Outside in a courtyard on the University of Washington Campus Wednesday, advocates for several threatened medical programs rallied to demand the university protect their workplaces. Inside, at a meeting of the UW Board of Regents, the chief financial officer of the UW Medical Center painted a dire picture of the organization’s budget.
“This is an extraordinarily difficult time from a financial standpoint for healthcare providers,” said CFO Jacqueline Cabe.
At the end of the last fiscal year, UWMC had an operating loss of $75 million or 1.6 percent of its total budget. In recent months, the medical center has used those financial challenges to defend several controversial decisions. UWMC is considering closing its unionized laundry, which cleans linens for its hospitals and clinics. UWMC also considered closing its psychiatric unit, known as Seven North. UWMC cited expensive upgrades required at Seven North to reduce ligature risk for patients. The administration has since announced it will keep the unit open until it opens new beds at Northwest Hospital.
Speaking to the regents meeting Wednesday,
three nurses two nurses and an attending physician from the psychiatric unit said they were grateful for the temporary reprieve. However, while UW says the new unit will be similar to Seven North, nurses worry the new beds at Northwest Hospital may not in fact serve the same clients as the current unit. In particular, nurses told the regents they worry about women with high-risk pregnancies, who can currently seek both mental health and obstetrics care at Seven North. They also raised concerns about access to mental health care beds for UW students.
The current plans “will harm students, high risk patients, and the community,” one nurse said. “We have a responsibility to students and their parents to do everything we can to safeguard their lives.”
A worker from the UW laundry also urged the regents not to close the facility. Staff at UW's dental school, which is not part of UWMC but is also facing a deficit and layoffs, spoke at the meeting. They urged the school to await a forthcoming audit before making more cuts.
After public comment, Cabe delivered a presentation that offered few direct responses to workers but offered some insight into UWMC’s financial troubles. Harborview Medical Center is a “key driver” of the medical center’s financial loss, Cabe said. The hospital is often full or nearly full of patients, but some of those patients are staying “without medical necessity” to be there, which costs the hospital money. A shortage of longer term healthcare facilities is causing that backlog, Cabe said.
A change in what is known as “payer mix” across UWMC’s facilities is also driving the shortfalls. As more patients use government programs like Medicare and Medicaid, hospitals are making less money. According to Cabe, 45 percent of UWMC’s payments came from private insurance in 2017, down from 54 percent in 2006. According to Cabe, “every percentage point decline is worth about $7 million at the bottom line.” To address the shift, Cabe said the hospitals are working to improve “access” for people with private insurance by reducing hold times and waits for appointments. (Cabe later emphasized the hospitals seek to improve access for “everyone.”)
“We care for all people, but we have to have a reasonable balance,” Cabe said.
During the presentation, Cabe did not speak directly to the concerns of psychiatric nurses or laundry workers, other than to say no final decisions have been made about the laundry. Cabe called balancing UWMC’s budget “a big lift.” The organization is currently finishing its budget for the 2019 fiscal year.
“There is no doubt that’s difficult,” Cabe said. “We’ve seen some examples here today of the impact that change brings in terms of people being uncomfortable. It’s hard.”