Ed Lovern of Ascension St. Agnes Hospital: ‘There are ways that hospitals can work together’

The COVID-19 pandemic brought a devastating blow to the industry, and it’s still having ripple effects. At this point in 2022, what kind of impact is the pandemic having on operations?

We don’t think about it as much as we have in the past, but it’s still with us. We have about five to 10 patients in the hospital a day who are COVID-positive, and while our staff is very used to taking care of these patients and the severity is different, it still requires all the gowning up, all the personal protective equipment—a different level of care than you’re dealing with when you have a patient without COVID.

What do staffing challenges look like for you?

It’s global. It impacts all of us. I’ve had the benefit of getting to serve as chair of the Maryland Hospital Association’s Task Force on Maryland’s Future Health Workforce, and I’ve had a chance to get to see other hospitals and how they’re dealing with it and talk to other experts.

We first have focused a lot on trying to expand the pipeline of getting more people into healthcare fields, and there are a lot of different ways to do that. One of the things we are doing more of is collaborating with not-for-profit organizations: closer relationships with community colleges, with universities, with not-for-profits that train employees, because we want to be aware of where we can pull from. Another aspect is making sure we are reducing any barriers to people getting their healthcare education. We know there’s probably about a 20% dropout rate for nursing students, and there’s an opportunity to have a lot more wraparound services. If we can reduce that dropout rate by half, for instance, that’s a lot more people coming into the workforce.

We recently have had a program to take some of our employees and put them through training to get their LPN certification, and one of the aspects of that program is to make sure that we’re paying them for the time they study. We’ve got to really think about all aspects of how to make people successful when they go back to get their education, so they can get back into the workforce.

How would you say, in general, the staffing shortage is compared to 2020 and 2021?

I think 2022 has obviously been the worst, and we really started to see it hit in late 2021. It was driven up, I think, by the phenomenon of having a lot of agency labor demanded by different parts of the country that were experiencing spikes in COVID. I think that fed on people’s burnout factor that they had gone through, the attitude that they needed to make money while there’s an opportunity to make money. It’s really changed the perspective. It’s important to say that I completely respect the way workers have gone about that. If I had the same incentives, I think I’d consider the same opportunities.

A place like Ascension has always done a great job at making sure we have employee assistance programs and ways we’re looking out for employees’ well-being, but I think in the future, it’s got to change and be even more intense. We’re talking with some local not-for-profits and local service agencies to be able to offer those services in the hospital. A lot of things have gone online, and that’s great and makes it convenient and accessible, but really thinking about how people have that personal touch, so that when they have a problem—any sort of problem, whether it’s financial or emotional or career-oriented—they’ve got a place to go to be able to talk through that.

It doesn’t have to be a competitive opportunity. Again, with my work on the Maryland Hospital Association’s task force, we were very collaborative. There are ways that hospitals can work together to offer those services.

[As] hospitals begin to experiment with value-based care programs, we learn more and more that it is a long-term solution."
 

What are you seeing as far as financial performance? What are some areas that could use improvement?

We are seeing increasing labor costs through this year, our volumes still haven’t caught up to what they were pre-pandemic, and, obviously, there are other costs like PPE and other adjustments that we’ve had to make as a result of the pandemic. In Maryland, we’re fortunate in that we have a unique payment system that results in a lot more stabilization in the way that hospitals are paid. That’s helped us stay close to about a break-even performance.

In the short term, we have to do all the things that we’ve always done in figuring out how to reduce costs by reducing our supply costs and any other expenses like that. We are rethinking how to be more productive. We look for opportunities to grow. We are looking for opportunities to improve rates—anything that we can do to make the bottom line work out.

Going forward, I think we’re going to have to refigure how we do it and what the model of a successful hospital is. One of the aspects is moving to more value-based care, but that’s certainly not a quick fix. As we get into it and hospitals begin to experiment with value-based care programs, we learn more and more that it is a long-term solution, and with aspects and problems that we’re running into, it’s going to take more than just the hospital industry to figure [it] out.

What are you watching for when the public health emergency lifts?

Many hospitals saw an immediate jump in telemedicine and televisits as a way to provide care when people couldn’t come in. For us, it stayed at about 8% to 10% of our visits. We hope there is pay equity in the way we’re reimbursed for televisits going forward, that we’ll continue to have flexibility with the way that licensure is granted.

If anything’s been a positive with this, we tend to see more healthcare coverage, I think, probably through the pandemic [with] some of these flexibilities and extensions that have been given. I hope we’re very careful with how those are rolled back, because it will have an impact on public health, and it will have an impact on hospitals. At this point, there’s just not much margin for us to be able to have a cushion to adjust for things like that.

Do you have any idea what operating margins might look like in 2023?

I hope it’s enough for us to be able to break even and be able to put money into capital expenses and the other things that we rely on. There’s been a big push toward making the kinds of adjustments we have to make in order to have a better bottom line, but it comes at a cost. We end up doing away with programs that were more experimental and things that were designed in some cases to serve the community. What people really have to look to now is, how can they make a financial return? So, 2023 might be better from a bottom-line standpoint, but then I think we’re starting from a step further back on some of the programs that we know are important going forward.