COVID-19 has impacted all New Yorkers, but some are being impacted more than others.
In communities of color across the city, and the country for that matter, the impact of these inequalities is causing an already unleveled playing field to tip over. Poverty rates in communities of color, such as we see at St. Barnabas Hospital (flagship of the SBH Health System) in the south/central Bronx, were almost 40% before COVID. Job losses, school closings, and a decrease in support services are now impacting our community at a much higher rate than other communities.
This virus is also killing more people of color. Many say that COVID-19 doesn't discriminate and we are all equally vulnerable, but that doesn't mean it isn't biased. If you are a person of means, with resources, income and savings, you can still get infected by COVID-19; however, you can also weather a prolonged period of quarantine, thereby protecting your family and friends.
I am lucky. Before the COVID pandemic, I used public transportation, namely the B train from 96th Street and Central Park West. I would get off the subway at the Fordham Station (188th Street). Since the outbreak, I have been driving to work. My car is garaged, and I spray my steering wheel with a bleach solution before touching it and then douse my hands with a hand sanitizer. I park at the hospital, don a mask and walk to my office. I can easily stay more than 6 feet away from others. Thus far, I remain uninfected by COVID-19, but it's not so easy for many others.
Highlighting the inequalities are the multitude of videos of wealthy infected Americans quarantining in their homes, with the ability to hide out in their basements, attics, third bedrooms, mother-in-law apartments and vacation homes.
In New York City, especially in poor neighborhoods of color, social distancing and quarantining is a luxury that many cannot afford. In the Bronx, most people do not own cars. They often depend on public transportation to get to work, shop, or just get around, and many cannot afford to take taxis or Ubers. This increases the risk of exposure to COVID-19. Many who live in these same Bronx communities also suffer from such chronic illnesses as heart disease, asthma, emphysema, diabetes, kidney disease and high blood pressure. A significant percentage have service jobs, upon whom we all depend on to deliver our food, clean our buildings, take care of us in hospitals, protect us or transport us around the city. If they get infected, quarantining is not a simple practice, and family members and roommates also frequently become infected. According to the NYC Department of Health's COVID-19 database as of April 15, almost 91% of Bronx residents who died from COVID-19 had underlying health conditions. Compare this to an overall NYC rate of 75%. This is directly a result of poverty and, in large part, this poverty is a direct result of decades of systemic racism that has led to healthcare disparities in our community. Social Determinants of Health are real.
Before COVID, Bronx County ranked 62nd of 62 counties in New York, according to the RWJ Report ranking Health and Wellness. Many of us have spent our careers trying to impact that. It will be significantly harder now.
The human, economic and social costs of COVID are immense. Because of our service area, and the pervasive poverty, most of our patients who are lucky to be insured are covered by government-sponsored health insurance programs, the majority by Medicaid. Even most of our elderly patients, who may be covered by Medicare, are also Medicaid-eligible due to that poverty. This doesn't account for those undocumented members of our community, who despite working and paying taxes receive few if any benefits.
In the current health care delivery system, SBH is not financially viable. This fact is not new, and we have experienced growing negative margins over the past several years, as our revenue has not kept up with expenses. That is a direct result of rising labor and supply costs in a period of flat or decreasing government-based revenue. But just because we are not financially viable, it doesn't mean that we are not viable. We employ over 3000 people. We also serve as a Trauma Center, Heart Attack Center, Stroke Center, and Behavioral Health Hub, and have large women's and children's programs, as well as very busy substance abuse programs.
Before COVID, our intensive care units were full, and it was hard to find an available hospital bed on our inpatient units, including our locked psychiatry units. Our emergency department cared for around 90,000 people per year, and our total ambulatory visits numbered about 750,000. We trained 300 residents and fellows and over 300 medical students. Yet, we still lost money. We were fortunate to get additional support from the New York State Department of Health because they recognized our importance to the community. Yet, we still lost money. We delivered high quality care, almost eliminating all hospital-acquired Infections, and ranked among the top hospitals in quality by Healthfirst. Yet, we still lost money. We became the fiduciary for Bronx Partners for Healthy Communities (a part of the Delivery System Reform Incentive Payment Performing Provider System). We are efficient and effective. We are outcomes driven and patient centered. Yet, we still lost money.
After COVID, we will face an even worse financial situation. We expanded our inpatient capacity, including quadrupling the number of ICU beds. We are delivering the majority of our primary and specialty care via telephonic visits. We closed our inpatient pediatric floor and detox floors to accommodate our acute medical capacity. We eliminated all elective cases. We stopped receiving interventional cardiac patients to expand our ICU. We received private financial support of over $1 million to reopen an inpatient floor recently repurposed from office space. We pay for all of our staff members' meals and cover the cost of their parking and transportation.. We have spent millions on supplies, capital and overtime. Last week alone, we spent over $7 million on unbudgeted expenses associated with combatting COVID.
Due to New York State's budget shortfalls we were notified in the middle of last month that we were being cut almost $9 million as a result of Medicaid reforms, which thankfully in part was delayed but is still scheduled to impact us by next year. In addition, CMS had already been cutting reimbursements to hospitals delivering care to medicaid patient populations. . At present, unless there is a change, SBH faces a 10% operating loss. We may not be alone, but that will not reassure our staff or our patients, or a community that will suffer even more if we are forced to close.
The current healthcare system will not survive this pandemic. Poor community hospitals and public hospitals which depend primarily on government payers and especially Medicaid will not be able to make up the losses unless the economics change. Without change, we will not survive, and the safety net we offer our community will also not survive. This includes our cousins, the critical access hospitals (rural community hospitals) who face similar challenges. Without a change in how we manage populations and cover the costs associated with that care there will be no way to improve the lives of our suffering community.
Our community has earned the right to live better. It is unacceptable that we have permitted our communities of color to live without the same guarantees and protections as more affluent communities. We must use this experience to create sustainable programs aimed at addressing the major social disparities which permeate our poorer communities. Housing, physical and food insecurities; and education, Income and healthcare disparities must be addressed to ensure that the next pandemic doesn't wipe out the rest of our community.
Let's finally address income inequality by investing in safe, affordable housing; prioritizing education reform from preschool to college; ensuring access to high quality fresh foods; giving individuals the opportunity to make a living wage; and reforming our prison systems which would include training and education for incarcerated individuals so that when they are released they can more effectively be assimilated back into society. Let's finally address the disparities by investing in affordable healthcare that is patient-centered and focuses on wellness and prevention for everyone, not just those who can afford it. Healthcare is a right and not just a benefit reserved for some. Finally let's offer hope and a future to the countless children, teens and young adults who have none.
These are not pipe dreams. We are still the wealthiest nation on earth and we can rethink how we care for each other, given our new understanding of the risks of continuing to ignore our shared vulnerability. Let's not be satisfied with returning to a "normal" that doesn't address the disparities. Let us all dedicate our resources and commitment to supporting that change.