The coronavirus is devastating rural hospitals
Thursday, April 02, 2020
While urban hospitals and health systems are getting racked by an overflow of patients and the need to respond to an overwhelming number of patients currently infected with COVID-19, their rural counterparts are equally or more so overwhelmed, too.
In some cases, the impacts on rural hospitals are dramatic.
Many of these community-based hospitals will close because the pandemic is preventing them from performing profitable elective surgeries, physical therapy, and lab tests. This inability to perform the healthcare that keeps them afloat is cratering their already limited cash reserves even as they are overwhelmed with their own coronavirus cases.
This reality comes on the back of U.S. Vice President Mike Pence calling on hospitals nationwide to delay all elective procedures to free up capacity and resources for future coronavirus patients.
As COVID-19 continues to spread, many of the leaders of these small hospitals are issuing warnings that the odds are stacked against them exactly when they are needed most. Additionally, they face an increase in operational expenses as they are paying higher prices for personal protective equipment, including face masks and other gear that's in high demand.
The American Hospital Association’s leadership has asked Congress for at least $100 billion for all hospitals to offset coronavirus costs to help rural hospitals' cope with losses over the weeks and months ahead.
"If we're not able to address the short-term cash needs of rural hospitals, we're going to see hundreds of rural hospitals close before this crisis ends," Alan Morgan, the head of the National Rural Health Association, told Modern Healthcare.
COVID-19 is only the latest threat to rural hospitals, as many have faced other overwhelming fiscal restraints from fewer Medicare reimbursements and more patients with less insurance coverage.
“I think it’s reasonable to assume while the entry into rural areas may be lower and it may be easier to do some social distancing because of the lower population, we shouldn’t assume any part of the country is going to be spared,” said Jay C. Butler, M.D., deputy director for infectious diseases at the Centers for Disease Control and Prevention (CDC).
This crisis is nothing new, but only be exacerbated in the coming months as more than 120 rural hospitals have faced forced closure over the past 10 years. More than half of rural hospitals operate in the red (a loss), according to the Chartis Center for Rural Health.
The National Rural Health Association is calling for immediate cash assistance, no-interest loans, Medicare reimbursement adjustments, and more to addresses the financial shortfalls of these organizations.
Rural hospitals, like their counterparts, are facing shortages of supplies and supply chain issues. Whether clinicians continue to see patients with other conditions will depend on the spread of the virus and the availability of resources in a community.
Kevin Stansbury, CEO of Lincoln Community Hospital in Hugo, Colorado, said the pandemic already is having a significant impact on revenue even as the hospital isn’t likely going to be impacted directly by COVID-19 on the Eastern Plains of the state, but may plan to take on patients from other hospitals by taking some of their excess patients.
Colorado Gov. Jared Polis ordered hospitals to stop offering elective procedures but exempted critical access hospitals. Critical access hospitals include those as a federal designation for small hospitals that are a significant distance from another facility and are eligible for higher payments from Medicare than most other hospitals.
Sens. John Barrasso (R-Wyo.) and Michael Bennet (D-Colo.), have pushed for legislation that called for the equivalent of a three-month cash advance based on a health system's previous patient numbers. "Rural hospitals have already been closing their doors at startling rates, and this crisis will only exacerbate that fact," Bennet told Kaiser Health News. "There is an incredible opportunity for rural hospitals to shoulder some of the burdens of caring for patients and helping to meet possible bed shortages."
"This virus, and what it is causing for these hospitals, is the perfect storm that will close these hospitals at a time this country critically needs them," said Robin Rau, CEO of Miller County Hospital in southwestern Georgia, told Modern Healthcare.
Julie Jones, CEO at Community Hospital-Fairfax in Missouri, said she could only get specialty N95 respirator masks for about $5 each, which usually cost about 30 cents each.
Angela Ammons, CEO of Clinch Memorial Hospital in Homerville, Georgia, has warned staff that if hand sanitizer and disinfecting wipes continue to go missing, she'll watch the security video and will immediately terminate anyone caught stealing supplies.
In Washington state, rural hospitals are already struggling and have seen sharp declines in business in March. At least 13 rural hospitals, and perhaps others, have less than 45 days of cash on hand, and five of them face imminent closure, Cassie Sauer, chief executive of the Washington State Hospital Association, told the Los Angeles Times.
Gov. Jay Inslee requested at least $40 million in grants for hospitals in “extreme financial distress.”
Rural hospitals across the United States have sicker people; they are older and poorer than Americans as a whole.
“You’re very quickly starting to see rural counties light up on the map, and it’s probably a misconception that rural America is going to be spared,” said Alan Morgan, CEO of the National Rural Health Association, in Washington, D.C.
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