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In mid-March, Rand O’Leary was just three months into his new job as the head of Maine’s second largest hospital when a health threat of colossal magnitude — the coronavirus — was finally found to be spreading through the Pine Tree State.
The following weeks and months were a blur for Northern Light Eastern Maine Medical Center in Bangor. Like most hospitals, it rushed to stock up on critical protective equipment, institute new safety procedures and create plans for handling a possible spike in patients.
Then, something fortunate happened. Even though there was a surge of coronavirus cases across Maine that crested in late May, and while there have so far been 139 confirmed cases of the virus in Penobscot County, EMMC was never swamped with patients.
It has only admitted 15 patients confirmed to have the virus, averaging two or three in the hospital at the same time. Just a small portion of those were so sick that they had to be placed on ventilators, and at no point has the hospital come close to needing to open a backup treatment center at the Cross Insurance Center that once was seen as a last resort.
As the still quite new president of EMMC, O’Leary said he is thankful Mainers have been diligent about staying home and avoiding large gatherings for the last few months, which has minimized the spread of COVID-19 and prevented hospitals from being overrun.
O’Leary, who previously worked as an administrator of hospitals in Michigan and Oregon, also praised the staff of EMMC — which has 4,200 workers — and other local organizations, many of whom he met for the first time while they coordinated the regional response to the pandemic.
“Because of my years of experience, I felt I was in the right place at the right time to help,” said O’Leary, who is also a senior vice president at EMMC’s parent group, Northern Light Health. “I had a very good, experienced team at the hospital. For me, working with the community, getting to meet key members of the community and leaders, it was really accelerated by this.”
O’Leary said “a very low number” of EMMC staff have been infected with COVID-19, but that most of them are thought to have caught it out in the community rather than during their work. They have all recovered or are recovering from it.
He added, “Seeing frontline staff really pull together was inspiring to me. The resilience of health care workers is an amazing site to behold.”
Now, O’Leary is looking ahead to additional challenges that are coming in the year ahead.
For one thing, until a vaccine can be developed to immunize a large portion of the country against COVID-19, Maine will probably have to contend with the virus for the rest of this year and some or all of 2021, O’Leary said, adding that there is “no crystal ball that is 100 percent accurate.”
He expects EMMC to keep treating small numbers of patients with the disease, including when there are “small but manageable” outbreaks in congregate living settings such as nursing homes.
“We should be doing everything we can to prevent that, but at no time do we foresee any scenarios where we would outstrip our bed capacity or ICU capacity,” he said.
The flu season will be another challenge when it comes in the fall and winter, but O’Leary said that EMMC will probably be able stick with the strict safety measures it has already put in place during the coronavirus pandemic, including placing confirmed COVID-19 patients in their own unit with private negative pressure rooms, and having all staff and visitors wear various degrees of protective equipment.
Another set of issues will come from the precautions that all hospitals took during the first few months of the pandemic.
Based on recommendations from federal health officials and the American College of Surgeons, EMMC canceled or delayed many of its non-urgent services during the early days of the pandemic, including most routine screenings and elective surgeries. That freed up capacity for EMMC to handle any possible surge of COVID-19 patients, but it also cut deeply into the revenue that it normally receives from those services. At the same time, the hospital had to pay more for protective equipment and other resources to carry it through the pandemic.
In general, the hospital has ended many recent years in the black, with net operating income ranging from $8.8 million to $39.6 million between 2013 and 2018, according to the most recent data from the Maine Health Data Organization.
But this year, its outpatient surgery visits fell by 71 percent during their lowest point in the coronavirus crisis, while visits for emergencies, inpatient admissions, inpatient surgeries and doctor’s visits were each down between 38 and 45 percent from normal volumes.
EMMC is still calculating the revenue shortfalls from those drops in patients and evaluating how they could affect the hospital’s long-term finances, according to O’Leary. But he said that the $19 million it has so far received in federal relief payments represents just “a small fraction of the losses.”
The facility has also been able to draw $91 million in advance Medicare payments, which essentially functioned as a no-interest loan from the federal government to help the hospital pay its bills when patient revenue was down. EMMC now hopes that the feds will extend the time over which it has to repay that funding, O’Leary said.
Now, hospital-wide visits are back to around 95 percent of their pre-coronavirus levels at EMMC, but health care providers are offering many of them via videoconferencing programs rather than in person. While the hospital used to offer about 1,500 of those telehealth visits each month, that number skyrocketed to nearly 10,595 in May, as part of a recent nationwide trend towards more remote health care.
EMMC is urging patients to come back for medical care they may have delayed during the pandemic. Besides offering more telehealth appointments, its providers have also adopted new safety measures for in-person care, such as having patients wait in their cars until a nurse or doctor is ready to see them, O’Leary said.
He said that the hospital is now encountering more patients with chronic conditions — such as diabetes or chronic obstructive pulmonary disease — who are finally coming back to the hospital with illnesses that have grown much worse because they delayed seeing their doctors during the pandemic.
“We want them to come in and we want them to know it’s a safe place for care,” O’Leary said. “It’s really important people come in and see their doctors, and if they’re not comfortable, there are options related to telehealth.”