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Hospital performance improved in August, but health systems are still in negative territory, Kaufman Hall said in its new report.

The median Kaufman Hall Year-To-Date (YTD) Operating Margin Index was -0.3% through August, the consulting firm said in its new monthly report, which came out Monday. The index has been in negative territory for all of 2022 so far.

“Nine months into a challenging year, margins have fluctuated wildly,” the report states. “Although most metrics improved from July to August, organizations are still operating with negative margins and well below pre-pandemic levels.”

Even with hospitals making gains in some areas, “organizations are still in poor shape, with a negative median operating margin,” Kaufman Hall stated. Hospitals have higher expenses and lower volume compared to the levels before the COVID-19 pandemic began.

Hospitals are losing billions of dollars this year. Kaufman Hall prepared a report on hospital performance for the American Hospital Association last month. Its stark conclusion: 

More than half of all hospitals are projected to have negative margins for the rest of the year

Hospital leaders describe cuts in services due to financial crunch

Hospitals are seeing some improvement, but they are also seeing more competition in the form of urgent care centers and surgery centers, said Erik Swanson, senior vice president of data and analytics with Kaufman Hall.

“August was a better month for hospital patient volumes with both elective surgeries and discharges up, which combined to improve revenues,” Swanson said in a statement.

“Despite the short-term improvements, though, overall hospital performance is still well below pre-pandemic levels,” he said. “In addition, hospitals need to reckon with new market entrants, like urgent care centers and free-standing surgery centers, that are chipping away at hospital outpatient revenues and overall margins.”

As part of their long-term planning, health system executives should be considering ways to provide care outside the hospital, Kaufman Hall suggests.

As hospitals face economic downturn, leaders must think strategically

The latest report isn’t as dreary as some of Kaufman Hall’s other reports this year. Hospitals brought in more revenue, largely as they treated more patients.

Some patients returned to hospitals for elective procedures, the report suggests. 

Operating room minutes frose 13.6% from July to August and were up 5.5% year over year. Patient days rose slightly from July (0.7%), but are down 7.9% compared to August 2021. Emergency department visits increased 1.1% from July, but they are down 2.4% compared to August 2021.

Adjusted discharges rose 7% from July to August and were up 5.4% compared to August 2021.

The average length of stay in hospitals dropped a bit in August, falling 2.1% compared to July. In recent months, 

hospital leaders have said they are seeing patients who deferred care during the pandemic and are now sicker

, requiring longer and more expensive stays.

Congress gives rural hospitals a reprieve, for now

Gross operating revenue jumped 9.1% from July and is 5.5% higher than in August 2021. Outpatient revenue rose 10.9% from July and is up 7.8% year-to-date. Inpatient revenue rose 4.9% from July to August, and is up 2.3% year-to-date.

Total expenses rose 3.3% from July to August and are 6% higher than August 2021. Total expenses are up 8.9% so far in 2022. Hospitals paid more for supplies in August, with supply costs rising 10.7% compared to July.

Labor expenses rose 1.3% from July to August, but have jumped 10.6% since January.

The number of full-time employees per bed dropped 3.3% in August, compared to July. Kaufman Hall said that indicates “the labor shortage is still very much in effect.”

Kaufman Hall examines data from more than 900 hospitals to produce its report.

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Despite some revenue growth, many hospitals are likely to finish the year in negative territory, Kaufman Hall said in its latest report. 


Hospitals improve in August, but stuck in red for 8th consecutive month

Women don’t earn as much as men, even with similar education, and the gender gap has a big impact on the health of women.

Typically, women earn about 80 cents for every dollar earned by men, but the disparity is even wider among women of racial minority groups. Black women earn 63 cents for every dollar earned by men, and Hispanic women earn 55 cents for every dollar paid to men, according to U.S. Census data.

Advocates have pushed for better pay for women for years, and they are now putting more attention on how disparities in pay affect women's health. 

The County Health Rankings and Roadmaps, a program established by the University of Wisconsin and the Robert Wood Johnson Foundation, examined the toll of that gap on women’s health in a forum last week. (To find the gender gap in pay for any county in the U.S., go 

The COVID-19 pandemic added to the pay gap for women, said Corin Reyes, a registered nurse and the director of health equity for the YWCA San Antonio.

“The pandemic actually amplified a lot of the caregiver responsibilities that women were taking on,” Reyes said.

