Cash Crunch Complicates Hospitals’ Ability to Buy Gowns, Masks

Some hospitals and clinics still struggling to access personal protective equipment may be doing so because they can’t afford it, a top government supply chain official said in an interview.

Particularly in rural areas, hospitals that had to shut down their elective procedures during stretches of the pandemic may not have the income to buy new supplies, said Brig. Gen. David Sanford, director of the supply chain task force.

Prices for most types of PPE has gone up dramatically during the pandemic, with one April 2020 report finding prices for N95 masks increased over 6,000%.

Some rural areas weren’t hit as hard by Covid-19 earlier in the pandemic. But now that the virus has spread so much, they may be facing financial shortfalls when they have the most need for masks, gowns, and other PPE. The U.S. is likely producing enough PPE to meet its needs—with the exception of gloves—but getting those supplies to the right people has been a challenge.

“The vast majority of hospitals have been financially stressed by the pandemic,” said American Hospital Association spokesman Thomas Jordan.

“Those hospitals that were financially challenged before and that have encountered rapid growth in costs for PPE as well as costs for modifying their physical plant to treat unprecedented numbers of contagious patients, set up separate spaces for COVID treatments and created new testing sites and vaccination sites may be struggling to afford needed supplies,” Jordan said.

Cash Up Front

Some supply distributors are requiring large orders up front from health facilities. For example, a small clinic may only need 20 N95 masks, but it isn’t economical for the distributor to send that few, so they require the clinic to order at least 50. Some manufacturers also require facilities to pay some amount of cash in advance of receiving the supplies to ensure they get their order, and facilities may not have the funds for that.

Some hospital administrators in major cities have also decided to issue fewer PPE supplies than they have in stock to medical staff, Sanford said. Hospitals may do this for budgetary reasons or to have an extra supply in case it’s needed.

Sanford said states can access funds through the Department of Health and Human Services and the Federal Emergency Management Agency to help buy supplies, and that has helped some. Some hospitals in the Tucson, Ariz., area used grants to buy PPE and that gave them a cushion when there were surges in virus cases, he said.

FEMA also offers funding to help states set up 60 days of PPE stockpile, and those funds can also be used to rent warehouses to store the supplies, Sanford said.

Stockpile officials also can help match facilities that have a low supply with distributors. The federal government has a system in which hospitals and nursing homes report how much PPE they have, and Sanford said he regularly sends reports of those facilities to distributors.

Stockpile Requests

Hospitals and nursing homes also may not know how to request supplies from their states or the Strategic National Stockpile, he said. Sanford said he mentioned the issue to governors a few weeks ago and requested that they spread the word that help is available.

But Jordan said some confusion remains about requesting supplies from the stockpile and that “re-education at this point would be ideal.”

Hospitals and other health facilities request supplies from the stockpile by asking their state, the state will discuss it with key federal officials, and then the stockpile can deploy the supply, according to a presentation given by the stockpile’s acting director, Steven Adams, told reporters in December.

Some states’ processes include contacting the local county, while others—like Louisiana—require the health facility provide proof they’ve reached out to a certain number of PPE vendors before requesting assistance.

Sanford said requests sometimes come in for very specific types of N95 respirators, for example, and those requests can be difficult to fill because the stockpile won’t necessarily have that type. But if a hospital requests 1,000 N95s of any kind, the stockpile can usually fill it, he said.

“There’s no reason anyone should go without because we have it,” Sanford said, adding that there’s “no reason the states shouldn’t put a request in.”