In this podcast, attorney Ellie Bane speaks with Vonne Jacobs, Principal and Founder, Pharos Healthcare Consulting, Delphine O’Rourke, Partner, Duane Morris, Andrea Ferrari, Partner, HealthCare Appraisers, Michael Watters, Chief Legal Officer and General Counsel, Essentia Health, and Steve Clapp, President and CEO, Strategic Healthcare Advisers, about how rural health care providers are dealing with the challenges presented by the coronavirus pandemic. The speakers share stories of how rural providers are facing these challenges, and discuss issues such as limited resources and supplies, staffing and capacity issues, and the future of rural health care. From the Public Health System Affinity Group of AHLA's Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In this podcast, attorney Ellie Bane speaks with Vonne Jacobs, Principal and Founder, Pharos Healthcare Consulting, Delphine O’Rourke, Partner, Duane Morris, Andrea Ferrari, Partner, HealthCare Appraisers, Michael Watters, Chief Legal Officer and General Counsel, Essentia Health, and Steve Clapp, President and CEO, Strategic Healthcare Advisers, about how rural health care providers are dealing with the challenges presented by the coronavirus pandemic. The speakers share stories of how rural providers are facing these challenges, and discuss issues such as limited resources and supplies, staffing and capacity issues, and the future of rural health care. From the Public Health System Affinity Group of AHLA's Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Hello, and thank you for joining our conversation on rural healthcare and the impact of Covid 19. My name is Ellie Bain. I am the Vice President for education for the A H L A public Hospitals and Healthcare Systems Affinity Group, and have spent most of my 20 years in practice representing rural providers throughout the Southwestern United States. I will be moderating today's discussion. We have an amazing and diverse panel for you, with experience representing all types of providers and facilities across the United States, which means that they also have a range of experience in dealing with various stages of the Coronavirus Pandemic as it sweeps across the nation. Our panelists today are Steve Clap. Steve has served as president of Strategic Healthcare Advisors Ssha since its formation in 2015. For the last 20 years, Steve has worked with distressed healthcare operations focused primarily on rural hospitals. Ssha is assisting rural communities with the redevelopment of healthcare services where the community has recently lost its hospital. Additionally, s h a provides transactional representation and operational consultant services to various healthcare entities. Steve founded two rural hospital startup companies with a combined revenue base of 325,000,010 hospitals. Andrea Fer. Andrea is the chair of the A H L A Public Hospitals and Healthcare Systems Affinity Group, and is a partner at Healthcare Appraisers in Boca Raton, Florida. Andrea works with rural providers across the United States and was previously counseled to a public health system operating rural hospitals. Bond Jacobs Vaughn is an attorney based in Durham, North Carolina, where she is principal and founder of Ferris Healthcare Consulting. pH is a premier healthcare consulting boutique that provides customized education, strategic advisory, and business support services for healthcare organizations, including both urban and rural providers. Delino Rork Delfin is a partner in the healthcare practice of Dwayne Morris. She counsels health companies, hospitals, and healthcare systems and investors on the regulatory frameworks that drive their business. Delphine has extensive experience counseling rural hospitals as both in-house counsel and external counsel, and previously served on the board of the Rural Health Network for the past 15 years. Self's practice has also focused on the legal issues critical to emergency management, and therefore she is actively counseling a wide range of clients, including healthcare providers, public and private companies and investors. In connection with Covid-19 and Mike Waters, Mike is Chief Legal Officer at General Counsel at Essentia Health in Duluth, Minnesota. E Essentia Health is a two, two and a half billion health system that provides services in the northern half of Minnesota. As far west as Fargo and as far east as Ashland, Wisconsin, e Essentia has 14 hospitals, including seven critical access facilities. Prior to joining as Essentia, Mike practiced with a large Catholic health system and represented numerous rural facilities. Many of our listeners will be aware of the unique challenges that face rural healthcare, including recruitment and retention issues, the premium rural facilities have to pay to obtain professional services, the issues of dealing with a large geographic area as a sole community provider, and of course, financial constraint. Before we address the impact of covid rural providers, the panelists set stage what rural providers faced prior to and discuss the impact of and rural healthcare as we set the stage. I'm gonna turn the floor over to Steve Cap for a little, uh, table setting.
Speaker 2:Thank you, Elliot. Appreciate it. If you look at the rural market, I'm gonna, I'm gonna define the rural market as a county that has less than 30,000 people. I think a lot of people see rural communities is, you know, different sizes. But all, most of the work I've done has been in counties of thir less than 30,000. You've got about 1800 rural hospitals that are out there, um, of which we've lost 800. So the total was 2,600 before. When you look at it today, the first thing we encounter is very, very low margins, if any profitability at all. There's various statistics that were put out, you've seen over the last couple years. One said that 25% of rural hospitals were in danger of closing. Another one said that 35 to 40% of hospital rural hospitals are in currently in financial distress. And this was all predicated, and we've seen that over the last couple years, bef prior to this Covid virus hitting. And so you had a system in these rural communities that was already stressed, little to no operating margin, already looking for alternative funding sources to help just keep the doors open. And now all of a sudden you have this tremendous stressor put on with this Covid 19 virus that, that is impacting the country. Um, I know Mike has some other, uh, uh, concerns as well that, that we as providers have been facing as well.
Speaker 3:Yeah, I mean, you know, I think the, the only thing, um, that's certain about the future is that it's uncertain. Um, um, and depending, uh, on the size of the community you're dealing with, I think we're gonna see a variety of, of, uh, impacts long term. I think it, you know, the, the, um, whole pandemic and the financial ramifications are, uh, are currently and will continue, I think, to force, um, all of us from providers, uh, to regulators, to politicians, uh, differently about what really is necessary healthcare and what does it look like in communities that don't have the resources that a, a large metropolitan area, um, might have available. Um, it's very different, very challenging, but I think the future, um, is, is, uh, likely to look very different in these communities in terms of how we provide care and what care is provided than, than what we've, uh, been accustomed to.
Speaker 1:And I wonder, um, Steve, Mike, or, or maybe Andrea, if you can talk a little bit about, um, how difficult it's for rural communities to have, um, a significant physician present, um, such that, you know, with recruitment and retention, but also what happens when your physician staff members may get sick, um, with a a, a covid or, or something else, the impact to your, um, hospital or health facilities operations.
