Is 25-30% of your Emergency Department Volume gone forever?

Author: Betsie Sassen, R.N., M.S.N.

During COVID-19, volume in Emergency Departments across America have decreased by as much as 25-30% in some cases.  The volume that has been lost is mainly lower acuity patients that found another alternative such as Urgent Care, Acute Care Clinics, or even Tele-Health.  As these patients have been slowly transitioning away over the years, COVID-19 brought an abrupt halt to this type of volume coming to the Emergency Departments. These new avenues are not going away. The remaining patients are maintaining the higher acuity, and at times, even higher.  In fact, our clients are reporting that while there has been a drop in volume, there has been a rise in level charges.

The challenge many are facing today is how do we look at our current standards knowing that the department “DNA” has changed. Yes, we should be adjusting our staffing down as closely as we can to the existing standard, however, do we need to re-evaluate what that standard makeup is? Is there a need for us to re-model our grids and the projected volume knowing that the average patient is carrying a higher level of care? Our advice is to reset and determine the new level of care just as if a Medical Surgical Unit switched to an Intermediate Care Unit. In that case, you would change your targets and adjust your staffing. This does not mean there are not improvements that are to be made with the volume drop, rather, the totality of the improvement might be inflated until the target has been readjusted. This is also important because many Emergency Departments have started using outside agency and higher incentive pay to compensate during the COVID-19. This needs to be cleaned up, cleaned out, and an affordable yet high quality Emergency Department must be restored.

We can help.



Traveler Agency Nurses: Why Now?

Author: Betsie Sassen, R.N., M.S.N.

At C2 Healthcare we’re noticing a strange phenomenon happening in hospitals across America.  COVID-19 cases are dropping precipitously while other volumes are softening.  Yet, hospitals are adding Travelers and Agency Nurses now at unprecedented rates.  Why?  Are more staff nurses leaving to join Travel Staffing Agencies?  Some hospitals have decided to bring in agency to rest their staff.  Again, all this happening while volume is softening, and Agency Staffing Companies have increased their hourly rates 300% and are at an all-time high…upwards of $180/hour!

Many times, departments are using agency and overtime when they are running over on the Hours Per Patient Day (WHPUOS) target.  In most cases, the simple removal of agency hours would get a department to a zero variance on hours and obviously save 3 times what hours paid at straight time would be.  If a department is over on its WHPUOS, agency contracts should not be renewed and in some cases cancelled with penalty.  If a department is running over its target, look to see how many agency hours and overtime hours are being used, and eliminate those first to bring down the hours variance and improve cost.  The cost has become so unaffordable making them “budget busters”.

Unfortunately, the pandemic has left many staff nurses feeling tired, under-appreciated, and under-valued.  The lift from the “Heroes Work Here” signs and pandemic pay has worn off.  Staff nurses are aware of what hospitals are currently paying agency nurses and it is creating resentment and bitterness.

If the objective of adding agency is to replace vacancies left by nurses who left to be “travelers”, what are the initiatives around trying to bring them back or stop them from leaving in the first place?

If the objective is to rest staff by adding agency, make sure the initiative is working and that your staff is indeed taking time off.  Another and perhaps better question to ask yourself is if volumes are declining, is there a way to do so without adding agency?

The appeal of travel nursing will likely wear thin eventually for those who jumped ship.  But, in the meantime, what is your organization doing to stop them from leaving?  At C2 Healthcare we’ve seen effective “re-recruitment” campaigns of reaching out to former nurses and inviting them back.  The goal is to give them an opportunity before their position is filled.


Similar to digging out of the recent snowstorms, what is your plan to get out from under COVID-19?

Author: Betsie Sassen, R.N., M.S.N.

As much of the country has been blanketed with snow over the last month, we are in the process of digging out using various techniques that have been used for generations. These techniques and resources have been used for many years and have worked because the challenges we have faced with weather and snow remains consistent.

However, during COVID-19 we are facing many challenges that have never been seen. Whether it is a loss of nurses to agencies, increased bonus or hazard pay, or temporary market adjustment exceeded over 30% to fight the COVID-19 battle, we now must begin the process of digging out of COVID-19 and get back to a new sense of normal.

  • If the volume continues to return to normal without COVID-19, what does your bottom line look like?
  • What is your plan to “sunset” agency contracts?
  • What are you doing to quantify and eliminate the excess pay in resources used over the last 12 months?
  • What is your plan to regain nurses that have left for Nursing Agencies? What is your plan to replace them…travel and missing family at home may start to grind on them.
  • Are you looking to eliminate the bonus pay for COVID-19 units?
  • What is your communication plan to help the staff when this pay is taken away?
  • When do others return to work?
  • Do you have dates set when all staff needs to be back in the hospital? This may be an exceedingly difficult time for some as many have become very set in their habits.
  • Is there a change you made that you may want to continue? Decreasing leases, remote visits, cross training, etc.

These are all difficult challenges, like the after effect of a storm, but without a plan . . .

