Q&A: Steve Love on North Texas hospitals amid COVID-19

Steve Love is the President and CEO of the Dallas-Fort Worth Hospital Council.  With the increase in COVID-19 hospitalizations in Texas, Love has been at the forefront of preparing for increased strain on capacity in North Texas hospitals.

I spoke with Love to hear about what he’s doing to ensure North Texas hospitals are prepared for potential further increases in hospitalizations, DSRIP and hospital funding, Medicaid expansion, and what this pandemic has underscored about health care workers.  

 

 

Michael Goldberg: I know you provided reassurance to Texans in an op-ed that the rising number of cases in the state is not eclipsing the capability of North Texas hospitals to meet patient demand. Can you lay out what indicators you’re seeing that tell you North Texas hospitals are prepared and what steps you’re taking to plan for a further spike in cases?

Steve Love: We do have capacity because we are running roughly 70 percent occupancy in medical/surgical and about 70-71 percent in our ICU and we’ve got about 36 percent of our ventilators in use. So overall we feel good. But, I want to pivot and say we put that assurance out because people were panicking based on what they saw in Houston. 

With that said, we are consistently telling people, ‘wear a mask, wash your hands, practice physical distancing, practice good personal hygiene, and frankly behave yourself on July 4th weekend.’ Even though we do have the capacity now, we wanted to reassure people. It looks like the doubling rate related to the R-naught is beginning to decrease, which means there’s more community spread. If people get reckless, spend time in large crowds, 14 days after that,  between July 18-20 if we’re talking about the fourth of July weekend, we could see significant increases of patients in our hospitals and by the end of July, potentially a surge situation.    

So, we put that op-ed out to provide reassurance, but we underscored in that same article all the things people need to do. If we don’t change that doubling rate and we don’t stem the hospitalizations a little bit, the model was showing that by the end of July we might have to implement surge procedures, which we really don’t want to have to do.”

MG: It seems clear that staffing shortages are more of an issue than bed shortages. As some have said, a bed is just a bed without staff. Can you talk a little bit more about the staffing side of the equation and what DFW hospitals are doing to prevent burnout and other associated challenges?

SL: We’re doing three things. The workforce is so important, as you know. Everybody’s been trying to shift workforces in and out so that we don’t over fatigue people – they’ve been taking on COVID-19 for three and a half months. We have one thing in North Texas which blesses us: large systems like Baylor, Scott & White, Texas Health Resources, Medical City, Methodist, etc. They’re able to move their workforce around to where they have more COVID-19 – that’s number one.

Number two, not all, but some like Medical City might be able to bring staff from other locations in the country where HCA operates. Number three, we’re working closely with the state through the Regional Area Centers for Trauma to requisition additional health care personnel if needed. So, we’ve got some contingency plans in place.” 

Michael Goldberg: The Delivery System Reform Incentive Payment (DSRIP) has been an important funding source for Texas hospitals. Texas’ 1115 waiver is phasing it out. To my knowledge, you’ve been involved in attempting to figure out how to make up for the funding gap that could present. Can you talk about how you think the pandemic has moved the needle on that issue?

SL: You’re right that DSRIP has been very meaningful to the state of Texas, especially related to behavioral health issues and some services that aren’t covered under traditional Medicaid. So I think it’s great that we’re looking at how to replace that because it will go away very soon. 

Recently the focus has moved to COVID-19 and not so much what’s going to happen in the future. We have a new HHSC Executive Commissioner and hopefully they’re going to work with CMS so that we get some form of relief associated with the funding we got from DSRIP. 

With that said, I think COVID-19 has really shone a bright light on why we need to expand Medicaid in Texas. Our sister state, Oklahoma, just voted to expand Medicaid. I think we need to listen to the will of the people on Medicaid expansion because COVID-19 is a great example of where many people who are gainfully employed lose their jobs and become eligible Medicaid. If we had an expansion program in place, it would give better coverage to more people.”    

MG: Back to the workforce issue, is there a story you’ve heard about a health care worker during this pandemic that has caused you to rethink anything about how hospital systems operate? 

SL: I think it really underscores to me the servant attitude of the health care heroes that work in our hospitals. I’ll give you an example. I read a story about a young lady who is married and has two children – she’s a nurse in one of our hospitals. Ever since the middle of March, she’s had to go home and they have a little recreational, travel trailer that she stays in every night because she doesn’t want to run the risk of infecting her family. She sees her children, but from a physical distance, and she hadn’t hugged her children since March.

I think sometimes for the people who are out and about and don’t follow public health guidelines, like wearing a mask or avoiding large crowds, they don’t realize the sacrifices other people are making so they can care for people who get infected with COVID-19. I salute the health care heroes. The people that are shortsighted and selfish and won’t wear a mask, that’s unfortunate.”  

This conversation has been edited for clarity and length.