OHA exists to collaborate with member hospitals Fall 2020 and health systems to ensure a healthy Ohio. Hospital Insights PANDEMIC RESPONSE

Eight Months In: Ohio Hospitals Assess COVID-19 Response to Prepare for 2021

As Ohio’s 240 hospitals and 14 health systems mark the eighth month of battling the ongoing pandemic in our state, OHA and leadership of member hospitals have completed an assessment of the initial response to guide planning for 2021 and the emergence of future statewide calamities. As of Nov. 17, Ohio hospitals have admitted and treated 22,846 COVID-19 patients, including 4,250 who required intensive care unit stays. The state has recorded 312,443 total cases with 5,772 deaths. New cases and hospital- izations are surging to the highest levels of the pandemic and are trending sharply upward as we move toward the holiday season. Ohio’s economy and hospital economics have been upended during the response. OHA estimates hospitals continue to lose $6 million in revenue per day with a total financial impact on Ohio hospitals of $4.11 billion through the first week of November. The state is reporting unemployment above 8%, a primary factor driving more than 255,000 Ohioans to be added to state Medicaid rolls since March as job losses The OHA Resource Tracker and dashboards provide members and the DeWine Administration with daily updates resulted in lost commercial health coverage. on critical metrics. RETROSPECTIVE VIEW government coordination, member leaders to evaluate those factors across four Hospital leaders were asked to evaluate six coordination, data for decisions and layers of response: factors: capacity and resources, finance, communications. And we asked our member Continued "

MIKE ABRAMS Members Identified What Worked, What Did Not to Plan for New Case Wave Ohio’s first COVID-19 case was reported From that point forward, OHA and our member hospitals March 9, but a week prior Gov. Mike DeWine have been leading on the state’s response to the pandemic by asked OHA to assemble a group of OHA staff developing the data monitoring tools, community and member hospital leaders to advise the collaborations and surge preparation elements necessary for administration on the state’s response. The the state’s hospital community to respond. advisory group quickly determined the state As we look to 2021, OHA staff, the OHA Board of Trustees did not have the data collection and analytic and committee members invested time over the past few resources to provide critical, timely data to guide public weeks to review what we’ve learned, the resources now at health policy and statewide emergency response for COVID-19. Continued "

Hospital Insights | 1 Eight Months In: Ohio Hospitals Assess COVID-19 Response to Prepare for 2021 (Continued)

