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Ducey might allow elective surgeries under certain conditions

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Gov. Doug Ducey said Wednesday he’s looking to restore the ability of financially struggling Arizona hospitals to once again do elective surgeries.

The governor said he issued the directive last month to ensure that there is an adequate supply of personal protective equipment — masks, gowns and gloves — to handle what is expected to be a surge in the number of people hospitalized with COVID-19.

That peak is not expected until the end of this month, and possibly into May.

But in the meantime, Holly Ward, spokeswoman for the Arizona Hospital and Healthcare Association, said her members are hemorrhaging money because they’ve lost that business. And she said that there needs to be financial relief — and soon — to keep the doors open.

Ducey said he understands the problem.

“We’ve been working for the past 45 days to make sure we’ve got appropriate hospital capacity, ICU beds, personal protective equipment, ventilators, etc.” he told Capitol Media Services. And that, the governor said, required a halt to elective surgeries.

Now, Ducey said, he’s re-evaluating the situation.

Doug Ducey

Doug Ducey

“If we’re in a position where we’ve got enough supply that we have available inventory and we have product on the way as well, I am open minded to resuming elective surgery,” he said.

But when it occurs, it won’t be all at once.

“I would think this would be something where we would start with our rural hospitals first, and then, over a period of time, we would extend it into the urban core,” Ducey said. “It would be as soon as I have data that gives me the confidence to make a decision.”

Ward said that the hospitals agreed with Ducey’s original order.

“However, it is having dire financial consequences,” she said.

“Hospitals are reporting losses of 30 to 40 percent a month,” Ward said. “That’s a lot of financial bleeding that’s happening.”

She said loosening the restrictions on elective procedures, like knee surgeries and hip replacements, she said, will help.

But there’s more.

“We aren’t suggesting that elective surgeries are the be-all, end-all,” she said. Ward said that hospitals are just seeing fewer patients overall, including in emergency rooms.

The cause appears to be another of Ducey’s edict: his directive to Arizonans to remain at home unless they need to be out to work at an essential job or participate in essential services like shopping for groceries.

“People are staying home,” Ward said.

“They’re not having car accidents like they used to to go into the hospital,” she explained. “It’s not that day-in, day-out traffic that we would normally see.”

That complaint held no water with the governor.

“You want me to apologize for people not getting into car accidents?” he asked.

Policy issues aside, Ward said what hospitals need is some immediate and direct cash relief.

The governor last week provided some in the form of an additional $5.3 million in supplemental payments to “critical access hospitals,” those in rural areas located more than a 35-mile drive from any other hospital. And the state is advancing $50 million to hospitals in advance Medicaid payments, essentially fronting them money for services they have yet to provide.

Ward, however, said more is needed, whether from the state or the federal government.

How quickly an easing of Ducey’s ban on elective surgery could happen is dependent on several factors.

One is the question of when there will be a peak in the number of hospitalizations.

The governor last month directed hospitals to find another 13,000 beds by the end of this month on top of the 15,000 they already have. He also is working to reopen the closed St. Luke’s Hospital in Phoenix.

For the moment, there seems to be plenty of space. New information released this week shows total inpatient bed use in Arizona at less than 70 percent.

But Holly Poynter of the Arizona Department of Health Services says there are indications that the worst it yet to come.

She noted that Healthdata.org, which produces models for states and countries, predicts Arizona hitting its peak hospital need on April 30. Yet other models, Poynter said, have the peak further into May.

“Worst case scenario models are still predicting up to 13,000 (additional) hospital beds may be needed,” she said.

All this comes as the chief executive officers of Santa Cruz Valley Regional Hospital in Green Valley said he needs more immediate aid.

Kelly Adams said that, like other hospitals, his facility also has seen a sharp drop in revenues, with in-patient population down 50 to 55 percent and a drop of between 55 and 60 percent in emergency room visits.

But Adams also wants an immediate infusion of state aid, to the tune of $3 million. And he said he needs it soon if he is to make payroll this coming week.

Adams said that some of the help from Ducey’s prior statewide efforts have had only a minimal effect on his hospital. For example, he said, the facility didn’t get much relief from the governor’s decision to advance payments as the hospital serves very few Medicaid patients.

In a letter to Adams, Christina Corieri, the governor’s chief economic adviser, said the state is “willing to partner” with the facility during the pandemic. There are, however, strings attached.

One is that the hospital cannot make any payments to private owners, investors, shareholders, management consultants or board members. It also requires hospital executives to take a 20 percent pay cut and not receive any bonuses.

And Corieri said the hospital must remain in compliance with all federal and state conditions and licensing requirements, a condition she said was added “in light of previous violations.”

“I applaud them for asking the hard questions,” Adams said. “We’re working all those through.”

He said the 49-bed hospital, which emerged from bankruptcy in 2018 — he took over shortly thereafter — is viable if it can weather this financial problem and get the state help it needs.

“It takes years to turn a hospital into profitability,” Adams said.

 

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