After a decade of significant growth, the Valley’s health care industry has become an economic driver for the state. During this severe economic downturn, however, the health care industry busted the myth of being recession proof. But that doesn’t mean it’s recession battered.
Health care organizations have weathered the economic turmoil better than most industries in Arizona. For example, the Arizona Department of Commerce reports that in July, year-over-year job losses in health services stood at 1 percent, or 3,200 jobs. That was the slowest rate of loss of any major industry group in the state.
Nonetheless, hospitals and other health care organizations are feeling the effects of the recession and are working diligently to match revenue with expenses.
“Overall, the financial picture for Arizona’s hospitals is somewhat improved from the third and fourth quarters of 2008, despite decreases in volume,” according to Jim Haynes, vice president, finance, and Chief Financial Officer for the Arizona Hospital and Healthcare Association. “That improvement is not due to better payment from payers, like the federal and state governments. It is directly linked to the steps hospitals took in late 2008 to contain and cut costs in response to the economic environment.”
Case in point: Linda Hunt, service area president for Catholic Healthcare West Arizona, which includes Chandler Regional Medical Center, Mercy Gilbert Medical Center and St. Joseph’s Hospital and Medical Center, says many local hospitals are facing state and federal funding cuts, as well as dealing with growing numbers of people who are uninsured. In addition, admissions in some specialty areas are down because people are waiting longer to seek health care and are canceling or putting elective surgeries on hold.
Catholic Healthcare West also has seen a decrease in donations. Many donors are either curtailing their commitments or making smaller donations.
“The health care industry is strained just like any business,” says Hunt, who continues to serve as president of St. Joseph’s. “Financially we’re facing cuts, plus we don’t know what health care reform is going to bring, so we don’t know what our future is going to be. That’s stressful for the industry across the board.”
To deal with the economic slowdown, Catholic Healthcare West started making cutbacks and implementing cost-saving measures last September. St. Joseph’s reduced travel and catering expenses by 35 percent for a cost savings of $780,000 in fiscal year 2009. The hospital also became more diligent about the use of linens and replaced disposable pillows with sanitary reusable pillows, saving $90,000 in FY 2009. The hospital’s management team also took a 2 percent or more pay cut to help save jobs.
“We met with all the employees and they came up with great money-saving ideas,” Hunt says. “When all was said and done, employee suggestions helped save us more than $3 million a year. We are back on budget and that was our goal.”
Phoenix Children’s Hospital also has been prudent in pushing expenditures back. It cut administrative and advertising costs and stopped using traveling nurses, a move that saved the hospital $7.5 million a year. Bob Meyer, president and CEO of Phoenix Children’s Hospital, says they also have taken a hard look at attrition over the past eight months and have backfilled only 30 of 100 open positions. Phoenix Children’s $588 million expansion, which kicked off in 2008, has been scaled back, as well. Plans now call for shelling 1.5 floors of the 11-story tower for future growth.
“Given the economy and Medicaid reimbursement uncertainty (about 50 percent of kids in Arizona are on Medicaid), we have to be more conservative and push expenditures back,” Meyer says. “But even shelling floors will increase the number of beds we have from 345 to 486 when we open, which is what we need. Our patient volume is growing 15 percent a year and every bed in service is occupied almost 100 percent of the time.”
The tower’s first four floors will be completed in late 2010. Occupying the floors will be a cafeteria, kitchen, clinics, an imaging center and a retail pharmacy. The remaining floors of the tower are dedicated to the hospital’s Center’s of Excellence, clinical programs and private patient rooms. They will be finished in late 2011.
To keep Scottsdale Healthcare moving forward, President and CEO Tom Sadvary cut expenses and re-focused capital spending on medical technology, information systems and refurbishing projects. He also streamlined the management and executive team structure, creating fewer layers and a more agile organization. Green measures also were implemented at Scottsdale Healthcare’s three hospital campuses. Examples of the efforts include:
- Replacing 40 pickup trucks with electric vehicles at all three hospital campuses.
- Installing energy efficient lighting in three parking garages, saving approximately $82,000 annually.
- Reducing natural gas consumption by 10 percent at its power plants.
- Replacing 300 copier machines with new models that use 40 percent less energy.
- Eliminating printed payroll notices, saving approximately $150,000 annually and some 200,000 printed notices.
Sadvary contends that Arizona’s health care industry remains healthy and strong despite reimbursement challenges, nursing and physician shortages, and the abrupt changes the health care industry has faced over the past two years.
“I’ve been in Arizona 23 years and I’m proud of the health care industry here and what we’ve done to grow talent, capacity and to improve the size and sophistication of services for patients,” he says. “Arizona knows how to step up and we will continue to do that despite challenges along the way. The health care industry is sensitive to the budgetary issues the state is facing. And while we are all trying to be efficient and frugal with resources, our costs are going up. We’re doing the best we can to manage and provide great care with no more dollars coming in from the state.”
Banner Health President and CEO Peter Fine is a firm believer that major changes are coming down the pike in reimbursement formulas for Medicaid and Medicare that will cause more pressure on local hospitals. If that happens, he says, hospitals will have to make very difficult choices on what services to provide and what services they can no longer afford to provide.
“With rising costs and so many cutbacks in health-care spending, it’s amazing that hospitals and physicians can prosper today, as well as forecast for the future,” Fine says. “Companies have to be flexible enough to embrace change and move with what’s happening environmentally. Banner demonstrates flexibility by making investments grow and starting new programs. We also have great leaders at all levels and we invest in talent management, so our people are developed and prepared to lead us through tumultuous times.”
In spite of the economy, Phoenix-based Banner Health is continuing to make investments and grow in the communities it serves. Banner recently invested $289 million to build a new, seven-floor, 200-bed patient tower and emergency room at Banner Thunderbird Medical Center in Glendale. It also invested $12 million to rebuild the old Banner hospital in Mesa and create the Banner Simulation Medical Center, the largest simulation training center in the nation. The 55,000-square-foot center opened in August and has 20 full-time employees who will train 1,200 to 1,500 medical professionals (nurses, physicians, surgeons, respiratory therapists) annually. The simulation medical center occupies the bottom nine stories of the building, with the top eight housing Banner offices.
Students at the simulation center train on high-fidelity, electronic mannequins that look like human patients and come in a variety of shapes and sizes. The mannequins have a heartbeat and they talk, burp, sweat and bleed. They also have medical maladies such as strokes and heart attacks, as well as give birth and “die.”
“Banner Simulation Medical Center is basically a hospital where we can train nurses to work and interact with 20 patients on a floor at a time,” says Dr. Marshall “Mark” Smith, senior director for simulation and innovation at Banner Health. “Nurses that graduate from medical school can manage one patient, not multiples. We now have the ability to train new nursing graduates to care for multiple patients without putting them at risk or overwhelming them. ”