In recent months, COVID-19 cases have mostly been confined to urban centers and corresponding suburbs. However, many epidemiologists predict the virus will invade less densely populated areas throughout the U.S., starting in the fall of this year.
While rural care providers already operate on thin profit margins to treat communities that present an array of unique health risks, the current pandemic demonstrates the vital role they play in the communities they serve, not just as the chief care provider, but also as a public health authority and employer.
The Challenges Ahead
Rural areas so far have been protected from the coronavirus threat by their removal from seaports, airports, and high-traffic highways. However, recent outbreaks in prisons and meat-processing facilities are likely to infiltrate their surrounding rural communities, presenting a serious challenge to the hospitals in these communities.
Such a challenge would come on top of the already entrenched challenges rural providers face in caring for their populations, which typically skew older and show higher incidents of heart disease, cancer, chronic lower respiratory disease, unintentional injury, and stroke.
“We’re obviously hopeful that a second wave doesn’t happen, but it probably will,” Neil Todhunter, President of HealthTechS3, said. “The one thing rural populations have going for them is that people are already somewhat accustomed to social distancing measures. That might help slow the advancement of the virus in those communities. But unless there’s additional federal money to come, it’s going to be challenging for a lot of rural hospitals, whose profit margins are pretty thin as it is.”
A February 2020 report from the Chartis Center for Rural Health [LINK: https://www.ivantageindex.com/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf] says 2019 was the worst year for rural hospital closures in a decade, with 19 hospitals shutting their doors. Today, 453 of the 1,844 rural hospitals still operating in the U.S.—approximately one in four—show signs of being vulnerable to closure in the near future.
Among those hospitals that have yet to treat a single COVID-19 case, many have already taken a financial hit after having to cancel elective surgeries and other non-critical services, since such procedures present a drain on medical supplies and put staff and patients at risk of exposure.
In late March, Congress passed the $2.2 trillion CARE Act, an economic rescue package that includes more than $100 billion in emergency funds to compensate hospitals and other healthcare providers for lost revenue associated with COVID-19—including cancellations of elective surgeries—as well as up to $16 billion to replenish depleted stockpiles of medical gear, ventilators, and personal protective equipment, or PPE.
Still, if the predicted second wave happens, rural providers are likely to request additional relief, which might include further access to capital and more equitable Medicare and Medicaid reimbursement rates.
Time Is On Their Side
In addition to the social distancing that rural areas afford residents, Todhunter is quick to point out that rural providers have one significant advantage over their urban counterparts: time.
“Just about all hospitals, regardless of size, have a disaster plan that’s been reviewed and tested and that would be applicable in a pandemic,” he said. “Because rurals have not yet been impacted, they’re had more time to prepare and get their supplies in place. That should help them out over the next few months.”
The extra prep time also presents to rural providers an opportunity to seize their authoritative role in their communities’ well-being. By collaborating with nearby nursing homes, large employers, and other agencies, rural care providers could push public education efforts and share best practices related to disease prevention.
“Collaboration helps the community,” Todhunter said. “When it comes to public health measures, hospitals must work with public health departments and other providers so that there’s a coordinated approach.” “The current pandemic really demonstrates the importance of these rural hospitals in these communities, and not only with the healthcare they provide,” Todhunter added. “In many areas, these hospitals are the number-one employer in their communities. If anything starts to threaten their viability on the healthcare side, it could have a significant negative impact on the community. There’s a lot in play here.”