Isle hospitals scraping by


  • Hilo Medical Center

Hospital admissions and visits to Big Island emergency rooms are starting to rebound after drastically declining in the early days of the COVID-19 pandemic.

According to information provided by Hilo Medical Center, daily visits to the emergency department decreased by 47% in April. Prior to the pandemic, the emergency department had an average of 4,300 visits per month, compared to 2,298 in April.


Those numbers, however, are creeping up, with 3,550 visits in July and 3,362 visits in August.

HMC admissions also were down significantly in April — 537 compared to an average of 720 per month before the pandemic — but are increasing. HMC had 686 admissions in July and 668 admissions in August.

Dan Brinkman, East Hawaii Regional CEO, Hawaii Health Systems Corp., said HMC patient volumes have declined approximately 10% compared to last year.

“So, that obviously is going to impact our revenue,” he said.

But hospitals, which Brinkman said have “very high fixed costs,” are different from other businesses in that they cannot significantly reduce operations and infrastructure to account for such a decrease.

And fewer patients will have financial ramifications.

According to HMC, the hospital’s budgeted revenue for the 2020 fiscal year, which ended June 30, was $192 million, but actual revenue was $177 million, an 8% shortfall.

For the current fiscal year, HMC is anticipating another 10% revenue shortfall.

More than $11.5 million in federal funding provided through the Coronavirus Aid, Relief and Economic Security (CARES) Act has “certainly helped bridge some of that gap through the fiscal year we’re in now,” Brinkman said.

The state also decreased some of the hospital’s pension contribution requirements, and HMC reduced expenses as much as possible, he said.

Brinkman said HMC also was in a “strong cash position” going into the COVID-19 crisis.

As such, Brinkman thinks HMC can get through the current fiscal year, which ends June 30, 2021, without furloughs or pay cuts.

“We should get through this fiscal year fine, but like a lot of other businesses and individuals, we’re really worried about the next year and what the impacts might be.”

How HMC fares financially will depend on two factors.

First, Brinkman said, is how much COVID-19 is controlled within the community, “because the more COVID is out there, the less people access their health care services. … We’re still a business that is supported by the use of the community … More COVID means less patients in the long run — in all of our operations, not just on our inpatient side.”

The second is state funding.

As a public hospital, Brinkman said about 17% of HMC’s funding comes from the state. If the state is facing its own significant budget shortfall, it’s a concern the hospital “might not be funded as well as we need to be.”

Brinkman, however, said HMC has two main goals: to preserve its health care infrastructure and to keep people working.

Other Big Island hospitals also are seeing impacts from the novel coronavirus.

Judy Donovan, spokeswoman for Kona Community Hospital and Kohala Hospital, both of which are part of the Hawaii Health Systems Corp. along with HMC, said the Kona hospital’s emergency room has averaged about 40 visits per day compared to 60 per day before the pandemic.

Inpatient admissions are down by 20%, with about 65 fewer admissions per month, she said.

Overall, hospital revenue is down $1.5 million per month, according to Donovan.

However, KCH has received $12 million in federal coronavirus relief funding to help with lost revenue in the current fiscal year’s budget, she said. Kohala Hospital also received $3.5 million in federal relief funding.

Lynn Scully, spokeswoman for Queen’s North Hawaii Community Hospital in Waimea, said visits to the hospital’s emergency room dropped notably early in the pandemic.

“Volume has increased steadily since then, but (is) still lower than pre-pandemic,” she said in a recent email.

Similarly, admissions to the hospital decreased as elective surgeries were canceled in anticipation of a COVID-19 surge, Scully said.

“Elective procedures were re-established, and QNHCH has been fully operational now for several months.”

Scully said almost all medical facilities likely have had financial impact from COVID-19, including North Hawaii, “although there are some offsets thanks to the federal CARES Act funds.”

She did not specify how much of that funding QNHCH will receive and said those funds run through The Queen’s Health Systems.

As the pandemic continues, Big Island health care leaders also are encouraging the community to seek health care services when necessary.

“The staff at QNHCH would like to remind people to make sure they are taking care of their health,” Scully said. “There has never been a safer time to come for care, and ignoring health issues, especially with chronic issues like diabetes and asthma, can cause unnecessary complications.”

Brinkman said more people now are seeking health care — such as elective surgeries or addressing more serious conditions — but many are foregoing preventative care.


“I would really encourage our community to use their local health care services,” he said. “… I think these days, close to home is certainly better. The support of their hospital is very helpful in making sure we can preserve the services we really are dependent upon.”

Email Stephanie Salmons at

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