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Layoffs, pay cuts and potential closures: Alabama hospitals strapped for cash

Pickens County Medical Center was the most recent rural hospital in Alabama to close. It closed in early March before the coronavirus.
Chip Brownlee | The Trace

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More than half of Alabama’s hospitals were already in a precarious situation before coronavirus.

About 52 percent of the state’s hospitals had negative total margins before COVID-19, and 75 percent of them had negative operating margins, according to Alabama Hospital Association President Donald Williamson.

In layman’s terms, they were bleeding money.

Rural hospitals were in much worse shape. Nearly 90 percent of them had negative operating margins before the coronavirus outbreak. In the last eight years, at least 13 hospitals have closed in the state. More than half were in rural areas.

The last to close was Pickens County Medical Center in Carrollton, Alabama, which closed last month, leaving the rural county west of Tuscaloosa without a hospital. The next-closest hospital is more than 30 miles away.

But with COVID-19 impacting nearly every aspect of life, even in Alabama’s least-populated counties, hospitals, especially the small ones, have gone from bleeding money to hemorrhaging it.

“Hospitals around the country are struggling. Everyone’s bleeding. It’s just that we have less blood,” said Ryan Kelly, the executive director of the Alabama Rural Health Association, a group that represents the state’s rural hospitals and clinics. “If everyone is dying, we’re going to die quicker. It’s not a good position to be in.”

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The outbreak of the coronavirus has forced officials to take extraordinary measures to protect the public. But these measures, meant to protect hospitals from being overwhelmed, are also exposing a deep and precarious situation underlying Alabama’s health care system.

Smaller budgets mean less to trim. There is only so much that can be cut. And if it was trimmable, these cash-strapped hospitals have probably already cut it. More efficiency can’t solve these hospitals’ problems.

The pandemic prompted state officials to cancel elective procedures, which are generally more profitable and account for a large portion of most hospitals’ revenues.

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“Elective surgeries were really the only way some of these hospitals could make money,” Williamson said. “Coronavirus is seriously stressing hospitals.”

But elective procedures being canceled or postponed is not the only hit hospitals are taking. Sources of revenue from many other nonessential services have also dried up.

“They can’t really do a lot of wellness and prevention, because that’s not high on people’s radar, either,” Kelly said of the rural hospitals. “We’ve kind of built our health care infrastructure to be more wellness and prevention heavy. And that was great until something like this when wellness and prevention are seen more as luxuries. Now we’re back to just treating the sick patients, especially the critically sick.”

Fewer patients are showing up in emergency rooms, Kelly said, further cutting into costs. Telehealth and telemedicine is a growing revenue stream at these hospitals, but it is not yet in a position to match the lost revenue.

“It’s a tough position for everyone to be in,” Kelly said. “Most of our revenue was built off these other procedures that have largely stopped or, at a minimum, slowed.”

According to the Chartis Center for Rural Health, about a quarter of Alabama’s 45 rural hospitals are among a few hundred rural hospitals across the country considered “most vulnerable” to closure. The same report found that rural hospitals in states that have not expanded Medicaid are more vulnerable to closure.

Kelly said Medicaid expansion, at this point, wouldn’t be a “silver bullet” to solve the financial problems facing the state’s rural hospitals, though it could help. The Alabama Hospital Association, though, has advocated for Medicaid expansion to bolster revenues for the state’s hospitals and expand health care access.

Hospitals across the state have lower bed occupancy as officials prepare surge capacity ahead of what is anticipated to be a spike in COVID-19 hospitalizations by mid-April. As of Tuesday morning, hospitals across the state were at about 50 percent occupancy, Williamson said, down from 70 percent on a normal day.

Williamson also fears that hospitals could be forced to eat the costs of treating uninsured COVID-19 patients who may require hospitalization as the outbreak spreads. The state’s refusal to expand Medicaid under the Affordable Care Act — when most of the cost of the expansion would have been borne by the federal government — has resulted in a larger uninsured population in Alabama. Some 16 to 20 percent of adults in the state are uninsured. Bearing the cost of that uncompensated care could add to the strain.

One of Congress’s coronavirus response bills, the CARES Act, has $100 billion in funding for hospitals across the country. But that cash has not arrived yet, and no hospital is certain how much money it will get and if it will be enough to stabilize the balance sheets.

“Once it begins to be distributed, that will serve as a major help for hospitals, but it’s just not there right now,” Williamson said.

And many of the state’s hospitals don’t have a lot of money on hand to wait weeks or months for help. Some only have days, especially the rural hospitals, Kelly said.

“I would say that you could put good money on another hospital or two or four closing, but I’m certainly praying that does not happen,” Kelly said. “But really these hospitals only have days or weeks of cash on hand. You disrupt that revenue cycle any, and you could end up in a pretty big predicament.”

