From New York City to Barcelona, major cities across the globe were hit hard by COVID-19 in the early months of the pandemic. Now, rural areas are increasingly experiencing a surge in virus cases. While bigger cities are more densely populated, the Centers for Disease Control and Prevention notes that rural communities may be at higher risk during the pandemic because of their older populations, increased rates of chronic disease and limited health care infrastructure.
In this Q&A, Mitchell Clark, president of Cerner CommunityWorksSM, discusses the current and future financial and operational impacts of COVID-19 on rural health care organizations.
Q: Rural hospitals have faced unique challenges during the pandemic. What are some of the difficulties you’ve observed impacting these organizations?
A: The financial challenges are probably the most obvious. Most rural hospitals weren’t in good financial condition before COVID-19. With the suspension of elective procedures and a sharp decline in clinic visits, revenue has dropped to record low levels.
Staffing has also been an issue for rural providers. In the spring, some rural hospitals hired new staff and many dedicated existing staff to COVID-19 preparation. But for a large majority of these facilities, the anticipated surge didn’t arrive immediately. Now we’re five months into the pandemic, and we're seeing several rural hospitals in places like Texas that are at or near capacity. These rural providers are facing COVID-19 patient surges with less resources due to the significant decrease in revenue.
Another piece of the puzzle is that these hospitals don't have a deep bench of trained staff capable of working at their facilities. This means rural health organizations often don't have enough people to provide breaks in scheduling or to cover if staff members get sick.
Due to layoffs and furloughs, I've heard of hospital executives adding entry level duties to their workload, like preparing meals to distribute throughout the hospital, because the facility doesn't have enough people on staff to carry out fundamental tasks that are part of everyday operations.
Q: What do rural hospitals need most to help them financially recover from the pandemic and remain viable?
A: Providers need assurance that the reimbursement model in place today around telehealth will be permanent. Most of our rural health clients aren’t doing a large-scale ramp up of their telehealth programs because they're unsure about how the payment model will be structured long-term.
It would also help rural health organizations to have financial support that encourages the purchasing of equipment and solutions to expand virtual health strategies, including telehealth and other technology like remote patient monitoring. This could help offset some of the revenue loss they may be experiencing because fewer people are going to the hospital.
The availability of personal protective equipment (PPE) is another concern for rural hospitals. The stockpiles in many hospitals are dangerously low. Two hospital CEOs shared with me recently that they’re concerned about their ability to protect employees. Not having to worry about PPE would allow providers to focus on delivering quality care.
Finally, supplemental financial support to bridge the gap between past and current revenues at the lower operating level would help rural providers navigate the increasing numbers of COVID-19 cases.
Q: There are 38 states, plus Washington D.C., that have adopted Medicaid expansion. What role does Medicaid expansion play in the fight against COVID-19 in rural areas?
A: In July, Cerner CEO Brent Shafer wrote an opinion piece in support of Medicaid expansion in Missouri. Citizens of the state voted to expand Medicaid on August 4. Research shows that this is good news. A study by The Chartis Center for Rural Health finds that being in a Medicaid expansion state decreases the likelihood of a rural hospital closing by an average of 62 percent.
States that expanded Medicaid have more federal resources to address the pandemic and the economic fallout. They can provide more coverage for people who lost jobs, income and health insurance due to the crisis. These states are also in a better position to pay providers and help hospitals weather huge revenue losses.
Q: How is Cerner supporting rural providers during these trying times?
A: In addition to our traditional CommunityWorks delivery model, we have a new offering, CommunityWorks Foundations. It’s our newest cloud-based delivery model that helps reduce financial barriers for rural providers to switch EHRs, providing them with greater access to clinical and revenue cycle management tools that can support them in delivering the highest level of care in their communities during and after the pandemic.
Cerner is committed to helping community health providers get through this challenging period. This is why we’re offering our clients services and solutions around analytics and reporting, telehealth, testing, screening, cybersecurity and more to assist with response and recovery.
Q: What’s next for rural communities as they navigate this new health care landscape?
A: The impact of COVID-19 will be with us through 2021 and beyond. Health care organizations need to reevaluate financial and operational systems to thrive in the post-pandemic world. Everything from the reimbursement model to the care delivery process will be reimagined.
This pandemic has also revealed the need for additional investment and innovation around virtual health and outpatient services. Hospitals and health systems will need to place a greater focus on shifting from reactive to proactive care.
The experience of responding to the pandemic has made organizations work smarter and faster. A few clients shared with me that they had zero telehealth processes in place before the pandemic and COVID-19 forced them to adapt and learn along the way so they could quickly put something in place.
There’s an incredible opportunity for rural providers – and the entire industry – to grow from the lessons learned during the pandemic and to build a stronger future for rural health care.
CommunityWorks is a cloud-based deployment of Cerner’s traditional IT platform, tailored to meet the unique needs of community, critical access and specialty hospitals. Learn more here.