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Hospital leaders tell legislators about revenue challenges

RALEIGH —Hospital leaders are sharing concerns about protective equipment and lower revenue as lawmakers look for ways to help the health care system fight COVID-19.

The health care working group of the House Select Committee on COVID-19 met for the first time virtually Thursday, March 26. Lawmakers said they would translate the committee’s findings into law during a possible special session or the short session in late April.

“It is the intention of this committee to produce concrete legislation to help move our state forward to combat COVID-19,” said N.C. House Speaker Tim Moore, R-Cleveland.

When Rep. Gale Adcock, D-Wake, asked about a statewide shelter-in-place order, hospital leaders stressed the importance of protecting hospitals from getting overwhelmed with sick patients. After the committee meeting, Wake County issued a shelter-in-place order effective Friday at 5 p.m., lasting until April 17.

“I believe we are at that point, maybe a couple days past it,” said Donald Gintzig, president of WakeMed Health and Hospitals. “That’s our primary defense against it, is to slow the spread. It buys us time.” (One day later, Gov. Roy Cooper signed a statewide stay-at-home order.)

There are nationwide and statewide shortages of personal protective equipment. Hospital advocates have gotten more calls in the past two weeks than in the course of their careers, as doctors scramble to get protective equipment, said Chip Baggett, N.C. Medical Society lobbyist.

“Those calls are desperate, saying they can’t get PPE through the normal channels. So, I’m deciding right now whether to potentially expose myself by [continuing to see] patients, or to close my doors,” Baggett said. “They can take the risk for themselves, but can they really afford to take the risk for their families?”

But providers’ risk isn’t only personal and medical — it’s also financial. COVID-19 has put both hospitals and independent providers under monetary stress, sapping their most lucrative services and adding additional burdens of care, hospital advocates say.

Hospitals across the state have canceled or postponed elective surgeries to prepare for a surge of COVID-19 patients. The shortage in protective equipment has pressed health systems to postpone still more elective surgeries to conserve medical supplies. But canceling surgeries has cost hospitals.

“That’s created a real problem. It’s a cash flow problem for many of our hospitals, because these surgeries tend to help our bottom line,” said Leah Burns, North Carolina Healthcare Association lobbyist. “We’re talking about hundreds of thousands of surgeries that have been canceled.”

At the same time, hospitals and independent providers have both poured resources into expanding telehealth services.

“This has put a lot of burden on small and independent practices,” said Dr. Eileen Raynor, board member of N.C. Medical Society. “There’s such a drop in patient [visits] and a drastic reduction in the revenue flow. That affects those independent practices that are struggling to keep their doors open and provide care for patients who need it.”

Baggett has talked to physicians forced to lay off critical staff because of lost revenue. He also drew lawmakers’ attention to the threat of malpractice lawsuits during the COVID-19 pandemic.

“They’re having to make critical medical decisions under the same potential for a lawsuit,” Baggett said. “You can just imagine the pressure that is building up.”

Several bills at the federal level would provide relief to the health care system. Hospital advocates are asking North Carolina to cover uninsured residents’ COVID-19 related illnesses and to increase the Medicaid rates during the emergency. They also want to see the creation of a fund to help financially distressed hospitals during the outbreak. The legislature created a $20 million fund for struggling rural hospitals in 2019.

Hospitals also want temporary relief from regulatory burdens, namely scheduled, non-urgent inspections.

“Members of our House want to be doing something to help right now. We know many of the changes we’re going to have to make will require legislative action,” said Moore. “We know this is a game-changer.”’