WASHINGTON, PENNSYLVANIA — The Washington Health System in southwestern Pennsylvania has announced they are laying off healthcare staff due to several of their departments temporarily closing under the Gov. Tom Wolf’s state mandate that halted elective surgeries and diagnostic procedures.
Those cessations closed many of their outpatient services and caused a drastic decrease in inpatient, emergency department, and outpatient service utilization at all of their hospitals and physician offices, according to Lawrence Pantuso, the vice president of strategy and clinical services at the Washington Health System.
“When the governor here in Pennsylvania declared there was an emergency, he had issued a mandate to stop all nonemergent, nonurgent surgical cases,” he told the Washington Examiner in an interview.
“Following those guidelines, we did, we spoke with all of our medical staff, patients who could wait to receive procedures that weren’t in a life-threatening situation were triaged, and we had cases postponed,” he said.
Then came the domino effect.
“So, we saw a pretty fairly drastic drop in our surgical volumes, but also then, our ancillary volumes, as well, our laboratory testing for all the surgical procedures dropped off, X-rays for those procedures dropped off, the therapy services for postsurgical cases all dropped off,” Pantuso explained.
“And then, as the stay-at-home order came, then there were less and less people on the roads. So, as the restaurants and the bars closed, and as people who weren’t in essential job roles in the community were basically self-isolating at home, practicing their social distancing, that meant there were less people on the road, so then, the emergency department volume started to decrease,” he said.
In short, all of the routine, run-of-the-mill emergencies that community hospitals see every day dropped drastically.
“So, we saw the foot traffic even in the Emergency Department fall off by as much as 70% of what we would normally see in a day,” he said.
Pantuso said the decrease in all that volume coming in meant a significant decrease in revenue.
“We had to look at that and say, ‘How long is this going to go on, and what steps do we need to take to ensure we have the adequate resources to take care of this potential onslaught of COVID-19 patients?’ But also, that we have the essential finances maintained in place for when this crisis does resolve,” he said.
Washington County, located south of the city of Pittsburgh, so far has seen 40 cases and zero deaths in the suburban/rural/blue-collar mix county — the Washington Healthcare System has 262 beds in the county proper, with an additional 49 in their Greene County facility where 11 cases have been reported.
To date, Pennsylvania has seen 8,420 cases and 102 deaths in total.
The number of cases is in stark contrast to that of New York state where Gov. Andrew Cuomo reported Friday that 2,935 people in New York died from the coronavirus to date with 562 new deaths since Thursday.
In total, there have been 102,863 confirmed cases across New York.
Cuomo said the city’s hospitals have already reached capacity, and they are now converting over 20 hotels into hospitals, which will add an additional 10,000 beds to the city’s numbers.
Pantuso said the layoffs within the hospital system are in areas in which the health system had to stop or reduce services. At the same time, they are cross-training direct care providers to prepare for a potential surge.
Pantuso laid out why there were layoffs, their plan if and when the surge hits rural America, and how this pandemic has changed our healthcare system here in this interview.
Washington Examiner: Explain why layoffs, as in other regions in the country, are surging for healthcare workers?
Lawrence Pantuso: As part of our plan here to prepare ourselves for these COVID patients, we started to staff in the impacted areas who had skill sets that were transferable to other areas where they can potentially treat this surge of patients that are coming. We began training those providers, cross-training them, so that’s nurses and ancillary support staff, everybody who had a role that they could transfer.
They were just in an unfortunate situation where some people who had worked in departments that were just closed altogether and as patients were postponed in some of their services. So those employees, if they didn’t possess the skill set, they could be transferred.
We offered voluntary layoffs to those people, which were in one-week, two-week, or longer increments.
They are all available on a 24-hour call-back because we did understand that, although we don’t need those services right now, if we do have the, God forbid, onslaught that is predicted by some of the models out there, we very well may need all hands on deck.
As we’ve had this decline in services that we normally provide, we’ve had empty patient rooms, as well, a lot of those being prepared for the potential COVID patients, but then this virus really came to the forefront.
Washington Examiner: How are your supplies?
Lawrence Pantuso: We started to hear about it the third week of December or so, but it was obviously something that was occurring in Asia, and then, it really started to pick up steam here as we got toward the end of February.
So, all along, we were trying to acquire supplies and things that we would need. On any given day in the hospitals, we always have isolation patients, but it’s never the magnitude of potential [that] could come with the COVID patients. So, we had to really ensure that we had more stockpiles of personal protective equipment, assess our ventilator situation and medications, etc., all to be prepared for what is occurring.
