Depleted by two years of fighting a global pandemic, some of the state’s largest health systems have had to temporarily close their operating rooms due to staffing issues, exacerbating their financial troubles.
Many of the operating rooms have been shut off and on for months, due to unexpected staff absences and family leaves. An influx of sicker-than-expected patients onto hospital floors and into emergency rooms, many of whom delayed care during the pandemic, has also complicated staffing plans, as more specialized nurses or larger teams are needed to care for more complex patients.
“Across the health care system, closing ORs is a near-daily event,” said Dr. Eric Dickson, chief executive of UMass Memorial Health. “Some procedural area or OR is not open, and we’ve had to adjust cases because of our ability to staff.”
UMass Memorial has approximately 2,000 vacancies, including 500 openings for nurses. Despite hiring 700 traveling nurses since the start of the pandemic, managers have run into problems when people are unexpectedly out. Several dozen employees continue to call in sick daily with COVID-19.
“It certainly has an impact on the revenue,” Dickson said. “Any time you close an OR, your revenue is going down and your expenses aren’t.”
Operating rooms are one of the largest sources of revenue for some hospitals, accounting for more than 50 percent of revenue, by some estimates.
The most recent OR closures aren’t yet reflected in UMass Memorial’s publicly disclosed financials. But the health system is still grappling with financial issues from the state-mandated shutdown of elective procedures in late December and January, due to the Omicron surge. Those slowdowns contributed to a $41.4 million operating loss in the quarter that ended in March.
At Mass General Brigham, staffing and expected patient levels are assessed daily and hourly. Over the last couple of months, the system has had to close some ORs at both the system’s flagship hospitals — Massachusetts General and Brigham and Women’s — and at its community hospitals.
“It’s a relatively small proportion of our total number of ORs, but it’s definitely a weekly occurrence, in many cases a daily occurrence,” said Dr. Ron Walls, chief operating officer for Mass General Brigham.
Walls said that despite the hiring of temporary staff, the combination of worker absences and complex surgical cases can still force temporary OR shutdowns. Sometimes, particularly sick patients require specially trained people or larger teams to staff them, reducing the flexibility of where staff can go. Typically, the health system can predict that it will have to close an operating room, and will postpone surgeries when it is safe to do so. The health system said it reschedules them at the earliest time available that works for the patient, though it didn’t disclose an average wait time for rescheduled procedures.
The closures are no more than a few ORs at a time, and none have been closed permanently, Walls said. But about a third of inpatient/outpatient hospital revenue at MGB is associated with cases that use ORs. Temporary OR closures have added to the financial woes already present from rising permanent labor costs, the costs of temporary labor, inflation, and increased supply costs. Fixed costs have increased as the health system has struggled to turn over the beds quickly, given problems discharging patients to nursing homes — which have closed beds because of staffing shortages — and longer lengths of stay due to COVID-19.
“The overall ability of acute care hospitals to operate now and meet their payroll and meet their margin, or even break even, is really, really challenged,” Walls said.
State lawmakers have already begun to respond to the financial pressures, with the House passing the American Rescue Plan Act that would allocate $350 million to hospitals. State Senate lawmakers have unveiled a $400 million allocation to hospitals in their version, which they passed on Thursday.
Walls said he was grateful for the funding, but noted that reimbursements haven’t changed even as costs have gone up. The system was looking more intensely to cut its expenses as a result. The work is perhaps more urgent for Mass General Brigham than others, as it is facing regulatory pressure to reduce its costs after what some experts have said have been years of excessive spending.
Beth Israel Lahey Health has also had to limit some operating room capacity due to staffing challenges.
Michael Rowan, executive vice president of hospital and ambulatory services at the hospital, said the system is actively recruiting and trying to retain its existing staff to help solve the problem.
“We have also worked strategically as a system to maximize resources, including redeploying [surgeons] from our academic medical center and teaching hospitals to our community hospitals to optimize available OR capacity,” Rowan said in a statement.
The system was also still confronting the financial challenges from last winter’s elective procedure shutdown, reporting a $120.1 million operating loss in the quarter ending in March.
Even for hospitals that haven’t yet had to reduce operating room capacity, keeping ORs humming has been a logistical challenge. Lowell General Hospital, which is part of Tufts Medicine, has been running its 13 operating rooms, and got a staffing boost by bringing in employees from an ambulatory surgery center, which closed in September. The ambulatory surgery center has since reopened, but is now staffed through a joint venture with another company.
The surgeons, who are in private practice and work at both the hospital and surgery center, are operating on days they otherwise wouldn’t to accommodate the patients. The health system has also become more rigid in how it schedules nonemergency surgeries, instead of frequently slotting them at the last minute.
“Five to six surgeons meet with us every couple of mornings to look at the schedule. If we get tight, [we assess] what can get done tomorrow. It’s like a symphony, everyone playing their role,” said Jody White, president of Lowell General.
At Lawrence General Hospital, an independent community hospital with 186 beds, closing ORs isn’t an option. The hospital has one of the busiest ERs in the state, and chief executive Deb Wilson said it was imperative surgeries stay accessible for the community.
But it is also a financial calculation — when elective-procedure shutdowns happened in January, the hospital was losing $4 million to $5 million a month. The hospital is currently spending $2 million a month on agency staffing, including employing 70 to 80 traveling nurses on top of its staff of 500 nurses, to keep the hospital running.
“The economics are that we’re continuing to lose a similar amount during the height of the pandemic and now for different reasons,” Wilson said. “During the pandemic, it was the loss of volume due to closures. Now it’s the cost of providing the care.”