Speaker 2:Yeah, the, Steve, when you jump in, you know, you look at the, at the physician practice, uh, most of your rural communities have typically two, two types of physicians that are working there. One is the traditional model that has an inpatient and outpatient model. They've, they've worked there several years, maybe couple of decades, et cetera, and they work extremely hard. And then you've got a second wave. Now, physicians that have come in on medical staff that are traditionally outpatient models, uh, they only, they don't go to traditional medicine and take inpatients anymore. And so you have this disparity a little bit just among the medical staff. And so trying to recruit into these communities is very difficult because the traditional practice may be the equivalent of two FTEs in the market itself. And so it, it, it creates issues in terms of trying to attract people that are willing to work in those, in those environments. But also, um, you know, if you have one, one person go down, one person that retires and so forth, it creates a significant hole, um, in the, in the medical staff and the ability to deliver care, let alone if they got sick as a result of this Covid virus that's going around.
Speaker 4:So Steve, I think there's been, um, a shortage of providers in general in the US for some time. And it, I think has been particularly an issue in rural communities for a variety of reasons. Um, some of them have to do with lifestyle and the desire to live and work in an area where there are others, uh, that you can lean on. And, and for, for, uh, the most part, hospitals have been, I think, vital in making sure that there is a supply of providers and communities. So to the extent that those hospitals are threatened and have been by the financial situations of late, um, I think it could exacerbate some of the provider shortages that, that we've seen over the last few years. Um, in addition to having the economic impact on the community that you would expect, given that a lot of these hospitals are major employers in the community, um, and, and really provide, um, not only essential healthcare services, but um, often are, um, a, a center for just general, uh, bringing of folks together and wellbeing and, uh, promoting various types of, um, health initiatives. So I, I think, um, we're in a, a, a really pivotal time. Um, it'll be interesting to see what the outcome is after the Covid crisis. I think, um, as we'll talk about later, there are some potential opportunities, um, for rural providers to, um, change the paradigm a little bit as a result of this crisis. Um, but certainly, um, it's gonna be a long road to get there.
Speaker 3:You know, I think the, the dynamics of the market right now, the though I think are, um, um, are really, uh, unique, uh, in ways that, that's not been, um, that not that I've seen before. So you, so on the one hand, um, are typical recruiting is shut down. We're not recruiting people. We're, we're trying to cut costs and, and sort of, um, stabilize the, the, uh, the ship if you can't, if you will. So we're not looking to add new recruits, although it's not shut down totally. And we're certainly, you know, looking out toward 2021 or<laugh>, whatever the new future is. But at the same time, um, you know, there are, there are physicians whose, um, salaries are being cut who might be looking to move. So there might be a, there might be a lot of physicians who are available to move, but I'm not sure that there are jobs today for them. Um, and, and, and then along with those cuts, um, you know, a lot of systems are, are just making them, and hopefully, you know, their employment agreements permit'em to do that or whatever, but you at least have the possibility of, you know, breach of contract claims from physicians, um, uh, uh, that, that who ha who are having their, uh, their, uh, compensations, compensation cut. So, um, the, I think the dynamics within the physician community are interesting. Might be a nice way to say it. Certainly very unsettling for them because they're, they're, you know, their salaries are being cut and there's no, there's no, um, promise that, um, when we get through this, their salaries are gonna come back to where they were. Cuz we don't know what volumes will be looking like. So lots of changes.
Speaker 4:I I think income for physicians in rural communities has, um, been a struggle for, for quite a while. Um, there's certainly demand in those communities, but the demand, um, may not, uh, reach the level that it supports the type of salary that might be needed to attract someone to some of the more rural communities. Um, and the payer mix varies from community to community depending on, on the population. And so historically, uh, you know, at least anecdotally, um, I, I think there's a lot of support that comes to physicians from these hospitals, these institutions, um, and where they're not able to provide that support, um, or if they're not able to, to provide that support going forward. Um, there could be questions about the availability or the continued availability of providers.
Speaker 3:Yeah, I agree with that.
Speaker 1:And, and with a, a provider availability influx for rural facilities. Um, a another issue that comes about is, you know, the ability, and this was pre covid for those facilities to, um, have any positive income flow. And I know a number of our panelists, um, have handled, um, distress or, or bankrupt, uh, rural providers. So I'd like to hear from, um, um, Steve first and then Andrea and, and then any of our other panelists that have particular experience in this.
Speaker 2:Yeah, I think when you look at the, what's happened in the rural communities, the last say 15 years, you've had 170 or so rural hospitals have closed over the last 10 or 15 years. You've had over a hundred now hospital bankruptcies that have been filed in the last three years, obviously with the latest being quorum, who's obviously another rural hospital operator. Um, I think we're gonna continue to see that, I think is the, the, the issues around elective procedures has impacted some of these rural communities as well as the tertiary hospitals, uh, that will, that will impact the, the, the rural hospitals a lot. Cause they, that's basically their entire probably, um, surgery suite capacity. But then also you've gotta higher supply costs. And so what that's gonna do is gonna put more op, more resulting closures and bankruptcies, uh, on the radar here going forward. The interesting thing to me as well, and doesn't get a lot of play yet, but kind of back to in related to the physician practice, you know, as hospitals we're used to drilling, you know, we drill once maybe at least twice a year for disasters. We do tabletop exercises clearly, potentially at least twice a year. And so that's what the hospital's doing to be prepared. But the physician practices maybe have, are, are more dependent on, Hey, tell me when to show up for the hospital drill and I'll be there. Um, but I'm, I'm working with clients right now that have, that are large physician practices that are trying to figure out, hey, what do we do? How do we do a cash flow analysis to figure out when our AR is gonna run out that we, that we generated last month, and when will it start picking up again? And so the question is, are the physician practices now another potential, um, issue that may arise in this closures or bankruptcies or, or looking for alternative sources of revenues or partnerships with, with hospital systems and so forth, because they were not well enough prepared for this impact going forward. So I think you've got your traditional hospital look and all the various healthcare segments and, and that will be addressed, but I think the physician practices very well could be at risk here, uh, going forward as well. I don't know if what others may think about that, but that's something I'm starting to see.
Speaker 5:Yeah, this is Delph O'Rourke. I'll jump in on that one because I received my first request today from a physician practice to, um, you know, defer payment obligation, a significant payment obligation under a settlement agreement to when business resumes, and we had a conversation around, well, what does that mean? You know, was it gonna be so a hundred percent levels? Um, is it gonna be a gradual transition? And now trying to connect contractual and financial obligations because their volumes are, are so low in the elective side, if, if any. Um, so I think we're gonna see, to your point, a lot more of that. And which relates to, you know, you mentioned the closure in 2020, even before COVID 19, we were expecting that there would be, um, an uptrend in closures. And, and my concern is for rural hospitals or hospitals that have been hit really hard, um, with Covid 19 is are they gonna have enough cash on hand to even make it to that recovery? Um, and some of these stimulus initiatives that we'll touch on later, you know, they, they might be good for part of it. Um, but definitely not in, in states like New York, around New York City or New Jersey or parts of Pennsylvania. Um, even the HHS payments aren't gonna be sufficient. So the time, the, the window and we start seeing a lot of these things collapse, the domino effect, um, I think will come sooner than initially anticipated.
