Navigating COVID’s Financial Roller Coaster: One Health System CFO Describes the Ride
The last year has been a trying one for healthcare stakeholders of all shapes and sizes, on a variety of levels. From an economic standpoint alone, while some health systems are finally starting to feel a small sense of relief, the path to financial recovery is still a long and daunting one.
For example, one analysis, made public in late February from Kaufman, Hall & Associates, and released by the American Hospital Association (AHA), showed that the COVID-19 pandemic will continue to impact the financial health of hospitals and health systems through 2021. The analysis specifically found that total hospital revenue in 2021 could be down between $53 billion and $122 billion from pre-pandemic levels. “This sustained financial squeeze on the hospital field could result in the slowdown of vaccine distribution and administration, continued pressure on tired front-line caregivers and diminished access to care, including in rural areas,” according to the report.
Just like for many patient care organizations, leaders at Edward-Elmhurst Health, a three-hospital system serving the west and southwest suburbs of Chicago, have had to deal with the constantly changing nature of the pandemic and the many different ways the community has been impacted. In a recent interview, Denise Chamberlain, system executive vice president and chief financial officer (CFO) at Edward-Elmhurst, describes the “financial roller coaster” the organization has been riding over the last year.
“It’s been a crazy year and yes, the best way I can describe it is a roller coaster. In terms of census alone, which drives our finances, we went from emptying out the hospital and suspending elective procedures, to making room for COVID patients who didn’t initially come, to then filling up the hospital with COVID patients, to [eventually] resuming elective procedures. But at the same time, some patients were afraid to come in, then we had multiple COVID surges, and now COVID has started to subside with vaccinations. And we also didn’t have flu [admissions], which usually fills the hospital,” Chamberlain illustrates.
She adds that at the onset of the pandemic, the initial goal was just trying to make sure the health system could survive financially and that it had enough financial liquidity to get through the roughest patches of having near empty hospitals. From there, operational leaders at Edward-Elmhurst were able to slow down and take a longer-term view, allowing them to make more thoughtful decisions. “This was in spite of the fact that with June 30 being the start of our fiscal year, just the first two months [of the crisis] hit us for about $100 million [in losses], not counting subsidies we received to cover some of that. But things have started to get better, and we think we’re turning the corner,” says Chamberlain.
One key factor in getting patients back in for necessary care that they might have delayed during the pandemic is to ensure their safety and quell fears that the hospital is an unsafe place to be. Undoubtedly, patients want transparency around an organization’s sanitary and safety protocols, while also having access to up-to-date information about the evolving pandemic. These revelations were outlined in a recent report from Accenture, which found that two out of three patients are likely to switch to a new healthcare provider if their expectations for managing COVID-19 are not met. Based on a survey of more than 4,600 U.S. respondents, the report, “Elevating the Patient Experience to Fuel Growth,” concluded that patients are looking for a safer, more secure and convenient healthcare experience.
At Edward-Elmhurst, essentially every single work process changed as a result of COVID, and all day-to-day actions suddenly had to be adjusted to accommodate patients’ new needs, explains Sherri Leahy, system associate vice president, quality and patient safety. “Patient safety is built around reliability and consistency, so we had to pivot quickly to adjust to all these new work processes and [still] maintain a safe environment, as well as good outcomes we’ve had for several years, by taking care of not only COVID patients, but the others in the hospital at that time, too,” says Leahy.
She adds, “We have been trained in high-reliability processes, tools, and techniques for more than five years, so all those things came into play. We pulled everything out of our [toolbox].” For example, before COVID hit, Edward-Elmhurst held daily safety huddles where leaders across the enterprise discussed issues that have occurred in the previous 24 hours and things that are expected to occur in the upcoming day. So using that as a foundation, the Edward-Elmhurst team developed a COVID huddle and expanded what they were doing previously, but with a primary focus of keeping COVID patients safe, Leahy explains.
Another example is the health system’s use of a real-time location system (RTLS) platform from SwipeSense, which aims to prevent hospital-acquired infections and powers applications such as hand-hygiene monitoring. As explained by officials, when a caregiver cleans his or her hands, a hygiene sensor located below a soap or sanitizer dispenser recognizes the employee’s unique badge identification and a green light flashes to indicate the data was transmitted. SwipeSense captures information when users enter or exit a patient room and when they clean their hands, only recording hygiene opportunities and events associated with patient room visits. While this was implemented pre-COVID, Leahy says it's been reassuring for all staff that hand-hygiene compliance is still being reported on in the daily huddle.
Indeed, going forward, a primary mission of the health system will be to continue to communicate and educate the community on the importance of coming back and why it’s now safe. “We wanted to use all the different vehicles we have available to get the word out it’s safe, that we have instituted measures to guarantee your safety here, and also to emphasize the importance of maintaining your regular healthcare schedule for tests, check-ups and procedures,” notes Keith Hartenberger, system director, public relations, at Edward-Elmhurst. “Between blogs on our website, social media, media releases, and making providers available for media interviews, we have used anything and everything to let folks know it’s safe to come to the hospital and that it’s important,” he says.
Chamberlain adds that the context and framing of this messaging has been equally as important as getting it out. For example, it was necessary to convey to patients that Edward-Elmhurst was not marketing to come back so they could generate revenue, but rather because “we care about you and here is the risk we want you to be aware of,” she says. “And we were also transparent; one of our hospital CEOs has been doing a podcast, and through that we have been very [open] with the community about our patient volumes, the ebb and flow of COVID, employee testing, and all the things we have done at our hospital. We weren’t just telling them the good stuff and asking them to buy services from us; we saw it as a community partnership.” She notes that the health system also held virtual community town halls, with different variations, in which the system CEO and other leaders were there to answer questions and provide updates with numbers.
Ultimately, Chamberlain reports that Edward-Elmhurst is “fortunate to be very strong financially,” and that the organization is forecasting to break even this year, even with federal subsidy help. However, she adds, “We don’t anticipate that there will be further subsidy dollars, so [a lot] will depend on how quickly patients come back. We have a stressed out and exhausted workforce that we need to continue taking care of with strong pay and benefits. The financial struggles have continued and getting back to profitably is a commitment for us next year,” Chamberlain acknowledges. “Figuring out how to do that will be a big hurdle for us.”
