HJAR Mar/Apr 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2021 17 we’ve never seen. This is in addition to longstanding patterns of slim margins in the state. The total patient revenue margin in 2019 was -1.01%, which was the lowest it had been in a couple of years. As an association, we are constantly worried about the closure of a hospital and about sustaining future financial viability of all hospitals, but to see hospital revenues already at a negative margin and then to have them severely re- duced doubled our concern about the future of hospitals. The financial stress forced hospitals to fur- lough employees. In hindsight, it certainly seems counterproductive to furlough health- care workers during a pandemic, but financial survival and uncertainty made these decisions prudent. Congress provided much-needed relief to hospitals and healthcare providers in the CARES Act, which was approved March 25, 2020. The federal Department of Health and Human Services began releasing allocations to healthcare providers in April and contin- ued through the end of the year, with different types of hospitals receiving payments along the way. The Governor and the CARES Act Steer- ing Committee invested other federal dollars in hospitals in August, an infusion that was extremely important to the ability of hospi- tals to survive, react and prepare for the CO- VID-19 surges we would see in the coming months. A second allocation from the CARES Act committee followed in December, which helped address the ongoing costs of supplies and staffing. These payments to hospitals and healthcare providers were essential to the healthcare sys- tem in Arkansas and kept hospitals open and viable during the pandemic. STAFFING It is difficult, now, to believe that there was a time in March and April when staffing was not in critically high demand and nurses took con- tracts for jobs in New York, where COVID-19 cases were surging at the time. As our state be- gan seeing increased cases in the fall, demand for nurses and respiratory therapists increased significantly, both nationwide and regionally. Arkansas hospitals began competing with Texas, Florida, California and national travel nurse agencies for staffing. Competition was necessary not only to recruit nurses to come to work in our hospitals, but even to retain the ones already employed here. Hospitals began reporting that many ICU nurses were leaving Arkansas for three-month contracts, and one hospital reported losing 8 ICU nurses over a two-week period. In the month of November, national demand for travel ICU nurses increased 79% over a 30- day period, and as of January 2021, ICU de- mand is 501% higher than pre-COVID num- bers. As we saw declines from the winter surge, 73% of ICU nursing jobs are still in crisis need. The continuing competition for staffing has driven the highest ICU nurse rate to levels that are more than twice the average pre-COVID rate. These rates are not sustainable and have contributed significantly to the financial stress on hospitals. A number we began watching closely in July was the number of hospital staff out on leave who had contracted COVID-19 or been ex- posed to those who had. Hospitals have done an excellent job of using protocols developed over many years to mitigate the spread of in- fectious diseases, so community exposure (contact with contagious individuals outside of the hospital setting) has been the source of the majority of these staff quarantines. Staff on leave due to exposure rose from 500 in July to above 1,300 per day at its peak. As we began vaccinations of healthcare workers in December, this total declined to 750 by the end of January and is expected to continue this downward trend. “As an association, we are constantly worried about the closure of a hospital and about sustaining future financial viability of all hospitals, but to see hospital revenues already at a negative margin and then to have them severely reduced doubled our concern about the future of hospitals.”