AUBURN — The COVID-19 pandemic has severely impacted the health care industry in everything from systems’ financial vitality to staffing levels, Central Maine Healthcare CEO and President Steve Littleson told members of the Lewiston Auburn Metropolitan Chamber of Commerce on Thursday.
“It really did reshape our industry and continues to have a major impact on our industry — and probably will for quite some time,” Littleson said.
Central Maine Healthcare serves about 400,000 people across central and western Maine through its network of three hospitals, two long-term care facilities, an urgent care center and a number of primary and specialty care offices.
Its flagship hospital, Central Maine Medical Center in Lewiston, is one of three trauma centers in the state and its two critical access hospitals — Bridgton Hospital and Rumford Hospital — serve rural communities in Oxford and northern Cumberland counties.
Littleson said CMMC has the “dubious distinction” of diagnosing the first patient in the state of Maine with COVID in March 2020. And although there were many challenges to CMH’s operational abilities during the first year and a half of the pandemic — from the prevention and protection restrictions put in place to the months of canceled surgeries — the system was mostly able to deliver care to the best of its ability under the new normal.
CMH, along with several partner organizations, were able to vaccinate about 60,000 people, Littleson said, at the state’s longest-running vaccination site at the Auburn Mall. “Things were going great in 2021” until the delta variant hit, he said.
At the same time, Gov. Janet Mills announced that all health care workers must be vaccinated against COVID-19 and a few months later, a federal requirement followed. By the time the state mandate went into effect on Oct. 31, 2021, about 300 employees had quit to avoid getting the shot, Littleson said.
Then, delta-fueled surge became the omicron-fueled surge in the winter of 2021.
The first three months of 2022 were “probably the three most stressful months of my entire 35-year career,” Littleson said.
“We had sick team members. We had a 50% vacancy rate in many of our clinical departments. And we needed help and we needed help fast,” he said.
In Maine and across the country, active-duty military officers streamed into health care facilities.
“I hesitate to think what would have happened had they not shown up,” Littleson said. Federal COVID response teams and Maine National Guard members stayed at CMMC, “basically staffing our emergency department.”
“They really helped us weather that storm,” he said.
But there’s another storm on the horizon: On May 11, the federal COVID-19 public health emergency ends and with that, so does the significant financial aid that has kept hospitals and health care systems afloat over the past three years.
He said that 80% of Maine hospitals are already operating in the red. On average, large hospitals in Maine ended this past fiscal year with a -4% operating margin, on a range of -2% to -22%.
He did not say specifically how CMH or its individual hospitals ended the year, but said they’re not at either extreme. Tax returns for the most recent fiscal year are not yet available through the Internal Revenue Service.
Littleson said that CMH got $40 million in temporary relief loans in the form of advanced Medicare payments — and now the federal government is asking for that money back. CMH had to repay the first big chunk at the end of last year.
“That put further stress on not just our hospital but frankly, every hospital’s financial performance as we were still working our way out of the pandemic,” he said.
Increased Medicare reimbursements will also go away with the end of the public health emergency.
He added that the Federal Emergency Management Agency has reimbursed CMH for about $10 million this fiscal year for infection prevention-related expenses. That, too, will disappear.
“That’s significant money that as of May 11, will dry up.”
COVID is still here, Littleson said, and it’s costing health systems a lot of money. CMMC is still diagnosing five to 10 inpatients with COVID every day and about 10 to 20 staff members are out sick with COVID in any given week, he said.
Plus, infection prevention is expensive.
“We’ve learned a lot about preventing infection. And that costs money and those expenses will be with us going forward as we continue to deal with COVID and other infectious diseases as well,” Littleson said.
Masking is still in place at CMH facilities and Littleson said there are no plans to end that.
In addition, insurance companies are not paying hospitals and doctors “fairly,” and some contracts are written where the payer can “unilaterally change the rate of payment.”
Workforce shortages, which have been compounded by Maine’s aging workforce and a significant exodus driven in part by the rise in violence against health care workers, are a major concern.
There are about 200 vacant nursing positions at CMH, about 33% of its nursing workforce. The health system currently employs 170 traveling nurses at a cost of $150 per hour. Littleson said they will spend $30 million on labor alone this fiscal year.
There are still more challenges that are negatively affecting health systems’ ability to operate and provide care. There’s the “quiet pandemic” of the near “complete lack” of beds for post-acute care patients, especially for behavioral health.
St. Mary’s Regional Medical Center in Lewiston, which has inpatient behavioral health units for children and adults, has been a great partner.
“But St. Mary’s can’t do it alone. And the lack of access in not just our community, but across the state, is really severe,” he said.
A 14-year-old sat at CMMC for 92 days waiting for a bed at an adolescent behavioral health facility. She ended up getting shipped to Tennessee “because we didn’t have a bed for that child in the state of Maine,” Littleson said.