ASHLEY CO. Ark, (03/30/20) — Rural hospitals across the country are feeling the impact of COVID-19 including the Ashley County Medical Center.
While there is only one positive case of the virus in the county, the hospital says they are already seeing an impact in their daily operations. Luckily for them, this hasn’t meant any layoffs or furloughs.
“It’s all hands on deck we have everyone working in the hospital even though we’ve had changes,” Chief of Staff, Dr. Brad Walsh said.
The clinic has had to restructure scheduling but has mostly transitioned to telemed services where they can meet with their patients online to reduce possible exposure to the virus.
The hospital has suffered the biggest change with having to scale down on one of their largest revenue sources.
“It has changed a lot in regards to the surgery department,” Dr. Walsh said. “Per guidance from the Center for Disease Control, we aren’t doing the routine things like colonoscopy and those other things that are normally elective that you can schedule. “
Rural hospitals like ACMC rely heavily on those types of surgeries and procedures to remain open. Now, most of those have been postponed and they’re depending on lawmakers on the state and federal level to help provide more resources.
Governor Asa Hutchinson announced last week that the Arkansas Department of Human Services (DHS) is submitting a Medicaid Section 1115 Demonstration Project (“waiver”) to the federal Centers for Medicare and Medicaid Services (CMS) to support rural hospitals, increase pay for nurses, provide workforce training and other measures as the healthcare system responds COVID-19.
The state is requesting approval for federal funding to support the care continuity initiatives which include:
- Environmental modifications payments to eligible hospitals, independent physicians, rural health clinics, and behavioral health agencies to modify their facilities to add protective features such as drive-through testing or to reconfigure patient intake areas to allow for adequate social distancing or the purchase or lease of specialized equipment.
- New flexibility and financial support to allow health care providers to adjust operations that are unique to their clinic so that they can continue to safely provide face-to-face services. This may include extending clinic hours or shifting schedules to accommodate sick visits versus healthy visits.
- Payments to expand and upgrade telemedicine and to provide non-emergency transportation so that patients may continue to connect with health care providers.
- Additional pay for health care workers who provide direct long-term services and supports (LTSS) in institutions as well as in homes. This would be an additional $250 per week for non-physician direct-care workers and $500 per week for non-physician direct-care workers who are employed in a facility that treats COVID-19 patients.
- Additional payments to nursing facilities that treat a disproportionate share of COVID-19 patients.
“Some of those things we’re going to need in the form of relief because this is going to stretch us,” Dr. Walsh said.
“As a county hospital and critical access hospital, our duty is essentially to the people of the county. We’re a non-profit and have been fortunate to operate in the black but that does not mean that there’s large cash reserves or anything like a bigger hospital or a for-profit hospital in a metropolitan area.”
The proposal will require approval from the state but until then Dr. Walsh says they’re working with what they have.
“We’re prepared as anyone else for this and may even be ahead of the curve when we look at our peers but it’s going to be a hard fight,” he said.
The pandemic could pose a threat for those rural hospitals who may reach capacity for the intake of patients.
Governor Hutchinson predicts the cases of the novel coronavirus could increase nearly 10 times in the next two weeks. Officials believe 750 people could be hospitalized.
There are 732 Intensive Care Unit (ICU) beds in the entire state of Arkansas. Of 75 counties, only 29 counties have ICU beds, according to a Kaiser report completed by Kaiser Health News.
These are the areas that have ICU beds:
Ashley County, 6 beds (pop. 21,853; 25% over 60 years)
Columbia County, 6 beds (pop. 24,552; 23% over 60 years old)
Drew County, 5 beds (pop. 18,509; 21% over 60 years old)
Ouachita County, 8 beds (pop. 26,120; 25% over 60 years old)
Union County, 16 beds (pop. 41,639; 24% over 60 years old)
Bradley County, Chicot and Calhoun counties weren’t on the list. Director of Infection Control and Prevention, Dr. Mark Malloy says they’ve been working to get more beds.
“What we’ve done locally is foraged for beds,” he said. “For instance the hospital had given the votech school some beds on last year for training their nursing out there so we have sequestered those back to the hospital since they’re closed.”
Now, Dr. Malloy said the hospital has between 12-14 beds and they hope to have more from the state, especially if a surge in patients arises.
If that’s the case, the hospital may have to transport patients to larger facilities in Monroe, Little Rock, Shreveport or Pine Bluff, especially if they’re really sick.
If those hospitals are overcrowded and there’s no bed to transport them to then Dr. Walsh says “every facility will be on their own.” He’s hoping it doesn’t get to that point and says prevention is key.
“If we can prevent everyone from getting sick or keep people from getting other people sick by following directions from the CDC we won’t go over capacity or we won’t go over by much,” he said.
“I would caution people against feeling that that we’re in Crossett so we’re safe from this but we’re not,” he said. “It will come for us just like it will everyone else.”
The hospital also has three ventilators. Currently, there is a competition between states on those machines in addition to personal protective equipment.
That’s also something that will have to be handled on the state and federal level but that’s why ACMC doctors say they’re trying to really train their staff to be prepared for what could possibly come.
“We have been one of the more fortunate hospitals in that we have gotten to see what other hospitals around the country and around the state are doing,” he said. “So, we’re learning from them as they learn through practical experience.”
Dr. Malloy also wanted to address rumors that people wanting COVID testing are being turned away by staff but he say’s that not’s true nor is it helpful.
“This is really not a good time for gossip or rumor,” he said. “We’re doing testing at all of the clinics and we’re getting those back anywhere from 5-9 days later. I can tell you that everyone that has been tested at the hospital and our clinics have come back negative to date and that’s a great thing.”