From a shortage of wheelchair vans to a looming shortage of nursing-school faculty, from weak Medicare reimbursements to soaring cost of part-time medical staff, from burned-out nurses who quit to patients who get sicker while waiting to be seen, it is hard to find an area of health care in New Hampshire that isn’t struggling as the pandemic era enters its fourth year.

“We’re not going to tweak our way out of this,” is how Steve Ahern, president of the New Hampshire Hospital Association, put it during a media briefing Tuesday. “We have to rethink and re-imagine the entire healthcare system.”

The briefing, featuring hospital physicians from Concord to Berlin, N.H., to Manchester, was held on the third anniversary of the announcement of New Hampshire’s first official COVID-19 case. The goal was to let the public know that even if the pandemic is slipping from our attention, many of the problems it produced are still here and in some cases getting worse.

“We need patience from our patients,” said Michael Peterson, CEO of Androscoggin Valley Hospital, which as an independent rural hospital is particularly hard hit. For example, he said, while hospitals in the state’s southern tier struggle with the rising cost of temporary nurses, technicians and other positions hired through staffing agencies, in the North Country it is sometimes not possible to find them at any pay rate. And there’s such a shortage of trained ambulance staff in a region where most ambulance services are filled with volunteers that the hospital may have to set up its own service.

Even in the Concord region, things have not eased. The three hospitals in the Concord Hospital system — Concord, Franklin, N.H., and Laconia, N.H. — are so consistently full that they have around 30 patients waiting for beds at any given time, said Dr. Chris Fore, chief quality officer for Concord Hospital.

A shortage of open hospital beds is both a function of increased patient load, partly due to the effect of years of delayed care during the pandemic, as well as staffing shortages. And it’s not just hospitals that are having trouble hiring enough trained people — similar shortages exist in places where recuperating patients are sent, such as long-term care facilities or behavioral and substance treatment centers. That can keep a patient in the hospital for days even weeks longer than necessary and since they’re no longer there for medical reasons, insurance companies often won’t cover the cost.

And while the briefing noted that some good things have come out of the pandemic — notably an increase in communication among hospitals and other health-care providers as well as more use of technology such as telehealth — that wasn’t enough to balance the shortfalls.

The Hospital Association is backing a half-dozen pieces of state legislation that target one or more of these problems.

They include SB149, which would establish a licensing process for the private agencies that provide temporary nursing staff, a move that hospitals hope will rein in costs, and SB82, which would increase notice requirements for health insurance carriers when they deny claims, as well as several bills regarding increases in Medicaid reimbursement. Gov. Chris Sununu’s proposed budget would raise Medicaid reimbursement by 3%, but several speakers Wednesday said what is really needed is much higher increases for certain services such as behavioral health and long-term care.

The association also supports SB58, which would allow police “to arrest a person without a warrant for interfering with the provision of medically-necessary health care services.” This is in reaction to what several people in the session said was the most unexpected and most unpleasant outcome of the pandemic: the way it galvanized opposition to modern health care.

“I was anticipating that collectively as a society … on the backside of this we’d celebrate the improvements (in health care), we’d celebrate the learnings. Instead, we are hyper-polarized: ‘I don’t actually have COVID even though I’m on a ventilator, that’s not what this is, give me Ivermectin’,” said Dr. Greg Baxter, CEO of Elliot Health System. It only takes one such angry patient interaction, he said, “before a person walks out of health care. They just can’t have that fight again.”

“It’s very difficult. I didn’t see that coming.”

Peterson agreed, saying he was surprised by “how much time we had to spend battling bad information.”

“I thought this would unify us — it divided us,” Peterson said. “That’s what struck me most.”

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