, the president of the National Rural Health Association, here to talk about how the corona pandemic is affecting rural areas. Good morning. Caller good morning. Guest good morning. Thank you for inviting me to be on your show. Host tell us what the National Rural Health Association is and what you do. Rural healthtional association started in the early 1980s as a way of bringing rural providers and people interested together. We have over 21,000 members. It is a notforprofit organization comprised of people from universities, rural health clinics, people in longterm care health centers, and anybody who would like to expand the voice for rural health. We are concerned about education, research, munication. Anything that can advance and support our Rural Communities and activate and increase access for Rural Health Care in our communities. Up theou also head illinois critical access hospital network. Tell us what that is. Ofst yes, it is a network 57 critical access and small rural hospitals across illinois. There are 51 critical access, and that is a small hospital, about 25 beds or less, and we have six hospitals of what we 2550 beds,s, located in our Rural Communities. They are similar to other states, but in 2003, a group of small hospitals came together and said, we want to have our own organization so we can have training, services to help members. He that started with 20 and we now have 57 the state. I work for them. Host tell us how the coronavirus pandemic is presenting itself in rural areas. I know for a lot of the last viewers have told us about the city. How is it affecting the rural areas . Roll it is starting to through our Rural Communities. There were earlier hotspots that were near large urban centers, like new orleans, areas where there was transportation centers, they were near areas where they were recreational skiing places, and so forth. Now, it is starting to roll through the Rural Communities. And our practices and our physicians have been getting ready for the virus to spread through. We are having i think there is now up to 80 of all the Rural Counties across america have had one or more coronapositive viruses. We have had a few losses, the the most, but for part, people have been healthy and they have been able to shelterinplace or admitted to the hospital. In illinois, we have not been any of our patients on a ventilator or anything like that, but the virus has been moving slowly from chicago downstate, so to speak. Around ther states country, it has been in the urban areas and moved out because it is less dense, and as people travel, our families and friends go to different places, they come back, and that is generally how we get it in rural illinois. Host what is access like for health care for those living in Rural Communities . For example, my parents are in mississippi. The town they live in has one hospital, and they continually have been downgraded my entire life. What is Health Care Life for those who live in Rural Communities are now like for those who live in Rural Communities right now . Guest im glad you brought up the hospital because that is very important in the rural community. That is really the main source for physicians, ems, Nurse Practitioners, pas, home health services. It all really evolves out of that rural hospital. The hospital will generally take the lead and partner with local Health Departments. The local Health Department is very important, particularly when you have a pandemic like that and the partnership of sharing that, resources, information, and trying to keep the local population safe. The hospital is like the hub. It partners with the Health Department and co. , fema, and other organizations, so we try , Health Department, county fema, and other organizations. So we try to make sure there is access through that area. Host we know before the coronavirus pandemic started, the rural areas were facing a huge problem with rural hospitals. Here is some data that we have from the university of north carolina, that shows that eight rural hospitals have closed so far already this year. And we are just in april. Eight have closed already. In 2019, we lost 19 rural hospitals, and there has been a total of 170 closures since 2005. Ofs that equate to a loss Quality Health care in Rural Communities . Guest yes, it does. We are concerned about that. A lot of it has to do with financials. Reimbursement systems change, and so, it is very important that we keep our Rural Communities and hospitals active. If you lose a hospital, think about the situation with the pandemic, these rural hospitals are able to take care of these patients in the Rural Communities, and they dont have to travel. They can get care right there. They can have their babies. They can come in if they have a heart attack. Mississippi,as in and im sure that is a farming area where you grew up, they have to have local access. If you do not have that local hospital, that ems has to drive sometimes 40 to 50 miles, so you lose that critical time of her covering and help for that patient time of recovering and help for that patient. Are Many Organizations working hard to keep our rural hospitals open for that access point. It is very important. We serve elderly patients in our Rural Counties. The National Averages about 14 15 elderly and counties in urban areas. 