Rural hospitals might not be capable of maintain their doorways open because the coronavirus pandemic saps their money, their CEOs warn, simply as communities most want them.
As the coronavirus sweeps throughout the United States, all hospitals are going through cancellations of physician visits and procedures by a terrified populace — worthwhile companies that often assist fund hospitals. Meanwhile, the establishments additionally discover themselves needing to pay larger costs for private protecting gear equivalent to face masks and different gear that’s in brief provide. Vice President Mike Pence known as on hospitals nationwide Wednesday to delay elective surgeries to liberate capability and assets for future coronavirus sufferers.
The American Hospital Association responded Thursday by asking Congress for $100 billion for all hospitals to offset coronavirus prices, citing rural hospitals’ incapability to face up to big losses for lengthy.
“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,” warned Alan Morgan, the top of the National Rural Health Association, which represents 21,000 well being care suppliers and hospitals. “This is not hyperbole.”
Well earlier than the COVID-19 risk, rural well being care’s profitability had collapsed nationwide attributable to a mix of narrowing Medicare reimbursements, a bigger share of sufferers missing high-paying personal insurance coverage and the hollowing out of rural America. Given such pressures, greater than 120 rural hospitals have been pressured to shut over the previous decade.
Those hospitals in small-town America which have survived rely closely on moneymakers equivalent to elective surgical procedures, bodily remedy and lab checks to make their razor-thin margins work. But, in line with the Chicago-based Chartis Center for Rural Health, nearly half of them nonetheless operate in the red.
So the added monetary hit from the coronavirus outbreak may very well be the ultimate straw for a lot of rural hospitals — exposing the sophisticated enterprise dynamics at play throughout the United States’ crucial public well being infrastructure.
“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,” mentioned Robin Rau, CEO of Miller County Hospital in southwestern Georgia. “This is going to be the death blow to them.”
Two weeks in the past, she began eliminating all medical companies that weren’t pressing. She estimated that has lower off at the very least half of the hospital’s income. Other CEOs warned comparable cuts at their hospitals imply they received’t make payroll within the coming weeks.
The National Rural Health Association, together with many rural hospital executives, is lobbying for instant money help, no-interest loans, Medicare reimbursement changes and different solutions to alleviate the ache. The affiliation favors a bailout plan being from Sens. John Barrasso (R-Wyo.) and Michael Bennet (D-Colo.), which in preliminary drafts known as for the equal of a three-month advance based mostly on hospitals’ earlier affected person numbers, in line with Bennet’s workplace.
“Rural hospitals have already been closing their doors at startling rates, and this crisis will only exacerbate that fact,” Bennet mentioned in an announcement to KHN. “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.”
Still, many rural hospital CEOs fear any help might come too late.
“And yet I hear they’re going to bail out the cruise lines? Really?” Missouri’s Scotland County Hospital CEO Dr. Randy Tobler mentioned.
Dr. Randy Tobler, CEO of Scotland County Hospital in Memphis, Missouri, speaks by cellphone with KHN.
As Tobler seems at his older, sicker, underinsured affected person inhabitants, he mentioned he’s afraid the hospital, positioned on the state’s northeastern rural border, may final solely till May earlier than working out of cash for payroll.
“In the truly safety-net areas, we’re being called to high duty,” he mentioned. “And we’re running on fumes.”
Michael Purvis, CEO of Candler County Hospital in Metter, Georgia, mentioned he’s already fallen right into a destructive money circulate scenario up to now week. The variety of sufferers coming to his hospital, which is about 65 miles exterior Savannah, for worthwhile outpatient procedures has dropped by half as individuals in droves have canceled their surgical procedures, MRIs and bodily remedy.
Purvis has carried out fever checks of individuals on the entrance. But he stays fearful that his billing workers may very well be pressured to quarantine themselves in the event that they fall in poor health — successfully shutting off the hospital’s income.
“If my billers and coders stay healthy, I can make it to April, maybe end of June,” Purvis mentioned.
On high of the huge lack of income, Julie Jones, CEO at Community Hospital-Fairfax in northwestern Missouri, mentioned she will solely get specialty N95 respirator masks that provide crucial safety for her front-line suppliers for about $5 every — greater than 16 instances the traditional price of 30 cents.
Ashley Ammons, CEO of Clinch Memorial Hospital in Homerville, Georgia, mentioned she has warned workers that if hand sanitizer and disinfecting wipes proceed to go lacking, she’ll watch the video footage and fireplace on the spot anybody caught stealing provides. And she is so apprehensive about working out of protecting gear, she’s asking any of her “crafty” workers with stitching machines to stitch cotton masks.
“I would rather staff go in with a fabric mask than no mask at all,” she mentioned.
To make certain, rural hospitals usually are not as geared up as bigger hospital methods to deal with essentially the most critical coronavirus instances. Many are not outfitted with ICUs or sufficient docs and workers to deal with a number of intensive care sufferers. That means they must switch these sufferers to bigger hospitals.
Still, rural specialists argue that their mattress and well being care capability will be leveraged to maintain potential coronavirus instances out of the foremost hospitals. Plus, rural amenities may very well be locations for preliminary triage or eventual restoration care.
And if nothing modifications, Rau worries, the nation is about to lose this crucial public well being infrastructure.
“We can talk all we want about the cost of health care in this country in this ridiculous health care system we have,” she mentioned. “But at a time like this, who for a minute would think about getting rid of rural hospitals?”