On March 1, if you had chest pains, you went to the emergency room. On July 1, if you have chest pains you go to the emergency room. Some things are the same today as before the coronavirus pandemic struck, said David Schreiner, a hospital president in northwestern Illinois.
That said, Schreiner has never seen so many changes at hospitals and in healthcare in such a short time.
“It has changed faster since March 15, than the rest of the 30 years,” said the president and chief executive officer of Katherine Shaw Bethea Hospital, known as KSB.
The 80-bed hospital in Dixon, Ill., with 1,000 employees all but emptied when Gov. J.B. Pritzker issued shelter-in place orders in March. Day one decisions had to be made for the safety of employees and patients, Schreiner said. All elective surgery stopped.
Revenue plummeted from $40 million monthly gross to $22 million.
The hospital instantly loss 45% of its revenue and suddenly had the extra expense of $2 million to prepare for a possible surge of COVID-19 patients. Happily that surge didn’t occur. They had only 10 cases and no staff tested positive. KSB Hospital is back to about $36 million in monthly revenue.
As a result of the lack of work and revenue, KSB had to furlough 150 employees.
“It is the first time we had this type of layoffs,” the hospital’s CEO said.
Most are back at the hospital where 95% of the staff is employed by the hospital rather than in private practice.
Such kinds of revenue changes can lead to the demise of a rural hospital, said Schreiner, who is on the American Hospitals Association of Small Rural Hospitals Task Force. Federal emergency funding has helped fill the gap here. Thankfully the federal government provided some subsidies and made pivotal policy changes to help rural hospitals, he said.
Some hospitals struggling
Rural hospitals across the state and country reeled with similar plunging revenue with no patients, said Pat Shou, executive director of the Critical Access Hospital Network, which represents 57 small and rural hospitals in Illinois. None of Illinois’ hospitals appear to be in immediate danger of closing their doors within the year because of the pandemic, but other states are not so lucky, she said noting the 76-bed Williamson Memorial Hospital in the West Virginia closed in late May — with the pandemic a factor in its last breath, she said.
Rural Illinois hospitals are back to running at about 50% capacity, Shou said. KSB is back to about 80% of its volume now, but initially there was a hesitancy to seek care. The shelter-in-place mentality had to change before people were ready, Schreiner said.
Now it’s time for people to get back to regular care including immunization for children, he said.
KSB serves about 45,000 people in Lee and Ogle counties, many of whom are in agriculture. This hospital was among the first in the nation to provide drive-thru testing,
As of June 27, they had given 2,283 tests with 75 positive — about 3.3%.
“Our percentages mirror what we see in downstate Illinois,” he said.
KSB also worked with Rochelle Community Hospital and Ogle County Health Department to test about 800 employees at Hormel’s Rochelle processing plant. The plant was closed for 14-days in April after two dozen employees contracted COVID-19. The company upped its health regimen above state requirements before reopening in May.
Health agencies worked together to address that hotspot in Rochelle, providing testing and education to 800 employees and the community in a matter of days, said Hinkle, who lauded the effort.
An overall increase in capacity for testing has grown from the pandemic, she said.
No one knows if there will also be a surge of cases among migrant workers harvesting vegetables and crops this summer, but primary health clinics are being set up as needed, she said.
The pandemic has brought exponential growth of telehealth services, said Shou, who cautions there is still a lot of work to do in this field.
“We need to get better and more effective with it,” she said. She is concerned with confidentiality — such as a doctor consulting about a patient’s problems on FaceTime in the grocery store.
KSB provided “hundreds of telehealth visits,” said Schreiner. “We were using it before, but we had to supersize it.
Telehealth was initially used for behavior and mental health most frequently. Primary care has not used it as universally before, but it has been beneficial in managing chronic diseases and medication during the pandemic, said Dr. Hana Hinkle, assistant director of the National Center for Rural Health Professions at the University of Illinois in Rockford.
Telehealth infrastructure, training and federal funding grew quickly.
“We might see more telehealth and comfort with it. It could benefit rural residents,” Hinkle said.
Schreiner also expects it to remain popular with farmers and rural people as a convenience, especially during busy seasons. The telehealth platform is now in place so it can be used going forward, he said.
Healthcare also responded to other technological needs with people working from home including getting security systems on computers as well as dealing with bandwidth and virus protection issues, Shou said.
During the pandemic, procurement of supplies required adjustments. Initially, when KSB hospital ordered 2,000 of something, they would get 200. Now they are rebuilding a supply inventory for the future. The reserves will be sufficient, not at “hoard level” and bought at a price that is “justified,” he said. Some costs for masks, for example, spiked erratically at first.
Further, hospitals are building a solid strategy with the Illinois Department of Health of how to get personal protective equipment to hot spots.
“Everyone has to figure out a new normal,” she said.
Shou is not keen on the over-used phrase, but says it’s the truth.
“We’ll be OK. It’s going be different, but we’ll be OK,” Schreiner said.