Patients Drive Hours to ERs as Omicron Variant Overwhelms Rural Hospitals

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Patients Drive Hours to ERs as Omicron Variant Overwhelms Rural Hospitals

Hospitals call staff with Covid-19 back to work to handle surge of patients in parts of country strapped for workers

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The Omicron-fueled surge in Covid-19 cases has hit hospitals in rural areas especially hard.

PHOTO: DOUG BARRETT FOR THE WALL STREET JOURNAL
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Jan. 15, 2022 8:00 am ET


When the Omicron surge hit the Navajo Nation this month, the main hospital that serves a far-flung and vulnerable population in the high desert across northern New Mexico and Arizona was immediately overwhelmed.

The 74-bed Gallup Indian Medical Center has so many patients that they are asking people, many of whom drove two hours for care, to go home and come back in a couple of days. “You’re not going to get a bed unless you need a ventilator, or you have a gunshot wound,” said William Porter, deputy director of operations at Team Rubicon, which sends volunteer military veterans to disaster areas. The group is deploying roughly 20 medical personnel to the Navajo Nation, home to approximately 173,000 people spread across 27,000 miles and three states.

The rise of the highly contagious Omicron variant is leading healthcare workers to take drastic measures to prevent breakdowns in care. Though Omicron may cause less severe disease than earlier variants, research has shown, infection rates far surpassing previous pandemic peaks has pushed up the tally of people experiencing severe cases of Covid-19. The U.S. this past week reached the highest recorded level of hospitalized patients with confirmed and suspected Covid-19 cases.

In rural America, the problem is worse. One or two missing workers can shut down an entire clinic. Now many are out sick with Omicron. Many rural facilities say they can’t afford to hire travel nurses at rates that have skyrocketed during the pandemic. And some clinics and family practices that typically provide care that can keep people from landing at hospitals are closing because Omicron has hobbled their workforces, too.

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Many rural facilities say they can’t afford to hire travel nurses at rates that have skyrocketed during the pandemic.
PHOTO: STEVEN SENNE/ASSOCIATED PRESS
Rural hospitals are using veterans groups and foreign nurses to bolster staffing. Some are recruiting unvaccinated workers who were fired elsewhere for failing to comply with mandates to get the shots. And some hospitals are asking workers with Covid-19 to keep working.


“We really feel we have an impending medical crisis here,” said Teresa Tyson, nurse practitioner and executive director of the Health Wagon, a nonprofit clinic that provides free healthcare in Appalachian Virginia.

To keep people out of the hospital, the Health Wagon had been treating people with Covid-19 with monoclonal antibodies. Now they are rationing supplies of the treatment, making it more likely that some will need to be hospitalized, Ms. Tyson said.

“We’ve had to do this thing where we take this 78-year-old cancer patient over someone who is younger who we think can better weather Covid,” she said.

Sanford Health, a hospital system that serves remote parts of the Dakotas, Minnesota and Iowa, started in late 2020 to recruit nurses from overseas to alleviate staffing constraints that worsened during the pandemic. Sanford’s goal is to convince upward of 700 nurses from countries including the Philippines, Nigeria, Brazil and India to move by 2024. The system plans to pair them with staff who can help them navigate harsh winters and other peculiarities of life in the Dakotas. The first eight nurses are set to arrive in Fargo, N.D., sometime this quarter.
 

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(continued)

Sanford said hundreds of its 34,000 employees are out sick with Covid-19 and hundreds more are awaiting test results. One of the system’s critical-access hospitals has closed after all four of its nurses went out sick with Covid-19. Some patients are driving two or three hours to the nearest ER as a result. Sanford is considering cutting nonessential services and elective surgeries. It has asked asymptomatic and Covid-19-positive employees who no longer feel sick to return to work after five days.

“This is an urgent situation,” said Erica DeBoer, Sanford’s chief nursing officer.

Recruitment, often tough for employers in remote regions, has gotten harder during the pandemic. Some recruiters are trying to draw nurses to remote areas for less money than they could make elsewhere by extolling the region’s natural beauty and the promise of recreation and adventure.

Justin Jacob, a recruiter at Uniti Med Partners and former ICU and ER travel nurse, recently placed a nurse in Sitka, Alaska, by saying that when he was nearly burned out, the state renewed his love for people and nursing. Mr. Jacob said he sold the nurse on moving there for fishing, hiking, whale watching and crabbing.

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Staff recruitment, which was already tough in remote areas, has gotten harder during the pandemic.
PHOTO: JON CHERRY/BLOOMBERG NEWS

Grant Studebaker, an assistant professor at the University of Tennessee and a family medicine doctor with West Tennessee Healthcare, said he arrived for rounds at a clinic recently to find the parking lot full of patients. The clinic in Jackson, Tenn., had switched from Covid-19 care during the Delta variant wave back to offering primary care, before returning to treating Covid-19 patients exclusively during the Omicron surge. Several staff were out sick, and the nursing supervisor was pitching in to run the lab.

“You know any pulmonologists by chance?” he asked. Several local pulmonologists have left or retired in recent years and haven’t been replaced, he said. General practitioners and medical residents now manage complex pulmonary problems and ICU patients, Dr. Studebaker said.

West Tennessee Healthcare is freeing up staff by having some patients monitor their own vitals remotely. It is also getting patients to conduct their own oxygen treatments.

“When that hospital gets strained, it puts a lot of people in this community in a really bad position,” said Leah Gilliam, a family medical doctor in nearby Lexington, Tenn.

