Overburdened health care systems from Texas to Florida are pleading with Western Pennsylvania hospitals to take on transfer patients at record-high rates as beds and ventilators reach capacity in covid-19 hot spots across the country.

“They’re running out of space, and they’re looking for help in trying to deal with some of those patients,” Highmark Health CEO David Holmberg told the Tribune-Review by phone Thursday afternoon.

Dr. Donald Whiting, chief medical officer of Highmark’s medical provider arm, Allegheny Health Network, said that this past Saturday and Sunday the health system experienced a “busy weekend for regional and national referral requests.”

The 14-hospital system headquartered in Downtown Pittsburgh has been fielding a surge in transfer requests from physicians in states where coronavirus cases and deaths are proliferating, including Oklahoma, Florida and North Carolina. Many patients have severe health needs other than covid, but they cannot be treated where they live because local facilities are full or lack sufficient resources or staffing.

“We’re seeing brain tumors and heart attacks in patients that normally would stay in the community where they live, but they can’t because their community is feeling the effect of that (covid) surge,” said Dr. Maggie Thieman, medical director of AHN’s physician-to-physician transfer and referral center. “As covid numbers rise, those patients take up the beds of patients who are suffering from something that has nothing to do with covid. It’s a domino effect.”

Thieman described a recent influx in “desperate attempts to get patients moved to a facility that can meet even basic medical needs.” In one example, a health system near the Oklahoma and Kansas border already had contacted about 115 facilities in its region to transfer a patient in critical need before requesting help from Highmark’s Allegheny Health Network. All the other providers were either filled to capacity or closed to transfers across state lines.

“This is alarming to us because communities far, far away are impacting us already, right now,” Thieman said. “The effects are more far-reaching this time than the first time around (in spring 2020).”

Highmark executives boasted during a quarterly financial performance presentation Thursday that in many ways, Highmark Health is better prepared to withstand the pandemic, both clinically and financially, than it was prior to covid-19 striking Pennsylvania last March.

“Our financials are strong and steady,” said Holmberg, “and we’re prepared to deal with the unknown.”

‘Rock-solid’ financial footing

Despite lingering uncertainty over the pandemic’s trajectory, Holmberg and fellow executives expressed confidence in Highmark Health’s financial footing and ability to advance ambitious growth and investment plans.

“We’re hitting on all cylinders,” Holmberg said. “The response to the pandemic has made us a better organization.”

Highmark took in $10.4 billion in total revenue in the first six months of 2021, a nearly $1.4 billion increase from the same period last year and $1.2 billion more than in 2019, figures released by the health system show.

Holmberg said he does not anticipate Highmark, whose assets now top $10.3 billion, needing any additional federal financial assistance at this time.

“We actually feel that we’re in a much better place than we were 18 months ago to be able to deal with anything that’s ahead of us,” Holmberg said. “Our balance sheet is rock-solid, and we have enough liquidity to deal with the pandemic plus any opportunistic growth and investments that are ahead.”

The pandemic did not hamper construction plans during the past year, including building 24-hour neighborhood “mini hospitals” in Harmar, McCandless and Hempfield. The latest project, AHN Wexford, is a 160-bed hospital is on track to celebrate its grand opening in Pine in late September.

RELATED: Highmark CEO: Covid-19 pandemic has not deterred growth across Pa., neighboring states

Highmark’s insurance arm, now spanning 6.6 million members across its core and Blue health plans, reported a gain of more than $480 million, driven by both commercial and government insurance revenue. Officials boasted of a 94% retention rate among insurance members through the first half of this year.

Highmark’s other diversified businesses, including Concordia Dental and stop loss business HM Insurance Group, reported combined earnings of more than $100 million. The system’s IT solutions business brought in another $9 million.

Allegheny Health Network’s patient volumes have returned to pre-covid levels, contributing to a $100 million revenue increase compared to the same time last year. AHN still logged a $9 million operating loss through June.

Outpatient visits spiked by 68% through June compared to the same period last year, during which providers statewide halted nonurgent procedures amid pandemic-spurred lockdowns. Emergency department admissions and physician visits grew by 18%, and patient observations and discharges increased by 9%.

“While we had a $9 million loss, we are very pleased with the $100 million swing from the first half of last year,” said Holmberg, “and we’ll continue to build on that.”