Speaker 4:So this is Andrea. When, when our group, the Public health Systems Affinity Group started looking at rural providers in rural health, uh, in the issues, uh, facing rural providers in rural, um, health and communities, uh, back, you know, seven or eight months ago, we started looking at, uh, various headlines in the news. And it seemed like almost daily, uh, there were headlines related to hospitals that were in financial distress, uh, and or declaring bankruptcy and or closing their doors. And a lot of them were rural providers. I think there's been a recognition of a, of a crisis, uh, with rural hospitals for, uh, at least a year, if not longer than that. Um, as far as the physician practices, the, the comment that Steve made earlier was that about the trickle down from the hospitals to the physician practices. I, I think that that's very true. Um, but I also think that some of those physician practices, uh, were struggling just not getting the same attention as the hospitals even prior, um, to the covid emergency and the current situation, um, the number of physicians who are inde in independent practice, uh, in rural communities who have income guarantees from hospitals is fairly large. Um, it's in part because hospitals can't operate without those physicians. They need to have them in the community, they need to have coverage. Um, but for all the reasons that we've been discussing, it's very difficult for those practices to kind of make it on their own. Um, the, the payer mix may not be great. The, um, the population might have intensive needs, um, but getting them to the care providers might be difficult. So there's demand, but not necessarily a match between, uh, that demand and payment. Um, and so that's historically been a problem. Um, and with the, the, the increased crunch on hospitals, I think we're, we're going to see a real threat to the physician providers in the communities as well, because they're so financially tied to those hospitals.
Speaker 1:So, so, you know, rural providers already had a, a pretty high hill to, uh, and a lot of obstacles, um, to deal with in providing care for some, um, geographically distant areas. And now there are, um, additional operational and functional impact of the pandemic on rural providers and communities. Um, I know all of our, all of our panelists have unique perspectives, um, on that and, uh, and beginning and certainly not ending with the experiences of canceling those elective surgeries that might be the, the financial lifeblood for facilities. Um, so I'm gonna open the floor to, to whoever jumps in first.
Speaker 3:You know, I think this is Mike. Um, I think the, uh, the health health systems are sort of following, um, the, the public discourse and just starting to, to think about what, what, what do we need to do to get back towards some semblance of normalcy? Um, I know we're, we're having some of those conversations now, um, you know, questions around, um, can we, can we start doing elective procedures? Um, we have a a a a governor's order not to currently. Um, but that, um, that, that I suppose is, is, uh, po um, it'll, it'll, that'll expire here before too long. Um, but the question, um, becomes, um, not just a financial one, but how, how do you do that exactly, um, uh, while keeping patients safe? That's ultimately, you know, the, the, the thing that we have to deal with is it's, uh, uh, one thing to, to, um, chalk up the, the revenues. But if, if you can't do the procedures safely, and you can't do it without having an outbreak of covid, let's say, among staff or other patients in your facility, um, you, you ought not to be doing it. So that to me is the, the hard question right now that we're wrestling with.
Speaker 2:Yeah, and I think this, Steve, when you, when you look at having, depending on where you're at, I think if you look at, in the, in the hardest hit areas like New York, New Jersey, Connecticut, so forth, it's not, it's not a matter of just having 30 to 45 days of delayed surgeries. You know, that that number's actually gonna continue for a while. A rural community, you know, where we've, we may have shut down, shut down the ORs for a little bit. We had plenty of, typically had plenty of capacity anyway. We may have only been running 30 or 40, maybe 50% of capacity. So we can catch those cases up. As, as Mike said, though, as long as we do it without creating another outbreak, but we had some capacity available in the, in the rural ORs to be able to, you know, ratchet up and maybe go a full eight hours for five days a week to, to absorb the, to the, the volume that was delayed. They're deferred. The other community hospitals may not have that capacity if they were already running 70, 80% on their ORs. And so now of a sudden you're talking about running longer, end of the day, longer on the weekends. And so you're, you're asking a staff that may already be tired in some of these communities to go ahead and do some extra. Um, and so that's gonna be a potential challenge and something I think all these community hospitals will have to watch.
Speaker 4:So Steve, I think that's a really interesting point that you're, you're raising. Um, there's been a lot of discussion about the fact that the canceled elective procedures, uh, now may result in almost a del use of, of postponed procedures after the crisis is over. And so that there might be some catch up, uh, as far as revenue, but I'm not sure that that would be reasonable or practical for some of these smaller rural hospitals that, that only have so much capacity for the, for the catch up. Um, and, and it may also be that if the financial situation of various people changes in the community, um, that they might be putting off those procedures even farther. So the opportunities for catch up might be less in the rural communities than elsewhere.
Speaker 2:Yeah, that's, that's true. I think the, the flip side of it is most of the ORs that, you know, we operated, um, in, in the rural towns, and I'm, you know, obviously talking, you know, these smaller, smaller facilities that may have two to five ORs, maybe, you know, the afternoons are typically available. And so for us to be able to catch up as, you know, what does want to come in, I think, you know, could be handled in the rural community, the or staff's already there pre and post-op. It's a matter of, you're right. Do the patients show up and are they comfortable showing up for to have care yet, or is that gonna delay later on into the fall?
Speaker 6:Yes, Steve, this is, I think that's a great point because one of the things that I've noticed in talking with my clients in rural communities is that even though they don't necessarily have an outbreak right in their face, that's overwhelming the facility right now, they've got a population that is in part either, um, defiant about the existence and or potential impact of covid or deathly terrified of stepping foot into the hospital at all. And if you're relying on this uptick of elective procedures that are gonna come back in a wave time, possibly at the same time as the second wave of an outbreak of covid, I think that's gonna be hard for a facility administrator to rely on elective revenue when you can't really anticipate that those are gonna show up. Because if your population's afraid to step foot on your campus, they're definitely not gonna let you cut them open in a, in, in, in a facility that they may not think is ready to handle, um, surgeries plus covid.
Speaker 4:I would have a, a question maybe for Mike or, or others that are working with hospitals right now that are redeploying their resources, perhaps, um, shifting the use of some space to have more intensive care beds or, or something along those lines to prepare for potential surge. Um, do you think that there will be difficulty or cost expense, some sort of a hurdle in shifting that space back to its normal use or moving those resources back to their normal use? And I think the, the same thing would apply, uh, with, um, you know, surge staffing, uh, providers who might be brought in temporarily and might have a different pay structure, um, or different compensation amount than they would have ordinarily. Would it be sort of difficult to switch back, um, and is that going to maybe create an additional hurdle or some additional challenges to going back to business as usual?
