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State, feds move to aid hospitals

Gov. Andrew Cuomo announced a plan on Tuesday to reauthorize some hospitals, outside of COVID-19 hot spots, to conduct limited elective surgeries again.

Elective surgeries keep many rural hospitals afloat, and the state-ordered cancellation of those services has been a financial blow to most health networks in the North Country.

Meanwhile in Washington, Congress and the president are moving toward approving a new $500 billion aid package that would include $75 billion for hospitals.

During his daily press briefing at the Roswell Park Cancer Institute in Buffalo, Cuomo said New York state plans to specifically allow “outpatient procedures” — meaning procedures that don’t require overnight stays in hospitals — to restart on April 28, but only in select counties with fewer than 10 new COVID-19 hospitalizations in the last 10 days.

It was unclear on Tuesday what procedures, treatments or surgeries would be allowed and which ones wouldn’t be. The state Department of Health is expected to issue specific guidance to hospitals in the coming days.

Surgical patients would be required to test negative for COVID-19 before getting treatment, according to the governor’s office. That might be an obstacle for places where testing is scarce.

Testing is severely restricted in the North Country to the sickest and most at-risk patients — as it has been for weeks, prompting public health officials to reconfigure how they count the number of COVID-19 cases here to include suspected cases given preliminary diagnosis by a doctor.

Because of the limited testing capacity, it’s unclear whether the new state plan will do much to stave off the multi-million-dollar losses rural hospitals like Saranac Lake’s Adirondack Health are facing.

Cuomo did not provide a full list on Tuesday of counties where hospitals would be allowed to restart elective surgeries. He did say that hospitals excluded would include those in New York City and Long Island as well as those in Albany, Dutchess, Erie, Rockland and Westchester counties — all places that have seen a surge in COVID-19 cases. His office later expanded that list to also exclude hospitals in other hard-hit counties, including Clinton County.

Essex, Franklin, Hamilton, St. Lawrence, Washington and Warren counties were not included in that list. The governor’s office did not respond when asked if hospitals in Essex and Franklin counties specifically would be allowed to restart elective surgeries.

Financial hurdles

Many rural North Country hospitals have been struggling financially for years, some either merging or downsizing. That reality was further exacerbated when the state directed hospitals to cancel all elective surgeries on March 22 in an effort to free up beds and conserve supplies for an anticipated influx of COVID-19 patients.

Elective surgeries, as well as the medical imaging and testing that goes along with them, serve as a significant money-maker for rural health care providers that serve relatively high numbers of elderly and low-income patients. With elective surgeries canceled, many North Country hospitals have seen their revenue plummet in a time when they are being asked to increase their capacity.

If a hospital is given the OK to start elective procedures next week, administrators may have to cancel them again if the number of COVID-19 cases in the county, or the hospital’s capacity, reaches a certain threshold, according to the governor’s office.

Cuomo acknowledged that some hospitals, faced with a decline in revenue because of having to keep hospital beds empty, have been laying off or furloughing staff.

Adirondack Health has offered employees a voluntary furlough option. The St. Lawrence Health System announced on Friday it would furlough at least 400 workers, 20% of its staff. Samaritan Medical Center, in Watertown, also announced last week it would furlough 230 people — approximately 10% of its employees. Claxton-Hepburn Medical Center in Ogdensburg placed nearly 70 employees, about 8% of its 850-member staff, on unpaid leave this month. Carthage Area Hospital put an undisclosed number of employees on unpaid leave. Elizabethtown Community Hospital has furloughed 25 people. Two weeks ago, Hudson Headwaters Health Network, based in Warren County, furloughed 85 non-clinical staff members.

Federal funding

Congress passed the $2.2 trillion Coronavirus Aid, Relief and Economic Security Act last month, which set aside $100 billion for hospitals and community health centers. The U.S. Department of Health and Human Services allocated the first $30 billion based on traditional Medicare payments received in 2019, a decision that was expected to let the department disburse funds more rapidly. But that HHS decision has been criticized across party lines, with lawmakers in both major parties saying it benefits hospitals with larger populations rather than rural hospitals or those most burdened by COVID-19 caseloads.

Adirondack Health, for example, received $1.9 million through the first CARES Act disbursement — which represented less than a month’s worth of losses.

The Senate on Tuesday approved another coronavirus stimulus package, this one for $500 billion. The bill was expected to include $75 billion for hospitals, according to the Associated Press, but it was unclear as of press time how that funding would be allocated.

President Donald Trump said he supports the bill, which now goes to the House of Representatives.

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