As We Look Toward a Post-Coronavirus Future, Don’t Forget Rural Hospitals

This post is part of a new series CAFP is hosting, which will be highlighting and amplifying the voices of family physicians as they adapt to continuing their vital work of safeguarding communities under extremely difficult circumstances. This first piece is from Kajsa Harris, MD, who was a former president of CAFP.

The COVID-19 pandemic is stretching rural healthcare in America to the breaking point. I should know — I am a doctor working in a hospital in rural Northeast Colorado. If we are to keep serving our communities, rural hospitals need immediate help.

Around three-quarters of a million people live in rural areas of Colorado, according to the Rural Health Information Hub. These people rely on small rural hospitals, often with fewer than 40 beds, to serve every aspect of their medical needs – from preventive care to triage, outpatient surgery and managing diabetes.

Rural hospitals aren’t what you might think, especially if your only experience is from city hospitals. We are often the only source for healthcare in an entire county, and we get to see patients at every stage of their lives. As family physicians, we truly see the whole person when they come in for acute care because we have already been treating them in primary care. And right now, our ability to serve our communities is being put at risk.

Our healthcare system is built around a steady stream of patients generating revenue through routine care. While this is true universally, rural hospitals are more reliant than urban hospitals on routine visits to be able to pay for staff and keep the lights on. We already faced razor thin margins before the pandemic hit, and several were on the verge of facing painful cuts.

But now, the same social distancing that is necessary to reduce community transmission of COVID-19 to a manageable level has also reduced the number of routine medical visits we see. Thousands of rural hospital workers have been furloughed or laid off – and pay cuts are happening across the healthcare system. It has placed dozens of rural hospitals into dire financial straits, and there is a real likelihood that some communities may lose local access to healthcare entirely if measures aren’t taken to keep the hospitals open.

When the first cases in Colorado popped up in early March, state officials advised rural hospitals to prepare for a potential surge of patients should the cities become overwhelmed. Eager to help, we did so: hiring more staff, transitioning people to outpatient care so we’d have free beds, and so on. The trouble is, the state soon pivoted to building field hospitals locally – in tents, at the convention center in Denver, and so on.[5] Outside the cities, cash-strapped hospitals spent money to increase our capacity but had the rug yanked out from underneath us.

The Small Business Administration has denied relief funds to many rural healthcare facilities because they get tax payer money as a normal part of their operations – public financing is the only way the people who live in these places can access care. Such capricious denial of relief doesn’t help anyone and makes the financial challenge we are facing even worse.

My own hospital was running in the black before the crisis. We can do so again once the crisis is over – but we do not know how long we can stay open without immediate help. If rural hospitals close because of this financial crisis, untold numbers of people will lose local access to health care – even the lucky ones who keep their jobs and healthcare coverage. And as the COVID-19 pandemic edges its way into more rural communities, this is the worst time for these same clinics to be facing the prospect of closure.

We need help to keep the lights on. Providing a few months of payroll support for rural hospitals would go a long way toward averting this crisis. We need legislation to keep rural hospitals open and serving their communities. Failing to do so would condemn too many of our neighbors to navigating a world without healthcare.

Kajsa Harris has been a Family Physician for more than 23 years. She completed Medical school at the University of North Dakota and completed residency at Southern Colorado Family Medicine Residency in Pueblo.  Dr. Harris served 6 years in the Army National Guard in North Dakota and Colorado, and two years in the Army inactive reserves. She has on the board of the CAFP and was president of the CAFP. Currently she is working in Holyoke in a rural critical access hospital. Her hobbies include ice hockey, running and hiking.