PMHD says finances have begun to stabilize
BRAWLEY – Just-intime, if unpredictable, relief from the federal government and strategic belt-tightening have helped sustain Pioneers Memorial Healthcare District so far through the first three months of the COVID-19 pandemic.
Prior to the pandemic, PMHD, which had already been experiencing multi-million-dollar losses over previous years, had enough cash on hand for seven to 10 weeks, per CEO Larry Lewis.
However, once the county’s shelter-in-place order was initiated in March, Lewis said 44 percent of the organization’s patient volumes and revenues suddenly stopped. Inpatient volumes fell approximately 22 percent, but there was a more severe drop-off in clinic visits, outpatient imaging, emergency room visits and surgical procedures.
He said this reduced patient flow represented an imminent single-month decline of nearly two weeks’ cash on hand.
“Without feedback from the federal officials regarding financial support for the mandated reduction in operations, this would have meant imminent disaster for all hospitals in the country and certainly for Imperial
County,” Lewis said.
The district made up some ground with staffing and payroll cuts. “About 10 percent of our payroll dollars hours were decreased (a little more than one day’s cash on hand),” Lewis said. However, it was not enough to offset the dramatic net loss in revenue after CARES Act support in March and April, he added.
CARES Act funding has been welcome, but unpredictable. Lewis said a deposit from CARES Act funds was made in the hospital’s accounts in April. He said the amount represented one week’s cash on hand.
“None of the CARES Act funding was accompanied by the federal government’s calculations, and no advance notice was provided regarding any future possible distributions,” Lewis said. “(We had) only high-level descriptions of which sectors of the economy were going to be addressed and no predictions of when, until the week they were going to be deposited and never advance notice of how much.”
Lewis said the hospital saw a bit of a rebound in May as inpatient volumes began increasing – including a 14 percent increase in COVID-positive patients. However, outpatient volumes recovered only 10 percent of the 46 percent drop in April.
Also in May, PMHD received an unannounced direct deposit representing more than two weeks (approximately 18 days) of cash on hand, Lewis said.
“This also resulted in a recovery of losses incurred in March, April and May,” he said, adding the money represented a great relief from a bleak future. “Without this funding, the district would have experienced another significant loss and another three days (fewer) of cash on hand.”
June has been unpredictable, Lewis said.
“Without any additional funding we were facing the erosion of cash, as much as one week’s cash per month,” he said. “(On) Monday, June 8, it was reported that another funding from the CARES Act was being developed for deposit on Friday, June 12, that would focus on Safety Net Providers. With that limited information and notice, we did receive a deposit, the equivalent of nearly 35 days in cash.”
On June 11, PMHD issued a release saying it had begun to recruit additional full-time, temporary registry for nursing and respiratory therapists to assist during the recent COVID surge.
Since that announcement, Pioneers has added two critical care registry nurses from temporary agencies, as well as four medical-surgical nurses and one respiratory therapist, Lewis said.
“We’ve also submitted a request for 17 additional critical care nurses and four additional respiratory therapists from the Emergency Operations Center in Sacramento, as they asked us to set up 10 additional ICU beds to accommodate the continued increase in COVID patients,” he said. “At the same time, we are searching for the same number of nurses and therapists to replace the state support as soon as possible.”
Lewis said the district is reaching out to various temporary agencies in its quest for help; however, the availability of qualified nurses and respiratory therapists has been limited due to the demands of the pandemic. He said the typical timeframe for this type of temporary assignment is 13 weeks, over which time the district can “evaluate the progression of the virus and its im
pact on hospitalizations.”
It also appears to PMHD is better situated to afford this extra help than it was two months ago.
“Today, we have adequate finances available and an increased confidence that the COVID hospitalizations will not soon subside,” Lewis said. “Additionally – elective surgeries are now being reintroduced and will help the district’s finances moving forward. That being said, we are always challenged with making such educated guesses and adjust as the reality of the unpredictable unfolds.”