The Honorable David Shulkin MD was the ninth secretary for the U.S. Department of Veteran Affairs, having served in both the Trump and Obama administrations. He is now working with organizations and businesses to ensure that medical expertise informs their COVID-19 continuity and recovery planning. The opinions expressed in this commentary are his own.

In addition to the devastating loss of life from COVID-19, financial losses to US hospitals across the country will be staggering. The $2 trillion stimulus package provided about $100 billion in financial assistance to health care providers around the country, and the Senate just approved an additional $75 billion for hospitals and $25 billion for testing. But this won't be enough to avoid an inevitable disaster to our country's health care infrastructure.

Health systems could lose up to $2,800 per coronavirus case, according to one estimate . But the larger impact will certainly come from lost revenue as a result of the cancellation of elective cases and the reduction in non-COVID patient activity seen by health care providers.

Even before the coronavirus outbreak reached the United States, many hospitals were already struggling financially. According to a recent analysis , hospitals saw a 21.3% decline in operating margins from 2018 to 2019. Many rural hospitals have been experiencing significant operating losses and will be particularly impacted by this crisis. Now, because of the coronavirus pandemic, hospitals around the country are losing unprecedented amounts of money, and many are beginning to lay off staff and defer essential expenditures that previously had been considered necessary. Boston Medical Center recently announced a furlough of about 700 employees. Trinity Health is furloughing at least 2,500 employees. For most organizations, the contributions they have been seeing in non-operating investment income will disappear.

In areas where the coronavirus is rampant, like New York City, New Jersey and New Orleans, hospitals have been overwhelmed with patients and have had to stop most non-COVID activity to respond to the urgent demands of infected patients. As a result, health care organizations are experiencing a significant reduction in revenue, while at the same time seeing increased staff and supply costs. They are also facing the likely possibility of an increase in uncompensated care as more people who have lost their jobs will be unable to pay. In addition, hospitals are not likely to see ongoing contributions from non-operating revenue, as their investment portfolios have been hurt as well.

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