Many women, in addition to shouldering the bulk of household and family responsibilities, are also assuming most of the caregiving duties for older parents or other family members. The typical caregiver of an elderly family members is a 49-year-old woman who is working full-time and providing 20 hours of care, or more. 

“That’s a heavy load to lift,” Reyes said.

As a result, women choose jobs that will accommodate their caregiving responsibilities. “They tend to go for the flexible jobs. Flexible jobs pay less,” Reyes said. “They’re going to take the lower paying job to get that flexibility to take care of home.”

Women with lower incomes are less likely to be able to pay for home healthcare professionals to help care for aging family members. Women are spending more time taking care of family members and often are suffering greater problems with their own health.

Seniors are getting more help at home after hospitalization, but what are the costs?

Women caregivers are six times more likely to experience anxiety or depression, Reyes said. Women caregivers are also more prone to chronic conditions, such as hypertension or diabetes, she added. They are also at higher risk of having a lower immune system.

“One-third of caregivers are already sick themselves,” Reyes said.

Not so surprisingly, those women doing more to care for family members are neglecting their own health needs. “They’re just not taking care of it,” Reyes said.

Two out of three caretakers don’t fill prescriptions at all, and one-third don’t go to doctors for preventive care visits, Reyes said. Exercise or other self-care solutions also fall by the wayside.

“You don’t have time, or if you’re suffering from depression, you just don’t feel like it,” Reyes said.

Misty Moon-Harty, director of racial justice and gender equity with the YWCA San Antonio, said gaps in pay aren’t typically tied to men having more advanced degrees.

“The reality is the wage gap is not about women not having the same level of education,” Moon-Harty said.

Over a lifetime, Black women lose $900,000 due to pay gap with men, and Hispanic women lose more than $1 million, Moon-Harty said.

In addition, many women retire earlier because they have to spend more time as caregivers.

“Women retire earlier typically to take care of family members and then they live longer on top of that. It puts them down in the hole a little bit farther,” Reyes said.

Health system executives have said many Americans have deferred care due to the pandemic. 

Hospital leaders said they are seeing sicker patients

, because some of those patients waited too long for treatment or preventive care.

Researchers have found sharp drops in cancer screenings, according to a 

in March. Researchers examined hundreds of cancer programs between April and June 2021. They found an 80% drop in colon cancer screenings, a 69% decline in screenings for cervical cancer, and a 55% drop in screenings for breast cancer.

In healthcare, women have been affected by the pandemic differently than men.

bigger career setbacks during the COVID-19 pandemic

. Women physicians were twice as likely as men to work from home (40.9% to 22%) and reduce their hours (19.4% to 9.4%) due to the pandemic, according to a 

The pay gap, combined with the COVID-19 pandemic, has created “a huge crisis” in the health of women, Reyes said.

“To prevent that, we should probably close the wage gap, so we don’t go down this road again, that we already saw with the pandemic,” she said.

Typically, women earn 80 cents for every dollar earned by men. Closing the disparity in pay would improve health outcomes in women, advocates say.

Women earn less than men, and their health suffers due to the pay gap

It’s not a long-term remedy for rural hospitals, but it is a reprieve.

Congress approved a short-term spending bill late last week to continue funding the government. The package includes a provision extending funding for two Medicare programs that provide $600 million annually to rural hospitals, the American Hospital Association says.

Lawmakers acted just in time, and not just because the federal government was set to run out of money on Sept. 30. The Medicare programs aiding rural hospitals were set to expire at the end of the month, adding urgency to the situation.

The spending bill finances the government, and those rural hospital funding lines, through Dec. 16.

Hospitals and health systems, particularly those in rural areas, have been pressing Congress and President Biden’s administration to continue those programs.

Rural hospitals have struggled financially for years

. Since 2010, 136 rural hospitals have closed, according to an 

“Without the appropriate support and evaluation of existing policies by the state and federal government, rural hospitals will continue to be on life support,” the AHA said in its report.

Hospital leaders and analysts say the COVID-19 pandemic has pushed more rural hospitals to the brink. 

Most hospitals are facing staffing challenges and higher expenses

, but rural hospital leaders get the bulk of their money from government sources, which pay less than commercial insurers.

