Hospitals throughout Marin have been confronted with an array of financial challenges brought on by the COVID-19 pandemic. Personal Protective Equipment (PPE) had to be located and provided for staff, facilities needed to be furnished with new supplies, and programs to assist the community had to be created. Although hospitals would normally be able to recover the money spent on these efforts with outpatient procedures, decreased patient volume has left them with drastically reduced revenue in recent months. We spoke to MarinHealth CEO Lee Domanico about how the healthcare organization is traversing this new landscape.
Tell us what’s been going on at MarinHealth since the beginning of the shelter-in-place mandate.
The past couple of months has been a tale of two cities, in a way. There’s some very good news, and there’s also some challenging news regarding the financial impact that this pandemic has had on us. The good news is that we have successfully treated patients with COVID-19. We have not had one employee or patient contract the virus while in the hospital. During the pandemic, we have delivered 300 babies, about 100 a month, which is our normal volume, we conducted an open heart surgery successfully by way of example.
How many COVID-19 patients have you had at one time?
Between zero and three patients at a time, at most, so we’ve been able to handle it. In hindsight, the good news is, we didn’t have to empty out the hospital because we didn’t experience the surge that we were afraid of and that we were prepared for. But as a result, the number of inpatients — which usually averages 130 — averaged about 75 because we eliminated all elective surgeries and procedures, like cath lab procedures, imaging procedures, and all we focused on were the immediate urgent and emergent needs for patients.
What programs have you implemented to care for those who are particularly vulnerable to COVID-19?
A couple of months ago we started a mobile care team which consists of a physician and two or three physician extenders on a van equipped with testing capability and personal protective equipment. Then we went out to the nursing homes proactively because they are the most vulnerable to the virus. Residents live in close proximity to each other, and their health is compromised. We went to the nursing home for education, for consoling, for testing patients, testing staff, and providing them with proper use of PPE. We believe we were successful in curbing any potential hotspot that could have occurred in the nursing home and residential care community that would have the potential of overwhelming hospital resources. Since then we have expanded that from one to two units — with the district funding — and the second unit will be going into vulnerable communities where the residents live in close proximity to each other. The Canal District, for example — the living conditions put residents at higher risk for contracting the virus because it’s harder to socially distance from each other.
What else has the district funded?
The district also funded take-home kits that’ll be distributed from the emergency department and from clinics. For patients who test positive, they include a pulse oximeter, a thermometer, PPE, and that’s important because the pulse oximeter measures your oxygen saturation. When that reaches a certain level you need to come into the hospital. If it doesn’t, you may not feel good, but you’re safely weathering the virus at home. We’ve also funded two pilot projects, one of which provides income replacement for workers whose income might disappear if they have to quarantine for 14 days. In other words, if they need to quarantine, and they don’t get paid during that period of time, and they need the income, they may be reluctant to quarantine. So we’ve set up a pilot program to provide income replacement during those 14 days as well as provide financial support or hotel accommodations for people who can’t shelter at home and perhaps need to shelter somewhere else.
How has MarinHealth been impacted during this time?
Hospital volume dropped 20 percent in March and it dropped over 40 percent in April. Our revenue was down 8 million in March, another 20-some million in April, and while we were able to reduce expenses, labor and supplies, this still resulted in significant decline. While we are now ramping back up, I mentioned that we were down about 75 patients a day, we’re now up to over 100 patients per day, but still about 20 percent short of our pre-COVID-19 volume. Similarly, our surgeries and elective procedures have rebounded, but not quite all the way to pre pandemic volumes.
What would you say to people who have safety concerns about visiting MarinHealth?
I want to be clear that it is safe to come to the hospital. Very safe. We follow proper precautions, we test all of our patients that need to come in before they need to come in, either for elective surgery or for visits, and anyone who comes in emergently also gets tested. And we know how to manage these patients, how to take care of them, and we know how to do it and keep everybody safe, both fellow patients as well as our team and our staff. One of the technologies that we have that I don’t believe any other hospital in the Bay Area has is called Banyan.
What does this technology do?
Banyan technology allows us to visualize the patient in the room remotely — we have a camera in the room, we can talk to the patient, and this allows us to treat the patient, where possible, without having to enter the room. That minimizes exposure of our team, but it also conserves on the use of PPE, because every time you go in and out of a room, you have to trash the PPE that you wore and you have to put on new PPE when you go back in the room.
What percentage increase have telehealth appointments increased?
Well, it went from almost zero telehealth visits to almost 75 percent of our total business. So three quarters of our business for the last few months have been by telehealth.
You spent about three million on all the related expenses — will that be used in the future, or will it expire?
No, we have an on-hand 30 day supply and we’ve been maintaining that for all our personal protective equipment to get regular shipments. We spent three to four million dollars on stockpiling and wrapping that up, and that’ll be ongoing until there’s a vaccine. This is not only on PPE, but we quadrupled the number of ventilators. We went from 19 to 60 or 69 ventilators.
And you haven’t needed them?
No, we haven’t. Most of our inpatients have been treated on the general medical/surgical unit, in negative pressure rooms. We’ve only had a minority of those patients who needed the intensive care and needed to be put on the ventilator.
It was great that you were able to act so quickly that there wasn’t a spread.
The other thing that I will say is that the community of Marin following the proper precautions has really saved us from the disasters that have occurred in other cities around the country, and I hope that we can safely open back up again by doing it in a safe way.
There are so many stories about people making masks. Did you receive any masks from community members?
Yes, we received masks from community members, we received tons of food, Mollie Stone’s provided boxed lunches for several days, and we received PPE. And we received monetary donations, we’ve had thus far over 3 million dollars in donations for the response to the coronavirus.
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Mimi Towle has been the editor of Marin Magazine for over a decade and is currently the national editorial director of Make it Better Media. She lived with her family in Sycamore Park and Strawberry and thoroughly enjoyed raising two daughters in the mayhem of Marin’s youth sports; soccer, swim, volleyball, ballet, hip hop, gymnastics and many many hours spent at Miwok Stables. Her community involvements include volunteering at her daughter’s schools, coaching soccer and volleyball (glorified snack mom), being on the board of both Richardson Bay Audubon Center and then The EACH Foundation. Currently residing on a floating home in Sausalito, she enjoys all water activity, including learning how to steer a 6-person canoe for the Tamalpais Outrigger Canoe Club. Born and raised in Hawaii, her fondness for the islands has on occasion made its way into the pages of the magazine. If you want more, she’s created a website, HawaiiIslander.com.