Washington
Washington state hospital system ‘very fragile’ after two years of losses
Hospitals in Washington state continue to deal with daunting financial difficulties.
While hospitals generally fared a bit better in 2023 than in 2022, most hospitals are continuing to lose money, according to a survey by the Washington State Hospital Association. Some are cutting services and reducing beds.
During a media call Tuesday, Washington hospital leaders say some organizations are on the brink, and some aren’t poised to handle more financial pressures. Cassie Sauer, president and CEO of the Washington State Hospital Association, also pointed to financial difficulties from the Change Healthcare cyberattack, which has affected hospitals and healthcare providers nationwide.
“What we really see is that the state of Washington’s hospital system remains very fragile after experiencing more than two years of significant losses,” Sauer said. “And these losses are now being compounded by delayed payments from insurers and the impact of the cyber attack on Change Healthcare.”
‘Unprecedented, unsustainable’
Cumulatively, the state’s hospitals lost $3.8 billion in 2022 and 2023, said Eric Lewis, chief financial officer of the Washington State Hospital Association.
“These losses are unprecedented, unsustainable, and represent a huge-post COVID financial challenge,” Lewis said.
In 2023, the state’s hospitals had a -5.2% operating margin, which actually represents a bit of improvement from 2022, when the margin was -7%. Lewis said 85% of the state’s hospitals are losing money.
The state’s hospitals ran in the red during the first half of 2023, and the losses mounted as the year progressed. Washington’s hospitals took in more revenue in 2023, but the revenues were outpaced by higher expenses.
The net operating losses for Washington’s hospitals totaled $1.7 billion in 2023, compared to $2.1 billion in 2022.“The losses, though not as massive, continued,” Lewis said. He noted that the state’s hospitals have seen significant losses for eight consecutive quarters.
Adding to the difficulties, more residents in Washington are relying on Medicare and Medicaid, Sauer noted. Fewer people are using commercial insurance, which typically provides better reimbursements to hospitals.
“That piece of the pie that’s commercial has really diminished quite a lot,” she said.
‘A large hole’
Ettore Palazzo is the CEO of EvergreenHealth, a community-owned, two-hospital system based in Kirkland. He said, “These terms, unprecedented and unsustainable, are absolutely true. And there are other adjectives that we’re trying to come up with because it almost doesn’t seem like those words are really appropriate anymore.”
EvergreenHealth has lost $158 million over the past two years, he said.
To cut expenses, EvergreenHealth has had to reduce some positions, including some non-clinical positions and an executive role, Palazzo said. Some services have had to be cut, including a “helpline,” where residents could call nurses with health questions. The helpline had been operated for 30 years.
While EvergreenHealth has made some headway in reducing losses, Palazzo said the system still faces a difficult road.
“We have a large hole to climb out of,” Palazzo said. “And the thought of any other disruption, whether it be self-imposed, or as a result of another pandemic, or anything that changes the current, really delicate balance of how healthcare finances work now, could put all that in jeopardy. And I do worry about how hospitals will be addressing their capital needs as they work towards improvements.”
Closing delivery services
Cathy Bambrick, administrator of Astria Toppenish Hospital, a 63-bed community hospital, outlined some of the sober challenges her organization has faced. The hospital lost nearly $8 million in 2023, after losing $7.3 million in 2022.
The hospital serves one of Washington’s most impoverished and ethnically diverse regions, including a large Native American population. The hospital is the only one in the state located on a reservation.
Lawmakers are working with the hospital to sustain emergency and acute care services, but Bambrick said some services have had to be cut.
In December 2022, the hospital closed its labor and delivery unit, leaving local women with a drive of more than 30 minutes, even in good weather. “And you know, in eastern Washington, we have very difficult driving conditions in the winter,” Bambrick said.
The hospital typically delivered a baby a day, she said.
“We couldn’t have felt worse about closing that delivery unit,” she said.
In 2023, the hospital had to close its MRI service. “We are one of two hospitals in the state that doesn’t offer MRI services to its patients,” she said.
