by Siya Verma
Some 1,821 hospitals have been crying out for help for the past 9 years — all in vain. Each year since 2011, more U.S. hospitals have closed than opened, a vast majority in rural areas. The pandemic is making things worse. Before 2020, one in four rural hospitals in America was at risk of closing down. Now, even more are in danger of closing. As if the pressures on these hospitals weren’t enough, the coronavirus pandemic ensured that they are in deep water.
When 2020 rolled around, a strain of coronavirus began its journey across America. Urban areas have the technology and power to try and contain the virus, but rural areas don’t. With the pandemic making its way into every nook and cranny of America and the world, rural hospitals are either flooded or emptied, both scenarios dire.
How are the overwhelmed hospitals affected?
The federal government did contribute $12 billion to hospitals, but there was a requirement that many of these small, rural hospitals didn’t meet in time due to their small ICUs: 100 COVID-19 patients by April 10, 2020. With 1.6 ICU beds (compared to the 2.9 in urban areas) per 10,000 residents, rural areas are posed with the disadvantage of not having enough space. As a result, they are not able to meet the requirements. Because COVID-19 has been devastating to the vulnerable elderly population who make up the majority of rural areas, hospitals aren’t able to balance their quality and the demand. On top of that, some urban and suburban residents decided to seek refuge in rural areas in the beginning of the lockdown when COVID-19 had not overwhelmingly spread in rural areas. Thus, they are left with intensive care units submerged with COVID-19 patients and no share of the $12 billion.
Not only were they without the necessary financial support, these rural hospitals are faced with the decision on how to spend the little money they have. There are independent hospitals such as Loretto Hospital in Austin, TX who aren’t backed by a larger healthcare system. They were 15 patients short of the minimum, despite the fact 70% of their admissions at the time were COVID-19 related. Their costs for PPE have reached more than $600,000 while revenue continues to plummet with more than a 40% loss as there are no additional safety nets for hospitals that are mainly treating patients on Medicaid. “You go out and spend $20,000 on N95 masks. Or you keep that $20,000 so you can make payroll in two to three weeks,” said the CEO of another hospital in rural Texas. These are some extremely tough choices.
On the other hand, large hospitals such as Northwestern Memorial Hospital in Chicago, IL did reach this minimum and are putting $33 million of support in their bank. Hospitals such as these originally had enough money and the support helped them provide more quality care, but a majority of the money isn’t necessary to keep the hospitals going. Meanwhile, rural hospitals can barely keep their employees working and are tightly holding on to every last strand of the string that keeps the hospital from closing.
How can some hospitals be empty?
In fear of sudden surges of coronavirus, hospitals cancelled many elective surgeries scheduled for the months ahead, procedures that provided most of their revenue prior to the pandemic. Their hope: the profit from coronavirus patients would cover the lost profit from surgeries. That didn’t happen. Instead, people bypass these hospitals to receive care in higher quality environments. According to Healthcare Finance, “The migration patterns of residents who live in rural counties in six states shows 76% of patients with a local hospital out-migrated for care.” This is compared to the 23% who bypass their local hospitals in urban areas. Residents in rural areas are not guaranteed the best care because hospitals are instead trying to balance their finances and the government isn’t supporting them. For these reasons, many hospitals have been seeing empty rooms as their hope turned into a nightmare in the midst of this pandemic.
Either way, people have been overlooking rural areas for far too long. The government needs to act upon it. Because of the lack of action on Medicaid and Medicare expansion, 28.9 million+ U.S. citizens are uninsured. Again, this doesn’t just impact the citizens, but it puts a burden on the hospitals who care for these patients. It’s a self fulfilling prophecy. With thinning resources resulting in low quality hospital care, less people come to those hospitals due to a lack of trust. In turn, there’s less profit which brings us back to thinning resources. In the long term, areas become inhabitable because there isn’t enough care to keep people alive. This pandemic has just revealed what rural areas are going through, amplifying their struggles. It will be a slow and painful recovery after the pandemic if no action is taken.