Speaker 3:Well, um, I think, um, it could, I think it probably largely depends on, on the specifics of your situation. Um, um, I would guess that we could probably, we could probably, um, if we said go right now, we could probably do electives in about a week, and it would prob probably take that long to get things turned around. But, um, um, you know, we're we in Duluth here, you know, we're a population of 85, 90,000. Um, we're probably better situated to do that than in, in certainly some of our critical access hospitals. Um, um, but we've got more space, so maybe, maybe they could turn it around, um, more quickly. Um, um, I don't know though that the, the, uh, the space use or turning the space into, um, you know, elective friendly space again, is probably the least of our problems that really at the end of the day, it's more, um, in some ways it's the psychological changes that would have to come in, um, you know, come to that would come to bear on the situation with staff and employees and physicians. There's gonna certainly be some people, um, that, um, who don't think that it's the right decision to, to do electives whenever that decision is made. And they're gonna be hesitant to do that. We have unions up here that, um, you know, we have to work with. So that comes into play if you, you know, if others have, have union, um, staff, uh, we've furloughed, um, folks as I know a lot of folks, um, around the country have. So some of those folks will need to come back. Um, and we, I think we can get it back pretty quickly, but, um, I think those are the, probably the, the biggest pieces of that puzzle that would have to be sorted out.
Speaker 4:I'd be curious to know what, uh, the group's thoughts were with respect to the, the different things that might be going on in rural communities. I know when we were preparing for this, we talked a little bit about the fact that, um, in some rural communities they're preparing, but folks are saying, okay, so where, where are all the covid cases? And then in others, um, you know, that we've read about recently or I read about recently, say in the, a recent New York Times article, um, there's a small population, but a large number of COVID cases per capita. And the hospitals are, uh, somewhat overwhelmed because they're really not set up, uh, to, to care and treat for pa care for and treat patients with that level of acuity. Um, I think it was, uh, Margaret Mary Community Hospital in Indiana was reporting that they had never before, had more than one patient on a ventilator at a time, and at one point had six, um, and really weren't sure what to do, uh, as far as resource allocation in their 25 bed hospital. So, uh, any thoughts from anyone in the group about, um, the disparity and, and what might be happening and how that might affect, um, what the aftermath is for different types of communities?
Speaker 6:Well, I was just gonna say, um, that for me it just highlights the policy failure that we have in terms of healthcare policy. And Matt, we've got a set of organizations and institutions that aren't really financially stable enough to be able to weather this kind of volatility. And that, to me is as much a policy failure as it is a business model failure. Um, and I would like to see more attention being paid to, um, a more holistic thought process around how we fund and, um, stabilize the healthcare industry, particularly in rural communities. I haven't heard a lot of conversation around that, and I get why that might be, since we're in very much in crisis mode. But for me, the things that we've been talking about on this call just for me, highlights the policy holds that we have yet to address in this country around the delivery and the provision of care for various populations across the c across the nation.
Speaker 5:Uh, I echo that. My concern is that we're gonna pass covid and then we're just gonna move on and, um, you know, to take that pause more than a pause and say, okay, what have we learned from this and how are we gonna change our funding? Um, cause it would be surprising if this is the last pandemic that we experience. Um, and as others have have stated, um, very few health systems are gonna come out, rural health or rural hospitals are gonna come out ahead after, after covid. Um, but I was gonna share that, you know, as far as experience, you know, and, and I heard that before and I hear that now. Okay, you know, we don't have any covid patients or we only have one, you know, it doesn't take that many to create a cluster. And, you know, we, we saw in New York, we started that Pennsylvania, a small cluster, you know, that you're sort of patient one who then spreads an epidemic. And I would suggest based on experience on the East coast is, you know, reach out now if your hospital, your rural hospital doesn't have vent management experience to other systems that may who are willing to send over physicians, uh, because that te that specialty is already in such high demand, um, that the more you can prepare ahead of time, even if you end up never having to call them in. But really getting those physicians who are trained in event management who can be deployed to your facility ASAP if needed. Now collaboration is key.
Speaker 2:Hey, this is Steve. I wanted to follow up on comment that Vaughn and Del Fe both just made about kind of the regulatory look at all this, you know, for the last several years I've had some chances to spend both at the federal and state level doing some lobbying. And I think when you look at this, there was starting to be some traction, uh, particularly at the federal level with the amount of distressed facilities in the rural communities where that the rural facilities were beginning to get a little traction. You, you saw some bills that were being introduced at the federal level the last two or three years on save our rural hospitals and so forth. But what concerns me is that traction that has been gained may very well be, you know, the, all the oxygen may be sucked outta the room with the, from this covid situation that now you have probably a potentially entire bailout of, of the all hospitals in this segment and as well as the tertiary hospitals. And so what I, what I think some of the traction that may have been made, gains that may have been made last year or two in the rural communities and raising the, the awareness of the issues and starting to see some movement in the federal legislation perspective may get, you know, um, uh, you know, um, removed or put on the back burner because of what you see now nationally with all the hospitals going forward.
Speaker 1:Yeah. I I wonder if we can also go back to, to a point that Delphine made that I think is really important, especially for rural providers, and that's the collaboration and the reaching out to others. Um, you know, I know there are a lot of sole community providers, um, that don't have another acute facility for, you know, maybe counties or hundreds of miles. Um, but they may be the sole community provider for numerous nursing homes. Um, they may be the, the designated jail for both, uh, um, provider for both the county, um, city and sometimes federal prisons. Um, I know Mike has had some experience with that, so I'll throw that question first to Mike.
Speaker 3:Yeah. Um, again, I think, um, to one of the points that was raised earlier, uh, this crisis has, um, sort of, um, brought to the surface a number of, of key points in our health system and the way we fund it, the way we deliver it, that are weak in a, in per, you know, in a situation like this. And so, you know, in a, in a smaller, uh, community, uh, I'll, I'll be, um, elderly are obviously more, more at risk with covid and, um, um, if you've got a nursing home and you've got a a, a patient with, with covid, you're likely to have more than one patient and all of a sudden you've got a little breakout, but you don't have the resources within the nursing home or within the assisted living facility or whatever. You have to really deal with it. And I mean, it's one thing I suppose to have, have, uh, covid patients in a hospital. That's another to have'em in, in a facility that's really not designed to handle that kind of a problem. Um, but that's where the problem is. And the community just doesn't have, um, the resources to deal with it, nor does the, the local hospital have the, uh, resources to deal with that kind of a breakout. They're trying to get ready for their own, um, influx of patients, and then all of a sudden they may be asked to run across the street and help, um, with somebody else's, um, breakout. So it really puts pressure, um, stress points, I think on, uh, certainly on the individuals who are being called upon, but on the whole system. And it really just begs, um, begs, um, for an, for, uh, a little bit more of a holistic, uh, view to, to how, how, how we provide healthcare, um, uh, within, within the country, amongs all the different segments of the, of the industry.
