As COVID-19 cases have increased exponentially in the U.S., CDC guidelines have led healthcare providers across the country to cancel outpatient procedures and elective surgeries. In rural areas, that's left already struggling clinics and hospitals without a vital source of income. Tim Wolters, director of reimbursement at Citizens Memorial Hospital in Bolivar says his health system now has to balance preparing for COVID-19 cases and maintaining staff.
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TIM WOLTERS: We've seen a significant drop off in services as far as both hospital revenues as well as in our clinics as patients are canceling appointments. We've discontinued most of our hips and knee replacements, things like that. Just in the last two weeks our revenue, our net revenue is down over 40 percent for the hospital and for our clinics. For a monthly basis, that would be the equivalent of about a $5 million loss in revenue. So just a very devastating impact as far as the health system itself, As we prepare for a patient surge that may be coming later in the spring. So it's kind of a quandry that we're in, in terms of trying to overcome the lost revenue but keep all the staffing in place so we're ready to meet our patients' needs.
HEALTH AND WEALTH: You mentioned the financial impact- the CARES act, the relief act that passed last week, is there anything in that that could soften the financial blow for you?
TW: There are a number of provisions in there that we are evaluating. There's some that provide some support; for example there's a suspension of the two percent Medicare sequestration cut that's been in effect since 2013. It takes about a million dollars a year out of our revenue and that's been suspended for an 8 month period. So that's nice, that's probably, maybe $700,000 of benefit, but with the benefit we've lost, that's less than a week of replacement for that revenue. The big issue out there is there's $100 billion emergency fund that is set up for healthcare providers to access. We are waiting for [Center for Medicare and Medicaid Services] and [Department of Health and Human Services] to issue the rules on how we can go about applying for that. So that I guess is the biggest single item in the bill. We are- personally I don't think that $100 billion is going to be enough when I see what's already happening in New York and Washington State and other places, and what those facilities are experiencing. So I don't know, and my concern is that fund may be drained pretty quickly, before hospitals in the heartland of the country have a chance to even apply for it. So we're going to have to try and go ahead and be ready to apply once the rules are there. If we don't, if that $100 billion fund for example, if that gets depleted too quickly, we are hoping congress will act to recognize we need more. I was really hoping within the CARES act there would be a separate pool for rural providers, because I think that's something that so many rural hospitals already have negative operating margins, which we had before this even started. We had a small negative margin and it's just going to make it that much harder. I'm afraid we will see rural hospitals that are going to close during this crisis. I think we need to do everything we can to keep them going through the crisis at a minimum, but hopefully long-term with some support from the federal government. I really feel like there's going to be a need from the federal government and hopefully from the state level as well. The state's getting some extra resources from the federal government, even on the medicaid side, and so I'm hoping Jeff City can even help out, because what's coming from Washington is not going to be enough for hospitals right now. So I'm hoping Jeff City will also be able to provide some support for Missouri providers.
H&W: Have you had any confirmed cases in your area?
TW: Yeah so we are in Bolivar, in the middle of Polk County, but we do serve all the surrounding counties as well. We serve Dade, Cedar, Hickory and Dallas County and St. Clair county. Cedar County has seen five cases so far, they went from zero to five over the weekend so that's the first significant outbreak in the rural areas around us. Springfield of course in Greene County had a number of cases. We do have one employee that works in Bolivar but actually lives in Cedar County that has tested positive. [They're] doing well, confined at home. But again I think that's one of the five cases in Cedar County, but again there's no official cases in Polk County so far.
H&W: The governor so far has refused to issue a statewide stay-at-home order; how do you feel about the prospect of such an order?
TW: I think it would help. I mean I kind of understand, in the counties that have no cases, why stay at home. But I think the whole idea is to try and minimize the potential cases, so yes I think it would make sense to try and have a statewide- obviously it's been encouraged but there's no order. But I think it would make sense to have an order just to try to keep those cases down and certainly keep it out of rural counties. Particularly because many of those rural counties that have no cases, they also have very limited healthcare resources out there. A number of the counties with zero cases also don't have a hospital, for example. So those patients, if they do have difficulties, they're going to have to travel to another county, particularly into an urban area potentially for care, and that's just going to stress the system even more. So I think it's important to try and minimize cases and keep it out of rural parts of the state. You know, hopefully all the residents in the area are doing as much as they can, staying at home. But I think a little more teeth in it from the state level would help as well, as most states have already done.