19 ,ral areas, it is sometimes 30 , the county is elderly. That access point is very important. Most of it has to do with financial changes and reimbursement systems, and so forth. Seeing any Rural Health Care facilities or Rural Health Care systems that are already getting overloaded from coronavirus pandemic patients . Or it just hasnt gotten that far yet . Guest as i mentioned a couple of minutes ago, there were several hotspots around the country, such as indiana, montana, colorado, louisiana near where they had recreational or transportation hubs or in urban areas like new orleans. They were really very much overwhelmed. A critical access hospital has 25 beds or less. Cms was greatmic, about opening the door and allowing these hospitals to expand their numbers so they could take care of patients. In many of those hotspots, they had to expand their bed count from 25 to 35 so they could accommodate the patients coming in. And then actually partnered with neighboring Community Hospitals to send some of those patients there. The vast majority of rural hospitals have not had that influx of patients coming through. We have had patients admitted, where they have been treated at home and shelterinplace, but we have not been overwhelmed, other than those particular hotspots. A hospital works very hard at controlling it, separating people when they come in with suspected cases in the triage area, so we really try hard to control the onset of that in our Rural Communities. Host let slip some of our viewers take part in the conversation. We will open it up, special phone lines for this conversation. If you live in a rural area, not the people who live in the city, if you live in the rural area and you would like to talk about health care and what you think may happen if coronavirus hits the rural areas harder, your number will be 202 7488000. Once again, if you live in a rural area, we want to hear from you. We are talking about health care and coronavirus. 202 7488000. If you are a Rural Health Care provider, whether you work in a rural hospital, medical clinic, if you have your own Doctors Office in a rural area, we especially want to hear from you and what you are seeing and how you are surviving during this coronavirus pandemic. The number for Rural Health Care providers is going to be 202 7488001. And if you want to talk about Rural Health Care coronavirus, we want to hear from you, even if you do not fit into the categories. The number for everyone else will be 202 7488002. Keep in mind, you can still always text your opinion. We are always reading on social media, on twitter, at cspanwj and on facebook. Com cspan. Little bit about the unique Health Challenges that people have in Rural Communities. I am assuming there are different issues that people who live in Rural Communities have to deal with healthwise than people in urban communities. What are those issues and how can they be resolved . Guest as far as Specialty Care and services that you normally have to go to a larger facility, we have been able to work with our clinics and hospitals as being able to use telehealth, being able to use the apps on your phone or on a screen, like in your computer, whatever it might be, and help to connect with Specialty Care that maybe you are not being able to travel with that. In our Rural Communities, we have also set up no different than the urban areas where you can drive by and get your lab en, evenr you can be se in the car. They have been accommodating that, being able to come out and treat the patients, so they can stay in their car if they are afraid to come in the hospital. I think that is very unique for us that we can do that. Basically, we have plenty of space, and we are able to do that. We also have been very concerned about our longterm health with folks in our Nursing Homes that are in our communities. And connecting with them and the hospitals. Reach out to them periodically to make sure they are ok. And are able to get the care and treatment they need. Host you mentioned telehealth a few seconds ago. One to to talk about that i want to talk about that. A lot of rural areas do not have access to broadband. How can they use telehealth if they cannot get on the internet . Guest that is a good question. Particularly, when you are in lockdown, you cannot go to the library, to the schools to get that, so your house or your apartment complex, or wherever it might be that you have access to the internet, if you do not have that resource, you cannot get on. That makes it a challenge. It is also difficult for many of the older folks. They are not used to using a provider. Alk to that is different for them. We have had many elderly individuals do very, very well with telehealth. They are comfortable, but others are not that savvy. If you do not have broadband, what do you do . You have to drive or call someone to pick you up, take you in, and you have to practice social distancing with the masks and so forth. Hadresting enough, we have reports of people driving to mcdonalds and getting access to their Internet Service so they can call in and make that contact. It is a problem, and that is something that we need to do as a country to make sure everyone has access to broadband, even in the more remote areas so that they can, in a case like a pandemic, get access, or at least they can