The announcement last week that LRGHealthcare was temporarily suspending the majority of outpatient services as a result of the COVID-19 pandemic was received with much disbelief and some anger. While the message was a surprise to many, the concept of a shutdown of health care services at LRGHealthcare has kept many of us awake at night for a few years now. It’s no secret that the organization’s finances have been poor for at least six years, and the worry was some catastrophic situation would provide an unbeatable challenge. While many thought a government shut-down or insurance crisis could cause such an event at LRGHealthcare, it ultimately turned out that a world-wide pandemic unlike any other seen in the last 50-100 years would be the cause.
A common question is how a hospital can shut down major services during a pandemic. While political leaders at the national level debate whether health care is a human right or an industry that requires more private investment, people need to remember that health care organizations operate like many other businesses. They generate revenue, incur expenses, and need to balance the two. As a result, hospitals all over the State of New Hampshire and the United States have furloughed, laid off and terminated staff. You’ve likely heard before about LRGHealthcare’s extremely high debt-load, the incredible cost of the electronic medical record mandated by the federal government, or the fact that we function with only a few days cash on hand, which makes the situation worse than the average hospital. The purpose of this column is not to discuss those issues in detail. It’s more important for you to hear what caused the decision to shut-down outpatient services temporarily, to answer your questions on the services that remain, and to discuss LRGHealthcare’s plan for the future.
The original decision to close services was driven by two needs: the necessity to distance as a society and the requirement to preserve limited personal protective equipment (PPE). Like all health care organizations, LRGHealthcare announced the cancellation of elective and non-urgent services to accomplish those two goals. Urgent and medically necessary services such as oncology center visits and infusion therapy remained at first, as did emergency medical services. As a result, revenue dropped by over 60 percent. Were the organization only motivated financially, it would have kept non-urgent, but better compensated services in place despite the public health risk. Instead, LRGHealthcare did what was right for the safety of the community, but not financially rewarding. This action ultimately drove another difficult decision: close most outpatient services immediately (with less time and planning than necessary) or keep things as they stood and likely close the entire organization by the end of April (right at the predicted height of the COVID-19 crisis). Clearly, neither choice was preferred, but a decision to save a portion of the organization was made.
Another common question addresses what services remain and how people can manage their health while services are closed. We recognize last week’s actions were not communicated clearly enough as we quickly made decisions and implemented them at the same time. Effective last Friday, however, a list of program changes now appears on our website (LRGH.ORG) and is running as an advertisement in The Laconia Daily Sun to better inform the public. The best option for all patients is to call the usual numbers to contact their physician, provider or program. A message will direct you to call one of two newly created, centralized practices. The two clinics, one in Franklin and one in Laconia, are equipped to answer patient questions, refill prescriptions, perform telehealth visits and triage patient needs. These practices will address COVID-19 and non-COVID-19 situations. Direct outreach via letter and telephone have been made to patients impacted by canceled appointments or in need of alternative plans for treatment. As earlier indicated, our hospital based services (emergency rooms and inpatient services) remain open for all COVID-19 and non-COVID-19 activity too.
Rumors are also swirling about our long-term future. The furloughs and temporary closures were put in place for up to 120 days not knowing what the pandemic would bring and how long the requirement for social distancing would remain. Plans are being created to reopen services but LRGHealthcare, like the rest of society, needs to see how the pandemic develops first. The financial assistance received from various government agencies allows us to function at decreased levels, but won’t enable closed services to come back immediately. And, while specifics cannot be shared at this point, there are plans to address our long-term financial issues and create a partnership which previously proved elusive. Perhaps one small silver lining of the current crisis is the opportunity to create a viable, long-term plan for health care in the region.
In closing, we would like to thank those who’ve supported us during this difficult time, including our dedicated workers and medical staff who have selflessly given of themselves despite personal risk. We’d also like to speak directly to those who have lost faith in LRGHealthcare. The decision to close services, even though temporary, was not made lightly. We expect to come back from these times and hope you are willing to give us a chance to provide the excellent, local care you have come to know.
(Kevin W. Donovan is president and CEO of LRGHealthcare of Laconia.)