Kelly said some estimates have said hospitals could face a 20 percent cut in revenue during the COVID-19 crisis — maybe even more. “I have not talked to a single facility yet that has said their business was normal,” Kelly said.

The dire budgetary situation facing more than half of the state’s hospitals has forced some to lay off health care workers and support staff and cut the pay or hours of some of those who can’t stop working.

Williamson and Kelly said they were aware of hospitals being forced to take these cost-cutting measures, but they did not have numbers to show how many hospitals have needed to do so and how many workers and providers have been affected.

Workers at hospitals are not the only health care workers affected by the virus. Dentists, providers at smaller clinics, rehab specialists and other medical practitioners have also been forced to scale back or temporarily shut down operations.

According to the Alabama Department of Labor, some 7,324 health care and social assistance workers filed an initial jobless claim for unemployment insurance in Alabama during the week ending March 28.

Even the state’s larger hospitals like Huntsville Hospital and DCH in Tuscaloosa have cut back the hours of workers in nonessential areas. Huntsville Hospital CEO David Spillers said at a briefing last week that the medical system would lose millions of dollars every month during the pandemic.

Williamson and Kelly said hospitals are doing everything they can to avoid cutting pay or laying off workers. When layoffs have been required, they said they have been in areas that would be the last to respond to COVID-19 cases and the least likely to affect a hospital’s ability to handle a surge.

“But that’s still not ideal,” Kelly said. “Let alone the fact that we need our hospitals right now to be ready in case there’s a surge of COVID-19 cases. So the last thing we want to do is just shut down operations when we might need it.”

The state’s hospitals are facing other problems, too, including shortages of personal protective equipment, Williamson said.

“I’ve got some hospitals that are telling me they have maybe a week’s worth of PPE,” Williamson said. “I’ve got a few others that are feeling that their shortages are more immediate.”

Hospitals have been trying to source PPE — including masks, gowns and gloves — from non-traditional suppliers, through donations and through the state. The Alabama Department of Public Health has secured some additional PPE, Williamson said.

The shortage is causing the prices to go up and making obtaining those essential supplies difficult.

“It is concerning how difficult it is to get,” Williamson said. “But I certainly don’t think we’re in the situation of New York.”

While the state’s largest hospitals like UAB in Birmingham, Huntsville Hospital in Huntsville, EAMC in Lee County and DCH Regional Medical Center in Tuscaloosa will likely bear the brunt of the COVID-19 patient surge, rural hospitals are not immune from it.

Many are already treating COVID-19 patients, Kelly said, and they may be needed to help alleviate the burden on the larger hospitals, Williamson said.

“When you look at how you manage surge, you start by eliminating elective procedures because you want to free up beds,” Williamson said. “But the next part of that plan is you take people who may not have COVID, who may not need the level of acute care provided in urban hospitals, and you transfer some of those patients into, say, a rural hospital.”

But that surge plan requires those rural hospitals to be there to be able to help.

“We’re just trying to hang on,” Kelly said. “You know, targeting cuts and layoffs, and conserve money as best as possible but still be ready for patients coming in. That’s the position that most hospitals are in.”

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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Justice Ginsburg’s death will supercharge a heated 2020 campaign

The passing of one of the court’s most liberal justices so close to the Nov. 3 general election has set off a political firestorm as to what president should pick the next justice — President Donald Trump or Joe Biden, should he defeat Trump in November.

Brandon Moseley

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President Donald Trump, left, and former Vice President Joe Biden, right, are running for president in 2020. (STAFF SGT. TONY HARP/AIR NATIONAL GUARD AND GAGE SKIDMORE/FLIKR)

Just hours after the death of 87-year-old Supreme Court Justice Ruth Bader Ginsburg on Friday, conservatives, including the Alabama-based Foundation for Moral Law, said Ginsburg’s passing is an opportunity to reverse the ideological trend of the nation’s highest court.

The passing of one of the court’s most liberal justices so close to the Nov. 3 general election has set off a political firestorm as to what president should pick the next justice — President Donald Trump or Joe Biden, should he defeat Trump in November.

The controversy over when and how to confirm a new justice will likely supercharge an already heated 2020 election campaign. Trump was at a campaign rally on Friday night when he learned about the justice’s death from reporters.

“Just died? Wow, I did not know that,” Trump said. “She was an amazing woman. Whether you agreed or not she led an amazing life. She was an amazing woman. I am sad to hear that.”

Ginsburg, since her appointment by President Bill Clinton, has been bastion of the court’s more liberal wing. The court was divided with four “liberal” justices led by Ginsburg and four “conservative” justices led by Samuel Alito.

Chief Justice John Roberts, though appointed by President George W. Bush, has been the swing vote on a number of major issues since the retirement of Justice Anthony Kennedy in 2018. Her death gives Trump the opportunity to appoint her replacement and potentially shape the direction of the court for decades to come.

