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Rural hospitals brace for peak of pandemic

Copyright © 2020 Albuquerque Journal

So far, Miners Colfax Medical Center has managed to avoid an overwhelming number of sickened patients since the onset of the COVID-19 pandemic – at least for now.

The 25-bed critical access hospital in Raton, near the border with Colorado, has had to transfer only two COVID-positive patients to Santa Fe for treatment – both of whom recovered successfully, CEO Bo Beames said.

But with cases surging to never-before-seen levels across the state, Beames admits he’s becoming concerned about his hospital’s ability to fight the pandemic in the coming months, even in a county with only 41 cases as of Thursday.

“We are concerned that we’re going to see increased numbers,” he told the Journal. “Even though we’ve had a pretty low case number, it’s all around us and it’s only a matter of time before we start to see more spread in our community.”

Cases in New Mexico’s largest communities are seeing some of their biggest increases of the pandemic so far.

In nearby Las Animas County, across the New Mexico-Colorado state line, there were 28 cases as of Oct. 13 – that number then doubled in a single week.

And it’s not just Beames who is worried. The recent surge has made many rural hospitals in New Mexico concerned about the potential impacts on both their operations and finances.

Rural hospitals often lack the resources and bed space found at larger centers in such major urban areas as Santa Fe and Albuquerque. Stephen Stoddard, executive director of New Mexico Rural Hospital Network, said many rural hospitals have only a couple of ICU beds, or none at all.

As a result, New Mexico has set up seven different “COVID hubs” across the state where smaller facilities can transfer patients in need of greater care.

Much of northern New Mexico sends patients to either Christus St. Vincent Regional Medical Center in Santa Fe or San Juan Regional Medical Center in Farmington. State officials have raised concerns that, with a seven-day rolling average well over 600 cases a day, the state’s health care system could become overwhelmed.

If and when beds at hub hospitals become full, smaller clinics may have nowhere to transfer their sickest patients and will attempt to treat patients with what resources they have.

Christus St. Vincent President Lillian Montoya said in a Oct. 19 press conference that the hospital had eight COVID-19 patients and wasn’t yet experiencing a surge.

Many rural hospitals are, however, still preparing for that scenario.

Bill Patten, CEO of Holy Cross Hospital in Taos, said his staff is already making plans to expand the number of ICU beds if demand increases. He said they will probably need to hire more traveling nurses in the event of a spike in cases.

“We could go from 25 beds to almost double that if we had to, in a worst case scenario,” Patten said.

Other rural hospitals have also begun planning, with some drafting complicated rearrangements of their facilities. Weekly meetings between hubs and smaller hospitals, which were discontinued when cases were fewer, started up again recently.

An influx of COVID-positive patients, though, presents significant risks for a hospital’s staff and its bottom line.

Infected medical workers became a problem for some hospitals near the beginning of the pandemic. At the start of June, there were already 646 positive cases among the state’s health care workers, according to the state Department of Health.

An outbreak at a smaller facility could hinder day-to-day operations. Beames said even just two or three of his employees testing positive could affect their ability to treat patients.

“One or two people is a large percentage of our staff,” he said. “It really hampers our ability to observe an influx of patients.”

An influx could also impact a hospital’s ability to perform other treatments for patients. In March, Gov. Michelle Lujan Grisham banned elective surgeries, often the largest revenue source for more rural facilities.

The ban has since been lifted, with many hospitals reporting a rebound in patients seeking procedures, but the number of procedures is still lower than it was pre-pandemic.

“They haven’t gotten back to 100% yet,” said Stoddard. “They’re not where they want to be, but they are much better than when they had it closed.”

Rural hospitals have also received a significant amount of financial relief, due to the decline in procedures and the coinciding rise in expenses related to COVID-19, which has helped offset some costs.

However, with no additional federal stimulus plans on the horizon, some fear that additional money won’t last long enough.

“Regardless of the money we receive from the federal or state governments, our focus is on providing the care the community needs – then, after the fact, figuring out how we’re going to afford it all,” Patten said.

Many hospitals say that, if they see an influx of positive cases, they may have to temporarily suspend elective procedures, dealing another financial blow.

And the risks of patients seeing doctors less frequently go far beyond just surgeries. Presbyterian Española CEO Brenda Romero said that when patients do go to her hospital, they’re often sicker and in worse health.

“We believe that they’re waiting longer than they should to seek care,” she said. “Our assessment is they’re trying to stay home so that they don’t get COVID.”

Executives agreed it’s important to show the public that visiting hospitals can be safe during this time, both as a way of stabilizing revenues and maintaining community health.

Some hospitals, such as Miners Colfax and Holy Cross, have avoided furloughing any of their employees so far, but a continuing slide in revenues could make that inevitable.

At Miners Colfax, which has the only obstetrics clinic for 100 miles, any furlough could burden services already lacking in the area.

In order to keep those operations running normally, more funding will be required.

“All those programs have been very helpful in keeping the doors open and keeping these facilities ready to serve their communities,” Stoddard said.

“The long-term picture is they need to be able to provide the full range of services that they offer in order to cover the costs.”

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