COVID-19’s impact on rural hospitals and clinics hasn’t received much attention in the national media, but its effects have been devastating and long lasting. Brock Slabach, senior vice president for member services for the National Rural Health Association (NRHA), says that 131 hospitals have closed in rural America, resulting in provider layoffs and furloughs and making it even more difficult for rural patients to access healthcare.
Fortunately, the federal government has provided much-needed relief in the way of cash flow for struggling rural facilities, benefiting patients and facilities alike by keeping doors open and healthcare close to home. And more significantly, many rural facilities have risen to the challenge and are finding new and innovative ways to reach out to patients and deliver care.
Relief funding for rural facilities
When the impact of coronavirus on rural healthcare started to become evident, the NRHA strongly lobbied for federal relief money for rural communities. Ultimately, they were successful — of the $100 billion economic relief package that was distributed by the U.S. Department of Health and Human Services as part of the CARES Act, $10 billion was earmarked specifically for rural healthcare facilities.
“That $10 billion has been really instrumental in supporting rural hospitals and clinics and their efforts to ensure that we’re preserving access to care,” Slabach says. “We worked with Congress and received lots of resources including the rural allocation for providers, hospitals, and clinics, and federally funded clinics received significant financial incentive to tide them over during this really distressing period of lack of revenue for their facility.”
Rural patients access healthcare via telehealth
Another big shift for rural healthcare was the transition to telehealth. Spurred by the need to continue providing care while protecting the most vulnerable, telehealth usage has exploded across the country. For Medicare patients alone, telehealth visits rose from 14,000 telehealth visits per week to nearly 1.7 million visits per week since the beginning of the pandemic.
However, one major concern for rural patients and providers is access to technology. This includes not only the connectivity issues related to rural telecom infrastructure, but also patient access to the technology that allows them to connect with providers.
“One, you’ve got people who are maybe in homes that don’t have Internet access, particularly if they’re living outside of a city. Secondly, they depend on the best service they can get which is probably LTE cellular service,” Slabach says.
However, rural providers have also come up with innovative ideas to overcome the technology concerns. “Some providers have used their staff — who would otherwise not be very busy — to help set up patients with access to the technology needed for adequate telehealth access. For example, they take an iPad to the patient’s home and set up the connection to the clinic. This has allowed some patients to be able to see their practitioner when they otherwise wouldn’t be able to.”
Slabach says he has been impressed with how quickly rural providers have embraced and adapted to telehealth as a way to deliver care to so many people.
Reassuring patients so they seek care
Another major concern for rural providers is patients who are delaying — or simply not seeking — care for emergent conditions such as a heart attack or stroke. With patients becoming more comfortable receiving medical care virtually, they also need to understand the importance of going directly to a hospital or urgent care facility for more serious conditions.
NRHA has partnered with the American Heart Association for the “Don’t Die of Doubt” campaign, which helps to reassure patients with symptoms of heart attack or stroke that it’s safe to be seen at a hospital or clinic. “They may be afraid of contracting COVID,” Slabach says, “but we want to reassure the public that their trip to the emergency room or clinics will be safe. It’s important we emphasize the importance of this.”
The future of rural healthcare post-COVID
Slabach expects rural facilities to be in the COVID response period for the next 12 months, and the pandemic will require them to change the way they prepare for the future. “The recovery phase will lead directly into preparation for the next emergency. We are already preparing the NHRA for the response that’s going to be required.”
He also stresses that rural healthcare must recognize the value of telehealth. “We need to consider telehealth within the context of the ‘person-centered medical home,’” Slabach says. “Continuity of care will require a discussion of how we adjust and effectively weave telehealth into the medical home. We think that is incredibly important in rural care.”