Allen County Regional Hospital is hoping the government stimulus package will provide some financial relief to recover from losses expected from the coronavirus pandemic.
Rural hospitals are facing significant revenue losses as they have shifted to providing mostly urgent and emergency care to avoid spreading the virus. Provisions in the federal government’s $2 trillion coronavirus response bill are expected to provide financial assistance to hospitals.
ACRH likely will apply for those grants or loan programs, Larry Peterson, chief financial officer and interim CEO, said.
“At this point I don’t have any idea what dollars will be available, but we’ll take what we can get,” he said.
Most non-essential health care has been postponed, hurting rural hospitals that rely heavily on the income from outpatient clinics and elective surgeries.
ACRH stopped all elective surgeries March 17, providing only those that are considered urgent or emergencies. Those elective surgeries account for about 80% of the hospital’s surgeries, Peterson said.
The hospital also is seeing a 30-40% decrease in outpatient visits, such as for various clinics as well as emergency room visits, he said. About 75% of the hospital’s revenue comes from outpatient services, Peterson said, so the recent decrease in visits likely will translate to a significant loss in revenue.
Some providers have reduced or temporarily suspended services at ACRH. Some patients have chosen to postpone treatment themselves. Some outpatient clinics continue to operate, while some are offering telehealth appointments with physicians based elsewhere.
The hospital’s in-patient count — which includes those admitted to the hospital as well as those recovering from surgeries or other procedures — also has dropped. ACRH’s in-patient count has been lower than expected for several months, following a national trend that emphasizes outpatient and home-based care rather than admitting patients to the hospital. In recent months, the hospital’s daily number of patients averaged between 3.7 to 5.8.
But ACRH is trying to reduce in-patient numbers even further, Peterson said. That’s both to minimize the number of people in the hospital to avoid spreading illness and to prepare for any possible surge in local patients who become ill from the COVID-19 coronavirus.
As of Wednesday, no positive COVID-19 cases had been reported in Allen County with 68 tests conducted. All other regional counties, except Anderson, have reported positive cases.
IN ADDITION to the revenue losses from reduced services, the hospital’s expenses have increased because of the monitoring and preparation for the virus.
ACRH has restricted visitors and screens everyone who comes into the hospital for signs of illness and travel history. The main entrance is staffed from 7 a.m. to 5 p.m. for screenings, and the emergency room entrance is staffed at all times.
The expenses for those salaries are directly related to the coronavirus and could be reimbursed by the stimulus program.
Also, a reduction in patients and services has not translated to a reduction in staff. ACRH hasn’t laid off staff, though some nurses and others may have seen reduced hours, Peterson said.
ACRH needs to keep staff available in the event of a surge of patients from COVID-19, Peterson said. Plus, ACRH is expected to begin operating under a lease with Saint Luke’s Health System effective July 1, and ACRH employees will then become Saint Luke’s employees. Layoffs could complicate that transition.
But administrators have needed to get creative to keep staff members busy during slow periods, Peterson and Traci Plumlee, the hospital’s public relations director, said.
For example, the reduction in surgeries has left the surgical nursing team with few responsibilities. Some are manning the entrances to screen patients and visitors.
Most of the surgical nurses are cross-training in other departments, so they will be available to assist with any possible surge of coronavirus patients.
“They have the knowledge and training so it’s not like they’re learning something new, they’re just dusting it off and reacclimating to a different department,” Plumlee said.
IF COVID-19 cases were to hit Allen County, the most serious cases likely would be transferred to larger facilities in Kansas City, Wichita or elsewhere.
That’s because small, rural hospitals like ACRH do not have intensive care units and are not prepared for long-term ventilation needs.
“If someone needs breathing assistance like supplemental oxygen or temporary ventilation, we can do that, but not long-term, intensive care,” Peterson said.
ACRH is licensed for 25 beds, but could increase that number to around 29 or so if the county saw a surge of coronavirus cases. The bigger problem is staffing, Peterson said.
“Our limitation is not space,” he said. “It’s having enough staff to care for those patients.”
The hospital currently has enough personal protection equipment (PPE) — masks, gloves, gowns, face shields — but could face shortages if there were a surge in coronavirus patients. Administrators and the county’s emergency management department were able to receive some additional PPE but other requests remain on back order.