Conservatives want Trump to select the nominee and the current GOP-controlled Senate to confirm the Trump appointee.

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The Foundation for Moral Law — a conservative legal group founded by former Alabama Chief Justice Roy Moore — released a statement saying that Ginsburg’s passing is an opportunity to move the court in a more conservative direction.

“For many years United States Supreme Court has been a bastion for liberal anti-God ideology,” Moore said. “The passing of Justice Ruth Bader Ginsberg will be an opportunity to reverse this trend. I’m hopeful that President Trump will immediately nominate a true conservative who understands that our rights come from God and no authority in this country can take those rights from us.”

“This is a very critical time for our country and our future and the future of our posterity depends upon our vigilance and direction,” Moore said.

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Judicial Watch, another conservative legal group, echoed Moore’s statement.

“Judicial Watch sends it condolences to the family of Justice Ruth Bader Ginsburg. She had a wonderful judicial temperament that will always be remembered,” said Judicial Watch President Tom Fitton. “President Trump now has a historic opportunity to nominate yet another constitutional conservative who will honor the Constitution and the rule of law across the full spectrum of constitutional issues.”

“And the U.S. Senate should move quickly to work with President Trump to consider and approve a new justice who will faithfully apply the U.S. Constitution,” Fitton said. “There is no reason we cannot have a new justice by Election Day.”

Trump is expected to put forth a nominee to fill Ginsburg’s seat in the coming days, according to ABC News.

Senate Majority Leader Mitch McConnell, R-Kentucky, wrote in a statement that, “President Trump’s nominee will receive a vote on the floor of the United States Senate.”

But Democratic senators and Senate Minority Leader Chuck Schumer, D-New York, disagree.

“The American people should have a voice in the selection of their next Supreme Court Justice,” Schumer wrote on social media Friday, parroting a similar quote McConnell used in 2016 when he refused to give then-President Barack Obama’s nominee, Merrick Garland, hearings and a vote for confirmation to the court. “Therefore, this vacancy should not be filled until we have a new president.”

Republicans in the Senate blocked Obama from selecting Justice Antonin Scalia’s replacement. Scalia was the most conservative jurist on the court.

Ginsburg was a staunch supporter of abortion rights and voter protections, and she played a major role in upholding Roe v. Wade, the Supreme Court decision protecting abortion rights. She also voted in favor of same-sex marriage and to uphold the constitutionality of the Affordable Care Act.

Most political observers expect Trump to appoint a woman to fill Ginsburg’s spot. Political insiders have suggested that Trump believes that appointing a woman to the court could help him with woman, a key swing demographic that will likely decide the next election.

Will the Senate confirm Trump’s appointment before the election or wait until after the public votes? If Republicans lose control of the Senate, could a lame duck GOP majority select the direction of the court on their way out?

Alabama Sen. Doug Jones has been widely criticized for his vote against the confirmation of Justice Brett Kavanaugh. If the vote comes before the Nov. 3 election, Jones’s decision on whether to confirm Trump’s appointee will be heavily scrutinized.

The questions about the Supreme Court is likely to only further inflame passions on both sides this election cycle.

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U.S. Supreme Court Justice Ruth Bader Ginsburg dies at 87

Eddie Burkhalter

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(APR GRAPHIC/SUPREME COURT PORTRAIT)

United States Supreme Court Justice Ruth Bader Ginsburg — a champion of women’s rights and voter protections on the nation’s highest court — died Friday at the age of 87 from complications from metastatic pancreas cancer.

The justice died at her home in Washington D.C., surrounded by family. Only the second woman ever to be appointed to the highest court in the nation, she served 27 years on the court, becoming a champion for women’s rights and voter protections. 

“This news is a devastating loss for our country and for all those who have been inspired by the inimitable Justice Ginsburg during her long and historic career. Justice Ginsburg led a life guided by principle and filled with purpose. A true trailblazer in the legal field in her own right, she inspired generations of young women to reach for heights that previously felt impossible. Through her quiet dignity, her willingness to bridge political divides, and her steady pursuit of justice, she was a standard-bearer for positive leadership,” Sen. Doug Jones said in a statement. 

“Her bold dissents in the Ledbetter v. Goodyear Tire & Rubber Co. and Shelby County v. Holder cases are particularly meaningful to me, and to so many in Alabama and across the country. She stood for what was right and for the constitutional principles of equality and democracy that she held dear, even if it meant she was in the minority on the Court. As only the second woman to ever serve on the Court, she made full use of her opportunity to serve as a voice for women on the bench.

“Beyond her legal acumen, Justice Ginsburg will also be remembered for her sharp wit, her tireless advocacy for voting rights, and her historic role in fighting for a more equal society for women across the country. She will be greatly missed. Louise and I extend our sincerest condolences to Justice Ginsburg’s loved ones. We’re praying for them as they grieve this tremendous loss,” Jones said. 