Speaker 1:Do any of the other panelists have any, um, experiences with coordinating patient transfers? Any specific, um, movement or issues for rural providers to be aware of? Especially in this time?
Speaker 5:Yeah, on a nursing home, what have you to touch on that? So, um, it's been a challenge because we reached capacity very quickly in nursing home facilities or nursing homes, um, in, in a, um, in the interest of, um, sort of keeping their existing residents from being infected were very reluctant, continue to be very reluctant to accept patients who have been in the hospital, even if they weren't covid positive. So just the fact that they were an inpatient, um, we're finding that many nursing homes are just not interested in accepting them. So that's creating a real, real problem of a, you know, a backlog. And even those who, even those facilities that will take patients who have been, uh, inpatients, they're asking for two, uh, negative tests. And as you know, it takes two to three days, if not more, to get those results back. So, yet again, uh, a backlog. But we're also seeing as, I think it's New York Times on Friday reported that the numbers now for nursing home deaths are up to 6,900. Um, a horrifying story about a nursing home in New Jersey, um, and patients who died there and then, um, it's actually somebody they think internally who reported, you know, bodies being stacked up. So nursing home is really a dire situation. Um, and again, more lessons learned on the transfer from one facility to the other. And workers also transferring unintended, um, transfer from patient to patient because it really is dire.
Speaker 6:Yeah, this is Vaughn. I've got a couple of clients who are taking advantage of the new regulatory flexibility to try to get in some arrangements in place, sort of on a regional level. So I've got one client that's part of a tri-county hospital system, and they are working together to try to figure out ways to, within that small region, manage the, uh, resources they, they have and sort of put patients that are of similar acuity in, um, one location. But that's a real hard thing for them to do. It's, it's requiring a lot of effort on their part. Um, and they're still feeling like they're falling short because there's still a lack of ppe. There's still some equipment that they don't have that they wouldn't like to have, like a couple of extra ventilators, but they're trying, because that's the only thing they know to do, is to at least get their closest neighbors together to try to figure out a plan for what they can possibly do, knowing and anticipating that they're not going to be as effective as they wanna be, and they're likely going to be more deaf in the community that they would like to see.
Speaker 1:I wonder, um, talking a little bit about operations, something just came into my head. I wonder if any of our panelists have any experience with any of their clients or facilities where there have been infected employees who are delivering who, who were in a position of delivering healthcare, um, and how you've gone about either isolating that department or that unit or clearing it for that employee to come back. Have any of you had to deal with that?
Speaker 3:Well, we've certainly had to deal with it. Um, I can't tell you the specifics, but I would tell you our approach has evolved probably weekly based on the most recent information. And the best educated guess is that, you know, folks are able to make, um, given what we know about the disease, the, the virus. So, you know, we, we initially, you know, had an approach that if one person is, is, uh, test positive, you trace it, figure out who, who all they've worked with that wipes out another 10 employees and they're all quarantined for two weeks. We've then morphed it into, uh, a little less of, uh, less draconian in a sense, um, process where we, um, you know, we're, we're masking folks up, um, and all that, but we're, um, not assuming that people are symptomatic unless they actually are. So our, our approach has certainly evolved.
Speaker 4:I think there's a real concern around, among some rural providers about the infection, um, or the possible infection of staff, in part because in some places there is such limited staff, there is the shortage of providers, not enough, um, physicians to allow for backup staffing necessarily, uh, unless they're drawing from outside the area. And, and it might be that the providers, depending on where the community is located, who are outside the area are, uh, needed for more urban facilities or are otherwise occu occupied. So, you know, I, I think that in some rural communities, it may be of particular concern to make sure that the staff stay is healthy, um, or to have some contingency plans in place with backup staffing.
Speaker 1:The supply chains, um, in our ordinary life have been affected by covid. Um, I'm interested in if there have been any facilities who've who faced and, and maybe conquered a specific supply chain issue. Um, specifically I know there's an increased need for dialysis, not only for those patients who in a rural area may have more, um, incidents the dialysis needs, but also after covid, we've seen some of those recoveries dependent upon daily dialysis and how that might affect a rural facility.
Speaker 5:Um, okay, so ha, happy to take a stab at it. So yes, I've been working with clients who've had shortages from the beginning of PPE and, and ventilators, and now we're seeing shortages of, um, you know, some of the, the drugs that are, are needed for patients who on ventilators, uh, the relaxants. Um, so it, and it continues to be a challenge and there's anticipation. There are gonna be other shortages, uh, along the way that are, um, you know, that are common to all facilities and that are also unique to facilities based on where they were getting their supplies. So, um, what what I see clients doing is right now it's a, you know, really trying to vet because there's been a flood on the market of, of companies that are gonna solve all your, all your supply issues, um, trying to vet, um, the, the proposals that are coming in and hospital association in New Jersey, that Pennsylvania as well, um, are also triaging so that there is some type of quality control, cuz we've already heard about. Um, and I have, clients have told me about these, these schemes that they've been presented with. Um, so we're already hearing about scams where, or companies are asking hospitals to pay cash upfront, et cetera, et cetera. So we know that, I think it was March 23rd, president Trump, um, and issued an executive order that HHS and DOJ were gonna work together to really look at price gouging and, and go after fraud and abuse in the healthcare space. So it's, you know, getting those supplies balancing and making sure that health systems, and I think this, you know, for, so for rural health hospitals, I would rely, uh, and there's a scam going on where a company was claiming that Mayo had bought all their supplies. I mean, there's just so much stuff going around that, again, if there's an organization that you can touch base with or your hospital association and, and start getting, um, access to reliable sources. I've also heard of, you know, I have clients who have prominent board members who are reaching out to 3M for certain maths, et cetera. But it's a real challenge and will continue to be, um, as the situation evolves. Cause to your point, we don't know the long-term impacts of covid. So, you know, five weeks ago kidney failure wasn't necessarily on the top of the list. Um, and now it's, now it's a problem.
