New Jersey hospitals are a microcosm of potential COVID-19 financial impact
The last time margins sank so deeply into the red was after the Balanced Budget Act of 1997, though today's margins are faring worse.
COVID-19 continues to have deep and lingering financial impacts on hospitals in New Jersey. A midyear analysis of financial data shows nearly 60% of the state's hospitals in the red and an average statewide operating margin of negative 4%.
The effects have been profound, and serve as a potential microcosm of the continuing impact of the coronavirus on hospital operating margins nationwide.
The decline in the state is the result of a dual blow of declining revenues and rising expenses, according to the report from the Center for Health Analytics, Research and Transformation at the New Jersey Hospital Association. Officials said the state's hospitals haven't experienced this level of fiscal distress in more than 20 years.
In fact, the last time margins sunk so deeply into the red was in the late 1990s. At that time, the Balanced Budget Act of 1997 resulted in significant payment cuts to the state's hospitals, with margins falling to -1.7% and -2.3% in 1998 and 1999, respectively. And those numbers are not as distressing as the ones being experienced during the public health crisis.
WHAT'S THE IMPACT?
The report, "At Mid-Year, COVID-19's Financial Wounds Continue for N.J. Hospitals," shows the impact of continued loss of revenue from the suspension of elective procedures at COVID-19's peak in the spring, and the slow rebound of patients returning to the hospital.
CHART's data, comparing June 30, 2019, with June 30, 2020, shows that total patient revenues declined 6.6%. Emergency department cases plummeted 23%, while hospital admissions fell by 8% and outpatient visits dropped by 22%.
An additional aggravating factor is a 12% increase in total operating expenses, because COVID-19 required hospitals to redirect resources to increase staffing; boost supplies of personal protective equipment, pharmaceuticals and ventilators; and modify operations and facilities to expand capacity.
CHART's analysis takes a closer look at the disruption of elective procedures in New Jersey hospitals and its lingering impact. Governor Phil Murphy's Executive Order 109, in effect March 27 through May 26, required hospitals to suspend elective procedures during the state's COVID-19 surge. CHART used claims data for some of the highest-volume elective procedures performed in New Jersey hospitals – bariatric surgery, pacemaker insertion, spinal fusion, knee replacement and hernia repair – to gauge the impact.
In April and May 2019, the state's hospitals performed these procedures 4,336 times. That number plummeted to just 400 statewide in April and May 2020. The state's executive order suspending procedures during this time allowed exemptions for cases in which a delay would result in "undue risk to the current or future health of the patient."
The year-over-year decline persisted even when the suspension was lifted. In June and July of 2019, 4,194 procedures from the list of high-volume procedures were performed, compared with 3,191 in June and July of 2020.
But the greatest decline in volume by percentage was seen in hospital emergency departments, where cases nosedived 23.4% between June 30, 2019, and June 30, 2020. That has healthcare leaders concerned.
NJHA officials said a hospital turnaround is critical for the statewide recovery from the coronavirus.
"The state's hospitals pump $25 billion annually into the New Jersey economy and employ 154,000 people," said NJHA's Roger Sarao, vice president of economic and financial information and lead author of the CHART report. "They are an essential part of the road to recovery from this public health and economic crisis."
THE LARGER TREND
The effects of the pandemic on the nation's hospitals will be long-lasting, especially among nonprofits. A recent Fitch Ratings analysis showed that the full effects have yet to be felt.
The agency predicted that capital spending will be greatly reduced in the initial years post-pandemic, though some of it will ultimately accelerate due to anticipated merger and acquisition activity.
Fitch expects hospitals to take on added expenses to perform the same level of service, and predicts revenue declines from a shift in payer mix.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
The Business of Health
This special collection of stories, which will be updated throughout the month, explores how hospitals, health systems and physicians are attempting to not only financially survive, but thrive, under the new normal.
