Houlton Regional Hospital has reduced pay to salaried employees, including physicians, and furloughed its hourly employees to keep its doors open as it prepares for a surge in COVID-19 patients.

The need for cuts at rural hospitals across Maine highlights a paradox – at a time when health care professionals are most needed, the state’s smaller hospitals are looking to save money by reducing pay and furloughing employees.

Salaried employees at Houlton face pay cuts ranging from 2 to 10 percent, and hourly workers are being required to take one furlough day a month, said Shawn Anderson, the hospital’s director of operations. In all, 400 workers are affected.

He said the cost-cutting measures are largely driven by two factors: the hospital is no longer getting revenue from emergency room visits, because people are staying home and not getting injured, and elective procedures have been canceled to make room for an expected surge in patients with COVID-19, the disease caused by the new coronavirus.

Anderson hopes the cost-cutting measures will buy the hospital time until federal assistance arrives.

“None of us like it, but we do recognize it is our present reality,” Anderson said.

Hospitals throughout the state have taken measures to get ready for an anticipated surge of patients infected with the coronavirus later this month. But those moves have left hospitals, particularly those in rural areas already operating on tight budgets, without the money they need to maintain staffing levels, forcing them to consider pay cuts and furloughs.

Steven Michaud, president of the Maine Hospital Association, said several hospitals told the association during a recent conference call that they are considering similar cost-cutting measures. He said the association is surveying members about what cost-cutting measures they are adopting.

Hospitals with fewer than 500 employees are eligible for payroll assistance from the economic rescue package Congress passed last week, which contains $75 billion for hospitals, Michaud said. But he’s also lobbying state officials for financial assistance, since hospitals have lost revenue by canceling elective procedures at the state’s request.

“There is big money set aside for this kind of thing,” Michaud said. “We just don’t know how much we’re getting and when we’re getting it.”

He added, “Rural hospitals are on the edge anyway. They just eke out a little to get buy.” 

Mount Desert Island Hospital is doing everything it can to save money, but hasn’t yet had to resort to salary reductions or furloughs to make up for the 60 to 70 percent drop in patient volume, the hospital’s CEO said.

“We are in a financial position that for a very, very short time we are able to sustain the drop in volume we’re experiencing at the moment,” Art Blank said. “We’re in this situation where we’ve emptied the hospital and knowing it could fill up on a moment’s notice. The economic strain is palpable.”

Some hospitals have become “ghost towns,” Michaud said, but they still must meet payroll and maintain staffing so they can respond to any influx of COVID-19 patients. Some rural hospitals will not be able to meet payroll in a couple weeks, he said, unless financial assistance arrives.

“I am pleading with state government to join the federal government to step in here,” he said. “We can’t have (hospitals) going bankrupt. We can’t have them laying off employees at a time when we need them more than ever. We have got to keep them alive for now.”

As of Friday, the Maine Center for Disease Control and Prevention had reported 432 cases of COVID-19 – an increase of 56 cases from Thursday. Nine people have died, and 75 people had been hospitalized at some point during their infection.

Aroostook County, where Houlton Regional Hospital is located, and Washington County each record their first cases each on Friday.

Of Maine’s 289 intensive care unit beds, 110 are available for use, according to the Maine CDC. Based on the experiences in Italy and New York City, about 15 to 20 percent of all COVID-19 hospitalizations require an ICU bed for the most severely ill.

So far, the state has been contacted by more than 2,200 medical professionals, including retirees and students, who are willing to address staffing needs at existing hospitals or temporary sites, the Maine CDC said. Most are registered nurses. And 750 are part of the Maine Medical Reserve Corps and an additional 80 are part of new school nurses group.

Until that assistance arrives, some rural hospital workers will be getting paid less at a time when they face a greater risk. The coronavirus spreads easily through respiratory droplets, and hospitals nationwide are facing a shortage of personal protective equipment.

The risk to health care workers was highlighted Friday. Maine CDC Director Dr. Nirav Shah said that 75 health care workers have tested positive for COVID-19. That’s nearly one out of every five cases.

The case in Aroostook County involved a patient who went to the Houlton Regional Hospital this week with mild symptoms, Anderson said. He said the patient is self-isolating and recovering at home. He declined to provide additional information, including the patient’s age or gender.

“I couldn’t be prouder of our team,” Anderson said. “All elements of our emergency plan went off exactly as it should have. At the end of the day the patient is home recuperating.”