'Patients deserve better': Hospital leaders describe cuts due to financial crunch

While rural hospitals provide essential care to their communities, they typically have a lower volume of patients. About half of all rural hospitals have 25 beds or less.

The American Hospital Association and other healthcare groups have been pushing Congress to extend the Medicare programs aiding rural hospitals.

Lawmakers in the House of Representatives have introduced 

a bill to extend the programs for five more years

The House bill would extend the Medicare-dependent Hospital (MDH) program for five years. The program offers more assistance to smaller hospitals with a large share of Medicare patients. There are more than 170 hospitals with this designation.

In addition, the bill would also continue Medicare’s Low-Volume Hospital (LVH) designation. The program offers assistance to rural hospitals with a relatively small portion of Medicare patients. This program supports more than 600 hospitals.

A similar bill has been introduced in the Senate, with one critical difference: 

it would preserve both Medicare programs permanently.

The Federation of American Hospitals has urged Congress to reauthorize the Medicare programs.

Chip Kahn, president and CEO of the Federation of American Hospitals, said he was glad to see the Medicare programs get at least a short-term extension. He said on 

 Friday that it was “a step in the right direction” that will help rural hospitals keep their doors open.

Ultimately, Congress should permanently extend the programs, Kahn said.

 to congressional leaders to continue the funding.

“Rural hospitals traditionally serve patient populations that are older, lower income, uninsured and more likely to rely on Medicare and Medicaid when compared to the national average and to their urban counterparts,” the letter stated.

Nearly 900 rural hospitals – 40% of America’s rural hospitals – are facing a serious risk of closure, according to 

the Center for Healthcare Quality and Payment Reform

The Centers for Medicare & Medicaid Services have proposed 

a new designation for rural providers to help keep them afloat

. Beginning next year, CMS is planning to create a new provider designation dubbed “Rural Emergency Hospitals” to help hospitals with emergency and outpatient services.

Federal programs that provide critical aid to rural hospitals were set to expire at the end of September. Lawmakers approved a provision in the short-term spending bill to sustain funding into December.

Now that the immediate crush of COVID-19 has passed and the dash to implement and roll-out digital offerings has eased, healthcare leaders are beginning to do some soul-searching around their digital strategy.

Top of mind: “What are the digital capabilities that are most important to us—and how can we refine these capabilities for better patient experiences?”

COVID-19 underscored deficiencies in some health systems’ digital approach. For instance, in the rush to mobilize a digital presence, such as for virtual care, most health systems invested in at least three platforms; in fact, 20% of academic medical systems host eight platforms or more, one 

Now, “platform sprawl” presents an obstacle to seamless digital experiences. It’s one reason why 77% of healthcare leaders say their goal is to move toward a single, fully integrated platform.

Taking a new look at digital investments and capabilities from the lens of what is working—and what isn’t—is vital to a truly transformational approach.

Here are three lessons learned in developing a digital and mobile strategy that best meets an organization’s unique needs.

This occurs when lots of digital components are stitched together, but they don’t complement one another, resulting in a disjointed experience.

A thoughtful approach takes into account each aspect of the patient journey to consider: “How could we provide an end-to-end ‘digital companion’ for patients throughout their care experience?” It looks at the larger framework of a digital health platform along with the critical role of mobile engagement.

From there, teams can map out the services that a consumer might find most beneficial, from the ability to schedule services online or view wait times at urgent care clinics to wayfinding assistance beyond the hospital lobby, access to discharge instructions following a patient visit, communication with a nurse when questions arise, and online bill pay. This creates a cohesive experience that consumers crave, boosting engagement and digital retention rates.

At Piedmont Health in Atlanta, where the health system’s mobile platform is integrated with its Epic EHR, the ability to both integrate MyChart and add customized features resulted in a highly agile platform. This positioned Piedmont to respond quickly to changing needs during the pandemic. When COVID-19 vaccines became available, the health system used push notifications to alert consumers and enabled online registration as well as wayfinding assistance to vaccination sites. This gave consumers the information they needed at the touch of their smartphone while relieving pressure on customer call center staff.

If a consumer wanted to use your organization’s mobile platform for wayfinding assistance, would that person need to remember their patient portal login?

It’s one thing to protect access to patient records and other sensitive information. It’s another to require users to authenticate their identity before checking wait times for the emergency department, searching for a physician, or seeking information about a particular service, such as the health system’s maternal health services.

