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.
Imagine setting out, on foot, for a journey not knowing how long it would take. Now imagine doing it with two animals as traveling partners from Washington State to Washington, D.C.
“Now I’ve started this leg of the journey in Morton, Washington where I was spiritually requested to go to Washington, D.C. and sing the song ‘Imagine’ by John Lennon on the Capitol steps,” says Jacob Holiday.
Jacob Holiday is on his way across America so he can sing a song he says signifies peace in the hopes, he says, of ending violence everywhere.
“I want so much peace. Cops would no longer carry firearms. We’re going to send the militaries of every country, I don’t care which one you’re talking about but every country, home to go to sleep. I don’t care what they do. But I want all this violence, everything, all this violence to stop.”
He has two wagons and his traveling companions are a dog and a goat. Holiday started in Washington State in July and he’s not worried about how long his hike across America will take.
His multi-state trek has seen him encounter a lot along the way, including a run-in with a bear.
He carries food for himself and his dog and his goat on carts that he says weigh a couple hundred pounds. Besides necessities, Holiday has one thing he’d greatly appreciate receive being able to buy as he continues his mission.
Holiday says he knows his mission isn’t an easy one, and he uses it as a metaphor for life as a whole.
We caught up with Holiday in the early part of November on a 70-degree day in Cambridge, Nebraska then spoke to him again a few days later in the rain as he headed east on Highways 6 and 34, so no telling how far he’s gotten now.
After we met with Holiday, we did notify the local sheriff to perform a welfare check, but we’re told Holiday wanted to continue his walk with his Capitol Steps goal still ahead of him. We also offered him food for himself and his animals, which he declined saying he had enough food on his carts.
The extent of the damage in Washington state is profound but unclear after more than a week of heavy rains and record flooding, according to the state’s governor, Bob Ferguson.
A barrage of storms from weather systems stretching across the Pacific has dumped close to 2ft (0.6 metres) of rain in parts of the state, swelling rivers far beyond their banks and prompting more than 600 rescues across 10 counties.
More high water, mudslides and power outages were in the forecast. Elevated rivers and flood risk could persist until at least late this month, according to the National Weather Service. Wind and flood watches and warnings are expected in much of the north-west for the next couple of days as storms bring rain, heavy mountain snow and high winds.
As of Tuesday, authorities had recorded one death – of a man who drove past warning signs into a flooded area – but key highways were buried or washed out, entire communities had been inundated, and saturated levees had given way. It could be months before State Route 2, which connects cities in western Washington with the Stevens Pass ski area and the faux Bavarian tourist town of Leavenworth across the mountains, can be reopened, Ferguson said.
“We’re in for the long haul,” Ferguson said at a news conference. “If you get an evacuation order, for God’s sakes, follow it.”
It won’t be until after waters recede and landslide risk subsides that crews will be able to fully assess the damage, he said. The state and some counties are making several million dollars available to help people pay for hotels, groceries and other necessities, pending more extensive federal assistance that Ferguson and Washington’s congressional delegation expect to see approved.
According to the governor’s office, first responders had conducted at least 629 rescues and 572 assisted evacuations. As many as 100,000 people had been under evacuation orders at times, many of them in the flood plain of the Skagit River north of Seattle.
SEATTLE – As more heavy rainfall is expected in western Washington this week, the region remains under a Flood Watch, with road closures, evacuations, and power outages persisting.
A Flash Flood Warning was activated and later canceled for parts of south King County after a Green River levee failed. The levee has since been repaired, patched by sandbags after nearby businesses were evacuated.
Desimone Levee breech. (Dana Ralph, Kent Mayor)
Keep reading for live weather updates for Tuesday, Dec. 16.
8:05 a.m.: Resources available in Pacific, WA
Valley Regional Fire listed several resources on behalf of the city of Pacific:
- Warm location that will be serving coffee and breakfast: Senior Center and the gym at the Pacific Community Center (100 3rd Ave SE)
- Auburn Community and Events Center (910 9th ST SE) is open with Red Cross resources
- The Filipino American Community of Puget Sound in Algona (103 6th Ave N) is also offering a warm location
- Alpac Elementary School (310 Milwaukee Blvd N) parking lot is available in addition to restrooms.
- Sandbags are available at 224 County Line Road
7:42 a.m.: Puget Sound Energy crews make significant progress in restoring power outages in WA
Puget Sound Energy (PSE) crews made great progress overnight after more than 50,000 people in western Washington lost power on Monday. As of 7:42 a.m. on Tuesday, there are only 56 outages impacted 1,343 customers.Snohomish PUD is reporting outages impacting 490 people. Clallam County PUD is reporting 0 outages.
7:40 a.m.: SR 167 remains closed between Kent and Auburn
‘Go Now’ evacuation in Auburn
Flooding from the Green River is forcing Level 3 ‘Go Now’ Evacuation order in the area between South 277th and north of 42nd, and east of SR-167 and west of Green River.
The Washington State Department of Transportation said both directions of State Route 167 remain closed on Tuesday between South 212th Street in Kent and 15th Avenue West in Auburn due to flooding.
Drivers are advised to take alternate routes and expect delays on I-5 and I-405.
