Preparing for ‘the 7th level of hell,’ Boise health care firm lays off 53 people
“This is going to haunt me forever,” Nate Poulson, the chief executive of Boise Anesthesia Physician Associates, said Tuesday.
He and other physicians who own the company had just laid off 53 nurse anesthetists.
When you’re in the hospital, a nurse anesthetist is often the person who helps you “go to sleep” before a surgery, relieves the pain of childbirth with an epidural, or keeps your body from moving while you’re under the knife in the operating room. They have advanced training and education.
As local hospitals work to prevent the novel coronavirus from spreading, and gear up for a wave of COVID-19 patients, some are canceling all non-urgent surgeries. That’s a large percentage of the surgeries that happen in the Treasure Valley — like knee replacements and back surgeries. And it’s the main source of revenue for Boise Anesthesia.
The anesthesiology practice is one of the first to be hit with the economic ripple effects of the virus, and “so many medical contractors in the state (are) facing this right now,” Poulson said.
It also underscores one of the complications of America’s health care system, which relies on a steady stream of fees to operate.
“COVID-19 could be a double whammy for hospitals’ finances in that they’re putting off high-margin surgeries to treat expensive, complex coronavirus patients with no way to predict reimbursement,” industry publication Modern Healthcare reported Monday.
The U.S. surgeon general on Saturday urged hospitals to stop doing elective surgeries.
Saint Alphonsus Health System decided to postpone “all elective and non-emergent surgeries and invasive procedures until at least June 1,” it said Wednesday in an emailed statement.
The system “will continue to perform urgent and emergent surgery and procedures, including those that if delayed would have significant medical deterioration or materially impact the patient’s prognosis, morbidity or treatment plan, as determined by the patient’s surgeon,” the statement from Saint Al’s said.
The system itself has not laid off any employees but is reassigning them to other roles as needed, St. Al’s said.
U.S. health care business not set up for pandemic
The Boise Anesthesia practice is a self-contained business, working under contract for Saint Alphonsus Health System. So, its doctors and nurse anesthetists aren’t directly employed by the hospitals. That means it relies on the hospital doing surgeries and other procedures to make money.
Poulson said he and the other physicians who own the Boise Anesthesia group came to the conclusion over the weekend, after Idaho’s first COVID-19 case was confirmed, that they could no longer make enough money to support their entire staff.
“The problem is that all of the economic incentives for the way the health system is built right now are diametrically opposed” to financial stability during a pandemic, Poulson said. “I have to maintain cash flow to pay my employees … to pay the bills.”
But the company looked 30 to 60 days in the future and saw a steep drop in its cash flow.
“We know that our revenue is about to trickle to nothing,” he said.
The physicians who own the practice decided they would start taking no pay. They reached out to a banker to get a line of credit to keep the business afloat through the pandemic.
They learned on Monday that wasn’t an option without putting their own homes, assets and savings on the line. They considered what would happen if they just continued to operate and then filed for bankruptcy.
They decided it would be better to give their employees as much of a head start as possible — four weeks’ pay — and continue their benefits for as long as possible while they tried to find new jobs.
Medical staff will be critical to COVID-19 response
Even though their business model relies on elective surgeries, anesthesiologists and nurse anesthetists will be necessary to help COVID-19 patients who end up in the intensive care unit, Poulson explained.
Under “the rosiest of rosy scenarios,” he estimates that 50,000 people could end up needing care at Treasure Valley hospitals.
Many of them will have COVID-19 complications like pneumonia, sepsis and acute respiratory distress syndrome, which essentially suffocates the patient.
“They come into the hospital three-quarters dead, and I have to hold them in that state, in a livable fashion, keeping them from going to four-quarters dead,” Poulson said, adding that patients who need 10 days of ICU care have impulses that, without anesthesia services, make them want to leave before they’re better.
Poulson says he believes the slow-moving nature of the disease will soon overrun the health care system. He hopes it will be less severe than in Italy, where health care providers were forced to choose which patients received life-saving care. He expects that he and the other anesthesiologists will work alongside other hospital staff, and that they may contract the virus themselves.
“I feel like I died four days ago, and I woke up in hell,” Poulson said Tuesday. “Anywhere from 30 to 60 days from now, I’m going to descend into the seventh level of hell, and I don’t know when I’m going to come up.”
Poulson said the physicians are trying to find jobs for the nurse anesthetists whose jobs were cut. Hospitals will continue to need nursing staff at all levels, including the nurse anesthetists his company laid off this week, he said.
“The people that work for our company are tremendously talented people,” he said. “This story will not just apply to us. This is going to apply to a lot of different providers.”
Poulson said the employees are being released from contractual obligations that could hinder their ability to find jobs right now.
“I try to think about their families without health insurance, and I pray to God that somebody hires these people,” he said. “The hospitals will just need everybody.”
This story was originally published March 18, 2020 at 12:42 PM.