Dr. Gilliam has been seeing patients with Covid-19 symptoms curbside during the Omicron wave out of fear that she could bring the virus home to her newborn. She said the influx of patients has been overwhelming. But for many, she’s the only option.

“If I turn them away, what am I going to do?” she said. “I don’t want them to go to the emergency department. They’re full.”
 

bnew

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living in a city gives you access to at least 2-3 hospitals within 30 minutes of driving.:wow:
 
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Its been happening all along. There are societal costs that “Survival rate” enthusiasts never seem to grasp. If your mother with cancer gets booted out of a bed and has some procedures canceled a couple of weeks later due to unvaccinated influxes to the hospital, they might actually understand the gravity of the shytuation we face.
 

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:francis::francis::francis: america 3rd world status and yet biden cant pass a infrastructure bill because one a$$hole in the way...
 

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RURAL AMERICA

“Crisis”: Half of Rural Hospitals Are Operating at a Loss, Hundreds Could Close​

A new report paints a grim picture for small-town health care—especially in states that have not expanded Medicaid.​

JAZMIN OROZCO RODRIGUEZ

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Editor’s Note: This article was originally published by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide.

In 2022, Ryerse’s South Lincoln Medical Center was forced to shutter its operating room because it didn’t have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed.

Ryerse said the publicly owned facility’s revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming.

South Lincoln’s financial woes aren’t unique, and the risk of hospital closures is an immediate threat to many small communities. “Those cities dry out,” Ryerse said. “There’s a huge sense of urgency to make sure that we can maintain and really eventually thrive in this area.”

A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the United States that are “vulnerable to closure.”

“We’re really talking about the future of rural here."

Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, said the report’s findings weren’t a surprise, since the financial nosedive it depicted has been a concern of researchers and rural health advocates for decades.

The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn’t.

Leaders in Montana, whose population is nearly half rural, credit Medicaid expansion as the reason their hospitals have largely avoided the financial crisis depicted by the report despite escalating costs, workforce shortages and growing administrative burden.

“Montana’s expansion of Medicaid coverage to low-income adults nearly 10 years ago has cut in half the percentage of Montanans without insurance, increased access to care and preserved services in rural communities and reduced the burden of uncompensated care shouldered by hospitals by nearly 50%,” said Katy Mack, vice president of communications for the Montana Hospital Association.

Not one hospital has closed in the state since 2015, she added.

Hospitals elsewhere haven’t fared so well.

Michael Topchik, national leader for the Chartis Center for Rural Health and an author of the study, said he expects next year’s update on the report will show rural hospital finances continuing to deteriorate.

“In health care and in many industries, we say, ‘No margin, no mission,’” Topchik said, referring to the difference between income and expenses. Rural hospitals “are all mission-driven organizations that simply don’t have the margin to reinvest in themselves or their communities because of deteriorating margins. I’m very, very concerned for their future.”

People living in rural America are older, sicker and poorer than their urban and suburban counterparts. Yet, they often live in places where many health care services aren’t available, including primary care. The shorter life expectancies in these communities are connected to the lack of success of their health facilities, said Alan Morgan, CEO of the National Rural Health Association, a nonprofit advocacy group.

“We’re really talking about the future of rural here,” Morgan said.

Like South Lincoln, other hospitals still operating are likely cutting services. According to Chartis, nearly a quarter of rural hospitals have closed their obstetrics units and 382 have stopped providing chemotherapy.

“It’s just bad public policy. And bad policy for the local communities.”

Halting services has far-reaching effects on the health of the communities the hospitals and their providers serve.

While people in rural America are more likely to die of cancer than people in urban areas, providing specialty cancer treatment also helps ensure that older adults can stay in their communities. Similarly, obstetrics care helps attract and keep young families.

Whittling services because of financial and staffing problems is causing “death by a thousand cuts,” said Topchik, adding that hospital leaders face choices between keeping the lights on, paying their staff, and serving their communities.

The Chartis report noted that the financial problems are driving hospitals to sell to or otherwise join larger health systems; it said nearly 60% of rural hospitals are now affiliated with large systems. South Lincoln in Wyoming, for example, has a clinical affiliation with Utah-based Intermountain Health, which lets the facility offer access to providers outside the state.

In recent years, rural hospitals have faced many added financial pressures, according to Chartis and other researchers. The rapid growth of rural enrollment in Medicare Advantage plans, which do not reimburse hospitals at the same rate as traditional Medicare, has had a particularly profound effect.

Topchik predicted sustainability for rural health facilities will ultimately require greater investment from Congress.

In 1997, Congress responded to a rural hospital crisis by creating the “Critical Access Hospital” designation, meant to alleviate financial burdens rural hospitals face and help keep health services available by giving facilities cost-based reimbursement rates from Medicare and in some states Medicaid.

But these critical access hospitals are still struggling, including South Lincoln.

In 2021, Congress established a new designation, “Rural Emergency Hospital,” which allows hospitals to cut most inpatient services but continue running outpatient care. The newer designation, with its accompanying financial incentives, has kept some smaller rural hospitals from closing, but Morgan said those conversions still mean a loss of services.

“It’s a good thing that now we keep the emergency room care, but I think it masks the fact that 28 communities lost inpatient care just last year alone,” he said. “I’m afraid that this hospital closure crisis is now going to run under the radar.”

“It ends up costing local and state governments more, ultimately, and costs the federal government more, in dollars for health care treatment,” Morgan said. “It’s just bad public policy. And bad policy for the local communities.”
 
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