The COVID-19 pandemic is starting to reach rural areas as cases in several states start to rise with economies reopening.
With that rise sparks new concerns about the financial vulnerability of rural hospitals, which were already in a precarious position. Since the onset of the pandemic in March, another four rural hospitals have closed. Nearly half of rural hospitals were already operating at a loss.
“Our big concern is that we aren’t gonna have the rural hospitals around if and when these pockets hit the rural communities," said Maggie Elewhany, vice president of government affairs and policy for the National Rural Health Association.
COVID-19 cases are spiking in Texas, North and South Carolina, Oregon, Arkansas, Utah, Mississippi and Arizona, according to an analysis from the Washington Post last week. Some of these cases may be due to reopening of state economies and has sparked concern that rural areas are seeing an uptick.
Rural hospitals say they are ready to meet any crush of COVID-19 cases.
While Texas cases are on the rise, the state’s rural facilities still are able to meet bed capacity, said John Henderson, president and CEO of the Texas Organization of Rural Hospitals.
“There have been a few spikes in rural Texas — mostly related to meat packing and/or nursing home cases, but I’m not aware of a rural Texas hospital that has reached capacity or been unable to transfer COVID patients who need significant respiratory support to urban hospitals with [intensive care unit] capacity,” Henderson said.
At LifeBrite Community Hospital of Spokes in North Carolina, the critical access hospital is in constant contact with its local health department to get a feel of cases in the community.
“We are making sure that we have a good daily tally of our [personal protective equipment] and how quickly we would burn that,” said Hospital Administrator Pam Tillman. “Those are all things that we have been doing daily for a long time.”
As a critical access hospital, LifeBrite doesn’t have an ICU but does have an emergency room and satellite surgical center that had shuttered procedures.
A major concern for LifeBrite isn’t PPE, but staffing.
“Nursing and staffing has always been a challenge,” Tillman said. “As a small hospital, the challenges are that we have to use our very few people to keep up with the regulations.”
She said that the state’s hospital association and health departments have been a big help to the hospital on getting critical information.
Help from Washington
Rural health advocates say the pandemic underscores the need for major reforms to rural healthcare.
First and foremost, rural facilities need more federal funding, advocates say. Congress passed $175 billion in funds to help providers slammed financially during the pandemic, but the Department of Health and Human Services (HHS) has been criticized for a delay in sending funds to providers that rely on Medicaid, which includes some facilities in rural areas.
HHS has since announced plans to distribute $15 billion to primarily Medicaid and Children’s Health Insurance Program providers as well as $10 billion to safety-net hospitals that do a majority of charity care.
“The influx of cash has definitely been a lifeline,” Elewhany said. “It is a lifeboat. But it is a small, inflatable raft.”
She said many rural hospitals have anywhere between seven and 31 days of cash on hand.
“While they received some relief, that is not going to last long,” Elewhany said.
She also pressed Congress to make some longstanding reforms to ease rural hospitals.
Elewhany pointed to a bipartisan bill proposed by Sens. Dick Durbin, D-Ill., and James Lankford, R-Okla., that reforms the requirements to become a critical access hospital, which is paid at a higher Medicare rate than a regular hospital.
The bill introduced last December would change the critical access hospital designation to enable more rural hospitals to qualify.
She also pointed to legislation from Sens. Joe Manchin, D-W.Va., and Lisa Murkowski, R-Ala., that requires any remaining relief funds to be equitably distributed to rural providers.