Rural hospitals feel pinch with fewer patients

Nurses prepare for an influx of patients and gusts inside a screening tent at Holy Cross Hospital in Taos, New Mexico Morgan Timms/Taos News

As the state braces for a potential COVID-19 medical crisis, New Mexico's rural hospitals have taken a severe financial blow and are worried about their futures under federal guidelines and a state order to forgo elective medical treatments, a primary source of their revenue.Most of New Mexico's hospitals already were suspending elective treatments with the aim of creating more bed space in intensive care units and shifting personnel to emergency teams to battle the pandemic. But for the state's two dozen rural hospitals, which often run on thinner financial margins, fewer elective procedures creates a financial strain that may be difficult to withstand in the long term.

Smaller hospitals transfer many of their acute and emergency cases to larger hospitals, so without elective surgeries they face a sharp drop in patient flow, said Caleb O'Rear, CEO of Alta Vista Regional Hospital in Las Vegas, N.M.

"It's literally putting us in a really bad position," O'Rear said. "Our hospital being a small hospital, we really survive on elective surgeries."

Another factor, he said, is the fear some patients will catch the virus if they're around sick people. The result: They don't go to the hospital. Alta Vista's emergency-room admissions have dropped from an average of 55 patients a day to as few as 18, O'Rear said.

"The COVID-19 pandemic has drastically impacted the daily operating environment of hospitals across the country and here in New Mexico," said Brooke Linthicum, marketing director for Eastern New Mexico Medical Center in Roswell. "With social distancing, stay-at-home orders and the state order to suspend elective surgeries, hospitals ... will continue to see significantly fewer patients than usual."

Meanwhile, increased testing has shown the virus to be spreading in New Mexico, with the state moving above 300 confirmed cases.

About $100 billion in federal stimulus money is earmarked to aid the nation's hospitals in the crisis, but local hospital officials say no one knows how much will be allocated to New Mexico's hospitals or what restrictions would be placed on the funds.

On Wednesday, most of New Mexico's congressional delegation joined other senators and congressmen to in a letter to the U.S. Department of Health and Human Services Secretary Alex Azar, asking him to direct funding to rural hospitals.

Hospitals of every size across the state collectively are losing 40 percent to 60 percent of their revenue in the pandemic, which adds up to roughly $200 million a month, said Jeff Dye, president of the New Mexico Hospital Association.

O'Rear said if Alta Vista doesn't receive some financial relief and the pandemic drags on, the hospital might be forced to lay off employees or even close. At that point, the nearest hospital for Las Vegas residents would be 60 miles away in Santa Fe.

Stopgap measures

Other rural hospitals also agree the loss of elective surgeries is causing financial hardship but wouldn't say whether it might drive them out of business. They do acknowledge hospitals and doctors are experiencing these financial disruptions just as they need to be gearing up for an influx of critically ill patients, Linthicum said.

Eastern New Mexico Medical Center's parent company, Community Health Systems, has hospitals in Las Cruces, Carlsbad and Hobbs. The company will ask health insurers for interim payments to help carry its hospitals through the pandemic, Linthicum said.

Interim payments are reserved for extraordinary circumstances such as a pandemic when the medical system is strained and not working as it should. Insurers send payments at the normal level to hospitals and then settle any overpayments after the crisis is over.

Even before Gov. Michelle Lujan Grisham called for a freeze on nonessential medical treatments to preserve the limited supply of masks, gloves and other supplies needed to battle COVID-19, New Mexico's hospitals were following recommendations from the Centers for Disease Control and Prevention and the American College of Surgeons to shift resources toward emergency care, O'Rear said.

The governor's order made it compulsory.

Hospital officials say they are having to be creative with staffing, whether it's moving personnel to different jobs or giving more people paid time off.

Holy Cross Hospital in Taos, which has seen a decrease in surgeries, is reassigning some operating-room nurses to the emergency room as an example of reshuffling, said Gayle Martinez, the hospital's marketing coordinator.

The hospital is trying to deal with the drop in patients as it waits to see what federal subsidies will become available through the stimulus package, Martinez said.

Alta Vista's employees are taking paid time off in regular rotations so the hospital isn't overstaffed amid this patient slowdown, O'Rear said. In a few weeks, the hospital will have a better idea of whether it must take more drastic measures such as shortening work weeks or laying off people, he said.

Bigger hospitals better at absorbing losses

Larger hospitals also have lost money by slashing elective services but are better equipped to weather the crisis because they are emergency care providers for the region.

"It does have an impact, it is our bread and butter," said Lillian Montoya, chief executive of Christus St. Vincent Regional Medical Center, said of non-urgent procedures. "I do think that our smaller rural hospitals are going to feel it more substantially because they don't have [regional] surgical centers. They largely serve as an anchor for those smaller communities."

In recent weeks, smaller hospitals have transferred more emergency and acute cases to Christus St. Vincent, possibly because these hospitals have reduced their staffs, said Dr. Jose Sterling, a trauma surgeon at the hospital.

Nevertheless, the loss of elective surgeries has diminished St. Vincent's patient flow enough that it is asking much of its staff to take paid time off, partly so they are rested when the COVID-19 outbreak escalates, Montoya said.

"When Santa Fe and New Mexico in particular feel this wave from the virus, we're going to need all hands on deck and fully engaged," Montoya said.

Presbyterian Santa Fe Medical Center has had a 70 percent decrease in surgeries since it suspended elective treatments and shifted its emphasis to emergency care, John Wade, the hospital's CEO, said in an emailed statement.

Staff pay at Presbyterian will remain the same until at least April 30, he added.

Montoya said Christus St. Vincent will work with smaller hospitals in Northern New Mexico on a regional strategy to tackle the pandemic in hopes of collaborating through the crisis.

"We don't know how long this pandemic is going to last," she said. "I don't know what it's going to look like a month from now."

This story first published in the Santa Fe New Mexican, a sibling publication of the Taos News.

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