Look for ways to ease access to digital information and services where it makes sense. Remember: Not everyone who accesses your mobile platform will be a patient with a portal username and password. The mobile platform should serve as a digital front door for everyone in your community.

When patients must enter a username and password, make it worth the effort. At University Health in San Antonio, patients can schedule appointments and access their medical records via the mobile platform, in addition to accessing a chatbot to answer questions when they arise or wayfinding assistance from their home to the point of care.

Bring the right people to the table for digital design

One of the downsides to innovation during the height of the pandemic was the speed with which transformation needed to take place. For health systems that had not yet explored mobile platforms, this made it difficult to gather large-scale input on the features that would drive installs and keep consumers coming back.

Now, healthcare leaders have an important opportunity to involve multiple stakeholders—from marketing to patient access to employee and consumer focus groups—to help answer the question: “What mobile experience do consumers most want?”

They also can leverage employees to help promote use of the mobile platform by teaching consumers what they could gain by using the app, such as the ability to more effectively monitor their chronic condition or request a medication refill from their doctor.

At WakeMed Health & Hospitals in Raleigh, N.C., leaders held a “launch party” for their mobile platform where employees could try out the health system’s new digital platform and offer feedback. They also hung posters throughout facilities and in the parking garage and created TV commercials heralding the arrival of the app and included messaging in employee and physician newsletters about what to expect.

Today, WakeMed employees often serve as “mobile ambassadors,” showing patients how to use the app and all the features they can access. Even if your organization has rolled out its mobile solution, now might be the time for a “relaunch party” to underscore its value.

By taking a fresh look at digital investments from the viewpoint of the user experience and the impact for operations, health systems can more effectively adjust their approach for long-term engagement and value.

Joshua Titus is CEO and founder, Gozio Health.

Hospitals and health systems can develop digital and mobile strategies that meet their unique needs. 

A strategic approach to digital transformation: 3 lessons learned 

Airica Steed has been named the next president and chief executive officer of The MetroHealth System in Cleveland.

She will succeed Dr. Akram Boutros, who announced late last year that he planned to retire at the end of 2022. She will take over on January 1.

Steed is currently executive vice president/system chief operating officer of Sinai Chicago Health System and president of Mount Sinai and Sinai Children’s Hospital.  MetroHealth noted that Steed comes from an urban academic health system that is also focused on improving health equity.

She said she sees great opportunities at MetroHealth.

“Coming from one of MetroHealth’s national peers, I know it to be one of the most admired, innovative and progressive public health systems in the country,” Steed said in a statement. “MetroHealth has done an incredible job in developing a patient-centered, whole-system approach that aggressively targets health equity and has a bold and unapologetic focus on eradicating healthcare inequities.”

MetroHealth selected Steed after a national search. MetroHealth Board Chair Vanessa Whiting, who is chairwoman of MetroHealth’s board, hailed Steed’s focus on improving health equity and her history as an innovator and strong collaborator.

“Dr. Steed’s capabilities, character and experience are a perfect match for the qualities we wanted in our next CEO,” Whiting said in a statement. “She comes from a major safety-net healthcare system that shares a similar focus to that of MetroHealth: improving the health of the community in an urban, academic setting.  Airica has been successful in improving quality of care, patient satisfaction, operating results, and health equity.”

MetroHealth operates four hospitals, four emergency departments and dozens of other healthcare sites.

Lydia Watson has been named the next president and CEO of MyMichigan Health.

Watson, MyMichigan Health’s senior vice president and chief medical officer, will move up to the CEO post on Dec. 1. She will succeed Greg Rogers.

Rogers will serve in an advisory role to Watson through the month of December. He called Watson “a well-respected and trusted leader in the industry and here at home.”

“She has been instrumental in guiding our system through the pandemic, is a steadfast advocate for quality care and patient, employee and physician satisfaction, and accomplished in establishing and maintaining cultures of excellence,” Rogers said.

The MyMichigan system endured tragedy earlier this year. In March, Diane Postler-Slattery, MyMichigan Health’s longtime president and CEO, died in a plane crash. Her husband, Donald, also perished in the crash.

Jenee Velasquez, board chair of MyMichigan Health, referenced the tumultuous time.

