Already-Struggling Rural Hospitals Now Deal With Coronavirus Challenges

Salem Memorial District Hospital, a 25-bed facility in Dent County, is ready for coronavirus patients.

Mike Gruenberg, director of disaster preparedness at Salem, said that meant making major changes.

“We don’t usually admit patients on ventilators, so usually those kind of patients, we would send to the urban facilities,” he said. “We have had to change our way of dealing with that. We have some extra ventilators in house. We are able to keep these patients.”

The hospital, located in a town of about 5,000, set up special rooms to treat COVID-19 patients, bought more protective equipment like gowns and masks, and canceled all elective and nonemergency procedures to avoid cross-contamination.

The hospital tested more than 50 patients with coronavirus symptoms, but the tests all came back negative. So far, there hasn't been a single confirmed positive case in the county.

“We hope it never comes, but we have to be ready. And we are,” Gruenberg said.

Missouri Baptist Sullivan Hospital, about 50 miles southwest of St. Louis, has made similar preparations. Dr. Sahil Goyal said he and his colleagues have treated a few patients with COVID-19.

“We have seen a handful of patients, and so far, we have had good outcomes. And I think my colleagues, as well as the nursing staff, feel pretty confident about treating the patients,” Goyal said.

Salem Memorial and Missouri Baptist Sullivan’s stories are similar to those at many of the 39 Critical Access Care hospitals in Missouri and the 49 in Illinois. Those are federally designated and partially supported hospitals in rural areas that are deemed necessary to serve people who would otherwise have to go too far for basic services. They can have a maximum of 25 beds, must be at least 35 miles from the nearest hospital and staff an emergency room at all times.

While they are ready to treat the coronavirus, the mandate to cancel all elective and nonemergency procedures is hitting these small hospitals hard. Those patients and procedures account for most of their revenue.

Tony Schwarm, president at Missouri Baptist Sullivan, said the federal relief packages have not done much for him or his peer hospitals.

“You might hear some of the funds that are being allocated to the hospitals; that won’t even come close to replacing the revenue that we’ve lost,” he said. “We have some tough days ahead of us, but we’ll get through it.”

Missouri Baptist Sullivan is part of a bigger hospital system and has access to additional resources. But many rural hospitals don’t have that safety net. 

U.S. Rep. Jason Smith, R-Cape Girardeau, is part of a 30-member delegation that is calling on Congress to do more for small hospitals. He said the first couple of rounds of the Coronavirus Aid, Relief, and Economic Security Act were not enough.

“A provision that was highlighted in the CARES package was the Medicare-accelerated payment program, which is a loan, and that concerns the rural hospitals a lot, because the last thing they need is another loan,” Smith said.

Rural hospitals, many of which routinely struggle financially because they serve populations that are older, sicker and poorer, need more, Smith said. He is advocating a loan forgiveness program if a hospital can show that repaying loans to cover coronavirus shutdown losses would put the hospital at risk of closing.

That risk is real, said Kasey Lucas, CEO at Salem Memorial. While he said his hospital is OK, some in the region aren’t.

“They were doing poorly when this hit, and it just made things worse. I mean, without saying names, I know a hospital that is teetering at this point and could probably go,” Lucas said.

Since 2010, seven rural hospitals have closed in Missouri and one in Illinois. An analysis of critical access care hospitals nationally by the research firm Guidehouse showed that 1 in 4 rural hospitals is in danger of closing — and that analysis was based on data collected before the coronavirus outbreak.

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