• Within their local communities OHA, DEWINE ADMINISTRATION Models used across the country, including • At the state government level COLLABORATION Ohio, were not tuned to account for • At the federal resource level unprecedented levels of social distancing • With the Ohio Hospital Association The early collaboration between the DeWine achieved in spring. The immediate administration and OHA facilitated a rapid catastrophe was avoided, but proving a OHA staff members response to the immediate surge threat and synthesized negative is difficult, and models were viewed enabled a long-term strategy to manage as grossly overstated. Consequently, responses, COVID response. The governor’s Executive analyzed adjusted modeling approaches now being Advisory Group, which includes OHA staff used to forecast surges in an environment of current data and leaders of member hospitals, identified and managing flare ups over a longer duration the need to bolster Ohio’s regional with unknown sustained immunity. evaluated emergency preparedness infrastructure the changing geared for short-term, localized threats such TESTING landscape of as a flood, tornado or mass casualty event. the pandemic. Three zones were created to better Testing constraints drove off-label use of antigen testing that provides higher false As we plan to L coordinate efforts across the regions and to OCA ITY support our L COMMUN work closely with DeWine’s leadership team. positives and negatives. The DeWine member hospitals in OHA and the advisory group quickly Administration brokered a deal with 2021, OHA is guided by three fundamental determined the state did not have data Thermo-Fisher to bolster anemic testing lessons learned in our first eight months: collection and analytic resources to provide capacity, but that was quickly consumed by staff productivity increased for those critical, timely data to guide public health increased demands of re-opening of schools working remotely; the DeWine policy and emergency response for COVID-19. and college campuses and sports, large Administration relies on OHA’s leadership OHA’s data, IT and economic specialists employers wishing to test employees and and ability to mobilize hospital-based developed several data collection tools to track federal requirements for nursing home testing. initiatives; and our member hospitals can and report through dashboards statewide effectively collaborate in highly competitive levels across multiple critical areas: Facts and information about this marketplaces. • OHA Resource Tracker measures daily hospital bed, ICU and ventilator virus have changed since early EVOLVING APPROACH capacity; along PPE inventory and burn March. Our strategic approach Facts and information about this virus have rate; and staffing levels (physician, must evolve too. changed since early March. Our strategic nursing, ancillary) approach must evolve too. • Financial tracker measures COVID-19 financial impact on hospitals ONGOING ROLES FOR OHA, Early days of the pandemic presented MEMBERS unforeseen challenges in Ohio with missteps at the federal level. The unreplenished MODELING OHA’s ability to quickly deploy staff, National Stockpile, coupled with worldwide In March, early models predicting case and technical skills and measurement tools led demand for personal protective equipment hospitalization surges were based on the DeWine Administration to charge OHA fueled an early crisis that required delaying susceptible-infectious-recovered, or SIR, with developing and managing two ongoing all non-essential procedures to conserve PPE. methodology which is typically used to COVID-response initiatives—assuring the First COVID tests developed and released estimate the impact of infectious diseases nearly 1,000 nursing homes in Ohio are by the CDC were faulty and delayed on a population. Given the contagiousness partnered with a specific hospital as a identifying and containing early spread. The of COVID-19 and early data from China and backup to monitor PPE resources and U.S. opted to forgo a national testing Italy, the exponential curve and size of the quality control measures; and developing strategy, leaving states and local predicted surge was alarming and facilitated and tracking the Hospital PPE Readiness communities to compete for limited testing widespread compliance with Ohio’s Stockpile to assure backup inventories are capacity while also competing for PPE. shutdown orders and hospital preparation available to all hospitals and nursing homes for the surge. within each of the three response zones.

Members Identified What Worked, What Did Not to Plan for New Case Wave (Continued)

hand and, most importantly, where we need to focus our therapeutics and potential vaccines. efforts on behalf of members as cases are spiking and Yet, as we head into the holiday period where Ohio families planning for vaccine distribution is beginning. are likely to gather in groups large and small, cases and Much is still unknown about the virus itself, but we have hospitalizations are hitting record numbers. better tools to track and project supplies, staffing and financial In developing this report, we asked our member leaders to impact for our members. Leaders of OHA member hospitals share what worked—and what did not—within their own are directing the reconfigured zone management approach. organizations, with OHA and with state, local and federal OHA, along with members, continue to drive numerous authorities. Our aim is to provide our members with a clear public awareness campaigns to share the prevention and view of the resources at hand to help guide your strategic virus mitigation strategies that we now know can work. Ohio decisions to attack and manage climbing case numbers and hospitals are on the forefront of developing and testing new to guide our advocacy on your behalf.

Hospital Insights | 2 BOARD OF TRUSTEES OHA Board Identifies Key Priorities to Prepare for COVID Escalation

The OHA Board of Trustees in mid- well as local, state and federal authorities on • Are there initial successes we can build on? September used its annual retreat to each six focus areas. Then, board members • Are there initial breakdowns that must highlight next steps for the association to were asked to define: be addressed? work with members to address the next • What strategies in each of the six focus • Where can OHA be most influential? phases of pandemic response. areas would you recommend to best Highlights of those recommendations are On a scale of 1–5, with 5 being best, mitigate the potential impact of a included in this summary. members ranked the performance of OHA as “perfect storm” of pandemic escalation?

POLLING RESULTS AND NECESSARY NEAR-TERM STRATEGIES

AVERAGE Strategies Strategies AVERAGE SCORES SCORES • More consistent public communication • Testing strategy still lacking—Increased Local 3.0 between cities, counties and local health validated antigen testing and resources Local 3.9 State 4.1 departments needed State 3.5 Federal 2.1 • Connecting health departments with • Stockpiles need to be re-examined at all Federal 2.1 OHA 4.7 regional hospital associations levels, as they were inadequate for the first OHA 4.3 • Increased coordination with local health surge departments on testing and supply needs • Alternative care site/increasing capacity—What does that look like for a potential winter second surge? • Supply chain competition—Need for federal support

