How the coronavirus pandemic has affected hospitals. : The Indicator from Planet Money The coronavirus has strained healthcare systems — and not just in their ability to deal with surges. We talk to one hospital administrator about the financial strain of COVID-19. | Donate to your member station here.

Healthcare: The Pandemic's Financial Fallout

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CARDIFF GARCIA, BYLINE: Hey, everyone. Just before we start our show, we have something to ask you. In order to continue providing coverage of the U.S. economy and other events throughout the country in this extraordinary year and to continue keeping up with how workers and other regular folks are doing, we would so appreciate it if you would donate to your local NPR member station at npr.org/indicator. It would go a long way towards continuing to be able to provide the kind of journalism that you expect from us. Thank you so much, and happy holidays.

SYLVIE DOUGLIS, BYLINE: NPR.

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STACEY VANEK SMITH, HOST:

This is THE INDICATOR FROM PLANET MONEY. I'm Stacey Vanek Smith.

The coronavirus pandemic has wreaked havoc on all kinds of businesses, but it has been especially hard on hospitals. At the same time as hospitals were dealing with a raft of extremely sick patients and scrambling to get protective gear for workers, they were also seeing their revenue collapse. Elective surgeries - things like hip replacements that hospitals count on for money - all of those were canceled. And in a strange twist of fate, in the middle of a terrible pandemic, hospitals were laying off their workers.

We first spoke with Dr. Patrick Cawley in April. He is the CEO of the Medical University of South Carolina Health, a large network of teaching hospitals with thousands of workers. We first spoke with Patrick back in April. At that time, he was moving mountains to get PPE for his workers, and he'd created emergency spaces in gyms and other places, preparing for a surge of COVID patients. Also, his hospital's business had cratered. MUSC went from a highly profitable health care center to being around $30 million in debt basically overnight, and Dr. Patrick Cawley had to lay off more than a thousand employees. We talked to him the day after he made that decision.

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PATRICK CAWLEY: I would say it was the hardest decision I've ever had to make in my entire career, and I've had some tough decisions I've had to make. But I would put this right up there as the hardest one because these are - it's a great team. I mean, I've really worked with this team a lot over the last 15 to 17 years. I know them well. I know many of them on the front lines. I worked with them years ago.

VANEK SMITH: A lot has changed since we last spoke with Patrick. South Carolina has seen a surge in COVID cases since Thanksgiving. But also, a vaccine is on the way. So after the break, what the hospital business looks like now.

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VANEK SMITH: Dr. Patrick Cawley, CEO of MUSC Health, thank you for joining us. So first of all, what is happening with COVID cases in South Carolina? What is your hospital seeing?

CAWLEY: Well, since the last surge that we had, which happened in late summer, things sort of petered out over the course of several months and actually got very, very low by mid-fall, and they pretty much stayed there until about Thanksgiving time. And at Thanksgiving, you know, we've seen a slight increase up, but nothing like we saw last summer. So just to compare it, in our hospital today, we have 26 patients with COVID. Compare that to last summer in July, where we had about 126.

VANEK SMITH: I mean, you are obviously a scientist and a health care professional. But also, you are a manager. You're running a business. And your business was very affected. I think the first conversation we had, you had had to furlough most of your staff, and you had seen your revenue, which comes in from elective surgeries and screenings and things like that, just completely vanish. What does the business of your hospital look like right now?

CAWLEY: Well, it's not quite back to complete normal. You know, why that is - it would appear that people are not doing checkups. You know, I hope that doesn't mean that they're putting off more serious things, but it just - it's just not quite at the same level that we had seen previously.

VANEK SMITH: The last time we spoke, you had actually sort of launched sort of an informational ad campaign to kind of reassure people who might be nervous. Are you still doing that? Did that work?

CAWLEY: Well, we've kept it up, maybe not quite at the high level when we first started, but we've kept it up to a certain degree. We are intending to keep that up, and we don't plan to stop that until we're really past this and people feel completely comfortable.

VANEK SMITH: And what is the situation? Have you been able to bring back your employees, 'cause that was, I think, a really difficult thing for you? You had to let go a lot of people who you'd worked with for years that you were - that you knew personally.