use their phone, computer, whatever. Interesting enough, along with broadband, you still have to have the tools. You have to have a phone, smartphone, or computer, and you have to be comfortable. So we have made much progress in that area, but we still have a ways to go. We are learning from this pandemic, to more need to go with telehealth pandemic how much more we need to go with telehealth. Host we will start with sheila, calling from personnel, oklahoma. Good morning. Caller thank you for taking my call. I am very concerned about our hospitals. Verge oftal is on the closing because we do not have the covid virus here, so you cannot do elective surgeries. I have heard her talk about computers. I dont own a computer, sir. Even a mcdonalds to go to. And goodness are governor has the foresight. He will start opening the hospitals for elective surgery because we do not have this problem in oklahoma. And think about the flu. , and yet, itcines still doesnt keep people from flu. Even when you open up, you are going to have the virus, but the older people will stay inside. I will be staying inside. We will be taking care of ourselves, but we need to have the elective surgery to keep our hospitals alive. I do not want to them to disappear. Host pat, i have seen a couple of other people on our twitter feed have said that as well. It is the lack of or the banning of elective surgeries that is hurting these small hospitals, these rural hospitals the most. Is that what is happening . Guest yes. We talked about the hotspots, but i have said the vast majority have not been impacted. And they did. They are not having the elective surgery. They are not having the physical therapy treatments or the o2 Occupational Therapy treatments, you know, any of those outpatient, elective things, even lab work. It is a problem. Think about our rural Community Hospitals. Most of them take care of 80 outpatients. If you take almost all of that business away, it is a financial strain. I agree with sheila as she mentioned that as a concern. Want to takeitals care of our patients whether covid or not, and that is the number one concern, but after that, how are they going to financially keep things going without having the ongoing business . They still have to have staff in place. Many have been able to reassign staff. Lets say you work in the outpatient surgery department. Those Staff Members have been reassigned to triage and so forth, so you still have those costs. Most of your small hospitals employ physicians and Nurse Practitioners and physician assistants. You still have to keep them on salary. We need them. If you are an orthopedic surgeon, and you are normally doing a number of cases, 10, 12 cases a week, and you are not doing any of those, you could see the financial strain of that. Also, those people need treatment. We need to have a good plan and be prepared to begin to roll out so we can keep our small hospitals open and take care of it. We do not want to prevent people from coming to the hospital for other things because if they have had an injury, they need physical therapy. We are very much needing to open up. The financial picture is very much foremost in their mind sides being available to take care of all of you. Callingts talk to don, from stanton, michigan. Good morning. Caller good morning. Ofh, i am very concerned what the load is going to be additionally on these small, small town hospitals as the covid spreads, like here in michigan. The weather has been pretty cold for this time of year normally, and i think that has kept a lot of people indoors, but once the weather warms up, people start going to the lakes, or cottages, coming from the more rural areas, where the covid is more prevalent. Besides the normal accidents that are going to happen as people get out and about, and people ignore the governors travel ban, and, yet, i really think there is going to be a definite strain on the local hospitals. I am very concerned about that. Host go ahead and respond, pat. Guest thank you. I agree with don. We are always trying to be ready for that. We have the threat of the covid virus. We know it could hit us anytime. About this. You mentioned recreation, but we have a number of small hospitals located near prisons. Miles toof 2200 b 10 15 miles from a small rural hospital or meat plant might be 10 miles to 50 miles from a small rural hospital or meetpacking plant. At the hospitals have been trying to do is meet daily, not only with their staff or but they aretners, planning for this. They have reached out to neighboring hospitals and trying to decide if a patient comes in and we do not have enough room, how do we transfer the patient that may be is not as sick or does not have it . And how do we protect those who have the virus from those that do not have that . We have been working hard to make those plans. We do not have a Perfect World out there, but i do understand dons concerns, and i hear that every day when i talked to hospital ceos and staff. They really are concerned about it, but they are doing the best they can. We worked out arrangements for transfers, or if the hospital does not have an intensive care unit. Many of these small hospitals do not anymore, but they can make arrangements for transfers or bring highly trained people into care for the patients in the meantime. The