Why U.S. Rural Hospitals are Struggling to Keep Doors Open During COVID-19

April 05, 2020

Densely populated urban areas have been home to the most severe coronavirus outbreaks, with the highest reported cases in New York, and while urban hospitals are in jeopardy of becoming overwhelmed with patients, rural hospitals face a different set of threats.

Before the pandemic, rural hospitals were already struggling with bad debt cuts, sequestration and other medicare changes for rural providers. In the last decade, over 121 rural hospitals closed since 2010 and over 400 vulnerable to closure, according to the National Rural Health Association (NRHA). 

The effects of COVID-19 are accelerating these trends across rural healthcare facilities, and putting them on the brink of closure.

Hospitals are Fighting for a Financial Safety Net

Hospitals across the country are on directives to postpone elective surgeries and eliminate medical services that aren’t urgent, and for some rural hospitals, this means losing up to 80 percent of their revenue. Rural hospitals also rely on government funding, but in many cases, Republican-led states have not expanded Medicaid to lower-income families. Along with the outbreak, rural healthcare providers report paying high prices for personal protective equipment that’s in short supply. 

Healthcare leaders are speaking out to improve financial conditions.

In a letter to congressional leaders, Alan Morgan, CEO of NRHA, said that rural providers need “immediate relief,” and requested a $100 billion grant package to offset coronavirus costs and loss of funding, with at least 20 percent set aside for rural providers. “Prior to the COVID-19 the outbreak, nearly half of all rural hospitals were operating at a financial loss, and now these hospitals are facing catastrophic cash shortages,” Morgan said.

The Trump administration is reportedly working on a deal to help hospitals with federal aid, specifically those in rural America, but there isn’t yet a timeline on when these hospitals will receive the funding they desperately need. 

Severe Shortage of Healthcare Professionals

Health Resources & Services Administration (HRSA) reports that 77 percent of rural counties are considered health professional shortage areas. Nurses are battling coronavirus on the frontlines and have become America’s saving grace during the pandemic; unfortunately, rural hospitals are in desperate need of nurses. Rural communities are at a disadvantage when recruiting and retaining experienced nurses at their facility. Experienced healthcare professionals are harder to come by for these facilities because they typically offer lower pay and a less vibrant social setting, compared to urban counterparts.

COVID-19 has prompted a drastic increase in the demand for nurses over the past few months. The lack of nurses on the frontlines has forced hospitals to ask nurse retirees to come back to aid patients in need. Travel nurse rates have doubled since the outbreak began, according to a recent study by HIT Consultant. Rural hospitals, already lacking proper contingency spend, struggle to pay the high prices demanded by experienced travel nurse contracts.

Long grueling hours and burnout have long plagued nurses on the frontlines, and effects from the pandemic are set to exacerbate turnover rates in rural areas leading to more shortages.

The Fight for Access to Healthcare in Rural America

Coronavirus has spread to over 1,000 rural communities, and with the threat of hundreds of hospitals vulnerable to closing, tens of thousands of rural patients will not have access to local healthcare services. 

Some rural counties in the U.S. are getting stretched thin and have access to limited resources. For example, in Blaine County, Idaho, there are 351 positive cases, with only a small 25-bed facility to serve them. In Eagle County, Colo., there are 314, with a county that only has 56 beds, according to Morgan’s congressional letter. Unfortunately, this reality means that hospitals will not be able to care for all those who need it, providers will be forced to make crucial decisions on who will receive life-saving medical care.

Since rural populations are per capita older, sicker and poorer than those in urban communities, they are more susceptible to chronic conditions and disease. According to a 2017 CDC report, the “death rate gap between urban and rural Americans is getting wider.” The long-term effects of coronavirus will have a detrimental effect on rural hospitals and their population.

The NRHA, and the 21,000 members it represents, hope the sharp blow to rural hospitals will help enact policy on a national level. “Hospitals, clinics, and front-line providers are fulfilling their commitment to their patients in these unprecedented times, and they require immediate relief to weather this pandemic,” said Morgan. 

If the rate of closures continues to rural hospitals, it will soon become cataclysmic to the nation’s public health infrastructure.