CAWLEY: Yes, we did leave a lot of people go. And then as business got better over the summer, we were able to slowly begin to bring more and more people back. End of September, we had brought everybody back except for about a hundred people.

VANEK SMITH: But that was - I mean, initially you'd furloughed how many people?

CAWLEY: Oh, we were well over a thousand.

VANEK SMITH: So you were able to bring back all but a hundred. That's a lot.

CAWLEY: Yes, yes. To lose about a hundred - it's still a big number.

VANEK SMITH: Yeah.

CAWLEY: To me, I would've preferred not to have done that. But in the end, we just had to do it.

VANEK SMITH: And what about the revenue situation? I know you - like, I guess a year ago, the hospital was quite profitable.

CAWLEY: Well, we make - in a good year, we'll make around $15 million to $20 million a year.

VANEK SMITH: In profit?

CAWLEY: In total profit, yes.

VANEK SMITH: And then that was just all gone when I first talked to you. I mean, it was like the projections were not looking good. And what about now?

CAWLEY: We're back to hitting budgets, which is just a little bit of profit, but not much. But we're not losing, also, like we were back in the springtime. So at the moment, things are stable. You know, it's a tenuous situation. We'll just have to see how it plays out. I mean, COVID could come in and surge here again in January or February. I hope it doesn't, but it could happen, and it could upend us again.

VANEK SMITH: Have you guys gotten vaccines at the hospital? I know a lot of essential workers - doctors and nurses - are able to get the vaccine. Have you guys been able to?

CAWLEY: Yes, we did get the vaccine this week. We actually received it on Monday, and by Tuesday, we were giving it. And at this point, we've given almost 4,000 doses.

VANEK SMITH: How many doctors and nurses - how many essential workers do you have at your hospital?

CAWLEY: It's about 10,000 what we call in the 1A category. So these are people that directly interact with patients, and there are almost 10,000 of them across our entire health system.

VANEK SMITH: Do you - have you gotten a COVID vaccine?

CAWLEY: No, I have not gotten the COVID vaccine. I've had an illness in the past couple of weeks, and I've not been able to do that. But the first chance I can, I will take it.

VANEK SMITH: I don't know if you've seen anyone get vaccinated or...

CAWLEY: Oh, yes. Yes.

VANEK SMITH: Have you?

CAWLEY: Yes. No, I've seen multiple people get vaccinated. You know, it's almost a surreal experience in some ways. This is the first vaccination process that I've seen where I've seen people cry.

VANEK SMITH: Oh.

CAWLEY: You know, I don't - I've never seen that before. You know, for a lot of people, there was a surreal experience, and there was an emotion by many folks who received it. You know, there's just been so much on people in the last nine months. I mean, think about what we've all been through - how we've completely upended our lives and our children's lives, and there's just so much weighing on people. So, you know, it didn't surprise me at all to see that happen. And at the same time, you know, there's people just, you know, in full-on elation as well. So it's just great to see all those different emotions sort of mixing.

And finally, you know, in a way, one end comes, and another end - another beginning about to start. So here we are giving vaccines for this thing that wreaked so much havoc. And this is what will give us our life back. This is what will allow us to be free and move around and get back in schools. And what scientists have done here in such a short period of time is nothing less than, you know, putting a man on the moon and some of those other great accomplishments.

VANEK SMITH: That's true. Well, Dr. Cawley, I can't thank you enough for taking the time once again to speak with us.

CAWLEY: OK, Stacey. Good talking to you.

VANEK SMITH: And I'll talk to you again soon. Hopefully, next time we talk, you will have antibodies in your system.

CAWLEY: I certainly hope so. And hopefully you will, too.

VANEK SMITH: Hopefully I will, too. All right, Dr. Cawley, thank you so much. Have a great day.

CAWLEY: Talk to you soon. Bye-bye.

VANEK SMITH: This episode of THE INDICATOR was produced by Brittany Cronin and fact-checked by Sean Saldana. Our editor is Paddy Hirsch. And THE INDICATOR is a production of NPR.

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