Speaker 3:Yeah. And I think, I think we facilities in some ways are at a distinct disadvantage, um, in the supply chain, uh, discussion. Um, and, and and their ability to, to get the, the resources that they need, PPE or otherwise, because, um, you know, they're obviously they're smaller, uh, less population and, uh, if a city like New York or Minneapolis or Chicago has an outbreak, um, there's gonna be more people impacted. And so to the extent there are national or state resources of, uh, ppe, let's say, um, they're gonna have a larger voice in saying, send them to us. Don't send them to, um, you know, rural America, uh, where they may or may not be used. And there's some, you know, that's not an unrealistic, uh, that's not a silly argument, but it's, it puts the rural facilities in a little bit of a bind if they're supposed to get ready, but really can't because they don't have the ppe, for instance.
Speaker 6:Mm-hmm.<affirmative>, one thing I had a client ask me about, um, and they are a county owned hospital and they have a lot of restrictions around who has authority to authorize large expenditures. And one of the conversations I've had with them is preparing ahead of time and, and authorizing ahead of time the ability to make purchases given that market prices keep rising. If they were to be able to find a supplier and find equipment and be able to get in line to buy that, making sure that the CEO of that facility actually has the authority to make that purchase. Because they run into this in the past where they may need something but they, they can't, under the bylaws of the organization, authorize that purchase without board approval and sort sort of starting to think ahead of the game. Um, cuz it's not something they've had to worry about before. But now with the market prices rising so fast and things changing so quickly, if you don't have the authority when you need it, you won't be able to act.
Speaker 3:Well. You know, we spoke earlier about what is the future gonna look like? And, and I think it'll be very interesting to just sit back and watch the industry over the next year or two. I I could definitely see some, or quite a few rural facilities that are more or less on their own right now, uh, saying, look, that's it. This is, this could happen again. Um, we need some help. We need to, uh, affiliate with somebody. Um, so I think one of the ramifications of, of the crisis is gonna be, there's gonna be a fair amount of consolidation. Um, I would think in at least the rural communities, probably urban as well. But I think that'll, that'll happen here once we get through this.
Speaker 4:I think that raises a really, um, interesting point, which is that it is very difficult for some of these small hospitals that are in rural communities to to weather a storm like this on their own for all the reasons that we've been discussing. I mean, one of the things, uh, that, that struck me as we were talking about supply chain issues and, and getting supplies is that as a small independence, uh, provider in a in a rural community, you're not gonna have a lot of negotiating power with the suppliers. Um, and to the extent that the suppliers are stretched, um, you may end up at the bottom of the barrel, um, in, in trying to secure things. Um, and just to have other resources available to you for purposes of making sure that your needs are met. Um, it might be important to partner with others, whether that be some sort of a formal affiliation, um, or just, uh, developing a network. Uh, some of our clients, um, they work with other providers who are similarly situated, uh, to, um, not so much jointly negotiate because that would get into all sorts of, uh, legal issues, but to make sure that, um, they're understanding the best ways to go about, uh, ensuring that everybody has the resources they need. And it may be that one hospital, uh, or one provider in a community becomes a source for certain, uh, supplies and equipment that they're not using that could be used by the other facility. Um, and going back Devon's point about thinking ahead, um, thinking through those types of, um, solutions to the problems is something that can, uh, be I think very helpful for these facilities, um, thinking about it in advance because then you have to kind of make it happen.
Speaker 3:And, and, and just to put a, I think a fine point on that is it's not like the virus is gonna go away. We're gonna, this is, this is our new life. We're gonna have to figure out how to, how to provide healthcare with it around whether that's getting PPE or, or, or doing safe surgeries. We're gonna have to figure that out because it's not going away.
Speaker 1:Yeah. I I, to, to that point, Steve, I, I wonder, um, what the rural provider experienced is in response to the impact of, um, surge preparation of obtaining, um, alternate staffing on, um, those all important ledgers and bottom lines and budgets. How, how is y'all's, uh, different facilities and clients than handling that or not handling that as the case may be?
Speaker 2:Well, depending on what the facility looks like, you know, take the elective procedures for instance, you know, or typically were running hundred to 200 surgeries, you know, a month, all of them would qualify as elective, you know, maybe 95% of'em anyway. So you basically had that staff sitting there, um, or reassigned maybe. But in the rural markets, since the, since the virus may not have hit, depending on which rural community you're in. Um, you've got staff kind of sitting there, you've been, you've, you've eliminated their ability to do cases. And so then you're stuck with, do you furlough those folks? Do you need, et cetera. And so I think, I think it has had, you know, an impact. Now the, it may be a little bit different experience where, you know, where there was an outbreak in that particular rural community, but, um, it's gonna have a definite impact. And then what, how long it takes the cases to come back, that's gonna be a, a big issue, uh, for the small community hospitals, rural hospitals.
Speaker 4:Does anyone, um, think that there might be, uh, an issue with, um, out migration of providers from the rural communities? Uh, if this crisis lasts long enough? There are certainly opportunities, um, in some places where there's a very significant need for providers, for folks who might be furloughed in a rural community to, to go and, and find work. And does that leave the rural providers in a bad situation if and when they're ready to resume normal operations and folks are still deployed elsewhere?
Speaker 2:Well, I know Steve, I know that once we, when when local hospitals, competing hospitals around us would raise rates, you know, maybe new grad rates, et cetera, you know, 25 cents, 50 cents an hour, we lost staff to that. I think now with what you're seeing, particularly in the urban markets where there's a tremendous need for supplemental staffing to fill the hole to, to replace maybe the folks that are, that are going, I think, that are going out with illness or just worn out and they gotta have staff, you know, as replacements temporarily, I think we've, you've seen a, I know a lot of people in the south here have, have, have, there have been folks that have gone to New York and so forth and they'll take, you know, half a dozen folks and go up and, and take a temporary staffing gig to uh, one cuz the money is really that good. Um, which does potentially leave you in a hole, um, in the rural communities.
Speaker 5:Okay. I think that's a gr got a great point. And um, you know, I think will also be interesting to see is, I mean, to the point of people just being tired is I've talked to physicians who, you know, were, had great practices and, and were thinking of working maybe one or two years and now we're thinking of retiring earlier because of the risk. I mean, we already have physicians who had covid have been out and now are coming back and they're just saying, you know, I don't know if I wanna be doing this. It'll also be interesting to see whether there are, again, for health reasons, physicians who say, I wanna be out of the New York City. Cause the risk is gonna be too high, too long and are looking for, for different environments. So it'll be interesting to see cross migration.
