Like most hospital systems across the nation, FirstHealth of the Carolinas has been pulled in opposite directions during the coronavirus pandemic — a critical provider of care, yet a business struggling to cope with plunging finances.
In a candid and clear-eyed assessment of his business last week, FirstHealth CEO Mickey Foster said he’s never been through such a challenge in his long career.
Foster was the featured guest panelist during a virtual event on Wednesday sponsored by Moore 100, a subgroup of Moore County’s Partners in Progress.
The healthcare industry and associated businesses provide 36 percent of private workforce employment in Moore County. Like tourism and agricultural interests, the regional economy is intrinsically tied to a robust healthcare system.
This spring, that system was mightily tested as a result of the COVID-19 global pandemic — a fight not yet won as both the disease and economic repercussions continue to smolder.
“It caused a dramatic impact on our organization in a very short time,” said Foster, who took over as the top executive at FirstHealth last year. “This was the hardest thing I’ve done in my 25 years is to lead an organization through an event — that we are still leading through.”
In mid-March, FirstHealth experienced, essentially, an overnight plummet in patient volume that continued through April. The loss extended to every department, from food service to wellness visits at clinics, in addition to the decision to postpone non-elective surgical procedures until May 11.
“There is no blueprint or training to deal with a pandemic that goes on for weeks and months. It was an incredible experience for our team to go through.”
FirstHealth’s average in-patient count dropped from 307 to 195. The emergency department average of 400-500 patients dropped to 219 — nearly a 50 percent reduction. Average surgical volume of 43 patients per day dropped to 19.
“We are a census-based organization,” he said, noting that staff schedules regularly flex up or down depending on patient volume. “As CEO, there is nothing I could do or say to control that situation.”
FirstHealth of the Carolinas employs some 5,000 workers across its 15-county footprint. Foster acknowledged that employee furloughs and reduction in hours were necessary; however, there were no staff layoffs.
The organization also initiated an immediate multi-million dollar expense reduction plan to cut discretionary spending drastically, he added.
“We had two or three months of some of the hardest work. I don’t think our leaders have put in more work than any other time in their careers.”
Throughout the pandemic, FirstHealth leaders have met regularly for a "virtual huddle” with partners from Pinehurst Surgical Clinic, Pinehurst Medical Clinic, and Moore County officials.
“So everyone knew what the CEO knew,” Foster said.
Communication was critical, he explained through a detailed timeline review. FirstHealth held a board meeting on March 17 to prepare for COVID-19 cases. The healthcare system's first patient tested positive at the MRH-Hoke campus the following day.
As part of its initial response, FirstHealth also activated its Emergency Operations Plan and opened a command center. In the ensuing weeks, visitor restrictions were tightened and Foster said the organization’s 1,000-strong volunteers were asked to stand down for safety purposes.
By March 30, FirstHealth had its first hospitalized inpatient and, in early April, reported the first death of a patient to the disease.
FirstHealth has been conducting 100 COVID-19 tests per day, on average, with 15 positive results, Foster reported. On any given day, approximately 15 to 18 positive COVID patients are hospitalized, primarily at Moore Regional in Pinehurst. On Friday, that number was 20.
Throughout April and May, FirstHealth saw a surge in telehealth or virtual medical visits while in-person clinic volume dropped. Foster described this as a “dual track” for healthcare services.
In a bit of serendipity, “FirstHealth On The Go,” the organization’s online telemedical app, launched last December.
Dr. Daniel Barnes, president of FirstHealth Physicians Group, also participated in the Moore 100 panel. He said the purpose of the online app is to help fill gaps in coverage for patients who might not be able to make it to their primary care physician. During the pandemic, this technology has proven particularly useful for medical staff and helpful to patients.
Dr. Paul Jawanda, an infectious disease specialist, also participated in the discussion.
He described COVID-19 as a “brand new virus that humanity is learning about,” with researchers discovering new information constantly.
Jawanda said recent information indicates there is more transmission of disease when people are not only in proximity, but actively engaging each other in conversation.
“People of all ages can be infected,” he reminded the Moore 100 group, but those with underlying medical conditions are at greater risk for complicating factors and severe symptoms.
Foster said FirstHealth remains committed to patient satisfaction and quality. Earlier this year, Moore Regional Hospital-Pinehurst, along with Moore Regional Hospital-Hoke and Richmond campuses, ranked No. 4 for “patient picks” according to Business North Carolina magazine.
“We have not had a drop in patient satisfaction or quality as a result of the pandemic. We are trying to create a culture of the best in healthcare.”
He also spoke glowingly of the community’s support — “humbling,” he said — of the thousands of handsewn masks donated by the Pinewild Country Club community and others. Then there’s been the corporate support, including face shields from Ford Motor Co., first-responder vehicle parades, the Meals-to-Medical program and its many private donors, prayer services and a fly-over by the Bandit Flight Team.
“We have signs across our organization that say ‘Heroes Work Here.’ That is true of our medical staff and employees. I could not be more proud of our team.”
FirstHealth’s “new normal” began on May 11, Foster said, with the reopening of non-elective surgical procedures. The Fitness Centers have resumed some specific programs, in addition to some rehabilitation programs such as physical therapy. Visitor restrictions were also recently eased back a bit.
“Our physicians and staff have gotten us through a lot of this. I cannot tell you how proud I am.”