“The leadership and direction provided by Greg, Dr. Watson and the entire leadership team has been nothing short of exceptional,” Velasquez said in a statement. “Dr. Watson’s commitment to the health of our communities combined with her long-time leadership and respect for all those with whom she works will continue to strengthen this beloved health care system for generations to come.”

Watson joined MyMichigan Health’s administrative staff in 2013 and has held several leadership posts. Previously, Watson served as an obstetrician-gynecologist at the Medical Center in Midland. She also was an active staff member at Saginaw General Hospital from 1988 to 1996.

MyMichigan operates nine hospitals and employs more than 8,800 workers.

Blue Cross Blue Shield hires leader of lobbying

David Merritt has been named the senior vice president of policy and advocacy for the Blue Cross Blue Shield Association.

He’ll lead BCBSA’s advocacy at federal and state governments, including lobbying, political affairs, and legislative development. Merritt will lead a team of more than 50 people in the association’s Washington office.

“It is a privilege to join BCBSA and continue to drive policy solutions that make quality health care more affordable and more accessible for the people we serve,” Merritt said in a news release.

Merritt leads public affairs at America’s Health Insurance Plans (AHIP). He also serves as president of the Partnership for America’s Health Care Future and on the board of directors for the Campaign for Sustainable Rx Pricing.

He has worked with some high-profile figures in politics. He helped lead political and messaging research for Frank Luntz and worked with former House Speaker Newt Gingrich on health issues. Merritt also worked with Mike Leavitt, the former HHS Secretary and Utah governor, leading Leavitt Partners’ Washington office.

“David has a proven track record in politics, policy and public affairs in Washington and states across the country,” said Sean Robbins, executive vice president of external affairs. 

Saint Mary’s Health Network names new CEO

Derrick Glum has been named the new chief executive officer of Saint Mary’s Health Network in Reno, Nevada.

Glum succeeds Tiffany Coury, the system’s former CEO. Saint Mary’s is part of Prime Healthcare, which operates 45 hospitals in 14 states.

Glum brings nearly 20 years of healthcare experiences to Saint Mary’s.

“I am thrilled to be joining such an impressive, community-focused healthcare organization in Saint Mary’s,” Glum said in a statement. “Saint Mary’s has provided quality care to its patients for over 110 years, and I am honored to build on such a tremendous healthcare legacy.”

Previously, Glum served as the regional chief operating officer and hospital administrator for two hospitals in the Phoenix area – Mountain View Medical Center and Florence Hospital. The system said Glum oversaw substantial gains in hospital performance and patient satisfaction.

Prior to that, Glum served as a system vice president for Renown Health and was the CEO of Tahoe Pacific Hospital in Reno, Nevada.

MUSC appoints new director of Marion Medical Center

Shametra Swaringer has been named executive director of MUSC Health Marion Medical Center.

Swaringer brings more than 16 years’ experience with MUSC Health Florence Medical Center, and the hospital formerly known as Carolinas Hospital System. She previously served as critical care services director in the Florence Division.

As the executive director of the Marion Medical Center, she will oversee the hospital and nursing leadership. MUSC described her as “a passionate and trusted leader.”

MUSC Health Florence Division Chief Executive Officer Jay Hinesley welcomed Swaringer to her new role.

“She will focus on bolstering a strong culture, bringing additional efficiencies to operations, and standardizing processes between the hospitals in the Florence Division,” Hinesley said in a news release.

Based in Charleston, MUSC is the healthcare system of the Medical University of South Carolina and operates 14 hospitals and hundreds of care sites.

Ingenovis Health names first chief marketing officer

Lauren Pasquale Bartlett has been named the first chief marketing officer of Ingenovis Health.

The Colorado-based company is one of the nation’s largest healthcare staffing firms, with brands including Trustaff, Fastaff, U.S. Nursing, HealthCare Support, CardioSolution and VISTA Staffing Solutions.

The company says its business has surged in the COVID-19 pandemic, with hospitals and health systems seeking nurses.

"I am honored to take on the role of chief marketing officer for such a purposeful company,” Bartlett said in a news release. "Alongside dedicated colleagues and with an incredibly talented team, I am committed to our purpose of creating a home for healthcare talent and contributing to an industry-leading employment experience for our valued clinicians, and sustained quality patient care for our clients.”

Bartlett has worked in digital media, marketing and communications with the National Football League, USA Hockey and the U.S. Olympic Committee.

