We in rural American healthcare have seen the chaos and havoc that COVID-19 has wreaked upon our colleagues in hot-spot urban hospitals over the past several months. The emotional and financial effects on healthcare providers are unprecedented and continue to be well-documented.
My health system, Dartmouth-Hitchcock Health, has been relatively fortunate: We have not had to confront the massive surges of patients seen in New York and other urban areas or the skyrocketing rates of infections and deaths. We were ready, as were others, but our preparedness has come at a cost to our hospitals, patients and communities.
COVID-19 is collecting its victims in a different way in rural America. But its toll is just as devastating as it is among our urban counterparts.
In preparing to receive the potential surge of COVID patients, rural hospitals moved rapidly in early March to clear our schedules of most elective, time-sensitive surgeries and procedures, which are critical to our fiscal health.
At the same time, our supply-chain teams went to incredible lengths to find the necessary personal protective equipment. We paid million-dollar deposits to sometimes unscrupulous suppliers abroad for PPE, conceding where necessary, while beseeching our local communities, businesses and volunteers to donate equipment and sew masks to keep our healthcare workers safe. All in a matter of weeks.
Our efforts worked remarkably well—perhaps too well: Rural hospitals were nearly empty, but so was the revenue stream. That’s compounded by a dramatic increase in the numbers of the now unemployed and uninsured patients who will need care and result in a dramatic shift in reimbursement from commercial payers to Medicaid and Medicare and with it, tens of millions of additional dollars in lost reimbursement.
Small hospitals, already operating on razor-thin margins, are being forced into bankruptcy or closure, and thousands of healthcare employees have been furloughed or laid off. That puts our rural communities in double jeopardy: Not only are our citizens denied access to much-needed care, but the local economies are impacted by the loss of jobs.
Hospitals across the nation have scrambled to find a way to reopen. While most, if not all, have reopened, we are constantly reassuring patients that our hospitals are the safest and cleanest places you can visit and, most importantly: If you need care, you should not put off seeking it.
We are grateful for the federal stimulus funds and a number of steps that were taken under the state and federal emergency declarations that have temporarily helped provide better coordinated, patient-centered care. We hope those will continue beyond the public health emergency, taking important steps to transform our health system.
A recent report produced by the Bipartisan Policy Center includes a number of recommendations that can serve as a blueprint for rural hospitals’ recovery. They include greater support for telehealth—which has grown exponentially since early March—as a cost-effective way to offer high-quality care in rural areas. This is critical because of the significant distance patients must travel, even in normal times. The report also recommended creating funding mechanisms that reflect the specific challenges rural hospitals face; building and supplying a primary-care physician workforce that suits the specific needs of rural communities; and right-sizing healthcare services to fit the needs of rural communities, instead of a one-size-fits-all approach.
While we have successfully flattened the COVID-19 curve in many areas and saved lives, we need to be prepared for a possible second wave of COVID-19—and indications are that it’s coming. Despite the ravages of the pandemic on our healthcare systems, our economy and on our national psyche, there are opportunities to create innovative systems that serve our people well.
We are preparing for the challenge and all of us—healthcare systems as well as policymakers and regulators—must take the necessary steps to face it and improve healthcare delivery and outcomes. Our communities and patients deserve nothing less.