good news is if we have had a few weeks to plan for those things, put strategies in place, we still have to be smart as people in our communities and practice are social distancing, and be careful of what we do. We have been planning for it. We cannot predict the unknown, that are planning, working with our partners, the larger hospitals, so we can take and receive patients so we are ready for your. Host let me read you a list of tweets from our viewers because they all say the same thing. I want you to respond. Here is one that says hospitals are laying off people because they banned surgeries. The next one says the biggest challenge in small hospitals is having to shut down and take financial hits because the crisis is overblown. Hospitals prepare for patients that never materialize. One more two more one says, hospitals are furloughing staff because of lack of patience. Nursing homes are, too. One last one says our rural hospital are furloughing workers, waiting for covid19. So far, only one case in our county. Our hospitalist public owned and doing well. All of the tweets talk about rural or small hospitals either taking financial hits, laying off people, or furloughing people because, a, they are not able to do elective surgeries we were talking about earlier, or b, they have been stacking up and waiting for the coronavirus patients to show up and they dont have anyone. Now they are laying people off. What is going on out there, pat . Guest that is very much true. They have had to furlough. People have taken time off. They have used their vacation time, trying to be ready if they are needed but also understand the financial responsibility of the hospital. Yes, that is the biggest thing. 80 of the business in many hospitals is gone. We understand that. We have to be at this readiness, but, yet, we have to be able to financially keep her hospitals strong. If you lay staff off, will they be able to come back . Will they go someplace else . You work hard to find a position to come to your community, and if you have to furlough that person, that is really a problem for us. Issue out critical there. Now, we have had some relief in our hospitals through the cares buildd so forth to help those gaps and finances through accelerated payments, through the 100 billion we have gotten a percent increase for our rural hospitals. It may not be enough. One thing i heard in your last segment, you talked about the Small Business loan. Manyhas been available for small hospitals with 500 beds or less, but there is a catch to it. Many of our rural hospitals are governmentowned, and they were not able to apply it. We have had some hospitals affiliated with other systems, even though they are independent and have a different number, and they still have not been able to apply. Yes, we know we are furloughing. We have to do that. We have to keep our doors open. It is like a Small Business. No different. That support out there is critical for us, and we need people to act and support us. We need congress, and state legislators, to help support us to keep that open because we are fragile. Many of our hospitals have less than 50 days cash on hand. Some are in good shape. I mentioned a couple of hospitals had strong cash, but many do not. Hospitals why small are more fragile, and we have to be careful about that. And theoughs furloughs, and not being able to do elective, even though we are trying to be safe, is really difficult. Host lets talk to steve from ridgeway, pennsylvania. Good morning. Caller good morning. Thank you for taking my call. Area ofn a rural pennsylvania. We have two confirmed cases. The county south of us has four. Directly north has one. Directly east has one. Our Regional Health care system recently laid off 600 people. When i say recently, this week. My concern is not only the lack of services available, but now, if the coronavirus becomes rampant and prevalent in our area, what is the incentive for these people who have been laid off to come back to work and go back into the hot zones . We are talking a doubleedged sword here that i think in pennsylvania has been a lot of it has been pushed on us by the draconian rules of our governor tom wolf. The rules change daily it seems like, or every other day. I talked to health care professionals, pharmacists, and registered nurses who work in , it isystems, and it is the blind leading the willing is what it seems like to me. Host go ahead and respond, pat. Guest it is similar to illinois, and i can speak on behalf of of the folks in illinois at hospitals that it is a worry. As i mentioned, i like the term of the doubleedged sword. Yet, youto be safe, know the financial impact. In my county, there have been a couple of cases. Nobody has even been hospitalized in the Small Community hospital that serves the community that i live in, and, yes, we are experiencing that in illinois. And we understand it from the health care community. We understand the transmission and the concern of that, but we are also going to build guidelines for us to be ready. And our hospitals that laid people off, if you have physicians and others who are being laid off, how are we going to get them back . Will they come back . That is something that keeps our hospital administrators and staff up all night. I do not have an answer for you, but we have to begin