‘The worst is yet to come.’ How COVID-19 could wipe out many rural hospitals
PBS NEWS HOUR | April 16, 2020 | By Laura Santhanam
Rural hospitals in Texas have been bracing for COVID-19’s ominous arrival in their communities, only to be hit with another potential killer: a lack of patients and revenue to keep essential services operating on slim margins.
Compared to urban coronavirus hot spots like New York, where hospitals have raced to meet the onslaught of infections, the spread in more remote communities has been mostly slow, thanks to social distancing efforts and a widespread lack of public transportation — for once, a benefit. But the measures have also slowed the flow of normal patients to a trickle, with potentially dire, long-term consequences for everyone who lives miles around.
In Dimmitt, Texas, a place known for family farms that raise cattle, cotton, corn and wheat, a rural 17-bed critical access hospital — one of 1,300 nationwide — serves the entire county’s 8,000 residents, who are spread across 900 square miles. Castro County Hospital District has seen times of financial trouble before, but for the past 17 years, it has been on a steadier course. Outpatient services, such as physical therapy for hip- and knee-replacement patients, have helped the hospital climb out of the red. Up until a month ago, the hospital’s staff “weren’t rich by any means, but we weren’t having issues making payroll,” CEO Linda Rasor said.
“The worst is yet to come. The rural health safety net is truly unraveling.”
Then COVID-19 arrived. After passing through larger cities like Dallas, Houston and San Antonio, Rasor said, the virus hit Dimmitt and “our revenue has just tanked.”
Compared to three months ago, the number of patients coming daily to Rasor’s hospital and primary care clinic has dropped from 100 to 10, she said. Older patients who underwent recent hip- and knee-replacement surgeries (and stand at a higher risk for more severe health outcomes if infected with the virus) are “rehabbing at home” rather than coming in for physical therapy, Rasor said, after Texas issued shelter-in-place orders last month. Emergency 911 calls and rehabilitation services are down.
“Nobody’s going anywhere, and they’re not utilizing health care,” Rasor said. “They’re just treating themselves at home.”
It’s not just in Dimmit. With health officials across the country telling the public to stay home unless they need immediate medical care, rural hospitals have seen demand for services — and revenue — plummet. That’s problematic, because like so many other industries hit by this pandemic, hospitals are businesses, too. The national median amount of cash-on-hand for such institutions — the amount of money they have to make payroll and cover expenses — is enough to last just 33 days, according to recent research from the Chartis Center for Rural Health. Many facilities are approaching that turning point.
In Eastern Kentucky, Stephanie Courtwright Moore oversees White House Clinics, a regional network of nine clinics that offers primary and pediatric health care, dental services and behavioral therapy and treatment to 31,000 patients per year.
But since COVID-19, patient visits have nosedived by 90 percent, thanks to a statewide stay-at-home order (which she supports as good public health policy).
“If we need to do this for a month, or two months, I probably wouldn’t be as concerned,” she said. “The thought of this lasting four months, or six months, I just shudder at thinking what the financials will look like.”
The financial fragility of U.S. rural hospitals long predates the COVID-19 crisis. One out of five Americans lives in rural communities, but 453 rural hospitals are perched on the verge of closure, the report also found.
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