July 16, 2022
By John Hawkins, president/CEO, Texas Hospital Association
Originally published by the Houston Medical Journal
The passage of time takes the sting out of painful memories. It’s a coping mechanism that allows us to move on from trauma and move forward with hope. As the pandemic moves toward second-page news, it’s hard to recall the early days of intense uncertainty, rapid-fire disease spread, school closures, mixed mask messages, travel bans, hand sanitizer rationing, and an abundance of panic as the country embarked on what we thought maybe a few weeks of turbulence and closures.
Today, things are better, and while we’re grateful to be able to focus on progress, there is much to rebuild.
To learn from our past, we must take a hard look at what happened – and what might have been. The single biggest lesson learned is that hospitals – and hospital workers – were foundational to the country’s overall public health response. To date, some 500,000 COVID-19 patients have been admitted to Texas hospitals. Aside from admitted patients, millions more have been tested, treated, or vaccinated for COVID-19 in hospital outpatient and emergency settings. The critical role of hospitals in a public health emergency response cannot be overstated.
When COVID-19 hospitalizations surged, time and time again, and capacity was bursting at the seams, hospitals were there – for trauma patients, baby deliveries, accident victims – without missing a beat. Hospitals are the bedrock of health for communities, and during the COVID-19 pandemic, that was never more evident. Hospital workers were there while other industries shut down or moved to a work-from-home environment. Regardless of a patient’s ability to pay, federal law requires hospitals to examine all patients and treat any emergency conditions. And the life-saving nature of hospitals prompts them to take all comers.
Hospital staff showed up even when personal protective equipment was scarce and their lives were on the line. When Texas leadership announced that every Texan who needed a hospital bed during the pandemic would have one, hospitals were already there, having locked arms with public health officials to prevent illness and be ready.
While totally preventing community spread of COVID-19 was not realistic, hospitals embarked on an unprecedented venture alongside public health leaders to protect as many people as possible, rolling out massive vaccine campaigns, pumping out precaution messages, adjusting service lines to bend to new demands, launching programs to retain and find workers, administering new therapies and keeping the lights on during a time of darkness. The ability of hospitals to continue to perform during the worst circumstances should not be taken for granted.
With the most recent surge behind us, we’re able to examine where we are today. The health care workforce is battle worn, and an entire generation of hospital workers has moved on, burned out, or retired. Today, hospitals have begun to stabilize, but profound income losses persist despite earlier federal and state support. In 2021, U.S. hospitals were on pace to lose $54 billion in net income with 11% lower average margins than pre-pandemic, even after CARES Act payments. Now, halfway through 2022, margins remain cumulatively negative, with higher labor costs, labor shortages, and turnover negatively affecting financial performance, in addition to soaring costs of supplies, medications, and other operating costs.
When we look to the future, we must protect hospitals’ ability to respond to public health emergencies and ensure the Texas safety net is strong. Interim legislative hearings are underway, examining the state’s response and the industry’s use of relief payments. We are calling for additional financial resources and environments that favor our ability to respond and rebuild. We need policies designed to build and sustain a robust health care workforce to provide care for an expanding population. We are calling for strategies to increase behavioral resources across the board, to support efforts to improve vaccination for preventable diseases and to expand health care coverage to ensure Texans are protected.
The pandemic has prompted the hospital industry to double down on its public health role. Hospitals are critical to stabilizing health care for all Texans. We must support our heroic workforce that has proven to be foundational in a public health emergency – and every day.