Photo: Ortho sugery at RRMC. Photos courtesy RRMC.
by Olga Peters, Vermont Business Magazine “We're okay, we're doing well, we're financially stable, but we don't know what the future is going to be,” said Claudio Fort, president, and CEO at Rutland Regional Medical Center (RRMC).
When the COVID-19 pandemic reached Vermont last March, the hospital went into protective mode. It stopped all elective procedures and watched its revenues drop.
Next, RRMC took what Fort called “defensive financial measures” to ensure the hospital’s financial health. Measures such as extending the institution's line of credit, taking a $25 million advancement on Medicare payments from the federal government, and restructuring staffing levels. This led to a reduction in the workforce of a total of 41 FTE employees.
“We just didn't know about our future. I mean, we had saved for a rainy day, but it was, you know, it was pouring,” Fort said.
The hospital also furloughed some staff, Fort said. By the middle of summer, most of the staff were reinstated.
A year later, Fort said that between the financial changes and thanks to the emergency relief funding from the federal government and state, RRMC has a little excess funding.
The institution is also seeing a new wave of patients many of whom had postponed annual physicals or elective procedures last year.
For now, he cautioned. Next year still carries uncertainty.
“Our concern is next year,” he said. “How well will the rest of the economy rebound?”
“We've got some excess funding, but we've got to be very careful,” he continued. “We're putting our budget together right now for next year, and we're very careful about not adding resources, not trying to start new programs or services that we might not have the funding going forward to sustain.”
With caution in mind, the hospital is building its budget for the coming fiscal year. Fort described it as a “status quo” document that maintains the hospital financially without adding anything new. Except, of course, Fort clarified new COVID-related protocols.
“That, you know, there's no additional long-term funding for things like screening people when they come into the hospital, and providing access control, we see us needing to continue to do that for you know, into the next year,” he said.
Based on information from the state, Fort anticipates continuing to be in the COVID testing business well into next year if not longer. He estimates the added cost of screening people as they enter the hospital alone will cost $300,000 a year.
“We were very fortunate,” Fort said. “Most of the patients that came into this hospital, we were able to send home.”
RRMC hospitalized between 100 and 150 COVID-positive patients last year. As of May, the hospital was treating approximately five COVID-positive inpatients.
Testing And Vaccines
Early in the pandemic, Fort remembers worrying about having enough supplies. Personal Protective Equipment, such as N95 face masks, was hard to find. But so were routine supplies like the saline used to start an IV and some drugs, he said.
RRMC worked to build up a small stockpile of supplies but one hard-to-find item kept floating to the top of the list: COVID testing kits.
Photo: RRMC's facility access screener. Photos courtesy RRMC.
“The testing availability was sporadic so that when you're trying to manage this and you don't know whether that patient or that person, that is showing some symptoms has COVID or not, the only thing you could do was quarantine them and send them home,” he said.
Hospital leadership decided they couldn’t rely on outside facilities to meet their testing needs. So, said Fort, RRMC became the third in-house testing site in the state.
At that time, UVM Medical Center, and the state health lab were the only places in Vermont that were doing COVID testing, according to Fort.
A benefactor stepped forward and helped the hospital purchase three different types of what Fort called “testing platforms and equipment.”
Why three? Because even the testing supplies were hard to get. By investing in three different platforms, the hospital could switch to another platform if the supplies for one became scarce.
Fort estimates the institution spent approximately $1 million to buy the testing platforms. It was worth it, he said. Knowing within 45 minutes whether a patient’s fever was from COVID or the flu saved a lot of PPE supplies, staff time, and stress.
Fort is proud of how staff managed RRMC’s mass vaccine clinics. The hospital leased the lobby and main ballroom of the Holiday Inn located in Rutland. The staff can administer up to 800 vaccinations per day, he said. In the middle of May, the hospital celebrated giving the 50,000 shot.
“It was a tremendous amount of work, but we were very happy to do it because, after a year of being on defense, it was the first time now we went on offense in this war. “
Now that approximately 60 percent of the population has received a vaccine through the clinic, Fort said staff is switching to bring the clinics to community members.
“By mid-June or so we'll be able to ramp that down,” he said. “Now, you hear some of the internet providers talk about the last mile internet service, I think we're really quickly approaching the last mile of vaccine distribution.”
For example, the hospital is planning to set up a clinic at the Rutland High School for students whose parents want them to receive the vaccine.
“Yeah, really, the quickest way to stop wearing your mask is to get the vaccine,” he said.
RRMC needs approximately 475 nurses, said Fort. Right now approximately 450 work at the hospital with 40 of the nurses being traveling nurses.
Hospitals hire traveling nurses or doctors to backfill staffing shortages. These professionals are good at what they do, they also cost the facility more, Fort said.
Paying a traveling nurse costs on average 1.75 times what it costs to employ a full-time nurse, he said. During the height of the pandemic, the hospital was paying 2 times what they generally paid employed nurses.
“The nursing shortage was one of the things that we were increasingly concerned about before the pandemic and were looking for some innovative ways to expand nurse training and opportunities here in Vermont and partner with our colleges,” Fort explained.
The Community Pitches In
Fort’s voice carries a tone of awe and gratitude when he talks about all the ways community members and local businesses supported the hospital last year.
Restaurants and community members brought meals for the staff and businesses donated PPE. A local painting business and Casella Waste Systems donated their N95 face masks.
“We saw those stories of people where they were having the waves of infection, COVID patients coming in, and the nurses and the doctors with bandanas wrapped around their face,” he said. “That was one of my biggest fears and our business community came to the table and brought us some of their supplies from their businesses.”
Slowly Returning To Normal
RRMC is returning to its pre-pandemic days.
Visiting hours have been reinstated and by the end of May, the volunteer program will return.
“We had about 350 active volunteers here who were tremendously important to our mission,” Fort said. “We’ve really missed them over the past year, that's been one of the big losses.”
Fort joined the RRMC three years ago. He is looking forward to seeing the hospital come out of the pandemic.
“Our mission during this period was straightforward: protect our patients, protect our staff, and ensure the operational capability of this hospital. That was it,” he said. “As you can see, I'm tremendously proud of the people here and what they've done.”
Olga Peters is a freelance writer from Southern Vermont and a reporter for The Commons weekly newspaper in Brattleboro.