Major hospital system faces $50M budget crunch

Lee Health President and CEO Dr. Larry Antonucci watched a national news show recently with gnawing anxiety. On the show, a hospital administrator in Texas said his facility was at risk of being short multiple machines to treat COVID-19 patients. Not the oft-talked about ventilators, but another device, for heart monitoring.

That Texas official then talked about his worst nightmare: rationing care for patients based on available equipment. “That really scares me, that we won’t have the capabilities to care for the sick people of this community,” Antonucci says. “That just frightens me to death.”

Antonucci carries that burden into just about every meeting and decision he makes as head of sprawling Lee Health. The nonprofit has more than 14,000 employees, including nearly 1,500 physicians, spread through four acute care hospitals, two specialty hospitals and related entities. The bed count totals 1,812, making it by far Southwest Florida’s largest community-based health care provider.

'There’s nothing that can really prepare you for something as momentous is this.' Dr. Larry Antonucci, Lee Health

Lee Health is a giant financially, too. Its 2020 fiscal year operating budget is $2.11 billion, up 18.5% from $1.78 billion in 2018, according to its financial reports. In a world without coronavirus, Antonucci says the hospital’s current fiscal year operating revenue would have increased $70 million. Now he projects it will fall by at least $50 million. For an organization, Antonucci says, that normally relies on 3% to 4% in margins to support its work, that’s a big pinch. The $50 million deficit, he adds, “includes help that we got from the government when this first started.”

Antonucci and his senior-level leaders got to work quickly on the financial side during the crisis. Their strategy was similar to what many companies do during a recession: match payroll to revenue, in this case payroll to patient volumes; take a detailed look at every contract; and work with vendors in the supply chain.

More than 600 employees took a voluntary retirement and exit package. Another group of employees took Lee Health’s offer of a summer sabbatical, with benefits intact. The hospital then saved 10% by reworking some contracts and vendor deals.

The COO at Lee Health for six years, Antonucci was named president and CEO in 2017, replacing the retiring Jim Nathan. An obstetrician and gynecologist, Antonucci says while he’s addressed plenty of one-on-one patient emergencies, COVID-19 has tested him like nothing else. “There’s nothing that can really prepare you for something as momentous is this,” he says.

The biggest leadership lesson he’s learned is to deliver to staff four key principles: trust, compassion, stability and hope. “I’ve also learned to really appreciate the inherent resiliency of health care professionals,” Antonucci says. “You can throw just about anything at them and their ability to rise to the occasion has been remarkable.”

Hospitals across the region are grappling with dual problems: keeping patients alive and keeping budgets from collapsing. Hear from more hospital executives by clicking the links below:

• Hospital focuses on its north star in troubled times
• Health care system maintains payroll — despite nearly $200M shortfall 
• Hospital grapples with 'astronomical' PPE costs