Strategies • Produce more near-term, local surge forecasting OHA Strategies

• Provide more context for • Ensure that AVERAGE the models—ex. worst case distribution L S SCORES A scenario vs. w/mitigation T methodologies

R A Local 3.2

• Provide ‘error bars’ for models E T are more E

D State 3.1

E reflective

F Federal 3.3 AVERAGE of hospital SCORES operational OHA 4.2 Local 3.6 LOCAL needs State 3.6 Federal 2.4 OHA 4.3

Strategies • Inconsistency in messaging between federal (CDC) and local health department messaging • Work to be done to improve public health infrastructure AVERAGE Strategies AVERAGE SCORES • Vaccine distribution—major upcoming SCORES Local 4.3 • Better infrastructure with our long-term care coordination effort Local 3.3 and skilled nursing facilities • Continued close partnership with state State 3.8 State 3.6 • Better testing infrastructure for all government Federal 2.3 institutions • Role clarity needed across varying entities Federal 1.9 OHA 4.7 • More stable supply chain across the state (zone/state/local/etc.) OHA 4.6

Hospital Insights | 3 Eight Months In: Ohio Hospitals Assess COVID-19 Response to Prepare for 2021

OHA releases finance tool for OHA launches member-only member hospitals to track webpage tracking private payer extraordinary costs related to plans’ COVID coverage, billing COVID-19 to guide advocacy procedures. for hospital financial relief.

DeWine announces Ohio halts non-emergency Ohio Manufacturing DeWine convenes first Executive procedures to conserve Alliance and OHA’s role Advisory Group meeting with OHA hospital beds and personal as the group works to leadership and member hospital protective equipment. source PPE and critical executives to advise the Administration. supplies. Group goes on to launch member workgroups to create guidance OHA Resource Tracker launched documentation to address hospitals’ to collect member hospital Ohio’s emergency surgical, supply chain, testing and data data to support hospital response shifts to modeling needs. and DeWine Administration 3 zones led by OHA response planning. member leaders. OHA Resource Tracker becomes the OHA data analysis informs OHA launches member email state’s key view of daily hospital bed, redistribution of hospital and webinar briefings for ICU and ventilator capacity; PPE resources of Ohio’s hospital leadership. inventory and burn rate; and staffing eight-region emergency levels (physician, nursing, ancillary). Email briefings become nightly, management structure OHA further develops additional webinars weekly through the into three zones. Zone dashboards allowing members to summer and include regular leads then directed sort and view data to drive local updates from DeWine and Sens. standing up overflow and decisions. OHA Data Services can Brown and Portman. Email updates testing facilities. biweekly, webinars weekly as the submit the data to federal agencies pandemic continues. on behalf of members to guide distribution of financial, PPE and therapeutic resources.

OHA notified HHS’ blanket waiver includes 1135 waivers OHA requested on behalf of members. OHA’s Mike Abrams explains  These provided hospitals with Zone 1 hospitals’ preparation  flexibility by waiving certain Zone 2 and response strategy at  Zone 3 DeWine’s statehouse news Stark Law, hospital capacity, workforce, paperwork and briefing. telehealth requirements.

APR 1 MAR MAR MAR MAR 27 MAR MAR MAR MAR MAR MAR MAR 27 JAN 20 22 26 20 4 5 7 9 13 17 Coronavirus Aid, Coronavirus Aid, Relief, and First 3 COVID cases reported Relief, and Economic First U.S. COVID diagnosis, Economic Security (CARES) in Ohio; DeWine declares Security (CARES) Act Snohomish County, Washington Act signed into law state of emergency signed into law

Hospital Insights | 4 Eight Months In: Ohio Hospitals Assess COVID-19 Response to Prepare for 2021

OHA creates the Hospital PPE Readiness Stockpile to support re-opening hospital services.

OHA launches 2-month statewide “Do the Right Thing” campaign to support spread mitigation efforts. OHA launches statewide thank you campaign to salute hospital employees during National Hospital Week. OHA secures hospital- specific cost coverage OHA, OSMA, OCHA launch “Health Care is Safe in add-ons from ODM. Ohio” campaign and share tools with members.

