South Florida hospitals, facing financial gap, restart surgeries as COVID cases drop
South Florida hospitals are slowly resuming elective surgeries for a second time, after a summer surge of COVID-19 cases forced Miami’s largest hospitals to halt non-emergency medical procedures and call for reinforcements from out-of-state nurses in July.
The middle of August has brought some relief, with a fourth consecutive week of declining COVID patient admissions to hospitals, easing pressure on healthcare workers and coinciding with declines in new case totals, the percentage of tests coming back positive and general demand for testing.
But without a vaccine for the disease and with intensive care units still caring for the most severely ill COVID patients, hospital administrators are balancing the need to resume surgeries against a warning from the White House of a potential third spike in hospitalizations this fall, when flu season begins.
Memorial Healthcare System, the public hospital network for South Broward County, was one of the hardest hit hospital groups in South Florida, filling to capacity last month, prompting administrators to active their emergency plans to create more room by filling conference rooms and auditoriums with beds.
Nearly half of all patients admitted for COVID at Memorial Healthcare hospitals in Pembroke Pines and Miramar last month came from Northwest Miami-Dade.
Dr. Stanley Marks, chief medical officer for the hospital network, said Memorial is “winding down” those areas converted for patient care, but they will remain ready for the foreseeable future.
“They’re not going to be dismantled,” he said.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and White House coronavirus adviser, said this month that no one can predict how bad the pandemic will get this fall, when some schools and businesses reopen and the cool weather sends more people indoors, where the virus can spread more easily.
With Labor Day and flu season nearing, and as more of South Florida reopens, Marks said he’s concerned that some people will stop doing the things that helped bring down cases, namely social distancing, wearing masks and frequent hand washing.
South Florida hospitals voluntarily halted non-emergency surgeries in July, after a June COVID surge boiled over and far exceeded the peaks the healthcare facilities saw in the spring. They did it to ensure space to treat patients and conserve personal protective equipment, such as gowns and masks. But the decision was a blow to hospitals’ finances.
Hospitals statewide had already been forced to cancel non-emergency surgeries from March 20 until May 4, following an executive order from Gov. Ron DeSantis, leading to a loss of revenue for hospitals from cardiac surgeries, hip and knee replacements and other procedures.
With a second, bigger surge of COVID cases in June, and South Florida at the epicenter, Miami-Dade and Broward hospitals suspended surgeries once again — adding to the revenue losses of the first shutdown, said Justin Senior, CEO of the Safety Net Hospital Alliance of Florida, which represents 14 of the state’s public hospitals, teaching hospitals and children’s hospitals.
“Our hospitals have still not made up the losses they incurred from March 20 to May 4,” he said, during a press conference Aug. 13 to call attention to the lack of funds received by Florida hospitals through the federal Coronavirus Aid, Relief, and Economic Security or CARES Act, which set aside more than $175 billion for hospitals and other healthcare providers.
Senior said that members of the Safety Net Hospital Alliance, including Memorial Healthcare and Miami-Dade’s Jackson Health System, are likely to lose more than $1.5 billion in revenues when combining the two periods of canceled surgeries.
Based on those losses, Senior estimates that Florida hospitals collectively have lost about $7 billion in revenue due to COVID, and received about $4 billion in CARES Act funds. About $125 billion in CARES Act funds have already been disbursed to hospitals, and Senior is actively campaigning for Florida hospitals to receive their “fair share,” he said.
South Florida hospitals gradually resume non-emergency surgeries
The region’s largest hospitals are continuing to act in near lockstep, with Memorial, Jackson Health and Baptist Health South Florida all gradually resuming elective surgeries this week.
Marks said Memorial is easing into it, starting with outpatient procedures that won’t require a stay in the intensive care unit, where many of the most severely ill COVID patients remain.
“We still have a lot of those people still in the ICU. Their length of stay is fairly long,” he said, adding that the sickest COVID patients typically spend two to three weeks in intensive care.
