In the weeks and months after COVID-19 began it's spread acros the U.S., hospitals began furloughs and layoffs to help stem the losses from the subsequent loss of non-COVID business.
In Kentucky, a state that was certainly not immune from these economic factors, St. Elizabeth Healthcare — which saw volumes drop between 30% and 70% at its hospitals — was able to avoid job cuts of their peers. In fact, CEO Garren Colvin commited to employees that he had no intention of reducing hours or cutting staff pay.
While officials at greater Cinncinati health system attributed the ability to do that, in part, to a historically strong cash flow and healthy balance sheet heading into the crisis, there were other factors at play. That included some quick moves to centralized COVID cases at a single hospital and repurposing its workforce from areas of low need to areas of greater demand.
"Our strategy with COVID was pretty interesting in that it worked out in hindsight pretty well," Colvin said. Here's a look at our conversation with Colvin on some lessons learned on how the health system was able to avoid layoffs.
Fierce Healthcare: How does your health system fit in the local market?
Garren Colvin: We’re a $1.3 billion healthcare system located geographically in the northern part of Kentucky. So probably if you look at it, it’s the upper seven counties right across the river from Cinncinati, Ohio. So we compete more in our market with the Cinncinati hospitals than we do any Kentucky hospitals.
FH: What was the biggest move St. Elizabeth made to shore itself up when COVID hit?
GC: When Ebola hit a few years ago, we set up an infectious disease response team and kept those in place even when the threat of ebola went away. This IDR team stayed in training and it’s a group of individuals who went above and beyond with additional training. And so as soon as this issue came forward, we basically said: "OK, we’re going to turn our IDR team loose."
And we decided: if you have all that expertise, why spread that expertise over three or four hospitals? Let’s focus one of our facilities for COVID. So we took our Ft. Thomas campus and we turned that into our COVID hospital. We basically had our ICU for the really sick. But we converted other floors into mini-ICUs so to speak.
And we took, from a mechanical point of view, took two whole wings into isolation rooms which really allowed us to treat as many patients as we treated. We had a high of maybe 85 patients at one time. We probably had an average around the 40s. Right now we’re at 25. We’ve seen a significant decrease in our volumes.
Most of our patients who are sick com from nursing homes so we implmented a nursing home strategy in cooperation with our Director of Health Dr. Steven Stack, which we think has been somewhat of a game changer.
FH: How did that nursing home plan work?
GC: Our post-acute care team has a great relationship with senior living and nursing homes in our community and with our health department. So we agreed — in cooperation with the state — to test all of our nursing homes. We were aware of what happens when you test so many people at one time you get so many negative results. You have people who want to leave and walk out. So we tried to have a SWAT team ready to assist in these nursing homes in the testing process with any issues they had around cleaning, around sanitation, around PPE.
We were prepared to bring staff in and we brought a few people in here and there. But we never had to take over a nursing home primarily because of working with nursing home leadership to make sure they could segregate patients appropriately. At one point, we did have about 35 patients delivered over a two-day period from one nursing home. We were able to maintain that by basically having our staff on site controlling the transfer of those patients and then transferring them back so they could take care of them in the nursing home.
It's really the communication that’s constant between health department, nursing home and hospital.
FH: What did centralizing your COVID resources do for your health system?
GC: I think the beauty of being in the state of Kentucky and the early adoption of social distancing, the early adoption of restricting elective surgeries and procedures really hampered us financially early on. But I think the end result of that for me and our team was to see that Kentucky wasn’t going to have the same volumes as our neighboring states. I applaud the governor for the initiatives he undertook to see that was the result we were going to have.
As a result of that, we saw pretty early on that having one facility being the COVID hospital, that we were going to maintain the rest of our facilities COVID-free. Obviously, there were times when someone would show up but as soon as they were under investigation or positive, we would transfer them to our COVID hospital. That allowed us to do is to really concentrate on the point in time we would be able to reopen elective procedures.
What we were able to see is that day was going to come early for Kentucky hospitals than say New York hospitals or Ohio hospitals. What we thought is: we couldn’t afford to let our staff go because we wouldn’t be able to turn that switch back on. That’s where you have to applaud our board of trustees for having the foresight to maybe take a little bit more of a loss up front to maybe take more of a recovery a lot more substantial. That’s what occurred.
FH: What were employees at hospitals that were not designated as COVID-hospitals doing during that time, as much of that elective procedure business was drying up?
GC: We reassigned people. Everyday we had a demand. It was almost like a float pool where people reported jobs that needed to be done and individuals who could be reassigned were reassigned. Someone went out in nutrition services, we would fill that job from the float pool.
On our physician front, we guaranteed their salaries. They're contracted at 90% of their historical average of volume. But we pivoted significantly to help compensate for that. We were an organization doing fourteen to fifteen televisits a day. We quickly hit the 2,000 per day mark almost overnight. We reassigned. So rather than seeing patients in the office, they’re seeing patients through telemedicine. Physicians were rounding that didn’t round. If there was not a need then your compensation is still guaranteed. But I don’t believe anyone took advantage of us in that process. All nurses were guaranteed their salary.
The only time you had to use PTO or personal time was if you didn’t have work on your floor or unit because of volume and then when offered a reassignment you chose not to be reassigned, then you had to use PTO or use what we call voluntary time off. Reassignments were throughout the system.
FH: What are the biggest learnings from the pandemic for you?
GC: I’ll be honest. Early on in March, we basically took one business-based decision that "Hey, all these people will file for unemployment and we’re going to be the reimbursing hospital paying 60-70% of that cost anyway." We felt like we were better off keeping them in house. That also allowed us to focus on safety. So individuals like our athletic trainers who weren’t busy because high schools were closed and sports were closed came in and took temperatures of every patient coming in the door every day, of every staff member walking in the door everyday, every visitor walking in the door when you were able to have visitors.
That’s been a game changer for us and what we found was we needed a lot of that staff. We didn’t feel like we had a lot of excess we could afford to let go.
The last thing I would say is, we were fortunate — knock on wood — to be a AA-rated hospital so we had a very strong balance sheet and, as soon as we had kind of knowledge of what the CMS’ stance was going to be and what the CARES Act dollars could potentially be, we thought we might be able to survive it from a cash flow perspective. So we just maintained our workforce. On the flip side, everyone’s going to be twice as busy trying to recover so we needed employees to be excited and thankful and proud which describes everyone of our associates. It was almost a no brainer for us.
For our Cinncinati competition, it wasn’t the same scenario because they knew their start date for recovery was going to be significantly later than our so they didn’t have the opportunity to go down that same path.
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