If it takes 21 days to form a habit, imaging how many Bad habits we can develop in 21 pay periods?

Author: David J. LeClercq

It has been said that it takes 21 days to form a habit. What happens when it’s not 21 days or 21 weeks, it’s 21 pay periods! When I leave my office at lunch to grab a sandwich or salad and I see the same people walking around town in joggers because they have been working out of their house since March, I must wonder how difficult it is going to be for them when they must put their suit and tie back on for the first time. Will it even fit? There have been many changes to our lives since March, some are good, and many are bad. Will the wine and Netflix go from 7 nights to maybe 2? In our hospitals there have been many changes out of necessity with meetings and day to day responsibilities. Have we started the journey back with our at home working staff so to try and break some of the habits that we have developed since early March, if not, start with the Monday 8am meeting and ease into it.

Are there “positives or lessons learned” we can learn from this challenging time?

Author: David J. LeClercq

It does not seem like we are doing much of the same as we used to in 2020 as we have done in the past. This has been incredibly challenging, and every industry is looking for new ways to deliver their product, service, and in your case patient care. As bumpy as a road as this has been there also have been many “work arounds” and new procedures. We all have started to evaluate how we work to be successful during COVID-19. Do we have a plan to maintain those new procedures or work habits as we emerge from the pandemic? All great inventions stemmed from a necessity, COVID-19 was not a necessity, however our new improvements should be carried forward. Are we going to go back to the way we used to do things or are we going to re-evaluate certain changes we have made that makes sense to continue? C2 Healthcare has been nimble for years with remote coaching and training when not on site. During this time, we have identified many new improvements to our coaching and virtual presence to enhance our client deliverables. What are some of yours?

What will your costs look like when your RAC FEMA relief and other resources dry up?

Author: David J. LeClercq

Over the last few months there have been many resources that have been provided to hospitals around the country. These resources are a very welcome relief and well deserved. As you find your way through the “pandemic journey”, there will be a point when these resources are not available and there will be an absence of staff or allocated financial resources. Hopefully, we are coming close to that point from a health perspective. From a financial perspective, have you looked at your current staffing and expense levels and projected out the picture it creates when these resources have dried up?

Is your PTO accrual rising because employees working at home are not using vacation time?

Author: David J. LeClercq

With the new norm under COVID-19 many employees are working from home. Personally, I have been on video calls where attendees are dialing in from their vacation home or VRBO. Although this is not completely new behavior, the trend is growing exponentially. Additionally, as children are learning remotely, families can spend more time together at home or on extended “worcation” while still maintaining their job functions. It does not matter where you are as long as there is a strong wireless connection.

The question is, have you seen a dramatic rise in your pto accrual compared to last year, and what new guidelines must be adjusted or added?

How is your “volume” today compared to last year at the same time? Is it really that different?

Author: Betsie Sassen

Interestingly enough, most of our clients’ volumes are relatively flat today compared to the same time last year. It is the “nature” of that volume that has changed. It’s volume requiring frequent donning and doffing of PPE, extra staff to screen for COVID-19, alterations in caregiver to patient ratios due to increased acuity and maintaining separate care areas for COVID-19 and non-COVID-19 patients. Unfortunately, what we are hearing about other facilities is that while overall hospital volume is remaining flat, FTEs are not remaining flat, and in some cases have greatly increased, at unsustainable rates outpacing volume, in areas such as the Emergency Department, Progressive Care Unit, and in some cases the Intensive Care Unit. While COVID-19 does pose some legitimate extra “care” steps and challenges, what is your organization’s tolerance for these variances? What is acceptable? And if these areas must go over, are there other areas that run more efficiently to get the net impact to zero?

How is Covid-19 reimbursement impacting your financials? Have you calculated the new run rate without the extra payments and extra expense

Author: David J. LeClercq

I know this may be a difficult question to ask depending on where you are in the country, but have you figured out what your revenue would look like with the same patient population without the additional COVID-19 reimbursement or additional funding? You probably have and the picture might not look great. Do you have a plan to get back in order when this subsides? C2 Healthcare can help you with that.

What are the effects of Covid-19 in the benchmarking world?

Author: David J. LeClercq

The world of benchmarking is often “partly cloudy to cloudy”. Questions arise such as where my peer came from, what types of patients do they really have, what is the physical layout of the unit, and so on. During COVID-19, hospitals are making many changes such as allocating resources for COVID-19 in a general department. In this event there may be many inconsistencies occurring that change the traditional makeup of a nursing unit. As an example, if you are costing out your COVID-19 nurses to a separate cost center, they will not be consistently measured as in the past. In addition to that, the typical patient that occupies a bed within the nursing department could now be a COVID-19 population which is requiring an additional layer of staffing. In other words, a patient in 2020 might not be the same as a patient in 2019. We all need to be aware of these issues and the impact of the benchmarking industry. C2 addresses that, how do you?

© C2 HEALTHCARE 2021. All Rights Reserved.