In the war against COVID-19, two hospitals face far different fronts.

One is in a hot spot, battling a widespread virus that has resulted in thousands of patients. The other hospital has seen just a few COVID-19 patients and there’s no surge in sight.

Yet the disease threatens the financial health of both institutions as their most profitable customers — non-emergency patients — have stayed home. Both hospitals saw the number of their inpatients drop by half in April.

The hospitals have much in common. Both are at medical schools and serve as regional safety nets. But as of mid-May, UMass Memorial Medical Center in Worcester, Massachusetts, had admitted almost 2,700 COVID-19 patients, while MU Health Care’s University Hospital in Columbia, Missouri, had admitted only about 40.

Yet each hospital has canceled more than 2,000 surgeries. Tens of thousands of clinic visits have disappeared. Monthly patient revenue dropped by tens of millions of dollars.

The same has been seen nationwide. As coronavirus infections spread in March, visits to hospitals actually began to drop off.

By April, according to a Washington Post analysis of smartphone location data, that drop had turned into a crash.

As in many other industries, those lost visits represented a widespread financial crisis for hospitals and other health-care providers, even in places the novel coronavirus had hardly touched.

One-two punch

Many of the nation’s hospitals can ill afford theses losses. A third were already losing money on patient care before the virus hit, according to data compiled by Definitive Healthcare. More than 1,200 hospitals operated in the red in two or more of the last five years.

Then the coronavirus hit with a one-two punch. Patient revenue dried up, and preparing for possible outbreaks drove up costs.

One result of this financial stress: 1.4 million health-care jobs disappeared in April, according to the latest monthly government jobs report. Those included nearly 135,000 jobs lost at hospitals, more than 243,000 at physician offices and more than 503,000 at dental offices.

More than 260 hospitals have reported furloughs or layoffs due to coronavirus-related issues, according to tracking by Becker’s Hospital Review.

At MU Health Care, even with only a handful of COVID-19 patients at a time, cuts have affected 61 employees, 70 contract nurses and 300 open positions. UMass Memorial has been luckier, with no layoffs so far. Doctors and nurses whose usual work disappeared have been redeployed to help amid the pandemic.

March slowdown

Hospital visits started to drop nationwide in March as state and federal officials called for postponing non-COVID-19 treatments when possible to free up health-care resources. These cancellations included surgeries, outpatient procedures and even preventive services.

By mid-May, almost 94 million adults had delayed medical care because of the coronavirus pandemic, the Census Bureau reported in its Household Pulse Survey. Some 66 million of those needed but didn’t get medical care unrelated to the virus.

“Whether you have a lot of cases, or don’t have a lot of cases, you’re going to have a financial hit,” said Will Ferniany, chief executive of the UAB Health System. While COVID-19 patients never came close to filling intensive care beds at its Birmingham, Alabama, hospital, occupancy of other beds dropped to less than half. Ferniany’s system is losing $70 million a month in patient revenue, which it must try to make up with cost-cutting and federal aid.

Under the Cares Act, the Department of Health and Human Services says $175 billion was allotted for health-care providers, including hospitals in rural and high-impact areas and places treating uninsured COVID-19 patients. But hospitals could miss out on some aid if they hadn’t treated a minimum of 100 COVID-19 patients, despite the pandemic’s widespread financial damage.

In the latest smartphone data from the location tracking company SafeGraph, hospital visits started to recover in the first half of May, although they were still down from 2019 by about 40%.

Hospitals have begun rescheduling postponed surgeries and reopening clinics, especially in parts of the country where coronavirus cases never surged or are declining. Janis Orlowski, chief health-care officer at the Association of American Medical Colleges, said the rebound of local hospitals will depend on three factors: adequate supplies of protective equipment, the availability of coronavirus testing to insure that non-emergency patients aren’t infected, and contact tracing so that people exposed to the virus can be kept isolated.

“Rather than everyone staying home,” Orlowski said of this scenario, “the people who were exposed to the disease are staying home.”

Changes to remain

Mark Wakefield, associate chief medical officer of MU Health Care, said appointments at the Missouri system’s clinics are building back toward pre-COVID-19 levels. Rescheduling is underway for procedures such as hip and knee replacements, repairs for hernias and cataracts, and bariatric surgeries for weight loss, even as the hospital still reserves resources for a possible surge in coronavirus cases.

Returning patients and visitors across the country will see changes that are here to stay. Screening for infection symptoms before appointments. New barriers, social distancing and restricted visitation. Appointments spread out over longer hours to spread the traffic. Fewer forms to touch. Drive-ups for shots. Waiting in your car to see the doctor. More use of technology to keep space between patients and health-care providers.

Before the virus hit, MU Health Care was using telehealth for virtual patient visits about 200 times a month. Now, Wakefield said, “We’ve done more than a thousand a day for many days.”

Will it be enough to bring all the patients back? For Eric Dickson, president and chief executive of UMass Memorial Health Care, the goal of these changes isn’t just to successfully prevent disease. It’s also to help overcome fear, and reassure people still worried about the coronavirus that enhanced vigilance and infection controls make hospitals safe.

Dickson said he’s concerned about people staying home with minor symptoms, like the temporary numbness or weakness of a warning stroke. “We can prevent that big stroke, if people come in,” Dickson said. “But they’re not coming in ... We’re seeing a lot of that later-stage disease.”

It’s also unclear if all the jobs will come back. MU Health Care chief executive Jonathan Curtright said he sees a future where hospitals continue to cut costs, eliminate duplicated services and cast a critical eye on their need for buildings.

“We’re going to continue to have massive revenue pressures,” Curtright said. “We’re going to have to transform ourselves.”

About the data

Hospital traffic estimates for this story were based on data from SafeGraph, a company that aggregates location data from tens of millions of devices and relates it to building footprints. Other data sources: the Census Pulse Survey, conducted May 7-12, for estimates of people who delayed health care during the previous month; hospital financial reports compiled by Definitive HealthCare; county coronavirus infection rates compiled by The Washington Post; and annual estimates of personal spending on health-care services from the Bureau of Economic Analysis via Peterson-KFF Health System Tracker.