World News – UA – Rural Wisconsin hospital pandemic better than most, but warning signs remain

Dr James Heise, center, chief medical officer and hospitalist at Door County Medical Center in Sturgeon Bay, Wisconsin, speaks with medical student Jayme Nelson, right, and Dr Marc Binard, chief of hospital medicine, after daily case management meeting on August 5, 2020 Coburn Dukehart / Wisconsin Watch

Rural Wisconsin hospitals are doing better than most states But a significant number – about a third – remain financially underwater

And if rural residents continue to ignore the statewide mask order and fail to engage in social distancing, the COVID-19 outbreak that is overwhelming many urban hospitals of Wisconsin could also overwhelm rural health facilities, said Tim Size, executive director of the Wisconsin Rural Health Co-op

Citing data from the White House, Size said rural Wisconsin counties were among the worst in the country in terms of infection

In these areas, « it is not unusual to go to a gas station or a store without anyone wearing a mask, » said Mr. Size « We need the public’s help to get through this (pandemic) – and that help has been mixed »

Door County Medical Center, a small 25-bed hospital serving 30,000 people in Door and North Kewaunee counties, is one of the hospitals that survives the pandemic in fair condition Sturgeon Bay Medical Center is designated as a critical access hospital, which allows it to receive additional Medicare reimbursement to ensure essential health care services continue to be provided in rural areas

As of October 7, the hospital had treated 16 patients with COVID-19 in ‘The Cove’, the hospital’s four-bed intensive care unit, Chief Medical Officer Dr James Heise said. The first three patients have died

« It was a real learning curve, » said Heise, whose hospital has now recorded four deaths from the pandemic, « At the time, we didn’t know how it was going to turn out »

The hospital saw a « wave » of patients in early October, Heise said in a recent Facebook Live update. And while it remains busy, including with non-COVID-19 patients, « We are not not full – don’t worry, « he said

A room in the intensive care unit dubbed « The Cove » is where Door County Medical Center in Sturgeon Bay, Wisconsin, treated its handful of COVID-19 patients The hospital has added anterooms for that staff can open exterior doors and change into and out of protective gear Photo taken August 5, 2020 Coburn Dukehart / Wisconsin Watch

CEO Brian Stephens said the medical center sent COVID-19 patients to Green Bay, but only because of their underlying health issues

Despite having $ 10 million in revenue between March 18 and May 31, when elective procedures and many in-person appointments came to an end, the hospital generated more revenue in June than ‘in June 2019, said Stephens And federal pandemic funds for rural hospitals wiped out most of those losses, he said.

Small rural hospitals – critical access hospitals with 25 beds or less – in the United States have reported similar summer increases, thanks to programs providing health care providers with more than $ 310 billion in funding. federal stimulus, according to a Reveal survey of the Center for Investigative Reporting and members of the Institute for Nonprofit News, including Wisconsin Watch

Brian Stephens, President and CEO of Door County Medical Center in Sturgeon Bay Watch Coburn Dukehart / Wisconsin

This is because of the poor financial situation of many small hospitals before the epidemic, hospital officials in several parts of the country said in interviews

Sturgeon Bay Medical Center Received $ 6.9 Million Federal Pandemic Assistance It Is Also Eligible To Borrow $ 8 Million Under Medicare’s Expedited And Advance Payments Program Stephens said the hospital had not yet had to dip into any of those funds In addition, a local foundation raised $ 300,000 for the health system during the pandemic, he said

« I think we may be in a better position than most rural establishments, but I think all rural establishments, in Wisconsin anyway, have probably been there and are now back where they do elective surgeries and clinic visits and that sort of thing that generates the income that we need to stay open and do all the other things that we do, « Stephens said

He said federal CARES funding for rural facilities was based on hospital size, and Door County is one of the largest critical access hospitals

Door County Medical Center in Sturgeon Bay, Wisconsin, is a small, 25-bed critical-access hospital serving 30,000 people in Door and northern Kewaunee counties The hospital has largely weathered the pandemic storm of COVID-19, according to hospital officials Photo taken on August 5, 2020 Coburn Dukehart / Wisconsin watch

The facility was well positioned to weather the storm in large part because it invested in outpatient surgery, said Stephens – a very cost-effective service that’s also essential for retirees who make up a large part of the population in this picturesque peninsula surrounded by Lake Michigan

« The kinds of things people come to us for … are not going to go away just because of COVID, » he said

Despite the infusion of $ 2.8 billion in federal grants and loans to keep Wisconsin hospitals and health care facilities afloat – and millions more statewide – many remain in financial trouble precarious

The pandemic is expected to cause federal lawmakers to refocus their attention on the plight of rural health care, said Michael Topchik, national manager of the Chartis Center for Rural Health, a Chicago-based consulting group.