Washington Examiner: This is such a contrast to other areas that have been hit so hard with many places putting out a call for healthcare workers to come out of retirement. And then, you have to lay off people, can you help explain that?
Lawrence Pantuso: I think that’s the difficult situation healthcare systems across the country are facing, because as everybody prepares for the surge … and again, you listen every day to the CDC briefings, and we receive information from the local and the state, as well as the federal authorities on a daily basis.
So, as you prepare for this wave of patients and you see your local positive rates increasing, that’s where the give-and-take comes because you need to prepare and invest those resources and have people ready for the potential likelihood of a very large number of patients, potentially more than we’ve ever seen as a country from a single illness, at least since 1918.
But then, you also have a finite set of financial resources that you need to reallocate from what would have been traditionally supplied services that are now very less in demand because as patients aren’t doing things and aren’t getting the procedures done, those services aren’t being utilized, so you reallocate resources to prepare for where you think that would be. And that’s really the tough decisions that the healthcare systems are making.
Washington Examiner: What is the outlook of the entirety of our country’s healthcare systems in this moment?
Lawrence Pantuso: I think that if everybody continues on doing business as usual, there’s a couple of situations that will occur. You won’t be able to take care of the surge. If you’re doing the routine work day in and day out, then you’re going to have your hospital beds filled with the cases that you would normally have your hospital occupied with. Then, as the surge comes and, specifically, as the numbers come to fruition as they’re being suggested that they may, it’s going to be more patients than what the region certainly has available beds for. So, every bed is going to have to be available for when this comes. We hear the numbers change. We’re hearing within the next two weeks will be the surge here in Western Pennsylvania. That is certainly based on the data today that we’re anticipating.
But the other financial component is if you think about healthcare in general, about the last 10 years or so, and it’s a national issue, more and more cases were done under an inpatient category. So in the United States, inpatient procedures are paid under what’s called a DRG, diagnosis-based reimbursement. So, your patient’s diagnosed whatever they’re coded to. Based on the care you provide them, you receive the highest code’s reimbursement. So, the reimbursement rates are set by the federal government through CMS, which is Medicare, and then the insurance, private insurers, then pay usually a Medicare rate, and some other calculation above that, usually.
And so, over the last 10 years, more and more cases that used to be done on an inpatient basis were moved to outpatient, so they’re designated as outpatients, not as an inpatient. So they’re paid at a lower rate than what an inpatient is. So I think hospitals have had that struggle, as well, for the last 10 years. Again, it’s a national thing, where it’s quite often the same amount of work, that you did 10 years ago, except now, the patient is coded as an outpatient, so you receive less money for that, even though you’re really essentially doing the same amount of work.
And there’s a lot of information out there. If you Google “inpatient versus DRG reimbursement,” there’s a plethora of information about how that’s really impacted hospital finances, particularly over the last decade.
So, this COVID-19 crisis is really the convergence of several different storms all at once on a lot of the healthcare providers. And I think a lot of the private physicians are feeling the same pinch, as well, throughout the country.
Washington Examiner: How will this change our health system?
Lawrence Pantuso: That’ll be interesting. I think a couple things will change. I think number one, it’s going to put a lot more of the burden of staying healthy on the individual person. At least in my lifetime, I haven’t seen as much emphasis as I have over the last four weeks to the general public. I’ve heard about it from the healthcare side, but certainly not the general public, about the importance of frequently washing hands, about not touching things in public, about social distancing, covering your sneeze, and really made aware of different signs and symptoms that say you might be ill and maybe need to not be around people and seek help.
I think that is something that we really need to continue because certainly not of the magnitude of the coronavirus, but we do it with influenza, the seasonal influenza, every year in this country. And I don’t think that it nearly gets the attention that this did, obviously, for several reasons. But I hope that going forward that we, as a society, do practice better self-hygiene, particularly with our hands and our sneezes and just the public high-touch areas, making sure that they’re clean.
In healthcare, I think going forward probably one of the biggest changes that will last after this is the use of telemedicine. Telemedicine certainly has had a lot of uses in healthcare. It has really been increasing over the last, I would say, five to seven years. But I think it’s been slow for a lot of the commercial insurers, in particular, to embrace virtual care telehealth as part of the healthcare system, the mainstream healthcare system.
