Ensuring rural America’s right to convenient and high-quality healthcare is imperative for their survival. Now more than ever, with the entire population battling the impact of a pandemic, rural providers need support from their partners and lawmakers.
Alan Morgan, CEO of National Rural Health Association (NRHA) joins us in a two-part Q&A to talk about how COVID-19 is affecting rural hospitals and their communities. In part one we discuss the current rural healthcare landscape, the role of telehealth during the pandemic, and what lawmakers can do to help these essential providers continue to serve their communities.
MEDHOST: How has COVID-19 changed the landscape for rural providers and what are you hearing and seeing from rural communities concerning the pandemic?
Alan Morgan: It is a tale of two rural towns. For the vast majority of rural hospitals, they are struggling to keep their doors open. Of the roughly 2,000 rural hospitals out there right now, we have 47 percent of them operating at a loss prior to COVID-19. About half of the rural hospitals were thriving at the start of February. What attracts a lot of attention are the rural areas that are getting surges of patients from COVID-19.
At the mid-point of February all rural hospitals started to cease elective procedures. From a rural standpoint, that’s 70-80 percent of revenue. Even for the ones that were doing well – this is a problem. And for those operating at a loss – that’s a REAL problem. About half of them now have initiated furloughs and staff reductions. Though, they have been trying not to furlough clinical staff so they can have these team members ready when the surge hits.
MH: In light of recent news about hospitals reopening elective surgeries, do you see any hurdles in a rural facility’s ability to balance elective surgeries while responding to further COVID outbreaks?
AM: For even the hospitals who have been through the surge and are on the backend, the CEOs are saying that they have to have clinical staff available. It’s going to take them a while to feel comfortable with opening up more elective and out-patient procedures knowing that you may need to have that capacity for COVID patients.
MH: What does the COVID-19 outlook look like for the rural hospitals going forward and what are lawmakers doing to help improve that outlook?
AM: This is a rapidly progressing situation. Congress passed the CARES Act and it had two great provisions. One was advance Medicare payments – great for those hospitals needing access to immediate cash, but they have to pay these loans back.
The second was a 100-billion-dollar provider relief fund. We had asked Congress to have 20 percent set aside for rural providers. They didn’t do that, so the administration decided rural hospitals would close in the near term and took matters into their own hands and directed the first $30 billion of that fund tied to historic Medicare volume. Rural hospitals have a higher percentage of Medicare patients than their urban counterparts. In effect those payments in most cases are directed to rural hospitals which was very helpful.
Then, on April 22 the Department of Health and Human Services (HHS) announced that rural health clinics and hospitals would receive an additional $10 billion from the Provider Relief Fund. This funding will offer critical, immediate assistance to rural hospitals, rural health clinics, and other rural providers who have been struggling to keep their doors open.
Rural facilities have a one-month cash-on-hand reserve right now, which should be good through the first of June in many cases. We have the second version of the CARES Act going into Congress right now and are hoping to have further discussions with administration to help rural hospitals get through this phase. In theory, hopefully they can reopen their elective procedures by the end of the summer. But right now, we are just trying to bridge the gaps in the period we are in.
MH: What are some of the lessons learned that the government can use as guides to help the healthcare industry better prepare for these types of situations?
AM: They have temporarily relaxed so many telehealth regulations and those need to be locked in permanently. Just the value and benefits from a rural standpoint – once we get past this and start shifting to long-term sustainability – we are going to have to look into sustaining these telehealth regulations.
MH: How is telehealth impacting rural hospitals right now in the midst of the pandemic and moving forward?
AM: I think the rural perspective is lost in a lot of these discussions around telehealth. In particular, you have an older, sicker, poorer population in rural communities. There is also a higher percentage of members with comorbidities. This is the population most at risk for COVID-19 in these small towns of 15,000-20,000 people. It is a potential for a really bad situation to happen.
I’m hearing good things from our rural clinics. For the ones that were able to stay open, the ability to use telehealth has been good. Their big hurdle initially was broadband and connectivity. Now there is the ability to do patient care visits by the telephone without video associated and that’s going to be helpful. I think it’s working, but for anyone that’s lived in a rural community – that internet capacity, and even cell phone service, is very limited.
Check back here on our blog for part two where we cover more rural-specific COVID-19 topics and get Morgan’s perspective on a few other issues impacting rural providers.
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