HJNO Mar/Apr 2021

18 MAR / APR 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS STATE OF LOUISIANA’S HOSPITALS What is the role of the Louisiana Hospital Association? Since 1926, the LHA has supported its mem- bers through advocacy, education and mem- ber services. While the mission is simple and straightforward, in today’s modern dynamic healthcare environment, our activities include the traditional advocacy role but now span into innovative quality improvement initiatives, in- cluding the development of a federally listed Patient Safety Organization with the Agency for Healthcare Research and Quality, the ex- pansion of new data sharing programs, and of course, our strong partnership with LDH regard- ing emergency preparedness and response to hurricanes and the pandemic. Has the pandemic impacted the role of LHA? The COVID pandemic strengthened the LHA’s engagement with clinical leaders, emer- gency preparedness experts and elected of- ficials to ensure that front-line healthcare he- roes have the necessary resources to support their communities. In 2020, Louisiana hospitals experienced three statewide surges in COVID hospitalizations that threatened to overwhelm their ability to staff intensive care unit beds. At the same time, back-to-back hurricanes caused some of these same hospitals to evacuate pa- tients and to lose electricity and water for weeks. While the LHA has decades of experience in hurricane response, the COVID pandemic challenged our members to create a new play- book in the fight against a previously-unknown virus. Our industry values working with state leaders and playing a central role in disaster response efforts. For example, the LHA and its member hospitals facilitated countless calls where hospital clinical and administrative lead- ers provided feedback, expertise, and guidance that helped state and federal leaders develop effective and meaningful response efforts. LDH leaders, hospital chief medical officers and other clinical experts also shared best practices for treating COVID patients and for overcoming vaccine distribution challenges. Through this work, Louisiana hospitals collaborated to save thousands of lives during these public health emergencies and to improve medical outcomes for both COVID and non-COVID patients. We also coordinated grassroots and advocacy ef- forts to educate congressional leaders on the importance of COVID relief funding, which helped to preserve lifesaving services through- out our state. What is the current state of Louisiana’s hospitals? During the initial stages of the COVID pan- demic, hospitals experienced significant de- clines in patient volume and revenue caused by suspensions of elective procedures as well as from patients choosing to delay care. In ad- dition, many hospitals incurred extraordinary operating expenses. Beyond higher costs for pharmaceuticals, testing and personal protec- tive equipment (PPE), the cost of staffing sky- rocketed as hospitals’ largest expense that was exacerbated by an ongoing nursing shortage. We have been educating state leaders for several years and advocating for additional healthcare workforce funding. Before the CO- VID pandemic, Louisiana’s State Board of Nurs- ing projected this nursing shortage would qua- druple by 2025, leaving New Orleans, Baton Rouge and Shreveport with the most unfilled positions. More than a year into the pandem- ic, repeated surges in COVID hospitalizations stretched our nursing workforce thin, especially in hospital intensive care units. Fitch Ratings, a national hospital credit rating agency, found that hospitals “are competing for a limited supply of nurses, including more expensive contract nursing staff.” The agency warned “these pres- sures are heightened for smaller rural hospitals” where nurses are less abundant. In spite of these financial pressures, Loui- siana’s hospitals have found innovative ways to improve care delivery and save lives in their communities. Our industry is committed to the arduous, calculated and strategic work of look- ing ahead and helping to build a pathway to recovery for our state. COVID-19 has proved the importance of smaller and rural hospitals to communities across the country. How are these types of hospitals faring in Louisiana? Rural hospitals experienced significant finan- cial strains in the early months of the pandem- ic after elective procedures were postponed. During this period, one rural hospital reported that it only had seven days cash on hand to continue operating without incoming revenue. As COVID-related expenses increased, rural hospitals also faced inconsistent reimburse- ment requirements from certain health insur- ance plans that complicated care delivery and staffing challenges. Fortunately, Congress provided significant funding through COVID relief legislation to as- sist rural acute care hospitals and critical access hospitals. These and other rural health providers in our state received more than $226 million to help them cover lost revenue and increased expenses. Throughout the pandemic, Louisiana’s rural hospitals have remained open to serve their communities, and Louisiana residents want them to remain viable. A recent report by the U.S. Government Accountability Office identi- fied more than 100 rural hospital closures since 2013 and found that rural community residents faced longer travel times during a medical emergency after their local hospital closed. As rural hospitals in neighboring states continue to close their doors, funding under Louisiana’s Rural Hospital Preservation Act has helped our small rural community hospitals continue