Speaker 3:Yeah, I think that's a good point. Um, the question I was gonna ask to Steve or somebody else is, I'm, I, do you think the shuffling in the market will, will actually result in, uh, upward price pressure rate pressure or downward? It seems like it could go both ways, and I'm thinking may maybe more downward because there, there's probably going to be, if folks have furloughed a thousand people, they're not likely to to hire'em all back. So there's gonna be more, um, uh, about supply of workers perhaps that might, um, have a downward pressure on prices. Do you have any thoughts on that?
Speaker 2:Yeah, I think that's a good point. I think, um, I know of, I know of physicians that, you know, work at various types of staffing companies that have taken cuts recently. Um, and, you know, they may be on the front lines either in the er in the hospital, and so you're, they're kind of going, okay, I'm taking a pay cut here, why would I want to continue working this way? And so they may look for alternative, um, employment arrangements or, or employment, you know, employers to, um, that may be, you know, put them less at risk and so forth. So I, you know, I think the other thing is typically, you know, when with the large one I call, I'll cautiously say this, but you know, when you have, um, staffing reductions like this or furloughs whatever, you, typical as an, as a, you know, operator, you typically take the opportunity to maybe reduce the staff that isn't as productive as others. And so if you've got, um, opportunities to, to right size your staff, get the right people on the bus, so to speak, then you know, this is typically the time to do it. And so you will have, you will have some people that probably won't be back, won't be brought back. You'll have people that, that you typically want to, you wanna hold on bringing those employees back because you wanna make sure the ones you've got, you have work for before you bring on more. And so I think you're right. I think there'll be a hesitancy. I think there could be potential surplus of, of employees, uh, at least available employee pool there to, to draw from. Um, which, you know, the folks that went up and took the big bonuses for a 60 or 90 day contract may come back and find that they, they may have to sit out for a little bit of time in order to regain a job or start back at a lesser job, night shift, weekend shift, whatever it may be. But I think, I think Mike's right on that.
Speaker 3:I think
Speaker 4:From our perspective, at least working with our clients, it really is, uh, regionally dependent. Uh, the situation is different in different places. In some places there is a fear of losing providers in part because it has happened before and because there has been such a shortage in the community, um, in the past, and they're actually paying premiums for, uh, folks to remain on standby. Um, and or making, um, significant promises for what might be paid when, uh, when, uh, needs and staffing return to normal. Um, and, and other places, you know, as you have all mentioned, there are furloughs and, and so there may be, um, an impact that, um, more of a downward pressure, um, on, on wages and so forth. But I think it's going to, to vary and it's going to be hard to, to predict sort of where the cards are all gonna fall in the future. Um, it may be that people are just moving around, um, and that the increases in decreases are somewhat, uh, cyclic depending on how, uh, things shake out with Covid and with, with healthcare in general. There's certainly a lot of change that's happening. I think back to years ago, um, there was a nursing shortage, um, and nurses were making quite a bit. Um, and then lots of folks went into the profession and they, they took, uh, advantage of the opportunities and, uh, you know, wages were high and then they, they kind of went down and there were layoffs, um, and then they went up again. And, and I think that that probably will happen, uh, with respect to a lot of different types of healthcare workers, uh, in rural communities and elsewhere.
Speaker 1:And I, I think that discussion brings us nicely to, um, our next challenge of the brave new world, which is what can facilities do providers do at this moment, um, to access emergency regulatory changes, um, potential game changers that might come through legislatively, uh, what may be out there for them. I, um, and I'm gonna start with Del.
Speaker 5:Thank you. So, you know, I think one of the main changes that, um, are as worth noting for rural health providers is the new access to capital, um, important that, um, under the CARES Act, we know that there's 1 billion that was eMAR earmarked for new funding for healthcare providers, and then 30 billion that was released on April 10th, um, for immediate funding for healthcare providers. And initially because of some of the back and forth before, um, before the funds were issued, there was a thought that it was just gonna be for hospitals. And now, um, we, we know that it's for all providers and as of the beginning of last week, 26 billion. So in the first two days, 26 billion outta the 30 billion had already been issued. Um, so these are funds that will be critical for rural hospitals, um, but won't be sufficient, you know, uh, again, 26 billion was already, was already shared. It's based on 2019, uh, Medicare payments. Um, so it's important that we continue to push for if, if, you know, if these, those opportunities arise for additional funding for rural hospitals. And then, you know, rural hospitals can also benefit from the payment protection program. Um, there are additional Medicare payment improvements. Flexibilities are really important to get those funds, particularly in the short term. So they should have received the payment to whichever, uh, account usually receives your payments from Medicare. And it wouldn't necessarily have come with an, with an explanation, most likely it would've just said an all caps HHS payment. Um, and there is an attestation that needs to be completed within 30 days of receiving those funds. So if you haven't received them already or haven't identified them to just the rural hospital CFO or whoever, um, handles your, your Medicare payments, look for that payment, confirm that the calculation is correct. Um, it works out to about 6.2% of the 2019 Medicare patient, uh, payment. And then within 30 days you can either, um, confirm, sign the attestation and confirm that you received the money and that you can comply with the terms and conditions. And those are also available on the ATS website. Very important to look at the terms and conditions, um, their reporting requirements, quarterly reporting requirements, um, very, um, very precise indication in certain areas as to what they can and cannot be used, for example, cannot be used to support a computer network that doesn't have, um, a restriction on access to pornography. That's pretty specific. And then at the same time, um, when talks about the use and, and in connection with Covid-19 much broader. So if you cannot, if your facility cannot meet the terms and conditions, then it's important to return the attestation indicating such, and also returning the money if you don't return the attestation. And we will assume that you are complying with the terms and conditions and even though this money has been, um, highlighted as, uh, funds not alone and that that is correct. However, if you're audited at the back end and, and obviously we never do anything, um, knowing that we're not eligible and just because of potential audit, but there will be audits at the back end and if they find that in fact you weren't eligible or you didn't comply with the terms and conditions, they're gonna be able to call that money back and ask for reimbursement. And so couple concerns that I've had in talking, talking to clients is a, make sure that you look at the terms and conditions and that you are eligible and make sure that you document, I mean, think three 40 B, make sure you can document where the money went. It can't go for other losses to offset other losses that are unrelated to COVID-19. So really be able to trace that flow of funds, you know, separate accounts, hopefully track how much you spend on different phases, um, so that you can survive and be compliant with an audit. So that's a real big one.
Speaker 1:I was going to just ask if there are any other, um, comments on that. There's a lot out there right now.
