Report On Business® Roundup: September Hospital PMI®
While images of tens of thousands of delirious, mostly unmasked fans in stadiums around the country show that many Americans have resumed pre-coronavirus pandemic lives, the metrics indicate COVID-19’s presence might be more silent, but it’s no less severe.
On October 6, 2020, the seven-day average of coronavirus cases in the U.S. was 47,477; a year later, the figure is 101,361. Deaths averaged 696 per seven days in 2020, compared to 1,799 this week. And the most sobering statistic of all: COVID-19 has already killed more Americans in 2021 — with vaccines widely available not long after the start of the year — than all of last year.
Data continues to tell a gripping story in the U.S. hospital subsector, which has been confounded by high COVID-19 case counts, shortages and delays of supplies that are no longer limited to personal protective equipment (PPE), and an employment situation that has become “frightening,” Nancy LeMaster, MBA, Chair of the Institute for Supply Management® (ISM®) Hospital Business Survey Committee, said on Thursday.
#COVID19 kept confounding facilities in September, per the Hospital @ISM® Report On Business®, with declines in inventories (which stayed in expansion) and #employment (which contracted further). The Hospital PMI® was 60.6%. https://t.co/VrkDgHYzx0 #ISMPMI #economy #healthcare— Institute for Supply Management (@ism) October 7, 2021
Those dynamics were evident in the Hospital ISM® Report On Business® for September. The Hospital PMI® registered 60.6 percent, but — as was discussed after ISM’s Manufacturing report was released last week — the subindex data and survey respondents’ comments sometimes tell a story that belies “happy days” headline numbers. “It was just a really, really tough month,” LeMaster said.
She continued: “Hospitals were overwhelmed with yet another wave of COVID. ... I wish I could say there’s a glimmer of hope that (the pandemic is abating), but I think hospitals will respond to that slowly. It’s not a flip-the-switch kind of situation where COVID-19 units can be turned back into regular medical and surgical units — it’s a big physical and mental shift. Also, there’s still a lot of concern of continuing mutation of the virus, and until children and a higher percentage of the population overall are vaccinated, hospitals are going to be pretty cautious about thinking that the worst is behind us. Until then, it’s a race to make sure the resources to take care of patients.”
The September index numbers suggest that, for many facilities, that mad dash to serve patients feels like it’s on a hamster wheel. The most pressing issue is with labor, as the Employment Index declined 6 percentage points to reach its lowest figure since May 2020, after COVID-19 had slammed the U.S. coasts and hospitals nationwide were desperately trying to staff up for a coming surge of patients.
The current situation is double-barreled, LeMaster said: While burnout continues among physicians, nurses and clinical staff, competition with other industries remains fierce for such workers as food service and housekeeping. But the burnout issue is more worrisome over the long haul, LeMaster says, as it could depress the prospective health-care workforce.
“In a lot of these disciplines, there’s a significant education process involved,” she said. “So, we have to make the industry attractive to people considering nursing or staff positions. People see the suffering among current staff and how hard they’re working, and that can be (discouraging). If that becomes an issue with the pipeline, it will be a long-term problem.”
The Backlog of Orders Index rose 8 percentage points, indicating that elective surgeries were postponed as hospitals handed coronavirus patients. According to data from the Centers for Disease Control and Prevention (CDC), the seven-day rolling average of hospitalizations in the U.S. was 12,216 on September 1 — a 71.9-percent increase compared with August 1 — and remained above 10,000 for the first three weeks of the month, when much of the Hospital PMI® data was collected.
The parade of container ships anchored outside Southern California ports is a poster for the product shortages facing health-care professionals. Most of the world’s surgical gloves come from Malaysia, where COVID-19 continues to restrict manufacturing labor, and gloves that do get on ships take longer to get to U.S. hospitals. As a result, facilities are attempting to bolster their stocks; the Inventories Index declined 9.5 percentage points but remained in expansion territory.
.@ISM Hospital PMI® survey respondent: “Our sourcing group is doing a phenomenal job of keeping us with (the same) products, because substitutions come with a lot of training. Keeping products helps alleviate errors.” #ISMPMI #economy #healthcare https://t.co/x6kpcBUGFu #COVID19— Dan Zeiger (@ZeigerDan) October 7, 2021
Noting that the Inventory Sentiment Index increased 7 percentage point to grow further into too high territory, LeMaster said, “Survey respondents consider inventories too high and growing, but they feel they don’t have an option. They’re trying to hedge their bets, not knowing if there will be yet another COVID-19 spike.”
There are few bright spots in hospital subsector data, exemplified by a report by the American Hospital Association and Chicago-based health-care consultant Kaufman Hall that states more than a third (35 percent) of U.S. hospitals will post negative margins in the third and fourth quarters. While that percentage is an improvement from the first half of the year, facilities will lose an estimated US$54 billion in net income in 2021 due to higher costs and less revenue from outpatient services and elective procedures.
And ultimately, the human cost becomes the most critical accounting.
“Hopefully, we can get through another wave of COVID-19 and get back to a more balanced patient mix with more elective procedures,” LeMaster said. “That helps with the bottom line and profitability, but more importantly, finding the labor to take care of folks. The hospital industry as a whole is struggling and trying to figure out how to balance expenses with the demand for services in a way that allows them to continue serving patients.”
In case you missed the Report On Business® Roundup from October 1 on the release of the September Manufacturing PMI®, you can read it here. The Roundup on Tuesday’s release of the Services PMI® can be read here. For the most up-to-date content on the three indexes in the ISM® Report On Business® family, use #ISMPMI on Twitter.