WSDOT’s David Rasbach told Good Day Seattle there was still water over the roadway in the area.
State Route 167 remains closed between Kent and Auburn.
7:30 a.m.: Level 3 ‘Go Now’ Evacuation in Auburn, WA
There are still evacuation orders in effect in Auburn, Washington. This flooding from the Green River is forcing Level 3 ‘Go Now’ Evacuation order in the area between South 277th and north of 42nd, and east of SR-167 and west of Green River.
There are also Level 2 ‘Get Set’ Evacuations in several neighborhoods along both sides of the Green River, including areas near 104th Avenue Southeast, Pike Street Northeast and Pike Place Northeast – south of the Auburn Golf Course. Anyone who lives there should be prepared to leave at a moment’s notice if things get worse.
Officials say evacuees seeking shelter can go to the Auburn Community and Event Center and Ray of Hope Shelter in Auburn.
7:24 a.m.: Person dead after driving car onto flooded roadway in Snohomish County
A driver died overnight in Snohomish after reportedly bypassing road closure signs and plunging into a flooded ditch near East Lowell Larimer Road.
7:03 a.m.: Level 3 ‘Go Now’ Evacuation in Concrete, WA; School district closed
There is a Level 3 ‘Go Now’ Evacuation order in place for the Erikson Road neighborhood in Concrete, Washington.
The town says they found a landslide there last week, and with more rain and wind coming, they are asking people to leave the area.There is also an upgraded Level 2 ‘Get Set’ Evacuation near Burpee Hill Road that is impacting 32 homes. This comes after a landslide in the area on Monday.
The Red Cross opened a shelter for people impacted by those evacuations at the Mount Baker Presbyterian Church off Main Street.
County officials say pets can be accommodated.Schools in the Concrete School District are closed Tuesday. The district will continue to monitor conditions to make decisions for later this week.You can find more school closures across western Washington here.
6:20 a.m.: How you can help
GoFundMe has updated their list of verified fundraisers and non-profits providing help to those affected by the flooding.
To donate to Washington and Pacific Northwest flood relief fundraisers, click here.
6:09 a.m.: Flooding impacting local blood supply
The flash flood evacuation from the Green River levee breech is near Bloodworks Northwest’s Renton Lab and Donor Center.
Officials say the stored blood supply remains safe, but the donor center is closed.
Critical blood storage, supplies and vehicles were moved to a different location, and upcoming blood drives may be affected.
Bloodworks Northwest said more than 300 potential donations have been canceled since last week, which created a shortage.
The company is asking donors of all blood types are needed. To donate, click here.
6:04 a.m.: Evacuation efforts in Pacific, WA
Valley Regional Fire Authority crews are working to help residents evacuate in Pacific.
Officials said about 100 residents have been evacuated and no injuries have been reported.
The affected areas primarily are S of 1st, and E of Butte, S of Stewart, and Skinner Road.
5:20 a.m.: Tracking school closures and delays
Several school districts in western Washington announced delays.
Here is the latest list.
5 a.m.: New evacuation orders in Pacific
Early Tuesday morning, police in Pacific announced after 1:30 a.m. there was a Level 3 “Go Now” evacuation order due to a levee break on the White River.
The evacuation order affects the areas east of Butte and South of Third.
National Weather Service Seattle issued a Flash Flood Warning before 1:45 a.m. Tuesday.
Tuesday weather forecast
Heavy rain, gusty winds and mountain snow returns to western Washington by Tuesday evening, with the potential to push river levels even higher and knock out power to thousands due to downed trees.
The Skagit, Snoqualmie, Green, White, Cedar, Cowlitz, Stehekin and Skykomish rivers are back under Flood Warnings.
A Flood Watch remains in effect for parts of Western Washington through Thursday afternoon. (FOX 13 Seattle)
A Winter Storm Warning and Winter Weather Advisory will be in effect Tuesday afternoon through late Wednesday for heavy mountain snow.
Green River levee fails, Flash Flood Warning
A Flash Flood Warning was activated on Monday after a Green River levee failed in Tukwila, prompting evacuations in areas downstream from the levee break.
While the warning was canceled just before Monday evening, the Desimone levee breach was at one point described as “life-threatening” and reportedly threatened nearby structures.
Most of western Washington remains under a Flood Watch through Thursday due to the rainy forecast ahead, along with already high river levels.
Road closures in Western Washington
Several critical roadways across western Washington are closed due to weather effects, including highway washouts that will continue to impact travel.
On Interstate 90, eastbound lanes of the freeway are closed near North Bend due to a landslide. Additionally, though not weather related, all westbound lanes are closed near Cle Elum due to construction of the Bullfrog Road overpass.
U.S. 2 Stevens Pass is closed at Tumwater Canyon after a section of the highway was washed out by flooding last week. It’s blocked between Skykomish and Leavenworth, and there is no estimated time for when the road will reopen. Highway 410 is also closed at Enumclaw due to a washout.
MORE NEWS FROM FOX 13 SEATTLE
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The Source: Information in this story came from the websites and social media pages of various agencies and emergency management departments across western Washington, and FOX 13 Seattle reporting.
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