DENVER — When the COVID-19 pandemic began in Colorado, rural hospitals in the state were in a vulnerable position. Staffing shortages and funding shortfalls plagued a system that serves the health care needs of rural communities in Colorado.
But a system on the brink, hit with the biggest health care crisis in our nation’s history, pulled through and is actually innovating and growing, according to the Colorado Hospital Association. None of the state’s 43 rural hospitals, which makes up about half of the hospitals in Colorado, had to shut down during the pandemic. But that hasn’t been the case for rural hospitals in other states.
More than three dozen hospitals across the country entered bankruptcy in 2020, according to the American Hospital Association. The costs associated with preparing for the surge of COVID-19 patients, loss of revenue from the shutdown of non-emergent care during the height of the pandemic, and staffing shortages have proven to be too much of financial burden for many rural hospitals.
Benjamin Anderson, the vice president of Rural Health and Hospitals with the Colorado Hospital Association, said Colorado’s hospitals faced similar challenges going into the pandemic. The CHA projected last year $3-4 billion in revenue losses and increased expenses.
“COVID-19 shined a spotlight on the vulnerabilities that already existed in rural communities in terms of their health care delivery,” Anderson said. “With staffing, there's a shortage of frontline workers. There was an immediate need to cross train people with supplies. Leaders also had to innovative. We really found ourselves in some pretty financially dicey situations when the pandemic first arrived because of how we're reimbursed.”
Rural hospitals rely heavily on non-emergent care for revenue -- services like outpatient surgeries, clinic services and diagnostics, which were suspended by an executive order from Gov. Jared Polis in March of last year. Although the order exempted critical access hospitals, like rural hospitals, many went along with the order to preserve their personal protective equipment.
Medicare and other payers reimburse rural hospitals at cost, giving them little financial leeway to deal with a major health crisis like the COVID-19 pandemic, Anderson said. Other challenges unique to rural hospitals include low patient volume, geographic isolation, limited access to essential services, and an aging infrastructure.
"[Rural hospitals] may not have the days of cash on hand that some of our our other hospitals might have across the country. And so they were very vulnerable at the outset. And so it's a really a good opportunity to say that we're extremely grateful for our federal Congressional delegation, how they allocated or advocated for emergency funding last spring," Anderson said.
The federal Paycheck Protection Program helped many of Colorado's small hospitals stay open during the pandemic. Rural hospitals and health centers in Rangely, Hugo, Wray, Yuma, Sterling, La Junta, Gunnison, Walsenburg, Kremmling, Estes Park, Lamar, Alamosa and Craig were among those approved for loans between $1 million and $5 million, according to data from the federal government.
With the infusion of federal money into the system, hospitals were given some breathing room just as the pandemic began to spiral out of control. During the height of the second spike in cases in the fall of last year, ICU hospital beds were quickly filling up. And the state's rural hospital system was ready to take on the challenge.
"There's been statewide collaboration. We launched the Combined Hospital Transfer Center, or the CHTC, and rural and urban hospitals and health systems voluntarily collaborated to set up this model that would allow for efficient, reliable transfer of patients, both from rural to urban centers, and also from urban to rural centers," Anderson said.
The CHA and Colorado's rural healthcare system innovated techniques and systems that saved lives, Anderson said. The CHTC will be activated should the number of patients needing transfer exceed the capacity of the hospitals, allowing rural hospitals to take the burden off major regional health centers.
"So what has been, historically, mostly a one-way highway from the rural areas to the city was built out to a two-way highway, and urban patients were being shipped in certain crisis points out to rural hospitals, where they would get optimal care," Anderson said. "And so there was this well-coordinated system that was developed in crisis that ensures that we never had a situation where we had to turn patients away because we didn't have access to beds."
"Turning people away from care was not acceptable to us. We have the resources, the intellectual capacity to solve these problems. Do we have the will? Do we have the will as a state to solve these problems? And in many ways, we lead the country, in Colorado, in COVID response," Anderson said.
Rebounding from the pandemic won't be easy. But Anderson said the system is stronger now because of the innovations put in place because of the crisis.
"After after an emergency like this, with sustained stress on our healthcare delivery system, recovery is absolutely necessary, and recovery won't be easy. It can only come through an intentional strategic plan and our group of hospitals has a clearly defined collaborative statewide strategy for rural healthcare delivery that is primarily focused on the building out of the capacities of transformational leaders in our hospitals and clinics," he said.