Correction: a previous version of this story reported a COMTREA Health employee tested positive for COVID-19. The individual was exposed to the virus outside of work and quarantined, but was not symptomatic.
If someone gets sick in a seven county swathe of the Ozarks of southeastern Missouri, the closest place they can go for care is a clinic run by Missouri Highlands Health Care. Highlands is a federally qualified health center or FQHC, with clinics in some of the least populated and poorest counties in the state. Now, some of those clinics are are cutting back.
Karen White is Highlands’ CEO. She says dental care - a major source of revenue - is now restricted to emergency procedures. "“We just shuttered our dental clinic — we have three of them operating throughout the organization plus a mobile dental,” White said. She’s had to furlough a tenth of Highlands' 200 members so far, and has reduced hours for many others.
"“We have several who are single parents," White said. "That’s not a decision that comes lightly. because you do know that a lot of times, you are truly affecting the economic outcome of that family unit.”
There have been a dozen confirmed cases in the area Highlands serves. And those communities are particularly vulnerable. The region relies in large part on logging and wood processing, considered an essential sector under the state’s recent stay-at-home order. In addition to that, like much of rural America, the population skews older.
Like other providers, White says her clinics need PPE and COVID-19 tests. But while hospitals are being prioritized for shipments from the state, Highlands has had to reach out to the local manufacturing industry. "It's a very, very scary time for everybody," White said.
100 miles north, in rural Jefferson County — which has had three confirmed COVID-19 deaths — COMTREA Health center is facing similar challenges.
COMTREA CEO Sue Curfman says 59 staff are furloughed, 14 are unable to report to work, due to childcare or caring for an elderly member, and 49 are working reduced schedules. Curfman says one of her staff was exposed to COVID-19 outside of work and quarantined. While things are tight now, she says she hopes to bring some staff back soon to help with the clinic’s new telehealth offerings.
That’s one avenue FQHCs have for funding, as federal agencies have opened up Medicaid and Medicare to cover remote visits. The CARES act also has provisions for accelerated and advanced payments to providers under those two programs. While it has allocated $100 billion in funding for hospitals, the act only set aside $1.3 billion for health centers.
Missouri Primary Care Association Director Joe Pierle says that money might not go very far. “The important thing to really understand from that funding is we think it buys us maybe three to four weeks,” Pierle said.
Pierle's organization represents a dozen FQHCs with some 200 locations across the state. He says they anticipate Missouri clinics could get around 2 percent of that money, and is working with the state Department of Social Services on getting gap payments for clinics. He says state FQHCs saw Medicaid revenues drop from $13 million between late February and mid-March to $5 million from mid-March to now.
“We’re trying to find every resource we can to sustain our operations because we believe we will be the backbone to keep pressure off of the hospital systems and emergency departments,” Pierle explained.
In rural areas FQHCs and their clinics are often the only place in the county people can go for treatment. Missouri has seen 10 rural hospitals close since 2014, leaving rural residents with even fewer options. With COVID-19, that could mean increased movement of patients seeking care, and increased chances of the virus spreading. Missouri governor MIke Parson addressed those concerns at a recent press briefing.
“Are we worried about small towns with a clinic there being able to handle that? Yes we are," Parson said. "But do I think just because you live in rural Missouri you’re going to flood the hospitals in the urban areas? I do not think that.”
For weeks, Parson resisted issuing a statewide stay-at-home order. He repeatedly noted rural areas had any cases. in his decision. Now, confirmed cases in those rural counties are on the rise.