Rural health-care providers, such as Hermann Area District Hospital, are in the midst of a financial struggle that continues to sag lower under the weight of the coronavirus outbreak.
Responses to the pandemic are straddling HADH and its kindred hospitals in outstate Missouri, coupled with pronounced drops in revenues due to the loss of revenue from normal operations in lieu of shifted attention needed to combat the virus.
Hospital Administrator Dan McKinney said rural hospitals such as Hermann's are paid less in Medicare reimbursements than their urban counterparts, and that impairs the bottom line at a critical time of facing COVID-19. Yet that represents only one front in the short-term attempts to restore cash flow.
The advent of the virus in the area has led to a community call for more staff to help shore up the hospital's response, requests that seek to obtain volunteers and retirees who are experienced in health care.
"We're not even doing elective surgery" such as colonoscopies," McKinney added of the hospital's circumstances.
Congress has responded to the hospitals' plight by including $100 billion for the institutions nationwide. The lawmakers have also been moving to advance Medicare payments being requested by the state's hospitals.
On Friday, Sen. Roy Blunt, R-Missouri -- who chairs the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies -- said the U.S. Department of Health and Human Services will begin distributing more than $618 million in coronavirus response funding to hospitals and other health-care providers in Missouri.
The measure is one component of the Coronavirus Aid, Relief and Economic Security Act (CARES Act).
McKinney said the hospital will receive a share of the state's distribution to support healthcare-related expenses or lost revenue traceable to the coronavirus, including just over two weeks of the hospital's payroll, and to ensure uninsured residents receive COVID-19 testing and treatment. The hospital has also applied for the Small Business Administration's Paycheck Protection Program.
Blunt's announcement comes on the heels of a plea by the Missouri Hospital Association for federal relief in the aftermath of responses to the pandemic by its members.
"With the elimination of elective procedures, total revenues for Missouri's hospitals are down $32 million per day," wrote Herb B. Kuhn, the association's president and chief executive officer.
Kuhn said estimates of the losses do not cover the added expense of hospitals' preparations for the pandemic.
At HADH, efforts are ongoing for a potential uptick in virus cases in Gasconade County. Some forecasts predict Missouri could see a rise in patient numbers later this month.
"We're continuing to try to shut the hospital down," said McKinney. "We're trying to make preparations."
McKinney said 70 percent of the hospital's business is composed of outpatient, clinic, and emergency room cases.
"Of the remaining 30 percent being inpatient, 70 percent of that historically is skilled (rehabilitation) patients," he added. "On average, we are down 50 percent of our usual volume. Skilled nursing is down 40 percent (and the) ER is down 25 percent. Drops in volume really hit in mid-March."
State government leaders also say they are aware of the hospitals' situation, and say they are embracing a surge strategy that includes support for rural health care in Hermann and other parts of Missouri, along with the metropolitan areas.
"That's why we've developed a model" to create temporary bed space in St. Louis, said Missouri HealthNet Director Todd Richardson, who was responding to a question submitted by the Advertiser-Courier for last Wednesday's COVID-19 update by Gov. Mike Parson.