The Denver Health Medical Center in 2013.

The Denver Health Medical Center in 2013.

Denver Health is still grappling with a staffing crisis that's become significant enough that the hospital is limiting the number of patients it can take and is over capacity "multiple times a week," its chief medical officer said Friday.

As a result, the hospital is spending "more and more" on traveling nurses and providers, Connie Price said. It's a practice that became common during the pandemic and is essential to fill holes left by departing staff. It's unsustainably costly, Price said, and if the situation doesn't improve, the hospital will have to look at prioritizing some services and potentially limiting or closing others.

"What are the services that are absolutely essential we need to continue, and what are some of the things that might be extras, that we just can’t sustain?" Price said. "We’re not there yet, but if we don't get some relief, we’re going to have to call that into question."

Burnout and exhaustion have plagued the health care industry since the beginning of the pandemic. Staffing levels at Denver Health and other Colorado hospitals was more of a threat to daily operations than a crush of COVID-19 patients, officials have said over the past year, and the use of contract, traveling staffers became an unavoidable cost.

Denver Health spent more than $61.5 million on contract labor in 2021, $20 million more than it had expected, according to its audited financial statements. That, coupled with fewer federal stimulus dollars in 2021, meant the hospital lost more than $9 million in operating income last year. It had lost $664,000 during the first year of the pandemic after coming out ahead by more than $53.7 million in 2019.

"With healthcare workers leaving the workforce due to the pandemic, (Denver Health) had to utilize an unprecedented amount of contract clinical labor at higher than historical rates to meet the medical needs of its patients," its independent accountants, BKD, wrote in their year-end report. 

"If this doesn't get better, it becomes a question of, 'What can we do?'" Price said. "What should we do, what can we continue to do without having to be reliant on travelers to staff our institutions?" 

That report indicated the hospital expected its contracted labor costs to decrease by 15% as new hires were brought on. But in a financial report for the first quarter of 2022, the hospital reported it was still using more contract labor - at a higher hourly cost - than expected. The report also showed that while the hospital's revenues were slightly better than expected, its expenses were $17 million higher than budgeted through the end of March.

Denver Health has been focusing on "recruiting and retaining existing staff," she said, but the hospital can't compete financially with other, larger systems that have far larger pocketbooks. Officials instead focus on Denver Health's intangibles: its mission and environment, while trying to make sure providers are doing what they're trained to do, instead of returning messages or filling out paperwork.

The hospital is still trying to figure out what other measures are effective in combatting burnout to stop the bleeding, but it's a vicious circle: Every departing staffer means the rest have to pick up more work, increasing their own likelihood of feeling exhausted and subsequently leaving.

Price said hospital officials haven't talked about what specifically they may cut if the staffing situation doesn't improve. But she ticked off things such as closing beds, limiting the number of operating rooms available or examining services "that aren't financially sustainable and re-evaluate whether we can continue doing that work." 

Denver Health shoulders a significant share of the city's uncompensated and indigent care costs - meaning care that it essentially provides for free and has to absorb on a budget sheet - as part of its mission.

Its uncompensated care in 2021 nearly hit $300 million, according to its annual report, which is its highest level since 2013. With the staffing situation, Price said, the hospital has to ask other systems to begin taking on more of the load.

"We have to ask others to help out in maybe providing uncompensated care for cancer patients, or things that often we have been upon in our community to do," she said. "We need to ask others that maybe are more fortunate and maybe still are able to turn a profit to help us out, to help us take care of that mission, because we don't have the resources to do it."

"I want to be clear: It's never been solely Denver Health's obligation to serve that vision," she continued.

As part of hospitals' status as nonprofits, they must provide a level of community benefit, which often includes uncompensated care. "Everyone needs to take part in it. We just may need to hold others more accountable in that task."  

Seth Klamann is the health reporter for the Gazette, focused on COVID-19, public health and substance use. He's a Kansas City native and a University of Missouri alum, with stops in Wyoming, Omaha and Milwaukee before moving to Denver.