Nurses’ issues remain a question on Cambridge Health Alliance budgets. (Photo: Marc Levy)

Cambridge Health Alliance leaders see a brighter financial future for the coming year after a lengthy battering by the Covid-19 pandemic. A proposed budget for the next 12 months forecasts a margin of $4.3 million even without federal Covid aid and other special help. The expected surplus rises to $21.9 million with the extra aid.

The extra help from the state and federal government that will push CHA further into the black includes a total of $17.6 million in coronavirus relief and financial support for the expansion of psychiatric services announced last year.

CHA, which serves more poor and uninsured patients than any other Massachusetts hospital except Boston Medical Center, still anticipates losing money on its health care operations – $6.3 million. But that loss is much smaller than the estimated operating shortfalls in the past two fiscal years, when the pandemic raged: $54.1 million in fiscal year 2020 and $37.8 million in fiscal year 2021. The Alliance’s fiscal year runs from July 1 to June 30, so the pandemic affected finances in both years.

“The pandemic had profound implications to CHA operations and financial results,” the budget executive summary for fiscal year 2022 says. “In both FY20 and FY21, volume was significantly disrupted while staffing and other expenses remained at or above pre-pandemic levels.”

This year will be different, the document says. The budget “reflects an ongoing post-Covid recovery toward pre-pandemic volumes and, ultimately, a return to the growth trajectory that CHA was experiencing before the pandemic began in March 2020.” Overall, the budget represents a return to CHA’s pre-pandemic level of financial performance “and sets the stage for implementing the strategic initiatives and tactics necessary to achieve improved financial performance and sustainability in the years ahead,” the executive summary says.

The executive summary appears to assume there won’t be a new coronavirus surge or a lesser increase in cases. Asked how the Alliance views the future course of the pandemic and how that might affect CHA finances, spokesperson David Cecere said: “The budget does not factor in future Covid surges.”

More looks ahead

Budget details show that CHA expects a boost in the number of patients admitted to a hospital bed, but only because of the significant expansion of child, adolescent and adult psychiatric inpatient services. The Alliance will add 64 beds and move child and adolescent units from Cambridge Hospital to the Somerville campus. Volume in existing inpatient services will increase slightly or decline.

In addition, the budget expects that:

• The number of doctors’ visits to clinics outside the Alliance’s two hospitals will increase by 8.3 percent from the projected total for fiscal year 2021.
• Emergency room visits will increase from the fiscal year 2021 projected total but will lag behind numbers in fiscal year 2019 and 2020.
• Visits to the new urgent care clinic in Somerville and to psychiatry units will decline.

The Alliance expects to add the equivalent of 125 full-time positions, almost all to cover the expanded psychiatric services. It’s an increase of 3.2 percent, according to the budget. The budget includes wage increases for all employees totaling $9.5 million. That reflects a 1 percent pay increase this month and next January for nonunion workers as well as negotiated increases.

Nurses’ protest

In April, CHA union nurses held demonstrations to publicize their complaint that they had gone “from heroes to zeros” in contract negotiations. The nurses said they especially opposed a proposal to bundle their sick time, personal time and vacation benefits without guaranteeing that employees would not lose time to which they were previously entitled. The Alliance responded that its contract proposal was “fair, supports outstanding patient care and reflects respect for our nursing community.”

At that point, the dispute was before an impartial fact-finder. Joe Markman, a spokesperson for the Massachusetts Nurses Association, said negotiations are scheduled for Thursday. If no agreement is reached, “fact-finding is scheduled for Aug. 19,” he said.