Nevada County health care providers pivot on financial tight rope
In order to prepare for and mitigate the potential local outbreak of the COVID-19 pandemic, health care facilities in Nevada County have had to rework their practices and prioritize services, hoping to balance the immediate need to slow the virus and the long-term financial health of their institutions.
According to the National Rural Health Association, rural health care providers face funding, work force, and reimbursement challenges that has led to nearly 100 hospitals shutting down in the last decade.
A Centers for Disease Control and Prevention study found the disparity in health care access has led to worse mental, behavioral and developmental outcomes for rural patients, who are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than urban counterparts.
At Sierra Nevada Memorial Hospital, which serves 75,000 residents in western Nevada County, the facility has limited its essential services to include cancer care, lab work, ultrasounds, and infusion care in addition to inpatient health care.
According to Sierra Nevada Memorial Hospital CEO Dr. Brian Evans, the changes have been effective, with the hospital seeing just a few acute COVID-19 patients, but they’ve had a definite financial impact.
“We have good financial reserves but in the last few months we’ve really been upside down due to the lower revenue because of having to cancel elective surgeries and having a relatively low census in the hospital,” Evans said. “We’ll catch up and recover and get back to where we were but I don’t think the fundamental financial pressure that all rural hospital are facing are going to go away any time soon.”
Evans said the situation is difficult but preferable to the alternative which could have been catastrophic with the potential to overrun the hospital if services weren’t limited.
“If we did nothing, we could have seen some very difficult times at the hospital,” Evans said.
According to Evans, the hospital is now in position to evaluate what a recovery and return of services could look like going forward. Officials will consider their labor force, amount of patient influx, local coronavirus trends, supply chains and evaluate what is defined as an elective procedure as they map out their next steps, Evans said.
‘DAUNTING, CHALLENGING TIME’
Prior to the pandemic, the hospital implemented services targeted at alleviating the region’s rural barriers to health care access, including increasing access to telehealth practices. Other providers in the area say this will be one of the keys to how health care providers pivot into the future.
“The ability to do telemedicine in a rural setting is extremely valuable,” said Dr. Christina Lasich, Western Sierra Medial Clinic chief medical officer. “We’re planning in the future for this to be an important part of our business model and bottom line.”
According to Lasich, the clinic has seen a spike in behavioral health telemedicine demand, which she attributes to both the increased accessibility of services and stresses people are experiencing during the pandemic.
“Patients are very grateful to, in this situation, have the option to come in or not,” Lasich said. “Although this has been a very daunting, challenging time for people, its also an exciting time for medicine and health care in general. The COVID-19 situation has both challenged us and also inspired us to rethink health care.”
Lasich said the heath emergency has led state and federal officials to relax billing regulations, allowing health care facilities to get paid for services they wouldn’t normally charge for, like phone calls without a visual component.
dealing with downturn
Lisa Davies, CEO of Chapa-De Indian health clinic, said despite an overall decline in patients, the clinic has seen a similar surge in behavioral health appointments.
The clinic has suspended non-urgent and non-emergency dental and optometry care. Their daily visit count is down nearly 60%, leading the clinic to furlough just under half of its 250-person workforce.
“You drive down the visits because you want people staying home but by not coming in we’re driving down business which, in turn, drives down revenue,” Davies said of the furloughs.
The clinic, she said, will look to bring back those furloughed as the practice picks up and is confident that time will come.
Davies and many of the clinic leadership came on board in 2010 following the 2008 recession and have over the years prioritized ensuring the clinic can withstand a significant revenue decrease.
“Looking at our cash flow projections, in the worst-case scenarios, we can operate like this for about the next 10 to 12 months,” Davies said.
According to Davies and Lasich, as their health care facilities tread water while evolving to meet the needs of the pandemic they will look to continue some of the innovations created by the necessity of the situation but whether the regulations, broadband access and funding allows that innovation will be crucial.
“It’s an opportunity that kind of hit the pause button in some respects,” Lasich said. “We’re hoping going forward people are recognizing the value of having increased access through technology but right now everything we’re doing is a result of emergency declaration.”
To contact Staff Writer John Orona, email firstname.lastname@example.org or call 530-477-4229.
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