Margaret Huang, president of the Southern Poverty Law Center, in a statement Friday said that our country has lost a monumental and transformative figure. 

“Justice Ruth Bader Ginsburg was not only a trailblazer, a hero, and a singular inspiration, she was also a deeply principled person who demonstrated great courage and conviction throughout her entire legal career,” Huang said. 

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“At the time of her appointment in 1993, Justice Ginsburg was only the second woman to be seated on the U.S. Supreme Court, but it wasn’t her first time in the Court. As director of the Women’s Rights Project of the American Civil Liberties Union, she argued and won five cases before the Justices. And from her first term, she made it her mission to guarantee equal protection for women and other marginalized communities. We are eternally grateful for her decades of work — and landmark achievements — in pursuit of this essential goal.

“In her later years, she became an icon for a younger generation. Her resolute determination for justice inspired millions, including all of us at the Southern Poverty Law Center. With her countless accomplishments in mind and some of her courage in our hearts, we recommit ourselves to continuing her mission to achieve justice and equity for all,” Huang continued.

Supreme Court Chief Justice John Roberts said our nation has lost a justice of historic stature.

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“We at the Supreme Court have lost a cherished colleague. Today we mourn but with confidence that future generations will remember Ruth Bader Ginsburg as we knew her, a tireless and resolute champion of justice,” Roberts said.

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Governor announces $356,000 in grants to community agencies to address poverty

Eddie Burkhalter

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(STOCK PHOTO)

Gov. Kay Ivey on Friday announced the award of $356,250 to 20 community action agencies statewide for programs aimed at reducing poverty. 

The Community Action Association of Alabama is to use the funds to support programs by the local agencies which help low-income families, according to a press release from Ivey’s office. 

“Our state’s community action agencies provide vital services to low-income residents who are working to establish or regain their footing to be successful,” Ivey said in a statement. “I commend the work these agencies do to further the goal of reducing and eliminating poverty by helping families build brighter futures.”

The 20 agencies to receive the federal community service block grants offer educational and assistance programs, including job training and education opportunities, access to better nutrition and help with financial management and credit counseling, according to the release. 

The funds are administered by the Alabama Department of Economic and Community Affairs and were appropriated by the state Legislature.  

“Gov. Ivey and ADECA fully support the assistance programs offered by these agencies because we have seen how they can serve as a jumpstart for life-changing success for Alabama families,” said ADECA Director Kenneth Boswell in a statement. “ADECA is pleased to continue our partnership with the Community Action Association by supporting the many valuable programs offered by the state’s community action agencies.”

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Hindu temple planned for vacant theater in Hoover

Micah Danney

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The vacant AMC theater off Lorna Road in Hoover, Alabama. (IMAGE VIA GOOGLE)

A local Hindu organization purchased a 38,000-square-foot former theater in the Birmingham suburb of Hoover and plans to convert it into a sanctuary and educational space to serve the area’s growing Hindu community.

Hindus make up less than 1 percent of Alabama’s population, and while an accurate count of adherents in the state is hard to come by, the number of Hindus in the U.S. has more than doubled over the last decade. 

Rajan Zed, a prominent Hindu cleric based in Reno, Nevada, issued a statement claiming that there is an increasing population of Hindus in Alabama that will require new temples, or mandirs, to “help the community to pass on Hindu spirituality, concepts and traditions to coming generations amidst so many distractions in the consumerist society.” 

Zed urged Hoover’s mayor and city council to unanimously approve the temple plans, “thus expressing warm welcome to the caring Hindu community” that he said is known for its charity and community development.

BAPS Birmingham is the group that owns the theater property. It operates a temple in North Birmingham that is currently closed due the pandemic. It proposed the plans for its second temple, which include a large worship space and 14 classrooms, to the Hoover Planning and Zoning Commission, which voted on Monday to recommend them for approval by the city council.

Mayor Frank Brocato said that he doesn’t anticipate anything preventing that approval. 

Before it closed, the BAPS Shri Swaminarayan temple hosted weekly assemblies and offered classes to teach children Gujarati, an Indian language distinct from Hindi but similar.

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There is another Hindu temple near Hoover not affiliated with BAPS, in neighboring Pelham. 

BAPS, which stands for Bochasanwasi Shri Akshar Purushottam Swaminarayan Sanstha, is a Hindu denomination established in 1907 with more than 1 million followers. It operates charities and learning centers worldwide and requires five lifetime vows from its followers: no alcohol, no addictions, no adultery, no meat and no impurity of body or mind.

The population of Hindus in the U.S. increased from 1.2 million in 2007 to 2.23 million in 2014, according to the Pew Research Center. Zed estimated that the number is around 3 million now. It is projected to reach 4.78 million in 2050, or 1.2 percent of the U.S. population.

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