As you’ve probably heard on the news, hospitals across Washington State and the nation are facing unprecedented capacity and financial challenges. If you’ve frequented our Emergency Department (ED) or Walk-In Clinic recently, you may have had a longer wait than in the past. We know this is not an ideal experience when you’re not feeling well. Our staff are working diligently to help each and every patient who comes through our doors. As we close out the first half of 2022, I wanted to share an update on the status of healthcare both regionally and statewide.
Island Health has experienced a very busy first half of 2022, with higher hospital admission rates, sicker patients and longer lengths of stay. While these patients are not necessarily being admitted with COVID-19, many have delayed care during the pandemic, increasing the severity of their illness. Island Health and hospitals statewide are operating above capacity, to ensure acute care is available to all people who urgently need it. While there are several factors that are causing the capacity issues, I’d like to first clarify that we do not want you to delay your healthcare. Seek care when it’s needed. We are here for your healthcare needs! Delaying care can jeopardize your long-term health and wellbeing.
Hospital capacity across the State of Washington is being impacted by several factors, including:
- Difficulty placing or transferring patients who need a higher level of care or placement in a post-acute setting, such as long-term care facilities, nursing homes or behavioral health facilities. Statewide between 10% and 20% of hospital beds are occupied by patients who are awaiting discharge to a nursing home, adult family home or rehabilitation home, according to the Washington State Hospital Association (WSHA).
- Limited staffing due to the national labor shortage both in hospitals and at other healthcare settings. Hospitals across the state have increased employee compensation by an average of 10% to retain staff. However, the total number of employees has remained stagnant creating a need to hire high cost temporary staff (i.e. contract labor) to ensure services can remain open during the surge in patients.
- Low reimbursement rates from government payors. Medicaid, Tricare and Medicare reimbursement has not kept up with the cost to deliver care. At Island Health, anywhere between 60%-80% of patients are insured by one of these government payors.
If more patients are being treated at the hospital, doesn’t that mean hospitals are making more money?
The short answer to that question is no. Compounding the capacity challenges are the rising costs to care for our patients, some of whom are staying longer in the hospital than is typical, due to the lack of availability in other care facilities. As inflation impacts every household and industry, hospitals are also experiencing rising costs for labor, drug expenses and supplies with reimbursements from Medicare and Medicaid that are less than the cost of providing that care. As mentioned, between 60% and 80% of Island Health patients are on government insurance programs. These programs significantly underpay hospitals compared to what it costs to provide services to patients. On average, Medicaid paid 63% of the cost of care in 2020 according to WSHA. Due to cost increases, some hospitals were paid as low as 42% of costs in the first quarter of 2022. Most insurance companies use a fixed reimbursement model for admitted patients, meaning patients who remain in the hospital past a typical length of stay are here at a cost to the hospital. No additional reimbursement is made based on how long a patient remains in the hospital.
Island Health Action: What we are doing
In healthcare, we are resilient and overcoming challenges is not new to us. Our team is committed to working together to ensure our community has access to the care they need. As a small, independent hospital, we have the added advantage of being flexible and nimble.
Island Health is working with fellow hospitals to bring light to these challenges and we are seeking short- and long-term solutions that will help unclog the healthcare system in Washington to ensure hospitals can provide life-saving care and our hospital staff can receive relief from an overburdened system. We are:
- Educating legislators and state leaders in partnership with the Washington State Hospital Association (WSHA), about the current conditions in our hospital and asking for their support on some solutions, especially moving non-acute care patients out of our hospital and the larger facilities to create capacity for patients with acute needs, and increasing Medicaid rates to at least cover the cost of care.
- Focusing on hiring and training permanent staff to fill open positions and hiring temporary staff when needed to keep services open. We are about to launch our Island Health Clinical Academy in August which will train 15+ new nurses. We have also opened on-the-job training for Medical Assistants (MAs). No experience is necessary for this program. We will train the MAs on-site and help them achieve their certification.
- Increasing staff in the Walk-In Clinic to reduce wait times, and we have recruited two new primary care providers. We will continue to recruit additional providers to assist with outpatient appointments. Both primary care providers start this fall.
- Collaborating with department leaders, physicians and their teams to engage in process improvements to help remove barriers for patients, staff and physicians.
- Working with WSHA and local media to encourage patients to seek care in appropriate settings and avoid the Emergency Department except for emergency care. If you’d like to refresh your memory on whether you should go to the ED or Walk-In Clinic, visit https://islandhealth.org/department/emergency-department/.
- Working with WSHA to lobby for funding to support post-acute care to ensure the state’s healthcare system flows as it should and provides people with access to care in the appropriate setting.
- Utilizing tele-stroke and tele-ICU resources to provide good, safe care for patients who cannot be transferred out.
I’d like to thank our courageous team of clinical staff, support staff and medical staff who are here to deliver care for all who need it. As I stated before, please do not delay your care. Island Health is a vital source of healthcare for this community and we will triumph over these challenges to continue providing care to our community keeping our CARES values front and center.
Compassion, Accountability, Respect, Excellence, Stewardship