Schwarz said.
Fueled by such transfers, Manhattan hospitals took on more than 30% of all the city’s patients, the state stats show, even though the borough saw the city’s lowest infection rates as a sizable share of its population fled.
‘Gasping for Air’
No single facility cared for more COVID patients than Montefiore Medical Center’s Moses campus in the northern Bronx, which saw 3,353 hospitalizations — more than twice as many as Elmhurst.
While central Queens captured the public eye, the north Bronx suffered profoundly as the virus struck.
Four of the 10 zip codes in New York City with the highest rates of diagnosed infections are in The Bronx, according to the city’s health department. The 10469 zip code — including Allerton, Baychester, Pelham Gardens and Williamsbridge — had the second highest number of COVID-19 cases in the city and a fatality rate among the top five.
Prior to the coronavirus outbreak, Montefiore housed 816 beds, a figure that increased as demand grew. The hospital opened up a temporary ICU with 30 additional beds and a second emergency room, according to one worker.
Staff even used the Children’s Hospital at Montefiore to treat COVID patients, said a health care worker at the Bronx hospital, who spoke on the condition of anonymity. Understaffing proved a persistent theme, she said.
“It became insane. That’s the only way to describe it,” said the Montefiore worker, who has been in the medical field for more than three decades. “I have never, ever encountered what we encountered.”
Half of the staff in her unit got sick from the virus or took a leave of absence — an option the hospital offered as the pandemic took root.
“It’s hard not to get emotional when you remember the really bad days — when everyone was gasping for air,” the Montefiore employee said. “We were afraid, too. We were scared for ourselves and afraid for them. There was not enough staff and not enough support. We were running from one patient to the other.”
She added: “In hindsight, we were doing the bare minimum. That’s all we had the capacity of doing,” she said.
She had only looked at the hospital’s internal tracker that displays the number of deaths during a four day period once. In those 96 hours, 90 people had died. Five refrigerated trucks held bodies outside.
All of the patients she treated were local to The Bronx, and many were Hispanic or Latino, she said.
Montefiore declined to comment. But like other hospitals, it is now tallying the heavy costs of treating coronavirus patients while suspending usually profitable procedures.
In March, state officials directed hospitals to cancel all elective surgeries in an effort to increase capacity.
“The costs were really different than you’d expect,” said hospital finance expert Nancy Kane, who teaches management at Harvard’s T.H. Chan School of Public Health. “It’s not doing the stuff you got paid really well for. That really whacked people whether they got COVID patients or not.”
Hospitals also suffered losses from inflated costs of personal protective equipment, Kane noted, with some supplies costing as much as 1,000% more than they did before the coronavirus.
Hospitals are now striving to get elective surgeries that had been postponed during the spring back onto their operating room calendars.
Health + Hospitals postponed 9,000 elective surgery cases due to COVID, an official announced at a board meeting last month. As of June 11, operating rooms were at 63% of pre-Covid volumes, the chief medical officer said in the meeting, which she considered “very good.”
Montefiore said during a June 23 call with bond investors that just 10 days into reopening its elective surgery, inpatient surgeries had resumed at 70% of pre-COVID volumes.
Through May, Montefiore Health System lost approximately half of a billion dollars as a result of canceled elective surgeries, investors learned.
A hospital trade group, the Greater New York Hospital Association, began airing ads last month assuring New Yorkers that hospitals are safe and that further delaying treatment could be harmful.
The association says based on member surveys that its hospitals on average lost 38% of monthly revenue during the peak of the crisis, while expenses grew 23%, leaving deep deficits.
Service Cuts Loom
Federal aid through the federal government’s Coronavirus Aid, Relief, and Economic Security Act (CARES), disbursed in phases, has tided over hospitals — with Northwell so far getting $1 billion and Montefiore about $700 million, according to financial disclosures.
So has top hospitals’ ability to borrow cash. Northwell Health — the state’s largest private health care provider — drew $275 million of its available lines of credit in March, “to prepare for the potential effect of the pandemic on liquidity,” records show.
The following month, Northwell received $1 billion in Medicare advances and was able to repay the amounts borrowed. But despite the federal cash infusion, officials at Long Island Jewish still anticipate “a rather sizable loss” by the end of the year, said Michael Goldberg, the hospital’s executive director.
Reporting to bond investors, the NewYork-Presbyterian network forecast an operating loss of between $600 million and $1.4 billion for 2020, after accounting for government aid.
Hospitals’ shaky financial footing could affect their ability to respond to a second wave of COVID-19 — the subject of a recent memo from Hospital Association President Ken Raske detailing continued challenges.
Threats include patients nervous about coming back to hospitals for fear of COVID infection, the loss of well-paying private health insurance for legions of unemployed and their families, and state budget-driven uncertainties about Medicaid payments hospitals rely on.
Continued funding shortfalls, he warned, could deprive communities of more than just coronavirus care as hospitals “realign their costs” — a euphemism for spending cuts that would hit programs that cost hospitals more than they earn.
“It may involve painful decisions for patients and communities,” he wrote, “such as obstetrics, mental health, addiction, and other services for which Medicaid is the principal funding source.”