ODM orders MCOs OHA secures federal preparedness and to suspend prior response grant (ASPR) for members. authorization for discharges to post- acute settings

NOV OHA launches 8-week “Mask Up” 12 awareness campaign and share tools with member hospitals. NOV 5 APR JUL OCT MAY JUL 23 1 MAY 22 28 29 10 MAY JUN SEP 20 2 23

FIRST OHIO PEAK SECOND OHIO PEAK THIRD OHIO PEAK 1,100 hospitalizations 1,122 hospitalizations 2,075 hospitalizations 481 in ICU 348 in ICU 541 in ICU 333 on ventilators 174 on ventilators 270 on ventilators

Hospital Insights | 5 MANAGING THE WINTER SURGE Family Holiday Gatherings Likely to Extend COVID Case Spike

Most Ohio colleges and universities this fall We may be facing a winter surge from a religious leaders form a local COVID provided significant virtual offerings to their very difficult position, giving our current Defense Team to attack case surge in their students. However, with approximately surge. Unlike the first surge planning where local communities—communications 600,000 students enrolled in Ohio colleges hospitals had increased capacity, but limited tools have been provided and universities, and many other Ohioans PPE, the issue for this surge is not beds and • Work with the Executive Advisory Group attending college in other states, we know a facilities, it is staff. Nurse staffing shortages and the DeWine Administration on significant number of students were on are already affecting over 20% of Ohio vaccine planning campus or living in off-campus housing and hospitals. • Work with payers and the DeWine will be returning home to their families at Administration to adjust policies Thanksgiving. WHAT SHOULD WE DO ABOUT IT? affecting COVID surge management At the same time, Ohioans have pandemic fatigue and are eager for a return to life OHA CONSIDERATIONS FOR ZONES AND REGIONS before COVID. Between college students • Enhancements to the OHA Resource • Iron out load balancing plans, using the returning home, holiday celebrations that Tracker dashboards to support hospital assumption that many hospitals in the “expand the bubble” of gatherings with coordination in managing the surge region or zone are completely at capacity family and friends, • Discuss and plan for a worst-case colder temperatures scenario of a driving people back COVID patient indoors and the census four times inclination to not mask The slope of the upward trend what it is today around family is steep with no evidence of (nearly 8,000) members, we could be flattening to date. CONSIDERATIONS heading into the perfect FOR HOSPITALS storm from late Hospitalizations • Reevaluate surge November through Nurse staffing shortages plans, especially January. as the fact set has are already affecting over up 647% changed and ALREADY SURGING 20% of Ohio hospitals. since Sept. 20 staffing is the rate limiting factor The COVID patient • Work with the census in Ohio hospitals Executive on Sept. 20 was 563, a welcome drop after • In collaboration with the Ohio Advisory Group to implement Gov. the late July surge that hit mostly urban Organization for Nursing Leadership, DeWine’s call that community leaders, areas and congregate settings. Two months publish strategies for maximizing patient including mayors, local hospital later we are in the worst surge of the care with constrained staffing levels leaders, health commissioners, pandemic. Hospital COVID patient census is • Work with the DeWine Administration business leaders and religious leaders now 325% higher than the late July peak, and the professional boards to ease form a local COVID Defense Team to and the slope of the upward trend is steep credentialling constraints during the attack case surge in their local with no evidence of flattening to date. pandemic communities—communications tools New case numbers are surging, with Ohio • Work with the Executive Advisory Group have been provided adding over 7,000 cases per day. The surge is to implement Gov. DeWine’s call that • Plan for a worst-case scenario of a widespread across Ohio in urban and rural community leaders, including mayors, COVID patient census three times what areas alike. Unlike the other peaks, this time local hospital leaders, health it is today, as your neighboring the surge is happening all over Ohio at the commissioners, business leaders and hospitals may be at capacity as well same time.

CONTACTS SOURCES Amy Andres Ohio Hospital Association Senior Vice President, Quality & Data Ohio Department of Health, coronavirus.ohio.gov [email protected] Ohio Department of Medicaid caseload report For OHA data questions: Ohio Department of Job and Family Services [email protected]

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