{"id":266625,"date":"2020-08-26T20:48:21","date_gmt":"2020-08-27T00:48:21","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=266625"},"modified":"2020-08-26T20:48:21","modified_gmt":"2020-08-27T00:48:21","slug":"prognosis-for-rural-hospitals-worsens-with-pandemic","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/08\/26\/prognosis-for-rural-hospitals-worsens-with-pandemic\/","title":{"rendered":"Prognosis for Rural Hospitals Worsens With Pandemic"},"content":{"rendered":"
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As COVID-19 continues to spread, an increasing number of rural communities find themselves without their hospital or on the brink of losing already cash-strapped facilities. (Pixabay photo)<\/figcaption><\/figure>\n

Jerome Antone said he is one of the lucky ones.<\/p>\n

After becoming ill with COVID-19, Antone was hospitalized only 65 miles away from his small Alabama town. He is the mayor of Georgiana \u2014 population 1,700.<\/p>\n

\u201cIt hit our rural community so rabid,\u201d Antone said. The town\u2019s hospital closed last year. If hospitals in nearby communities don\u2019t have beds available, \u201cyou may have to go four or five hours away.\u201d<\/p>\n

As COVID-19 continues to spread, an increasing number of rural communities find themselves without their hospital or on the brink of losing already cash-strapped facilities.<\/p>\n

Eighteen rural hospitals closed last year and the first three months of 2020 were \u201creally big months,\u201d said Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill. Many of the losses are in Southern states like Florida and Texas. More than 170 rural hospitals have closed nationwide since 2005, according to data collected by the Sheps Center.<\/p>\n

It\u2019s a dangerous scenario. \u201cWe know that a closure leads to higher mortality pretty quickly\u201d among the populations served, said Holmes, who is also a professor at UNC Gillings School of Global Public Health. \u201cThat\u2019s pretty clear.\u201d<\/p>\n

One 2019 study found that death rates in the surrounding communities increase nearly 6%<\/a> after a rural hospital closes \u2014 and that\u2019s when there\u2019s not a pandemic.<\/p>\n

Add to that what is known about the coronavirus: People who are obese or live with diabetes, hypertension, asthma and other underlying health issues are more susceptible to COVID-19. Rural areas tend to have higher rates of these conditions. And rural residents are more likely to be older, sicker and poorer than those in urban areas. All this leaves rural communities particularly vulnerable<\/a> to the coronavirus.<\/p>\n

Congress approved billions in federal relief funds<\/a> for health care providers. Initially, federal officials based what a hospital would get on its Medicare payments, but by late April they heeded criticism<\/a> and carved out funds for rural hospitals and COVID-19 hot spots. Rural hospitals leapt at the chance to shore up already-negative budgets and prepare for the pandemic.<\/p>\n

The funds \u201chelped rural hospitals with the immediate storm,\u201d said Dr. Don Williamson, president of the Alabama Hospital Association. Nearly 80% of Alabama\u2019s rural hospitals began the year with negative balance sheets and about eight days\u2019 worth of cash on hand.<\/p>\n

Before the pandemic hit this year, hundreds of rural hospitals \u201cwere just trying to keep their doors open,\u201d said Maggie Elehwany, vice president of government affairs with the National Rural Health Association. Then, an estimated 70% of their income stopped as patients avoided the emergency room, doctor\u2019s appointments and elective surgeries.<\/p>\n

\u201cIt was devastating,\u201d Elehwany said.<\/p>\n

Paul Taylor, chief executive of a 25-bed critical access hospital and outpatient clinics in northwestern Arkansas, accepted millions in grants and loan money Congress approved this spring, largely through the CARES (Coronavirus Aid, Relief and Economic Security) Act.<\/p>\n

\u201cFor us, this was survival money and we spent it already,\u201d Taylor said. With those funds, Ozarks Community Hospital increased surge capacity, expanding from 25 beds to 50 beds, adding negative pressure rooms and buying six ventilators. Taylor also ramped up COVID-19 testing at his hospital and clinics, located near some meat-processing plants.<\/p>\n

Throughout June and July, Ozarks tested 1,000 patients a day and reported a 20% positive rate. The rate dropped to 16.9% in late July. But patients continue to avoid routine care.<\/p>\n

Taylor said revenue is still constrained and he does not know how he will pay back $8 million that he borrowed from Medicare. The program allowed hospitals to borrow against future payments from the federal government, but stipulated that repayment would begin within 120 days.<\/p>\n

For Taylor, this seems impossible. Medicare makes up 40% of Ozarks\u2019 income. And he has to pay the loan back before he gets any more payments from Medicare. He\u2019s hoping to refinance the hospital\u2019s mortgage.<\/p>\n

\u201cIf I get no relief and they take the money \u2026 we won\u2019t still be open,\u201d Taylor said. Ozarks provides 625 jobs and serves an area with a population of about 75,000.<\/p>\n

There are 1,300 small critical access hospitals like Ozarks in rural America and, of those, 859 took advantage of the Medicare loans, sending about $3.1 billion into the local communities. But many rural communities have not yet experienced a surge in coronavirus cases \u2014 national leaders fear it will come as part of a new phase.<\/a><\/p>\n

\u201cThere are pockets of rural America who say, \u2018We haven\u2019t seen a single COVID patient yet and we do not believe it\u2019s real,\u2019\u201d Taylor said. \u201cThey will get hit sooner or later.\u201d<\/p>\n

Across the country, the loss of patients and increased spending required to fight and prepare for the coronavirus was \u201clike a knife cutting into a hospital\u2019s blood supply,\u201d said Ge Bai, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.<\/p>\n

Bai said the way the federal government reimbursed small rural hospitals through federal programs like Medicare before the pandemic was faulty and inefficient. \u201cThey are too weak to survive,\u201d she said.<\/p>\n

In rural Texas about two hours from Dallas, Titus Regional Medical Center chief executive Terry Scoggin cut staff and furloughed workers even as his rural hospital faced down the pandemic. Titus Regional lost about $4 million last fiscal year and broke even each of the three years before that.<\/p>\n

Scoggin said he did not cut from his clinical staff, though. Titus is now facing its second surge of the virus in the community. \u201cThe last seven days, we\u2019ve been testing 30% positive,\u201d he said, including the case of his father, who contracted it at a nursing home and survived.<\/p>\n

\u201cIt\u2019s personal and this is real,\u201d Scoggin said. \u201cYou know the people who are infected. You know the people who are passing away.\u201d<\/p>\n

Of his roughly 700 employees, 48 have tested positive for the virus and one has died. They are short on testing kits, medication and supplies.<\/p>\n

\u201cRight now the staff is strained,\u201d Scoggin said. \u201cI\u2019ve been blown away by their selflessness and unbelievable spirit. We\u2019re resilient, we\u2019re nimble, and we will make it. We don\u2019t have a choice.\u201d<\/p>\n

Kaiser Health News<\/a> (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation<\/a> which is not affiliated with Kaiser Permanente.<\/em><\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>\n

Subscribe<\/a> to KHN’s free Morning Briefing.<\/p>\n

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