Dartmouth-Hitchcock ready to limit surgeries amid crush of COVID-19

Valley News Staff Writer
Published: 12/2/2021 7:15:43 AM
Modified: 12/2/2021 7:15:11 AM

LEBANON — Citing a “marked increase” in COVID-19 cases, Dartmouth-Hitchcock Health said Wednesday it was prepared to pause or limit surgeries that weren’t required immediately in order to free up space for patients in the pandemic.

The Lebanon-based health system was treating a total of 62 COVID-19 patients, including 33 patients at Dartmouth-Hitchcock Medical Center in Lebanon; 15 at Cheshire Medical Center in Keene, N.H.; one at Alice Peck Day Memorial Hospital in Lebanon; four at Mt. Ascutney Hospital and Health Center in Windsor; two at New London Hospital; and seven under the care of Visiting Nurse and Hospice of Vermont and New Hampshire, according to a D-HH news release on Wednesday.

The release said D-HH was prepared “to reduce or delay non-emergent surgeries,” among other measures, to make beds available for COVID-19 admissions.

New Hampshire had a total of 403 people hospitalized with COVID-19, the most since the pandemic began, and nine more deaths were announced, the state Department of Health and Human Services said.

As of Nov. 23, New Hampshire had the third-highest per capita daily average of new COVID-19 cases out of all 50 states and the District of Columbia. About 18% of all hospital inpatients in New Hampshire have COVID-19 and 39% of patients in New Hampshire intensive care units have the disease.

The surge is being driven, among other factors, by the delta variant and by residents who have not been vaccinated. Overall, 65% of New Hampshire’s population is fully vaccinated. Vaccination rates in younger age groups are lower, as is adherence to other mitigation strategies such as mask wearing in public and social distancing, according to D-HH.

“This is still insufficient to stop the spread of the virus,” the release said.

The financial picture

It’s as yet unclear what the latest surge in COVID-19 hospitalizations and the possible delay of elective procedures may mean for the D-HH system’s financial recovery from steep losses at the beginning of the COVID-19 pandemic.

“COVID-19 has taught us to expect the unexpected, and with the current delta surge and emergence of the omicron variant, we are hesitant to provide a financial forecast based on the rapidly changing and uncertain environment we’re in now,” Audra Burns, a D-HH spokeswoman, said via email.

The health system’s recent financial results have been mixed.

Burns said D-HH had a positive margin in October, but that came after it saw a loss on operations of $9.5 million, or 1.4%, in the first quarter of this fiscal year, which ended Sept. 30, according to a Nov. 23 filing with bondholders. The loss is in contrast with the first quarter of last year when D-HH saw a positive margin of $13.9 million, or 2.2%, which included federal bailout money.

The first-quarter loss, driven largely by expense increases in salaries and benefits including the cost of traveling nurses, comes following previous gains, which included ending fiscal year 2021 on June 30 with a positive margin of $53.6 million, or 2%, including $62.9 million in federal stimulus payments.

That positive margin in June marked an improvement of $137.8 million over fiscal year 2020, when the health system saw a loss of $84 million on operations.

Though improved over the prior year, June’s results were still below D-HH’s pre-pandemic financial performance. It ended fiscal year 2019 with a $69.9 million operational surplus on a total budget of $2.23 billion.

The improvement last fiscal year came as people returned for care following the postponement of elective procedures in the spring of 2020, but continued improvement in D-HH’s finances this year has been slowed by the delta variant and vaccine hesitancy driving increases in COVID-19 cases, workforce woes, and a dearth of sufficient intensive care beds in the region.

“Despite the increasing challenges of the pandemic, D-HH was able to post modest operating revenue gains,” D-HH CFO Dan Jantzen wrote in the bond filing. “Those gains were offset by other operational challenges.”

In the quarter that ended Sept. 30, both revenue and expenses are up over the previous year, but expenses, which totaled $683.6 million, outstripped revenues, which totaled $674.1 million. Revenues were up 5.2% over the same period last year, while expenses were up 9%

In the filing, D-HH attributed the growth in revenue to an increase in outpatient visits to its hospitals and clinics. But increases in surgical cases and in hospital discharges have “proven more difficult to achieve,” Jantzen wrote.

D-HH members “experienced significant challenges with inpatient capacity and throughput over the past several months, in part due to ongoing difficulties securing adequate nurse and clinician staff to support inpatient care and operative procedures,” he said. Staffing shortages have forced bed closures at times.

Patient discharges were slowed and the lengths of hospital stays extended further by staffing shortages and COVID-19 outbreaks at nursing homes and rehabilitation facilities that often accept patients from hospitals, he said.

Seeking solutions

In response to staffing challenges, D-HH officials have implemented targeted pay programs aimed at staffing hard-to-fill shifts and to recognize the most experienced members of the system’s nursing workforce. D-HH also recently increased its minimum wage to $17 in order to “attract and retain employees and to be highly competitive in the health care industry and, increasingly, and necessarily, outside the health care marketplace in the regional economy,” Burns said.

Increases in expenses were primarily driven by D-H, which in addition to DHMC includes clinics in southern New Hampshire. D-H saw total workforce costs of $18.4 million for the first quarter of this year, which was up 6.1% over the same period in fiscal year 2020. On Wednesday, D-H’s career site listed 1,163 job openings, which is almost 9% of D-H’s 13,500 employees.

Federal stimulus payments continue to help stabilize the health system’s finances.

D-HH still had $211 million in temporary CARES Act funds as of Sept. 30. D-HH had 198 days cash on hand at the end of the first quarter, well above the 168 it would have had without those funds, the filing said.

Burns said D-HH is looking for the community’s help in weathering the current surge.

“The most immediate relief we need now is for everyone who is eligible to get vaccinated and boosted, as well as continuing with safety precautions like masking, physical distancing and hand washing,” she said. “This is truly one way everyone can help relieve the strain on our overworked health care system — not just at D-HH, but everywhere.”

Meanwhile, construction of a new $150 million patient pavilion at DHMC continues. It is on budget, but approximately six weeks behind schedule. There have been “no serious building materials availability issues,” the bond filing said. The contractor, however, has seen some issues in labor availability, but is “proactively managing this challenge.”

The new pavilion, which is expected to include space for as many as 128 new beds, is expected to open in the spring of 2023. DHMC currently has 396 licensed beds.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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