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Open at all costs: How Kootenai Health faces uncertain 2021

by CRAIG NORTHRUP
Staff Writer | December 27, 2020 1:30 AM

Since the onset of the coronavirus pandemic in March, Gov. Brad Little has stressed maintaining Idaho’s health care capacity.

If health care capacity is exceeded, the quality of care deteriorates from adequate to something called “Crisis Standards of Care.” This could result in extremes ranging from performing procedures in conference rooms to setting up makeshift field hospitals to simply turning away the sick and injured.

“Keeping our doors open for both COVID-19 and non-COVID-19 patients is important from both a patient care and a financial perspective,” said Kimberly Webb, chief financial officer for Kootenai Health.

“We call this 'Dual Systems of Care.' To operate under Dual Systems of Care, we have done everything possible to expand our capacity within the state and national emergency guidelines to take care of both COVID-19 patients and the needs of the community."

Both Little and Kootenai Health CEO Jon Ness have warned the public that emergency standards such as these could lead to devastating impacts on communities’ abilities to weather the pandemic. But as coronavirus numbers have increased over the past four months, hospital leaders say the pandemic can and will lead to emergency efforts to try to save a company.

For example, a pediatric unit in Kootenai Health was reportedly moved to post-partem after a December rise in cases required additional COVID-19 beds. It was a real estate solution, temporary as it may be, but it brought forward another issue: How do you staff those new beds?

On Dec. 17, Kootenai Health had to delay or cancel elective procedures until at least Jan. 10, thus freeing up staff hours to help with the COVID ward.

But there is a financial cost that comes into play.

“Right now, with the extraordinary surge of COVID-19 inpatients, we are beginning to have to postpone and reschedule non-emergent but necessary procedures, such as joint replacements and heart procedures," Webb said. "These procedures contribute significantly to our profitability.”

Webb added that until the majority of the community gets vaccinated, the hospital may see continued capacity constraints and canceled procedures.

Some walk into Kootenai Health insured. Some do not. But more pressingly, insurance experts emphasize, COVID-19 is a new disease. It’s new for medical researchers. It’s new for doctors and staff seeing patients. And it’s new to insurance companies.

“Our work with insurance companies continues to be challenging, and might be even more challenging over the coming year,” said Shelley Woodward, director of revenue cycle operations for Kootenai Health.

She said hospitals and other providers had to search out the criteria to ensure billing and collections corresponded to the most current rules.

Woodward said those financial battles often ended up falling to the patient to figure out.

Like all brick-and-mortar businesses, hospitals require certain materials — medicine, available beds and personal protective equipment — to operate.

When asked how Kootenai Health managed to work with vendors to keep supply lines open earlier this year, Trevor Bober said one word came to mind.

“Partnerships,” said Kootenai Health’s director of supply chain operations. “Our continued successful response to this pandemic has been to partner with key vendors and hospital leadership.”

While Kootenai Health has so far managed to both prepare for and treat new patients, Webb said the hospital faces another financial issue: Safely getting customers out the door and back on their way toward a healthier tomorrow.

“Yes, we are busy,” Webb said, “but many of our patients are medical patients who require very long lengths of stay due to the severity of their illness. This is compounded by an inability to find a safe place to discharge these patients who no longer need hospital-level care.”

Webb said many skilled nursing facilities will not take patients who test positive for COVID-19, adding that many family members do not want to take these patients — or are simply unable to take them — out of fear of illness or an inability to properly provide for their loved ones.

Webb said the pandemic is creating a financial burden.

“The hospital is paid a fixed fee for most inpatients, regardless of the cost to provide their care, or how long they are in the hospital,” Webb said. “If a patient needs to stay in the hospital longer than normal, either because they still need care or because we don’t have somewhere to safely discharge them to, the hospital loses money.”

But Webb and others at Kootenai Health stressed that patient care comes first.

"We are the hospital for our community,” Webb said. “We will continue investing in the resources needed to get through this pandemic.”