It was several months ago when local residents raised concern over Sierra Nevada Memorial Hospital’s decision to terminate some of its positions.

While those sentiments have appeared to have faded — with the temporary halting of elective surgeries, and considering the typical strains of operating a rural hospital under normal conditions — local hospital administrators say they are closely watching their bottom line. They’re also applying for federal stimulus funding to remain stable, thereby remaining one of the county’s largest employers, keeping about 650 people full time, with about 800 total workers.

“We anticipate that we will receive enough funding to partially offset the impact of COVID-19,” Sierra Nevada Memorial Hospital President and CEO Dr. Brian Evans wrote in an email. Evans said the hospital has not made additional hires recently, but has increased staffing to better manage screenings and to enhance its emergency preparedness response.

During the pandemic, smaller hospitals, with less money in their reserves, are at a disadvantage compared with larger health systems as finances tighten, according to a report by Kaiser Health News. Rural hospitals, already struggling to stay afloat before the virus outbreak, typically have to deal with higher levels of older, poorer, sick people who are less likely to have insurance. These issues have not gone away since the pandemic hit. On April 6, the National Rural Health Association wrote an open letter to Congress imploring it to provide financial relief for rural hospitals so they can keep their doors open during the crisis. More recently, much of the lost revenue stems from rural hospitals’ inability to provide non-emergency care, the letter states.

Evans sympathized with this perspective.

“Delaying elective surgeries is creating a significant decrease in revenue for Sierra Nevada (Memorial Hospital), and most other hospitals around the country,” he wrote, adding that the local hospital intends to “resume elective surgeries shortly” under the guidance from state and national public health institutions.

Since 2010, rural hospital closures — many of them clustered in the southeastern U.S. — have been steeply rising, according to a report from the Chartis Center for Rural Health. Nineteen rural hospitals closed in 2019 alone, and a 2020 Guidehouse study found that 25%, or 340 hospitals across 40 states, are at high risk of closing unless their financial situations improve.

“Rural hospitals have a number of challenges,” wrote Evans. “Recruiting is difficult because most physicians and other health care providers often look for positions in more urban areas. We also offer similar services to take care of our community, but with lower volumes of patients, this can be financially challenging because we don’t have high patient volumes to offset expenses. This is particularly true for services like OB/GYN, specialty surgery and cancer care.”

Rural hospitals also struggle with fewer opportunities for commercial insurance payment, relying more heavily on lower payouts from government plans like MediCal and Medicare, Evans said.

‘A MIRROR OF OUR COMMUNITY’

Three things are needed to ensure a thriving community, according to Gil Mathew, president of the Sierra Nevada Memorial Hospital Foundation’s board. That includes a good regional airport, a higher education institution and a “state of the art” medical community — which, he said, Nevada County maintains.

“We have a world-class hospital,” said Mathew. “We have equipment there that they don’t have in Sacramento.”

But even with as much success as the hospital has had, Mathew said keeping the facility will always be a challenge to maintain with stringent rules and regulations and difficulties balancing quantity of labor and quantity of patients.

Both Mathew and Marty Lombardi, a hospital foundation board member, spoke highly of the hospital’s impact on the western county economy and local civic life.

“I hear the incredible empathy, the incredible compassion with how these folks go about their business,” said Lombardi. “I’m just so grateful that they’re here, that they’re in our community. I think it’s a mirror of our community.”

One of the few changes at the hospital that may occur post-pandemic, suggested Lombardi, is a heightened awareness of another viral outbreak, and even more readiness to organize quickly toward preparedness in case of an emergency.

As the hospital is currently in an emergency preparedness response mode, awaiting a possible spike in COVID-19 patients, Evans said that elective, non-emergency surgeries and practices will only occur once testing increases, enough personal protective equipment is supplied and there is a sustained reduction of COVID-19 cases in the area.

“We will continue to plan and prepare for all of these things, and ask for the support and partnership of our community,” he wrote. “That is why we are here.”

To contact Staff Writer Sam Corey, email scorey@theunion.com or call 530-477-4219.