MyMichigan Health hires its new chief executive, Blue Cross Blue Shield selects a new lobbying leader, and other leaders take new roles.

MED MOVES: MetroHealth System announces Airica Steed as next CEO, and more

Even after Hurricane Ian has moved away from Florida, hospitals and health systems continue to struggle with the aftermath of the storm.

Lee Health, which operates four hospitals in Lee County, Florida, is evacuating hundreds of patients. Three of the system’s four hospitals have no running water, said Larry Antonucci, president and CEO of Lee Health.

“We have made the very difficult decision to evacuate our patients,”  Antonucci said in a 

Lee Health is moving patients to facilities outside of Lee County, Antonucci said. The southwest Florida county, home to Cape Coral and Fort Myers, suffered severe damage to Ian, including widespread power outages, water service disruptions, and battered roads and bridges, including portions of Sanibel Causeway being swept away.

Hurricane Ian rips part of roof of Florida hospital

Lee Health has been transferring patients Thursday and Friday. Lee Health’s emergency departments will continue to remain open. 

“We will provide emergency care and then triage those patients to where they need to go, if they do need to be admitted,” Antonucci said.

The Agency for Health Care Administration, a Florida regulatory body, said the system had to transfer patients due to the lack of running water, and Antonucci said, “We agree with that.”

“We cannot run a health system and a hospital without running water,” he said. “It’s critical to what we do, not only from the perspective of patient care, but for fire protection.”

Lee Health’s hospitals are in generally good shape, Antonucci said, but the system said some campuses and outpatient facilities “sustained significant damage.” The lack of water and power are the main issues, the system said. Lee Health said it is offering free telehealth services to the community.

Hundreds of Lee Health’s patients are being transferred to the NCH Healthcare System in Naples. Jonathan Kling, chief operating officer of NCH Healthcare System, said in a town hall Thursday the system expects to take in about 400 patients from Lee Health.

“We will max out our system,” Kling said.

To accommodate the influx of patients from Lee Health, NCH has said outpatient facilities will remain closed through Monday, Oct. 3. Kling said that is necessary to free up staff. 

“We are going to need all hands on deck to care for an additional 400-plus patients from Lee Health,” Kling said in the town hall.

NCH will have to house some patients in areas that aren’t set up for patient care, Kling said.

NCH is getting assistance from the National Guard and the Florida Department of Health. But NCH is also looking for respite housing for staff. Typically, workers would use empty rooms.

“With the amount of patients we’ll get, we won’t have that luxury,” Kling said.

NCH hasn’t stopped caring for patients in the storm, but Ian has taken a toll. Paul Hiltz, president and CEO of the NCH Healthcare System, said the organization is offering assistance to staff. Some have seen property damage in the storm.

“There’s a lot of suffering out there,” Hiltz said.

Orange County Fire Rescue workers help evacuate residents from an assisted living facility near Orlando Thursday. (Photo by Orange County Fire Rescue)

Across Florida, at least 15 hospitals transferred patients due to the hurricane, the 

 said Thursday. Some hospitals transferred patients to other facilities before Ian made landfall.

More than 7,000 patients and residents have been transferred from 150 healthcare facilities, including nursing homes and assisted living facilities, according to the 

Healthcare workers have had vehicles damaged in the flooding. Some have had to navigate flooded streets. Some healthcare workers said they feel frustrated because they don’t feel adequately supported in the storm.

Doctors, nurses and other healthcare workers have been pushed to the limit well before Ian’s arrival, due to the COVID-19 pandemic. Staff are going to need counseling, said Sarah Warren, a nurse in southwest Florida.

“I’m very worried for the mental health and well-being of my colleagues,” Warren said.

HCA Florida Fawcett Hospital in Port Charlotte remained closed Friday after the winds from Ian tore off part of the roof, 

 said. The hospital also received some flooding. About 160 patients had to be transferred. HCA Florida Englewood Hospital is also closed. HCA Healthcare, one of the nation’s largest health systems, operates scores of hospitals and care sites in Florida.

, which operates several hospitals in Florida, has reopened some medical group offices Friday and expects all will be open Monday. Some urgent care locations remain closed.

 says all of its medical group offices and most of its urgent care centers have reopened as of Friday afternoon.

Lee Health has transferred hundreds of patients because there’s no running water. Patients are being moved out to facilities outside of Lee County, which sustained heavy damage. 