Needing a long-term remedy
Elise Cutter, CEO of Island Health in Anacortes, an independent, public hospital district, including a 43-bed facility, along with primary and specialty care clinics. Island Health is at a -12% margin over the past two years, she said.
“Over the past two years, we’ve seen an unprecedented increase in costs, yet have not seen corresponding increases in the payment for care,” Cutter said.
Even though Island Health operates a small hospital, Cutter noted that it’s “too big” for enhanced funding for rural providers from the federal government.
Despite the financial hurdles, Island Health’s hospital has received a 5-star rating from the Centers for Medicare & Medicaid Services for the past two years, she says.
“We need to find a long-term solution to ensure that independent, rural public hospital districts like Island Health can continue to be the safety net for our community, and provide 5-star care close to home,” Cutter said.
‘Heartbreaking decisions’
In addition to the losses, Sauer pointed to the gut-wrenching decisions some hospitals have had to make to reduce services in order to stay afloat. Even seemingly minor decisions, such as reducing a couple of beds, matters to people who are seeking care, she said.
“Over the course of the last year, we’ve seen hospitals make both what seemed like mundane, but also heartbreaking decisions, about service reductions and closures that are done to preserve access to other hospital services,” Sauer said.
And some of those decisions mean patients are waiting longer for the care they need, whether it’s closing a unit or even a couple of beds, she said.
“If you’re someone who’s looking for care, it can be a really big deal that your hospital now has less capacity,” Sauer said.
Beirut, Lebanon – On Tuesday, representatives from Lebanon and Israel met at the US Department of State in Washington, DC – the first session of a two-day round of negotiations that Lebanese negotiators hope will end an invasion of their country.
The negotiations, which started at 9am local time (13:00 GMT), come as Israel’s invasion of Lebanon pushes deeper than at any point since the year 2000 and as Hezbollah and Israel continue to trade attacks. Israel has killed 3,468 people in Lebanon since March 2, according to Lebanon’s Ministry of Public Health.
With the war raging on, what do Lebanon and Israel have to discuss and will the talks lead to an end of the Israeli assault?
Here’s everything you need to know.
What will Israel and Lebanon discuss?
Similar to past meetings, the two sides are ostensibly looking to come to some kind of deal following fighting between Israel and Hezbollah, with strong doubts it will be achieved.
Lebanon’s government is still pushing for a total ceasefire. However, as talks started, Israel was striking various parts of southern Lebanon. Lebanon is also trying to get Israel to withdraw from Lebanese territory in the south, so that more than 1.2 million displaced people can return home, and so the state can resume finding a way to disarm Hezbollah and rebuild areas devastated by Israeli attacks.
Israel is meanwhile looking to get assurances that Lebanon will disarm Hezbollah, a prospect analysts say Israel knows is complicated by the continuation of its military operations and occupation of swaths of southern Lebanon. Instead, Israel appears to be trying to fuel sectarian tensions inside Lebanon, leading to chaos and internal strife.
What has happened so far?
An initial meeting took place in April between Israel and Lebanon’s ambassadors to the United States. A second round took place in May with a larger delegation on both sides.
On Friday, a meeting took place with Lebanese and Israeli military representatives, while Hezbollah, the Iranian-backed Lebanese group, is not involved in the meetings.
Israel claimed the two sides found common ground in that they both wanted to see Hezbollah disarmed. Some Israeli officials suggested there may soon be trade agreements and an exchange of tourists between the two countries. Lebanon, however, said it preferred to find a deal closer to the 1949 armistice agreement between the two countries.
In the last meeting, Beirut reportedly outlined the damage done by Israeli attacks since the 2024 ceasefire agreement and presented detailed maps showing homes destroyed or razed by Israel.
Is there a chance for a ceasefire?
That remains to be seen, but for now, Israel’s Prime Minister Benjamin Netanyahu said his country’s military would continue attacking Lebanon.