Spike in patient transfer requests

Allegheny Health Network typically receives about 1,400 requests or everything from heart and liver transplants to heart failure and brain tumors, but never as many as it did in June and July of this year, the system reports.

In July alone, Highmark’s network succesfully completed 1,500 patient transfers to AHN facilities out of about 1,700 requests, or 300 more than made during a typical month.

“The requests are coming in at a faster rate than ever before,” Thieman said.

To qualify, the patient must require a high level of care that can’t be provided at their current facility — such as a severe covid-19 case or heart failure that requires a ventilator — and meet a rigorous checklist of requirements throughout the transfer process.

“Just like we take any request for a transfer,” said Whiting, “we take every one seriously, look at our capacity and capability, regional needs and internal needs and things like that.”

Like Highmark, rival health giant UPMC similarly has been accepting transfers throughout the pandemic, based on the policies and decision-making of lead physicians at each facility. UPMC Chief Medical Officer Donald Yealy maintains contact with doctors across the region and country “to ensure UPMC helps those in need,” a UPMC spokesperson said by email.

“Hospitals across the country continue to contact UPMC for transfer possibilities and for insight,” UPMC officials said in a statement. “We serve all who come to UPMC to our best ability.”

Getting enough access to supplies such as protective gear, covid tests and vaccines no longer is a problem. What’s worrisome, according to Holmberg, are issues such as the urgent need to boost vaccination rates nationwide and just how bad the delta-driven outbreaks could get.

“It’s not what we know that worries us, it’s what we don’t know,” Holmberg said. “This virus that we’re seeing is going to continue to have twists and turns.”

Delta variant spreads among unvaccinated

Fifty people are hospitalized with covid-19 across AHN’s 14 hospitals, up from just six covid-19 patients at the beginning of July. About 10 to 15 new patients are getting admitted for treatment of the coronavirus disease per day.

“And while those numbers are very manageable for our system at the moment, trends we are seeing across the country are extremely alarming,” said Dr. Brian Parker, AHN’s chief quality and learning officer. “The number of hot spots is growing exponentially every day, and the number of cases is on the rise in almost every community, including those that we serve.

“Our biggest concern currently is the emergence of the delta variant, and the role that it is playing in this latest pandemic surge — particularly in parts of the country where vaccination rates remain perilously low.”

RELATED: 5 things to know about delta variant of coronavirus

Statewide, at least 935 patients are hospitalized with covid-19, up from 472 hospitalized less than two weeks ago. About 226 covid-19 patients are in intensive care units in Pennsylvania, with more than 100 on ventilators.

Allegheny County last week joined a slew of counties throughout the state that are seeing “substantial” rates of covid-19 transmission, according to data from the Centers for Disease Control and Prevention.

Parker emphasized that the delta variant is “significantly more contagious and spreads faster than the original variant that hit our country last year.”

“It also appears to cause more severe disease than all other known versions of the virus, as we are seeing an increase in hospitalizations among younger, healthier, unvaccinated people,” Parker said. “And that is the operative word — unvaccinated. … They are almost universally unvaccinated individuals.

“And that’s why it is absolutely essential that we reach a much higher vaccination rate overall in this country. It is the only way that we are going to escape from the clutches of this pandemic,” Parker said. “We still have an unvaccinated rate here in our community that could lead to a surge that claims even more lives and further delays our return to normal.”

Push to get all employees vaccinated

Earlier this week, Highmark announced the expectation of reaching a 100% vaccination rate for all eligible employees by the end of September, unless individuals have a religious or medical exemption. To date, about 73% of AHN’s 21,000 employees are fully vaccinated.

“The people who are not vaccinated are at the most at risk — they’re the people who are getting sick and getting hospitalized,” Whiting said. “So it’s to protect them and to protect our at-risk patients.”

On Thursday morning, about 850 Highmark employees attended a town hall to learn more about the covid-19 vaccines and get their questions answered. Soon after, “a lot of people” began signing up at AHN hospitals to get their shots as soon as possible,Whiting said.

“They just needed the information and a little bit of a push,” Whiting said. “So we’re getting good response so far, and we’re optimistic that this is going to continue.”

In coming weeks, Highmark officials anticipate the Food and Drug Administration will grant full approval for the Pfizer-BioNTech and Moderna vaccines.  

“It is our hope that those approvals will spur even more acceptance from those who have been hesitant,” Parker said.

RELATED: Highmark, AHN step up covid vaccination requirements for employees

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