Referring to legislation long stuck in Congress, Topchik said: « Maybe it’s time to tackle and maybe remedy some of the systemic problems that are pushing rural hospitals to breaking point »

According to a Wisconsin Watch analysis of data from the American Hospital Directory, 38% – or 29 of 75 rural Wisconsin hospitals – had a negative operating margin in their latest financial statements

Rural hospitals in Wisconsin, however, are in better shape than most states In states that have expanded Medicaid under the Affordable Care Act, 41% of rural hospitals have negative operating margins, according to Chartis In states that have not expanded Medicaid eligibility, the situation is more dire, with 51% of rural hospitals operating in the red

Patients and visitors entering the emergency department lobby at Door County Medical Center in Sturgeon Bay, Wisconsin are urged to wear masks to curb the spread of COVID-19 Photo taken August 5, 2020 Coburn Dukehart / Wisconsin Watch

The Provider Relief Fund, distributed by the US Department of Health and Human Services, disbursed $ 1.2 billion to hospitals and health care providers in Wisconsin in September 23 In addition, HHS distributed $ 1.6 billion loans to hospitals and health systems in Wisconsin

Smaller state programs have distributed tens of millions of additional dollars to hospitals, including $ 40 million to cover losses in March, April and May

Between mid-March and mid-May, hospitals in Wisconsin lost nearly $ 2.5 billion in revenue because they followed federal guidelines to stop all non-urgent care to prepare for a surge in COVID-19, said Wisconsin Hospital Association spokesperson Mark Grapentine

This means that federal funds are almost equal to lost state revenue – although most of that money will have to be paid back with interest and losses continue to pile up even as non-emergency services have resumed said Grapentine

The Chartis Center predicts that hospitals will see a 20% drop in patient volume – and therefore revenue – for the foreseeable future Topchick said potential patients could opt for a video chat with their doctor or delay them altogether. care

« Frankly, if rural hospitals were to lose 20% of their outpatient volumes, it would be untenable for many of them, » he said. « They would simply collapse under the weight of their cost structure »

Rural Wisconsin hospitals have historically held up better than those in other states, said Mr. Size, due to strong rural economies, a market dominated by mission-driven, not-for-profit health systems, and a strong tradition of cooperatives, collaboration and integration between hospitals Rural hospitals will be more resilient during the pandemic for these reasons, he said

Financial health of rural hospitals varies, according to Size Some members of co-ops have already returned to their pre-pandemic income levels, he said, and others are on the right track

Still, some hospitals are running negative margins and eating into their cash reserves, Mr. Size And the sharply rising infection levels in areas such as northeastern Wisconsin are concerning, he said, noting that all hospitals, including the Door County Medical Center, have seen their costs rise. as they prepare and staff for an increase in COVID patients

Size said he would be « thrilled » if they made it through the pandemic without a hospital shutdown – a bullet Wisconsin has largely dodged Only one rural hospital has closed in Wisconsin since 2011

The most worrying issue is the damage the virus could cause to the fragile financial health of rural communities, which have yet to fully recover from the Great Recession, said Mr. Size Widespread agricultural bankruptcies and the poor health of the population reflect « a precarious ecosystem »

« Our hospitals hold up, but they are not as strong as their communities, » he said

No one knows what impact another wave of infections could have on the state’s rural hospitals, he said, adding: « If the hospital were to close again it could be devastating »

Iowa Watch reporter Lyle Muller and Coburn Dukehart and Dee J of Wisconsin Watch Hall contributed to this report, which is part of a collaboration between members of the Institute for Nonprofit News and Reveal of the Center for Investigative Reporting Examining Effect of COVID-19 on Rural Health Care Solutions Journalism Network funded the nonprofit Wisconsin Watch (Wisconsinwatchorg) report collaborates with Wisconsin Public Radio, PBS Wisconsin , other news media and the UW-Madison School of Journalism and Mass CommunicationAll works created, published, published or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or the one of its subsidiaries

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Wisconsin, Coronavirus, Tony Evers