Empty Hospital Halls

Two employees at Bozeman Health Deaconess Hospital speak with each other at the end of an empty hallway connection the hospital to nearby clinics Thursday, April 16, 2020, in Bozeman.

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Montana hospitals have cleared clinics and beds to prepare for unprecedented patient loads anticipated with COVID-19 cases. Meanwhile, many are sitting close to empty and their revenue has been halved.

Last month, Bozeman Health suspended non-urgent visits. People could get care if there was an emergency, but other appointments like joint replacements and physical therapy had to wait.

Cutting down visitors reduced the chance of spreading the highly contagious virus. And if there were outbreaks, fewer patients saved hospital beds and medical equipment.

But the stall in services also stalled incoming cash.

Bozeman Health officials said the system’s weekly revenue has dropped from $7.5 million to $3.75 million.

Rich Rasmussen, the president and CEO of the Montana Hospital Association, said similar plummets are happening across the state as health care facilities take the same steps to decrease the risk of COVID-19 and prepare for what might come.

“We have hospitals creating tremendous surge capabilities, but they have no patients,” Rasmussen said. “It’s not just hospitals; it’s every provider.”

Chris Whaley, a health economist and policy researcher with global think tank Rand Corporation, said hospital finances are getting hammered across the country.

Health care in the U.S. is a multi-trillion-dollar industry. Patients walking through the door are at the core of the business.

Montana health providers have been promised $111.5 million through the Coronavirus Aid, Relief and Economic Security Act. But it’s still unclear when and how that money will work through the more than 1,400 providers and systems anticipating a piece of it.

Some health care facilities received their first wave of federal aid last week. Bozeman Health’s initial batch was $4.8 million, less than enough to make up for two weeks worth of lost revenue.

Whaley, originally from Helena, said some hospitals will struggle more than others.

Bozeman Health has 200 days of cash on hand, and the expectation is that services will begin to come back long before that.

But many hospitals don’t have that much money available.

“There is a concern there that funding may be too late for some hospitals,” Whaley said.

So far, five Montana health centers have applied for emergency loans through the Montana Facility Finance Authority. The only way to qualify for the low-rate loans designed to help systems outlast the pandemic is for a facility to have less than 50 days of cash on hand.

The authority’s director Adam Gill said the loans — capped at half a million — wouldn’t do a lot for a large hospital. But he said that money could keep a rural center afloat for three to four weeks “depending on the size.”

The hope is that gives facilities enough time to apply for other funding.

Both small and large health providers have laid off workers in the U.S. Many of those providers have called it a temporary move to survive financially.

That’s also starting to happen in Montana, which was one of the last three states to record a COVID-19 case.

Last week, Kalispell Regional Health Care announced temporary layoffs and pay cuts that affected 600 employees. The health system with a workforce of 4,000 is based in Flathead County, which has one of the highest COVID-19 caseloads in Montana.

Bozeman Health Chief Financial Officer Brad Ludford said the health system has held onto all of its staff.

There were 372 employees whose jobs changed when Bozeman Health’s scheduled visits stopped. Roughly 200 of those workers have been deployed in other positions, whether that’s helping with the hospital’s COVID-19 response or sweeping floors.

Ludford said every Bozeman Health employee, even those sent home, have been promised their full pay and benefits through April.

“We’re going to need those people,” Ludford said

Bozeman Health is the largest provider in Gallatin County, which has consistently had more than a third of Montana’s known coronavirus patients. The health system has put $2.5 million toward its COVID-19 response for new equipment and makeshift screening clinics.

So far, the vast majority of Montana patients have recovered at home.

But Bozeman Health officials project a surge in novel coronavirus hospitalizations starting the week of April 27. They estimate that increased demand could last up to eight weeks.

At its peak, the system expects 100 coronavirus patients at its campuses.

Ludford said the system will be financially stressed through the crisis, but it’s not at imminent risk because of its reserves.

Private donors have also given more than $3.5 million for Bozeman Health’s COVID-19 response — a dollar amount many Montana counties would struggle to come up with.

Ludford said if the surge never comes, “we believe there will be a pent-up demand for services and we will need every one of our employees.”

Livingston HealthCare CEO Deb Anczak said the critical access hospital with fewer than 400 employees has also seen its revenue cut in half and new expenses to prepare for COVID-19.

She said the hospital began offering employees optional unpaid time off this week. There’s a committee looking at where to save costs, like switching supplies or dropping bonuses. Layoffs are a last resort, Anczak said.

Livingston HealthCare CFO Kris Kester said the hospital was able to get a small business loan through the paycheck protection program. That provides eight weeks worth of payroll and helps cover hospital utilities and mortgage payments.

Like in Bozeman, Livingston HealthCare also received some federal funding and there have been more donations coming in.

But all that hasn’t been enough to cover the hospital’s losses.

Whether layoffs come depends on how long it takes before patients can walk through the door again for primary care.

“We’ve kind of got our short-range vision glasses on, just because we don’t know what to expect next,” Kester said.

Allen Rohrback, the CEO of Madison Valley Medical Center in Ennis, said there’s concern about whether people will tap into primary care even once services begin to pick up again.

Rohrback said he’s already worried some who should reach out for essential care aren’t and it’s hard to know how long that side-effect of this pandemic will last.

The 10-bed critical access hospital is used to a negative operating margin. A local mill levy and donations typically cover the difference. But all that is factored on patient volume.

Like many small Montana businesses in a town known for its rivers and mountains, the Ennis hospital relies on summer vacationers and people who arrive at second homes in April and stay through September.

“We know that will probably be quite a bit different this year,” Rohrback said.

Like elsewhere, the pandemic has also significantly increased Montana’s unemployment rates. The majority of insured Montanans have historically had health coverage through a job, which many have lost.

There’s not yet any data on how many Montanans have lost health coverage, or if it’s a short-term or long-term lapse. But like most things, it’s too soon to say.

“My guess is just like our economy, this will probably affect hospitals for a while,” Rohrback said. “Is it two years, is it three years, who knows? But it’s certainly more than this stay-at-home period.”

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Katheryn Houghton can be reached at khoughton@dailychronicle.com or at 582-2628.