Hospitals Under PressurePosted on: July 11, 2020
With Central Florida hospitals under pressure on available beds and available staff as a result, we take a look at what that means in a broader sense, particularly as it impacts potential patients who are not affected by COVID-19.
SOME BASIC FACTS ON U.S. AND FLORIDA HOSPITALS
The American Hospital Association has indicated that there are currently 6,146 total hospitals in the nation with nearly one million beds between them. Of those beds, an estimated 10% are aimed at providing patients with Intensive Care. But even the Intensive Care Units can be broken down into subcategories ranging from surgical and cardiac to neonatal and pediatric. In other words, reaching capacity on ICU beds is not a near equivalent to reaching capacity on all the beds in a particular hospital, but it does require other departments to pull staff and beds in order to accommodate the pressure.
The Florida Hospital Association shows that there are 303 hospitals in the State of Florida with 67,081 available beds, most of which are found in community hospitals, though the definition of which is sometimes unclear. Generally speaking, a community hospital is governed locally and tends to be in a smaller town. Technically speaking, Florida defines an essential access community hospital as any facility that has “at least 100 beds” and is “more than 35 miles” from any similar facility. More to the point, a Hospital Bed is defined as “a hospital accommodation which is ready for immediate occupancy, or is capable of being made ready for occupancy within 48 hours.”
Before we move on, the FHA also indicates that the top ten diagnoses, or causes of hospitalization in 2017 make up roughly a quarter of all hospital discharges and are as follows:
- 215,160 Deliveries
- 96,753 Psychoses
- 79,609 Hip and Knee Replacement
- 76,838 Heart Failure
- 70,239 GI and Digestive Disorders
- 68,726 Chronic Obstructive Pulmonary Disease
- 45,525 Pneumonia
- 45,308 Abnormal Heart Rhythm
- 33,496 Cardiac Catheterization
- 22,146 Chest Pain
We can certainly imagine these numbers shifting drastically in future data that reflects on 2020, but the Intensive Care Units could easily become a leading source of care for about half of these diagnoses when an illness or a condition worsens.
WHAT IS THE RELATIONSHIP BETWEEN COVID-19 AND THE ICU?
When hospitals report having a shortage or a lowering of available hospital beds in their Intensive Care Units, they are referring largely to the seventh item above, those with COVID-19 pneumonia, those often requiring extensive monitoring or even mechanical ventilation. This tends to disproportionately impact older populations and greatly impacts the availability of care for these patients and others.
On Friday, we learned that Central Florida ICU beds are diminishing quickly with Orange County showing 18 percent availability, Osceola at 8 percent, Seminole at 10 percent, and Volusia at 17 percent. With kids returning to school in just a few weeks, this is raising some red flags.
THE BUSINESS OF RUNNING A HOSPITAL
Thinking of a hospital as a place to heal and recover is understandable and common, but thinking of a hospital more like a business may be slightly uncomfortable and unfamiliar. Take, for instance, the idea of revenue, the fact that a hospital cannot function on its own without an income. And most of that revenue comes from billing either patients themselves or their insurance companies. Which means that patient care for a hospital is as much about healing as it is about surviving. Without patients, a hospital would have to cut staff and downsize their departments.
Alas, when COVID-19 began dominating American headlines in March and hospitals had to stop “all nonemergency medical care,” the New York Times reported that even the Mayo Clinic was losing “millions of dollars a day.” The only offset for those losses has been an equally problematic revenue: Medicaid, which provides coverage for low-income patients. The reason this is problematic is because even Medicaid payments have historically tended to fall short of costs, meaning that they rarely make up the difference of what a hospital invests into each patient, low-income or otherwise.
The American health care system for years has provided many hospitals with a clear playbook for turning a profit: Provide surgeries, scans and other well-reimbursed services to privately insured patients, whose plans pay higher prices than public programs like Medicare and Medicaid.
But in the midst of a pandemic, this approach has proven vulnerable. One source even identifies four rural hospitals in Florida that have closed since the beginning of this year: Campbellton Graceville Hospital, Regional General Hospital in Williston, Shands Live Oak Regional Medical Center, and Shands Starke Regional Medical Center.
From a purely business point of view, hospitals are being forced to balance their priorities between “non–COVID-19 elective patient volume that positively affects the revenue cycle and maintaining optimal surge capacity for future peaks of COVID-19–related illness.”
WHAT WOULD HAPPEN IF A HOSPITAL RAN OUT OF BEDS?
In a 2017 study, it was determined that 85 percent is an optimal rate for hospital occupancy, but that most hospitals are much higher, forcing doctors and nurses to relocate patients to any available room or bed outside the normal area that they would recover. The patients are then treated as part of an overflow and receive, according to some, a significantly lower degree of care.
Back in March, when this was mostly all new to Americans, there was talk of providing emergency support from other organizations and businesses in other states:
In coronavirus hot spots, state and local governments have stepped in with unprecedented efforts to add thousands of hospital beds—all over the country, and all at once. A county in Washington State has leased a motel and erected a tent hospital on a soccer field as part of a push to create 3,000 hospital beds. California is reopening closed hospitals. New York is turning a major convention center in Manhattan into four 250-bed field hospitals. After requests from state leaders, Navy hospital ships that have 1,000 beds each will also deploy to Los Angeles and New York City.
What is unclear is whether similar options would be made available in Florida, should cases increase and hospitals exceed all their available options.
The bigger conversation in medical circles these days is being rooted in Telehealth Services, which is opening doors for physicians of every background to reach their patients without the need for an in-person visit. Even if you had COVID-19, Telehealth is making it possible to send patients home for regular, digital monitoring, freeing up beds where hospitals are full.
ARE FLORIDA HOSPITALS BACK TO DOING ELECTIVE PROCEDURES?
That depends. The first thing to keep in mind is the difference between elective and urgent procedures. A condition or a personal injury may be debilitating, but if it’s not life threatening, hospitals deem any procedure, any surgery, any time in the hospital for that reason to be elective, meaning you can temporarily survive without it under extenuating circumstances, albeit with great amounts of discomfort and potential pain. And putting elective procedures on hold is generally about conserving resources while also protecting more urgent patients from the risk of getting or spreading COVID-19. Still, the term “elective” does not equate to “unnecessary” and many hospitals are eager to offer healing to those elective patients while restoring their engine of revenue.
Over the last week in South Florida, for example, some facilities have announced a postponement of elective procedures with Miami-Dade making up roughly 80% of the new cases in our state, including a higher than expected number of doctors and nurses testing positive within one hospital system. On the other hand, some are toughing it out, selectively working to provide elective procedures and keep them clear of any hallways or sections where COVID-19 would be a threat.
So if you were on the list for a hip replacement, or a shoulder surgery, or some other kind of elective procedure, the best move is to call your physician, to call your surgeon, to find out where things are at in the moment and remain flexible. Try not to get angry or upset if the answer is yet another delay. Because in truth, your health care provider is just as eager to help as ever, but may have other factors still to consider.