Statewide, patient admissions for COVID as a primary diagnosis have been dropping by 500 to 1,000 patients a week for the past three weeks. On Wednesday, Florida’s hospital regulator, the Agency for Health Care Administration, reported about 5,300 patients hospitalized with COVID statewide.
In Miami-Dade, hospital admissions for COVID had dropped to about 1,000 patients as of Wednesday, according to AHCA’s online dashboard. AHCA reported about 700 patients with COVID at Broward hospitals.
At the peak in July, Miami-Dade had about 2,000 patients hospitalized with COVID and Broward had more than 900.
Preparation for a fall COVID surge is also on the mind of Jackson Health CEO Carlos Migoya, who said Miami-Dade’s public hospital resumed some elective surgeries this week. Migoya said Jackson Health’s ICUs also remain busy, and that as more patients are discharged from intensive care the hospital system will resume more complex surgeries.
But Migoya was careful to temper his hope.
“I want to be cautiously optimistic because I don’t want the public out there to think it’s OK to get out and party,” Migoya said.
“We have less patients and we feel better about it,” he said. “We feel optimistic this is moving in the right direction. ... It doesn’t mean that we’re not seeing any COVID patients.”
Unlike AHCA’s data, Miami-Dade’s so-called New Normal dashboard tracks admissions for COVID in addition to patients who tested positive for the disease after presenting for other emergency care. The county dashboard reported about 1,200 patiens — about 200 more than the state’s count — on Wednesday, the lowest number since June.
Surgeries needed for hospitals’ financial survival
Hospitals, hobbled by the loss of revenue from elective surgeries, now need help themselves as they face financial shortfalls in the hundreds of millions, said Senior of the Safety Net Hospital Alliance of Florida.
Senior said Florida hospitals have not received CARES Act funds for any patient care delivered after June 10, about the time when Florida was seeing the leading indicators of a resurgence. He said there’s about $50 billion in CARES Act funds left to be distributed to hospitals for COVID-related losses, and he’s advocating for the U.S. Department of Health and Human Services to direct that money to hospitals in so-called hot spots, including Miami-Dade.
“It needs to take into account hospitalizations from June 11 moving forward,” he said.
Senior said only hospitals in Miami-Dade, Broward and Lee counties suspended elective surgeries in July to prepare for a surge of COVID patients.
Migoya said Jackson Health’s revenue losses from the two periods of suspended surgeries are “well in excess of $100 million.”
In April, Jackson Health reported losses of about $1 million a day, but Migoya said the financial picture improved after surgeries resumed in May.
“We’re losing money,” he said, “but not like before in March and April.”
To date, Jackson Health has received about $76 million in CARES Act funds, leaving the public hospital system with a significant loss.
Migoya said the toughest month for Jackson Health was April, when the healthcare system’s three hospitals were 35% to 40% full with no elective surgeries taking place. Now, Jackson Health hospitals are nearly 100% full, he said, a figure that includes both COVID patients and those admitted for emergency procedures.
Baptist Health South Florida, the largest nonprofit hospital system in the region with 11 hospitals from Monroe to Palm Beach counties, also canceled elective surgeries in July and recently resumed some procedures in Miami-Dade, said Georgi Pipkin, a spokeswoman.
Baptist Health’s hospitals in South Miami-Dade were among the busiest in the county in July, with facilities in Homestead and Kendall filling to near capacity.
Baptist Health filed a financial disclosure statement this week noting that the hospital system has received about $205 million in CARES Act funds. Still, Baptist Health posted a financial loss of $500,000 for the quarter ending June 30. Without the CARES Act funding, Baptist Health would have experienced a loss of $125.2 million for the quarter, according to the document.
After resuming elective surgeries in Palm Beach County a few weeks ago, Baptist Health is slowly restarting non-emergency surgeries at its Miami-Dade hospitals.
“In Miami-Dade County, low-risk day surgeries and endoscopies are being done at outpatient facilities,” Pipkin said in an email. “At our hospitals, surgeries and procedures which do not require an overnight stay are being evaluated on a case-by-case basis depending on the urgency of the case and the capacity and circumstances of each hospital.”
This story was originally published August 19, 2020 at 5:56 PM.