to make plans for us to come back safely so we can be prepared. I do not have an answer for the gentleman in pennsylvania. Is the same in illinois and other states it is the same in illinois and other states. We are talking about how we can come back and do elective surgeries. I was on a call friday with the ceos i represent, and one of the ceos had been in contact with legal. How do we safely begin to open up surgery and all of those areas. We are trying our best to lay the groundwork. We wish we had that magic wand to make everything right at this point, but i understand the gentlemans concerns. Host lets talk to ben from hogans berg, new york. Ben is in the health care profession. What do you do in health care . Caller i am a family practitioner in rural upstate new york. Way up near the canadian border, where the coronavirus has been fairly a small amount at this point. However, i think we are talking about a different thing. Small hospitals were in big trouble already, well before this pandemic. And everybody is talking about they cannot survive without elective surgery. That is almost an anomaly. If it is elective, why would you run to surgery. See patients all the time that i do preop clearance on for thesete, breast cancer, truly are elective. I am sorry to say, they are overdone, very costly, and hospitals have become dependent on this money. Maybe that is why our Health System costs are totally out of control. Down,his pandemic calms we really needed to look at this. Thank you for the work that you do in new york. I know being a family practitioner is a challenge and thank you for all the work you have done over the years. Resonate. Nts do the fact that we cannot rely totally on surgery and in many of our rural hospitals, we dont. Pt, andedures such as ot, and speech and all of those things we do to keep people healthy or to follow up if they have diabetes to come in and get the blood test and so forth. Those are all part of that business that we have not been able to do. Even a scope for someone who is struggling with changes in their g. I. System. Those things have been eliminated and are not to be done unless it is a true emergency. Hospital help keep the financially and we need to rethink how we are doing our reimbursement. Our organization, we actually manage an organization, we have 27 hospitals that are participating in doing what we can to rebuild our primary care and focus on health and prevention. Forre in that transition more of a valuebased care and taking care of the patient itself. We cannot rely on surgery but it does help and if it is needed, our hospitals want to provide it. I know in a number of our communities, we have orthopedic surgeries and many of our older folks do need to have joints and hips and things like that. Ourry to do what we can in Rural Communities and i suppose you could speak onto that too. That we need to look at our reimbursement system and i hope we are able to take the time to do that when we finish this pandemic and rethink how we can preserve access locally and how we can look at prevention and keeping people healthy as well as balancing and keeping our hospitals and our clinics and our physician practice is strong. Is a perfect segue to something you have said before. You have been quoted as saying that this pandemic is going to make us rural and smaller hospitals rethink our business. In what ways do you think small hospitals, Rural Health Care needs to rethink their busines . Have learned the needs of our population and what is really important for healthcare. It makes us think that technology will be more of a factor. We like the one on one what are we going to have to use telehealth . How are we going to do that . It can be used very effectively. How are we going to do that . How are we going to be prepared for that . I think we can rethink how we deliver the healthcare locally. Is it a common nation of technology, will we be more flexible . Will we allow people to go more into their homes to have healthcare . Are we going to do more home health . Are we going to partner with our sheltered care places to provide care for our elderly instead of them having to come into a clinic . How can we rethink and really plan for our population . We are learning about how people use healthcare, what are their basic needs and how we are understanding the use of technology as we move forward . Host lets talk to bruce in pennsylvania. Good morning. Caller good morning. Democrat in the house of representatives says his estate gets 6,000 per virus patient to care for them. But in virginia, they are getting 400,000 and why is there such a disparity in . It is care for a sick person of the same virus. If you do not know the answer, could you please look into it . Answer as best i can right now. I dont know the particular cases for the patient. Maybe person in oregon, they were just diagnosed and they are being able to have medication and being treated at home and they are having to pay for testing, the doctors visit, the chest xray to diagnose the pneumonia. Not be as costly to take care of them in the home. That is what i am just assuming. I dont knowinia, that case exactly but maybe this person had to be on a ventilator. Maybe they have multiple issues. Maybe they had to have therapy
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