So far, COVID-19 cases have largely been located in urban metropolitan areas, but rural hospitals know it is only a matter of time before the outbreak reaches their communities and are now making moves to prepare.
But how can rural hospitals, many of which are already teetering financially, expand capacity and get new equipment especially as they must cancel revenue-producing elective procedures?
“We are going into this with nearly half of hospitals losing money,” said Roger Ray, physician consulting director for consulting firm Chartis Group.
The group’s Center for Rural Health said 120 facilities have shut down since 2010, and more are continuing to shutter.
“COVID-19 will dramatically escalate closures,” added Maggie Elewhany, vice president of government affairs and policy for the National Rural Health Association. She said a hospital in Kansas and another in West Virginia closed just last week.
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Right now, facilities are largely in planning mode and taking stock of staff and equipment.
The Texas Organization of Rural and Community Hospitals (TORCH) surveyed the state’s 157 rural hospitals to get a sense of staff and equipment. The organization found roughly 300 ventilators in rural Texas, about two per hospital.
“I’m scared this could become tragic in a couple of weeks if/when rural hospitals can’t transfer to urban [intensive care units] because of bed capacity,” said John Henderson, CEO of TORCH.
So the organization is trying to order an additional 30 ventilators and asking the same from the state.
“We have assembled a list of volunteers who are willing to use their car/airplane to shuttle vents to rural hot spots if it comes to that,” Henderson added.
The problem of getting ventilators is likely to not be unique to Texas.
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“As rural facilities tend to be relatively low on the pecking order for supplies because of buying power, their supplies tend to be very thin,” Ray said.
He stressed that rural hospitals need to work in concert with their state or local governments and any connections to health systems to assist with critically ill patients.
Impact of stimulus package
President Donald Trump signed into law last week a massive $2.2 trillion economic stimulus package that includes $100 billion to hospitals to help them recover lost finances.
But Elewhanny is worried about whether rural hospitals will get a cut of that money.
“We are also concerned that the large $100 billion provider fund was more designed for larger health systems and facilities to access,” she said.
The Centers for Medicare & Medicaid Services (CMS) also expanded its accelerated and advance payment program that will enable most providers and supplies to request up to 100% of their Medicare payment amount for a three-month period.
Critical access hospitals can request up to 125% of their payments for six months.
Elewhanny said the provision was designed to “provide access to upfront needed assistance, however, because it is, in reality, a loan that will have to be repaid to CMS with interest if delinquent.”
She said most rural hospitals will not have the ability to repay any advance payments. CMS should put together loan forbearance provisions that reduce or postpone loan payments for rural facilities, Elewhanny said.