Covid-19’s Impact on Healthcare in Rural America
During the first months of the COVID-19 pandemic, many of the images Americans saw were of hospital workers invaded on the front lines in major metropolitan areas such as New York, New Jersey, Los Angeles and San Francisco. Even if they don’t face the same volume of cases, hospitals in rural America have their own challenges related to COVID-19.
For example, the state of North Carolina does not see the same volume of COVID-19 cases, per capita, as other southern states such as Florida or Georgia. Still, many hospitals in the state have suffered a series of debilitating financial blows. As one of the states that did not expand Medicaid coverage under the Affordable Care Act, North Carolina has a large number of uninsured people with other conditions as well.
And as fearful patients canceled routine appointments and hospitals postponed elective procedures to make critical resources available for potential COVID-19 surges, many North Carolina health systems have seen sources evaporate. from income. To stem the flow and keep their hospitals open and available to care for all patients, state hospital administrators have had to be creative.
SensisHealth’s Sharon Carothers recently interviewed Cynthia Charles, Vice President of Communications and Public Relations for the North Carolina Health Association, to discuss the impact of COVID-19 on the healthcare industry in her state. Charles spoke about how a willingness to embrace new communication approaches helped her keep her hospitals supplied, resilient, and able to meet the needs of a diverse patient population.
Q: What’s been working in terms of communicating to patients or to the community at large amidst all the constant changes?
A: I certainly believe that health systems and hospitals that already had electronic newsletters or patient communication through MyChart (a portal for patients and EHR) have really helped keep the community up to date. I have seen health systems and hospitals do information sessions on Facebook Live and answer questions. I’ve seen them do podcasts or radio shows or virtual town hall meetings using zoom technology; it has been extraordinary.
Q: Is there anything you’re seeing around the application of COVID-19 and challenges that are different from regular care or vaccinations management of chronic conditions?
A: Absolutely. I have been very impressed by some of the members of our group of doctors and the hospital. They have taken the time to look at the patient population, where people live, and what their health status was prior to COVID-19. They are communicating with patients, especially if they are concerned that a patient is elderly or at high risk, to make sure they agree on their medications and understand what their next visit will be, be it a virtual or face-to-face visit. I think that even though we are still going through a very severe and intense pandemic, we have primary care practices that are reaching out and doing the right thing for patient care.
Q: Could you talk a little bit more about some of the challenges of having micro-systems that are unique in dealing with COVID-19?
A: Sometimes rural communities are at a disadvantage. North Carolina has never expanded Medicaid. Many of our rural hospitals have patients who do not have insurance. And they are dealing with other health challenges like health disparity, food insecurity, language barriers. We have to educate and protect the health of our most vulnerable populations.
Covid 19 References on Wiki
Q: Hospitals have needed to work very closely in the counties with the public, with the county public health department and infrastructure, with their local business community. So, we all work together to keep everybody safe and informed about their options and where they can go for testing in urban areas.
We had concerns about population density; we didn’t have enough test supplies. We felt we had a complete picture of the rate of spread and how to keep people safe. But we worked with the University of North Carolina and Wake Forest Baptist Medical Center, who had either developed and implemented their own tests, or already had established outreach programs like mobile clinics, video visits, and telehealth programs.
We would also have weekly calls to share information with health care associations and our member hospitals and health systems, and medical societies that represent physicians, nursing associations, and hospice and hospice skilled nursing facilities. I was really looking at a broad and inclusive cross-section of the healthcare industry, sharing information weekly on these conference calls.
Q: What are some of the long-term implications of your operations?
A: In fact, we recently had a conference call with our CEOs and members called COVID Forward to assess what we need to do to be effective in the future. Something that emerged was the importance of keeping the lines of communication open with the business community, since they are employers. Hospitals and businesses are suffering, and we all want to keep our employees and communities safe. We were mostly very aligned but at times we had some debate and a healthy discussion about reopening strategies and timing.
Another thing we discussed was the importance of hospitals being very open and transparent with the community about what their needs are and why they are doing what they are doing. There have been, for example, many questions about visitor policies and people trying to understand why they cannot be with their loved ones in the hospital. But again, there is a lot to learn and we are trying to keep everyone safe.
Q: What are some of the biggest challenges you’ve faced in the last couple of months related to COVID-19?
A: I think challenge number one was understanding what we were dealing with and what the plan was.
As an advocacy organization, we have a lot of interaction with federal and state governments, hospitals, and health systems that were asked to put elective procedures on hold at any given time, which is a significant source of revenue for them. . That immediately put them in a very difficult financial situation, not only because their main source of income was on hiatus, but also because they were trying to purchase medical supplies and PPE that were much more expensive than normal. And the suppliers had no inventories.
They were forced to search abroad, find suppliers, and even purchase items. And many of these companies were not known to them. Imagine you are a smaller rural hospital in North Carolina that needs to purchase items, how are you going to do it? Our association developed a very innovative, progressive and collaborative way for us to do group purchases, browse suppliers and use a digital platform to make it easier for everyone.
So those are just a couple of challenges. I think it is important to stay in contact with the state and federal governments to try to understand their plans. What is the testing and monitoring plan? What’s the plan for stay-at-home orders or reopening the economy?
Q: What areas of healthcare have you been focusing on during this time? How are these priorities shaping the future?
A: I think one of the most urgent priorities has been advocating with the federal government for hospitals to be included in the CARES Act and for our state legislators to understand why our hospitals need adequate funding. I think that has probably been the top priority of our advocacy work so far. There have also been all kinds of waivers that can be put in place to allow hospitals to move quickly to do what they need to do. Not only have we advocated for those exemptions, but we also maintain a working database. That way, we can consider whether any of them should be made permanent.
Q: And while we’re on the topic of technology, I’d love to hear more about the use of tech in your own work or elsewhere.
A: I think two of our greatest success stories have been my team at the North Carolina Healthcare Association, working with a Raleigh television station to produce a series of public service announcements. They were initially about the importance of staying at home, and then later about how you shouldn’t hesitate to call 911 if you’re having an emergency.
Then we did some PSAs about the importance of wearing a face covering, to be thoughtful and care for your family and your neighbors by wearing your mask. They were able to produce it at no cost to us. And we shared those PSAs with the North Carolina Association of Broadcasters so they could make them available to television stations across the state. It was a way for us to reach all people, even in rural areas.
Q: Have you seen any increases of telehealth especially in the rural community?
A: We have definitely seen an increase. Some health systems and hospitals were already using telehealth extensively, but we have certainly seen expansion and positive feedback from patients. It’s something we certainly hope will continue.
We also created the “response fund to fill the gap” to meet certain proactive care or reimbursement needs that were not going to happen at the federal and state levels and things like the CARES Act. We wanted to make sure we were proactive in finding and addressing underserved populations across the state, many of whom were minority populations or in rural communities.
Charities were the main donors in the effort, but we also had many individual donors. And so far, we have raised $ 5 million. This week, we are distributing a portion of $ 1.6 million in grants to 19 organizations. And most of these organizations are reaching out to support groups with needs related to COVID-19 that serve black populations in rural communities. These funds can be used for services such as more virtual visits, more use of mobile clinics, but also education and education in Spanish.
The last thing I would say is that I think we are still going to be dealing with COVID-19 for at least another 18 months, which is why I think it is so important to capture learnings and insights now and communicate successful practices because I think we will see a lot more in the fall and winter.