Hospitals in the U.S.
are under siege.
As the number of coronavirus patients continues to mount, medical facilities
across the country have run out of health care workers, ventilators and even
hospital beds. This is a hospital system where we have our foot to the floor.
This week, it's going to get bad and we really need to come together as a
nation. As of April 27, 2020, about a million people in the U.S.
were infected with coronavirus and more than 55,000 people have died.
New York, the epicenter of the pandemic in the U.S., has been devastated.
Prior to the outbreak, the state had 53,000 beds in 187 hospitals.
But that wasn't enough.
More than 57,000 people have been hospitalized for COVID-19 infections in New
York alone, as of April 26, 2020.
To make up for the shortfall, city and state officials announced they would
convert racetracks and tennis courts into field hospitals and demanded
hospital administrators increase capacity.
We are today issuing an emergency order that says to all hospitals,
you must increase your capacity by 50 percent.
You must. Health officials have been sounding the alarm about pandemics for
years. According to a study by Johns Hopkins University, if the U.S.
were hit with a moderate pandemic like the flu of 1968, about 1 million people
would need to be hospitalized.
In the event of a more severe outbreak, like the Spanish flu of 1918 that
killed 500,000 people in the U.S., about 10 million people would be sent to
the hospital. But over the past four decades, U.S.
hospitals have shed more than a half a million hospital beds.
The coronavirus pandemic is pushing the U.S.
healthcare system to the brink.
The question is, how will it respond?
And will the U.S. run out of hospital beds?
Healthcare in the U.S.
is big business and hospitals operate at or near full capacity to maximize
revenue. Every hospital wants to maintain full occupancy.
If you've got a bed, and it's not producing revenue, it's losing you money.
If a hospital gets down below 50 percent occupancy, it's probably going to be
in financial trouble.
If it gets down below about 70 or 80 percent, the executives are going to
be holding their breaths. For decades, the U.S.
government actively increased the number of hospital beds.
The Hill-Burton Act of 1946 provided over $3.7 billion over three decades
for hospital construction in cities and rural areas across the country.
But over the past 50 years, the U.S.
has seen a massive drop in the number of beds, from 1.5 million hospital beds
in 1975 to 924,000 in 2018, a 37 percent
decrease. According to analysts, the shift to decrease the number of beds can
be traced back to government regulations that began decades ago.
In July 1965, after Medicare and Medicaid were enacted, the government became
one of the biggest payers of healthcare bills.
Policymakers realized that hospitals had a big financial incentive to keep
their beds full.
We began to realize what we had created and it was a spending monster.
Around the late 1960s, early 1970s, we began to wonder what
we had done. We'd started to put the brakes on.
We realized that more hospital beds were exceeding the actual need and
were actually generating costs.
The theory was that if a hospital had extra beds, it would build them up and
charge for services, driving up costs to trim the number of hospital beds
across the country. Certificate of Need laws were passed in the 1960s and
1970s that required hospitals to apply for permission to build more beds.
So if you wanted to build a 400-bed hospital in Boston, you'd have to go to
the state and explain why this area needed a hospital.
In the 1980s, Medicare began to change the way it reimbursed hospitals instead
of paying for every service it paid based on a patient's diagnosis.
Hospitals suddenly faced the opposite incentive to get patients out the door as
fast as they could.
Hence less of a need for new beds.
So now the hospital decides to keep the three extra days and run four extra
x-rays and hundreds of extra lab tests that just comes out of the hospital's
bottom line. And according to analysts, the U.S.
had too many beds to begin with.
Medical advances were making it possible for patients to have shorter stays
and improvements in medication meant fewer patients required surgeries.
Operating at full capacity allows hospitals to increase their margins, but make
scaling up during a pandemic difficult and costly.
The U.S. has about 2.8 hospital beds for every thousand people, far below many
other countries who have been successfully fighting off the coronavirus.
South Korea, which had success containing the virus after an initial surge,
has more than 12 hospital beds for every thousand people.
And Japan, which has also seen a small number of fatalities, has 13 hospital
beds for every thousand people.
But it's the U.S. that has the biggest number of coronavirus cases.
And according to analysts, those patients may not necessarily be all that good
for a hospital's bottom line.
Hospitals make a big chunk of their revenue from high ticket services like
heart bypass surgery, joint replacement surgery and cardiac surgery, and a lot
less money for things like intensive care units and emergency rooms.
To prepare for the influx of coronavirus patients, many hospitals stopped
performing profitable elective surgeries, and sent patients with less critical
ailments home.
Ironically, while the hospitals see a surge in demand, it actually makes things
less profitable than the good old days of a month ago when they could fill
beds with lucrative procedures.
Those are moneymakers typically—elective surgeries, elective procedures, MRIs,
CAT scans, this is one of the revenue sources for a medical center.
And right now, a lot of that care is being triaged and cut off.
So, they have the surge of COVID patients and they also have less of their
normal revenue coming in.
