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How independent hospital MarinHealth is navigating the coronavirus pandemic: An interview with CEO Lee Domanico

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MarinHealth Medical Center, known until last summer as Marin General Hospital, has been treating COVID-19 patients since February.

Though levels of coronavirus-related activity haven’t reached crisis levels, the hospital remains prepared for the unforeseen and is once again accepting patients for surgeries and procedures. The Business Journal spoke with CEO Lee Domanico on May 18. He stressed the hospital is safe for the public, addressed the financial impact the hospital has faced from the pandemic and spoke about the future.

How is MarinHealth Medical Center doing these days?

For the last two and a half to three weeks, we have been waking the hospital back up, so to speak, and starting to do elective surgeries and procedures.

We’re up about 75% of where we were back in early March. So, it’s very important because starting in the middle of March, we eliminated or stopped performing all elective surgeries and procedures. That served to reduce our inpatient census by about 40% and reduced our revenue for the month of March by (about) 20%, and then by close to 40% in April.

I suspect that our numbers for May will be similar to March as we’re ramping back up.

Essentially, we freed up capacity so that if we did get a surge in COVID-19 patients, we would have beds for them. The good news is we never got the surge. The bad news is our hospital ran nearly half empty for a period of a couple of months. That’s going to hurt financially, as with all hospitals.

What does the hospital’s finances look like at this point in the pandemic?

We have received thus far about $7.5 million in stimulus money from the federal government, but I can tell you that’s less than 20% of what our losses will be for sure. If we can get back to full volume by July, we still will have lost $35 million to $40 million. We’re hoping the federal and state government comes in with more help for hospitals.

What has been the broader impact from COVID-19 to MarinHealth Medical Center?

There was no federal coordination of the response with this international pandemic. And as a result, every hospital was competing with every other hospital — and even with state government and, ultimately, with the federal government — to buy (personal protective equipment).

Marin General was by itself as a freestanding hospital, competing with these large billion-dollar corporations to find masks, testing kits, face shields and the like.

We were competing with 5,000 other hospitals, and I have to say we did very well. We found a contact, through our physician community, to China that allowed us to acquire N95 masks. We found a local 3D printer who began manufacturing face shields for us, and I think we were probably (one of) the first hospitals to have Cepheid testing kits.

(Editor’s note: Sunnyvale-based Cepheid manufactured a test kit with technology that provides results in about an hour.)

We ordered these before the company got FDA approval, and of course once they got FDA approval, everybody was trying to buy them, but we were near the front of the line.

Do you have any COVID-19 patients right now?

Yes, as of (May 18), we had four. (Editor's note: See the map of current virus conditions in California.) None were on ventilators; none were in the ICU. They were on the general floor, which means they’re sick enough to be in the hospital, but they did not need intensive care, which is good.

For more stories about the coronavirus, go here.

Track here how California counties are progressing toward criteria for reopening their economies.

What we’re concerned about now is that people are staying home who might need to see a physician — for example, with chronic heart disease or diabetes — because they’re afraid that we’re not safe. We are safe. We follow very strict protocols to keep our staff and our patients safe. We don’t want people to put-off care that might seem like it’s not urgent. It will become urgent, if postponed for too long.

How much was spent to acquire the equipment needed to treat COVID-19 patients?

In addition to emptying out the hospital to make room, we had to go out and spend extra money unbudgeted to acquire personal protective equipment. We added about 50 ventilators, which increased our ventilator capacity by 400%. They cost about $100,000 apiece.

We also increased our negative-pressure rooms — from four to over 30, where the air blows outside versus back into the hospital — so that we could accommodate COVID-19 patients.

Tell us about the mobile team of physicians and clinicians that was put together in March.

They go out to the nursing homes with PPE, they test patients and consult with the nursing (staff). It’s very important because people at nursing homes are already compromised. The patients who have tested positive in the nursing homes thus far have been contained. We’re really pleased with that, but that was another very significant added expense.

The annual cost of the team is estimated at about $400,000 a year. And then there’s the cost of testing, which is significant, but the cost of testing is being covered by the county when we go out and test people. Those tests can be about $140 apiece, and so it was quite a commitment.

I understand the Marin Healthcare District, which owns MarinHealth Medical Center, has made a significant investment to help with the pandemic.

The Marin Healthcare District just approved $900,000 of its money to fund two mobile teams — two vans — to fund two pilot projects to pay for people to stay in a hotel if they can’t go home because they’ve been exposed to the virus and their living situation doesn’t permit social distancing.

The other pilot is to fund some replacement income for low-income workers that might not be getting paid if they have to shelter at home for 14 days if they were exposed.

And then the last thing they funded was a take-home kit for patients that come to our clinics or the emergency room and test positive. The kit includes an oxygen pulse oximeter, a thermometer and some PPE. This is a way to allow people to treat themselves at home, so to speak, but then watch the numbers so they know if they need to come into the hospital for care. The idea is you want people to stay at home, if at all possible.

Tell us about how the hospital has increased its use of telehealth.

We converted 60% to 70% of our clinic visits to telehealth visits. … We believe that telehealth is here to stay.

Up until the pandemic, Medicare wouldn’t pay for a telehealth visit, so there was limited application for it because there was no reimbursement. Now they have decided to pay for it. The private insurers have followed suit.

We think it’s going to be a permanent change in the way care is delivered. There’ll be more use of telehealth where appropriate, so that will continue for sure in our clinics.

And you have new technology that lets caregivers visit patients virtually?

Yes. It’s by a company called Banyan. This technology allows us to visualize the patient in the room and talk to the patient from outside the room. So we can see patients without having to go into the room, which does a couple of things: It eliminates contact if it’s not needed between patient and caregiver; and when you eliminate contact, you eliminate the need to wear PPE. So it has a double benefit.

We’ve placed the few COVID-19 patients that we have in rooms that have the Banyan technology, which is going to be everywhere when we get to the new hospital.

What are your hopes for the new hospital facility?

The new hospital, because of its design, is going to be even safer. It’s all single rooms, no double occupancy. We have separate hallways for patients and the public. We have many more negative-pressure rooms for the proper air flow.

The spatial relationships are much larger, which will allow us to more easily social-distance while we’re taking care of people. So the new hospital couldn’t be coming online at a better time. And we will also have the vacated beds in the old hospital that are actually still usable until 2030, which is another 40 or 50 beds. So we will have a lot of capacity, if needed, if we were to, God forbid, have a resurgence of this virus in the future. We’ll be even safer with the new facility.

We heard you are getting ready to retire.

My goal 10 years ago was to get Marin General Hospital rebuilt, and we hope to have our first patient in the new hospital in September. Once that occurs and we get new leadership in place, I plan on retiring. I’ve been at this for about 40 years — 10 years at Marin General — so it’s probably time to do something else.

Do you think the hospital is viable in the long term? Do you have any concerns there?

No, Marin General will be viable in the long term. It’s going to be challenging. It’s challenging to manage a freestanding hospital today in any environment. So this environment makes it even more challenging. But I believe with the continued support of the community, which we’ve enjoyed, we will continue to be successful and be here and prepared when the community needs us, which is what occurred over the last couple months.

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