In a panel discussion hosted by Azalea Health, Jimmy Lewis, CEO from Hometown Health, and four additional CEOs including: Jon Green from Taylor Regional, Michael Hester from Stephens County Hospital, Brian Miller from Dewitt Hospital, and Tammy Mims from Liberty Regional Hospital, all discussed challenges faced by rural hospitals.
Jimmy Lewis, the panel’s moderator, began by warmly welcoming everyone, before asking, “What are the challenges in your hospital and how have you had to overcome it?”
Tammy Mims spoke first. For her hospital, testing kits were not readily available, ran low, and sometimes were non-existent. They experienced an upwards of 14-day delay in test results. Others agreed that this was a common trend for most rural healthcare clinics. Hospitals like Bruce Miller’s were luckier and had a surplus of supplies and testing machines. Though Miller added, “There’s no such thing as luck, only effective preparation.”
The lack of quick results greatly impacted staff for all CEOs, as many of their employees had to be quarantined for extended periods. Michael Hester said that there were unexpected challenges in staffing their personal care/assisted living facilities. The main difficulty was treating elderly patients who needed specialized care with no resources available. He was thankfully able to receive FEMA nurses to alleviate the situation, but not everyone has been so lucky. Many times, Mims said, they had to cross-train their staff to fill in any voids. This kept people employed but was not ideal.
There’s no such thing as luck, only effective preparation.
The panel then shifted to the topic of revenue. Lewis asked “From a revenue standpoint, how big of a hit have you taken? And what is your hospital doing with the money coming from the government?”
Waiting for government money while seeing little to no patients created razor thin margins. At one-point outpatient visits dropped 70 percent and inpatient dropped 20 percent for Hester’s hospital. “April was the hardest month,” Mims said. Revenue dropped steeply by 30 percent in some cases. The money coming in from assisted living locations was a major factor, they all commented. Hester reported that they had to furlough employees for a month, but once the Paycheck Protection Program (PPP) money came in, they were able to hire staff again. Miller called the stimulus money a blessing, stating that he would not have been able to receive some of the new medical equipment without it. The stimulus money will continue to impact his hospital positively even after the pandemic. However, Lewis and Miller agreed good detailed accounting will be very important, given the governments impending audit. All CEOs are wondering how much the government will ask for in return.
Jon Green noted that his hospital is already preparing for higher costs of supplies and staffing in the months ahead. Green remarked, “We do what we can today, and do what we can tomorrow. It just takes creative thinking.”
To which Lewis said, “We haven’t had a pandemic in 100 years, we haven’t had a lot of practice. But I think we are all doing a good job of acclimating to what is now the new normal.” He then directed the panel to the positives of new regulations.
All agreed that telehealth has been instrumental. Mims stated confidently, “I am convinced that telehealth is here to stay.” All CEOs agreed that telehealth was the future of medicine. However, Green shared his concerns, “The accessibility to cell service in some cases is a big barrier. People simply do not have the bandwidth or service to use telemedicine. We found that people were driving to parking lots of buildings with wifi.” While this is a short term “fix” to this issue, it is not viable, and he hopes the ongoing challenges with broadband access in disparate communities will get more attention.
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Lastly, the panel shared their personal takeaways and lessons that they would pass on to other CEOs. The three key points were: cross-training, communication transparency, and infection control. Mims highlighted cross training, saying that it allowed her to keep on her staff, even in the most stagnated months. She now sees her office running better than ever and recommends cross training to every hospital as everyone has a better understanding of downstream and upstream departmental impacts.
Green added, “I have a greater respect for healthcare employees everywhere. I was delightfully surprised to see how dynamic my staff could be.”
Both Hester and Miller went on to add that communication is paramount during these times. Michael said they assigned only one employee to speak with the community, “There is no he said she said, there is only one source of factual information.” Additionally, both hospitals are sharing information with the public via radio, Facebook, and newspapers. They are also in contact with their Sheriff’s office and local shops. Lewis nodded in agreement, “The best surprise is no surprise.”
Finally, Lewis shared his thoughts on the matter by noting that minimizing the spread of infection should be the number one priority, “Your hospital must be a very controlled environment. Make sure the people who are meant to be there are, and the ones who don’t stay home.” He addressed the basics such as masks and careful screenings.
The panel concluded with Lewis prompting the most pressing question, “When will this all end?”
To which he replied, “We haven’t even begun to see the beginning of it”. He stated that rural clinics will see the effects of Covid-19 for a long time. “Rural clinics have more elderly people, more poverty. It is likely we will be hit hard.”
We haven’t had a pandemic in 100 years, we haven’t had a lot of practice. But I think we are all doing a good job of acclimating to what is now the new normal.