And so this is quite a financial strain, and again, where government
involvement is going to be critical or some of these hospitals are not going
to survive the epidemic. NewYork-Presbyterian Hospital stopped performing
elective surgeries on advice from the CDC, and after the New York City mayor
signed a March 16th order requiring hospitals to cancel those procedures.
The hospital system has seven campuses with 2600 beds, and estimates the
COVID-19 outbreak could negatively impact operations by $350-$700 million
dollars. Beaumont Health, Michigan's largest healthcare system, said it could
see a drop in revenue by 20-40 percent as it shifts from high revenue surgical
procedures to much lower revenue medical patients suffering from COVID-19.
The eight-hospital system has 3,400 beds and $5 billion of annual revenue in
2019. Coronavirus has wreaked
havoc on New York City hospitals.
When March hit, that's when it exploded and that's when we realized that, oh
shoot, this is the coronavirus, this is the epidemic.
And we're actually thrown into a crisis that we were not prepared for in
advance. More than 150,000 people in New York City alone have tested positive
for COVID-19 infections as of April 26, 2020.
And more than 39,000 people have been hospitalized.
When the entire system is stressed and under pressure, and that's what we're
working on. For the hospitals capacity at the "APACS"
we need 140,000 beds.
We have 53,000 beds.
That's why we're scrambling and that's why we're asking you to do as much work
as you're doing. We need 40,000 ICU beds, the
ICU beds are the intensive care unit beds, they have ventilators.
We have, when we started, 3,000 ICU beds.
To assist with the overflow of coronavirus deaths, the Federal Emergency
Management Agency sent 85 refrigerated trucks to the city to serve as
temporary mortuaries.
Northwell Health, the largest New York City health provider, runs 23 hospitals
with over 6500 beds.
In 2018, the group had revenue of $11.5 billion, a 22 percent increase from
2016. Right now we're doing relatively well.
We're managing. We're in control.
We have seen a dramatic increase, however, in the last week and our system
alone. For example, we have gone from a week ago a hundred COVID cases in the
hospital, to today of 1200 in the hospital is our COVID patient
confirmed. And we have about a thousand other patients, more than a thousand
other the patients in the hospital waiting for the results of tests.
One of New York's hardest hit facilities was in Queens.
Elmhurst Hospital is a 545 bed hospital that has seen waiting rooms packed
with contagious peoples and patients waiting for 50-60 hours for a bed.
Prior to the outbreak, New York City had an average occupancy rate of 74.2
percent, according to a March 19th report from healthcare research firm
Advisory Board.
With hospitals already packed, New York hospitals weren't ready for an influx
of patients of this magnitude.
The state estimated it would need 140,000 hospital beds as the virus spread.
To add capacity, New York Gov.
Andrew Cuomo ordered hospitals to increase their number of beds by 50
percent. And field hospitals were planned for around the city.
On March 31, 2020, a 2,500 bed hospital operated by the U.S.
National Guard, received its first patient at the Jacob Javits Center.
The former convention center became the largest hospital in the country.
The following day, the U.S.
Navy Comfort, a 1,000 bed-hospital ship, started seeing its first patient,
along with a 68-bed field hospital in Central Park run by Mount Sinai
Hospital. By April 6, 2020, New York City had a total of 23,000 beds with
about 3,800 available beds.
While COVID-19 illnesses and deaths have been mostly confined to cities and
suburbs, some rural communities are now starting to see infections grow at
alarming rates.
Blaine County, Idaho, has an infection rate of 222 cases for every 10,000
people. By comparison, Manhattan, the epicenter of the pandemic, has an
infection rate of 124 cases for every 10,000 people, as of April 27, 2020.
Blaine County has 25 hospital beds and a population of about 22,000 people.
And it's not just Idaho.
Summit County, Utah has 355 coronavirus cases and 38 hospital beds, as of
April 27, 2020.
And Gunnison County, Colorado has 151 cases and only 24 beds.
Officials believe some of the infections in these states could have come from
tourists. The counties are located in areas popular for skiing and hiking,
according to the CDC.
Rural communities may also be at greater risk from diseases like coronavirus.
Rural communities tend to have higher rates of cigarette smoking, high blood
pressure and obesity.
They also have higher rates of poverty and are less likely to have health
insurance and access to health care.
COVID-19 patients are also costly to treat.
A study by the Kaiser Family Foundation estimated that it could cost the
hospital as much as $40,000 to treat just one uninsured COVID-19 person.
To make matters worse, many rural hospitals are already struggling
financially. Since 2010, more than 120 rural hospitals have closed and
one-third are at serious risk of shutting down.
In 2019 alone, 19 rural hospitals closed.
What we're learning now is that we're caught between a rock and a hard place.
We don't want excess capacity in the calm times because that's going to run up
costs. But we desperately need it in the crisis times like now.
And I suspect there will be a lot of policy work in the next few years
figuring out how to maintain that reserve capacity if we need it, but not
burden the system with accessors when we don't.