On Monday, Netanyahu announced that attacks on Beirut’s southern suburbs would resume, despite a ceasefire. Apart from two targeted attacks, Israel has not struck the suburbs, known as Dahiyeh, since April.
Iran, which has attempted to include Lebanon in a wider ceasefire between themselves, on one side, and Israel and the US on the other, then intervened by threatening to attack northern Israel.
US President Donald Trump reportedly intervened to stop Israel’s attacks. He announced another ceasefire, after his previous announcement of one between Israel and Lebanon on April 16, after claiming he had gotten the approval of Netanyahu and spoken to Hezbollah.
“There will be no troops going to Beirut, and any troops that are on their way have already been turned back,” Trump announced on his social media platform, Truth Social.
But attacks from Israel and Hezbollah are continuing.
How do Lebanese people feel about the talks?
Not everyone is on the same page.
Some Lebanese support the talks and say they are the only option the state, which has little leverage, has. Among those who believe direct talks are the best way forward are Lebanon’s President Joseph Aoun and Prime Minister Nawaf Salam.
“There is no option other than negotiation,” Aoun said in a statement on Tuesday.
Others, however, oppose direct talks. Parliament Speaker Nabih Berri and his allies, Hezbollah, have said indirect talks are preferred and that negotiations cannot be conducted while attacks are ongoing.
How are Iran and the US connected?
Israel and the US attacked Iran on February 28, killing the country’s longtime leader Ayatollah Ali Khamenei.
Iran is Hezbollah’s primary benefactor, and two days after Khamenei’s assassination, Hezbollah fired six rockets towards Israel on 2 March.
Hezbollah’s response brought a huge response from Israel, who have crossed the Litani River – the supposed buzzer zone in southern Lebanon it had created – towards the Zahrani River.
Despite a 2024 ceasefire, Israel had never stopped attacking Lebanon, while Hezbollah had only responded once in December 2024.
Iran has attempted to include Lebanon in the ceasefire deal it has with the United States and Israel, who say this theatre is not part of the agreement.
Although Trump has now announced a ceasefire between Hezbollah and Israel twice, the invasion of southern Lebanon continues.
Are there other actors involved?
Gulf states have also intervened. Saudi Arabia has been working behind the scenes to get Lebanon’s leadership – Aoun, Salam and Berri – on the same page. Meanwhile, analysts say Saudi Arabia and Qatar engaged the Trump administration to stop an escalation in Lebanon.
The Washington Lottery offers several draw games for those aiming to win big.
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11
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8-6-0
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07-08-09-18
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04-05-08-14-16-17-23-24-27-28-31-32-38-43-45-47-51-58-65-66
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05-09-10-15-21-26
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02-07-35-44-57, Powerball: 25
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Are you a winner? Here’s how to claim your lottery prize
All Washington Lottery retailers can redeem prizes up to $600. For prizes over $600, winners have the option to submit their claim by mail or in person at one of Washington Lottery’s regional offices.
To claim by mail, complete a winner claim form and the information on the back of the ticket, making sure you have signed it, and mail it to:
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When are the Washington Lottery drawings held?
- Powerball: 7:59 p.m. PT Monday, Wednesday and Saturday.
- Mega Millions: 8 p.m. PT Tuesday and Friday.
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- Powerball Double Play: 8:30 p.m. PT Monday, Wednesday and Saturday.
This results page was generated automatically using information from TinBu and a template written and reviewed by a Washington editor. You can send feedback using this form.
A contract worker was killed by a falling tree on Monday afternoon in Washington County, officials said.
The Washington County Office of the Coroner said in a news release that the contractor was killed after the tree fell on them around 4 p.m. The worker, who was not immediately identified, was hired to cut down a tree at a residence on Lynn Portal Road in Canton Township, and it fell in an unintended direction, killing the person, the coroner said.
No other information was immediately released on Monday evening. The Greene-Washington Regional Police Department and the coroner are investigating.
This is a developing story. Please check back for updates.
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