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4 Strategies for Rural Hospitals and Health Systems Hit by the COVID-19 Pandemic

By Melanie Blackman  
   June 18, 2020

Executive leaders from four rural health systems share solutions to the challenges their hospitals and health systems faced due to the coronavirus outbreak.

A recent webinar by The Bipartisan Policy Center (BPC) "COVID-19 and Rural Hospital Struggles," took a close look at how the COVID-19 pandemic has affected four rural health centers: Dartmouth-Hitchcock Health Care System in New Hampshire, Knoxville Hospital and Clinics in Iowa, Geisinger in Pennsylvania, and Marshfield Clinic Health System in Wisconsin.

" … to date, big cities and major urban areas have seen the greatest number of coronavirus cases and deaths, but a recent analysis from the Kaiser Foundation finds that the growth rate is higher in rural areas," BPC Senior Vice President Bill Hoagland said during the webinar introduction. "For the two weeks ending April 27, rural communities saw a 125% increase in virus cases and 113% increase in deaths. Both rates of increase almost double what was in the metropolitan counties."

Former senate majority leader and co-founder of BPC Tom Daschle spoke about closure struggles that rural hospitals faced even before the COVID-19 pandemic. "More than a hundred rural hospitals have closed since 2010," he said. "Today, nearly 600 are at the risk of folding." Rural hospital closings affect the rural communities they serve, causing patients to travel further for care or to forgo healthcare altogether due to inaccessibility.

Although the rural health systems that were represented in the webinar are located in different markets, they all have been affected by similar issues in the communities that they serve, including an increased loss of revenue, restricted patient access, and resource shortages.

Here are four solutions that the healthcare leaders shared on how rural hospitals and health systems can face challenges that the COVID-19 pandemic has either introduced or increased.

Related: 6 Steps for Rural Hospitals to Rise to the Coronavirus Challenge

1. Utilize telehealth communication between providers: While telehealth has become the new norm between clinicians and patients, Dartmouth-Hitchcock Health Care System CEO Dr. Joanne Conroy shared that the health system utilized provider-to-provider telehealth during the pandemic. "We actually took care of a COVID patient who was quite ill in Southwestern Vermont, connecting our ICUs and our providers. The patient was almost too sick to transport, and we helped the nurses and the physicians on-site actually care for that patient, and he was discharged to home from that hospital seven or eight days later," Dr. Conroy said. "I think the future of rural healthcare is actually using provider-to-provider support."

2. Change hospital designation for rural hospitals: Knoxville Hospital and Clinics CEO Kevin Kincaid explained that there are hidden costs in running an acute care hospital, so by scaling the hospital to an appropriate size and changing the designation, this can help offset costs. "We've … been trying to work with the Senate Finance Committee on a new hospital designation for rural hospitals and call them rural emergency hospitals. In Iowa, we had, last year, 53 hospitals with an average daily census of three or less, and there's a lot of upfront costs and maintaining acute care services," Kincaid said. "Hospitals and local boards and communities could choose to give that up [and], in exchange, be paid at a higher cost level for their emergency services, and other services in their outpatient setting, to scale the hospital to an appropriate size. … We think this is a great opportunity to restructure rural care in a more organized fashion that makes sense for how care is delivered today."

Related: Geisinger Seeks Opportunities to Accelerate Healthcare Transformation Through COVID-19 Response

3. Develop new business models and accelerate the move to value-based payment: The COVID-19 pandemic has changed the way hospitals and health systems do healthcare. "… It's very clear to us that coming back is not coming back to where we were before," Geisinger Executive VP and CIO Karen Murphy said. "… We will be required to build a new business model that matches the revenue challenges … it's a long trajectory of recovery. It won't be recovery to pre-COVID; it will be how do we operate in this new normal." By accelerating the move to value-based payment, Murphy explained that it would allow them to offer care "whether it be care in the home [or] whether it be virtual care. Develop payment models [that] incentivizes providers to do the right thing and to develop sustainable business models."

4. Change the current care model: Marshfield Clinic Health System CEO Dr. Susan Turney suggested bringing back patients in a purposeful and thoughtful way post-COVID, and to change the current care model as they see fit. "It's going to be a long road to recovery. It's going to be months or even years for us to get back to where we had been, and that doesn't mean it's going to look like it did," Turney said. "It means that we're going to continue to do the right things and change the care model in a way to best accommodate our patient needs."

Related: 'It's Alarming!' Coronavirus Pandemic Hitting Rural Communities Hard

“ … It's very clear to us that coming back is not coming back to where we were before.”

Melanie Blackman is the strategy editor at HealthLeaders, a Simplify Compliance brand.

Photo credit: Pittston, PA, USA, August 28, 2019: Illustrative editorial image of the newly built Geisinger clinic at the Centerpoint Business area in Jenkins Township. / Editorial credit: Noel Biesecker /

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