Speaker 6:Um, I was gonna ask Delphine, this is Vaughn, if you've had any clients, cuz I've had a couple of people talk to me about going after, uh, either FEMA disaster funding or sort of traditional, I would call it traditional U S D A grant funding or anything to help them survive the covid crisis since there was already, uh, programs in place to assist rural facilities in the, in, um, from those traditional programs, but they may not have taken advantage of them before. Um, have you seen any of your clients going for those kinds of funding now in light of covid and the difficulty they may be having, figuring out P P P or waiting on the HHS funding to come through? Yeah,
Speaker 5:That's, that's one of the big challenges is trying to figure out, um, the, which, which funds are, are available you're eligible for, and then the sequencing. So even in the HHS 30 billion funding, it says, you know, that you're not that other, that aren't otherwise reimbursable. So for example, in order of priority you would start with your business interruption and demonstrate that you've tried to get those sources from your insurance company. You know, so there's a, a priority list. FEMA comes at the end generally, so it's after you've exhausted HHS and other sources of funding that you can then go to fema. So yes, I'm already seeing confusion and, um, I'm doing a, a webinar on, on Thursday, for example, for the Pennsylvania Hospital Association, the CFOs, to talk about that prioritization and making sure that you don't miss out on an opportunity because you know, as we've seen already on some of the ppe, the funds have expired or you went to FEMA first were rejected by FEMA and now it's too late to go to another source. So it's definitely an issue and happy to, to talk more about it.
Speaker 4:I have a, a question for others on the panel. Um, whether they think that some of these, um, emergency relief measures, um, the, the CARES funding, uh, and or the reimbursement changes that are related to that, um, might be game changers for any of the rural hospitals. Um, whether, you know, there, there's going to be a significant impact, um, because of these changes or whether these, these, um, amounts that are available will really just bring them back to status quo.
Speaker 3:I'm gonna say no. Um, I don't think they're game changers. I think, um, I guess my, my concern personally is, you know, as we take all these measures to prepare and get p p E and train people and redeploy and cut expenses, while we're not doing, um, um, elective procedures and other things, we're pushing the, pushing the curve out and flattening the curve. But that curve might be several months away and, you know, most health systems can't, I mean, you're gonna have to cut so much of your operations to just survive to get to that point. Even with some of the federal and state money that's available, it, it, uh, my concern is it's um, it sort of feels like it might be, um, throwing good money after bad cuz it's all gonna be, it's, you're just pushing it out and it's all gonna be flushed down the toilet anyway. I don't know. I hope that's not right, but that's my concern.
Speaker 2:Yeah, I mean, I think, I think that's, Mike Mike's got a valid point. I think, you know, the challenge is, and, and having, you know, I think we, we prepared, you know, I went through the swine flu situation 10 years ago, 12 years ago, whatever it was, and you know, we did a lot of prep to, to make sure that we had staging areas and so forth, and we saw some cases, but we didn't see a lot. Now, you know, if we're flattening the curve out, does, do we get to the point we have a vaccine, you know, and, uh, so, or, or at least some mitigation strategies pharmaceutically, that allow us to, to reduce the, the impact. I think it, it, it, it's possible. And I think then what you've got is, you know, you've taken the money, some of it may be forgiven, some of it may have to be repaid. A lot of this money that is people may, you know, companies may be borrowing hospitals, may be borrowing, whoever may end up having to be repaid in some form or fashion parts of it, wherever it is, whether it's drawing on your line of credit, you know, drawing, you know, pulling money from the federal government, so forth. And so what people, you know, people that the hospitals that were already stretched, particularly these rural communities that didn't have any margin, how are they gonna repay those funds? When you go into a bankruptcy, I can tell you the first dollar that comes off is, you know, your, your federal regulatory co entities, DOJs gonna be in there wanting their money, uh, and the way they get it is withhold from your provider number post bankruptcy or via the bankruptcy. And so the, you know, unless there's a big huge bailout that everybody just wipes it clean, um, some of this money is, is more just being deferred for partially repayment, whether it's your bank, et cetera. So
Speaker 4:Those are all, uh,
Speaker 1:Very sobering points and, and I think it's important to remember as Vaughn and Delphine and a number of other panelists said is, you know, it's also what happens once we get out of this, um, pandemic how rural providers especially are able to, um, to, to affect legislatures, to take action, to protect, um, the healthcare in, in America's least, um, least able to withstand it communities. Um, before we leave, I know all of you have clients that are, are fighting this pandemic. Um, but before we leave, if I could just ask if anyone has any, um, other thoughts or suggestions, um, things that have worked, things that haven't worked, um, hopes for the future, et cetera.
Speaker 2:Hey, this, Steve. I mean, I think, I think key is we can't be complacent, you know, that's gonna be the, the goal here is as, um, you know, healthcare executives, operators and so forth. Uh, I think the thing is, we, we have to be cautious as we, as we turn the spigot back on. Whether that's, you know, as we open up the, the communities across the country, whether it's opening up our hospitals, whether or not it's, as we bring back staff, whether or not it's, as we take these funds, you know, moderation is gonna be really key here as we do this to make sure we get, get through and have operational entities on the other side of this going forward. The rural committees particular, were already at risk here, here we are, and we've got a crisis in front of us that's gonna affect us as well.
Speaker 6:This is Vaughn. My, my hope is number one, that we can actually make it through this crisis with our, our current and existing facilities intact. I'm not sure that's going to be possible, but it is my hope. My other hope is that this is enough of a wake up call for us on a policy perspective to really do the hard work of looking at the way we fund healthcare in this country and the way we provide access to care for people in its most vulnerable communities and find a better solution to that problem.
Speaker 4:This is Andrea. I'm gonna go out on a limb and say that I think that what's going on right now is a potential game changer, um, for a variety of reasons. One of which Vaughn just, uh, brought up, which is that it, it's a wake up call in a lot of ways. I think, um, this crisis has highlighted, uh, the importance of public health systems, uh, including those in rural communities, perhaps especially those in rural communities. Um, I think the attention to the problems, uh, that we have in allocating care and resources and the fact that so many of these providers in rural communities are operating on such thin margins and on the verge of failure, um, is something that, um, gives us the opportunity once we recognize it, to start to, to make some changes. Um, and I do think, um, although it's, it is a little bit perhaps like putting good money after bad, uh, in some respects, some of the funding that may, um, be coming down the pike for some of these providers is an opportunity to, um, at at least, uh, try and write the ship. Um, at least hopefully. And, and, um, if, if all the cards are played right, perhaps, um, the outcome might be different then it might otherwise have been, which I think would be a good thing for all of these communities.
Speaker 5:Susan? Yeah, I think that we've been talking about transformative change in healthcare for a while and, um, and you know, there've been so many initiatives to transform healthcare, and I think this is going to be the game changer, agree with Andrea, and this is forcing the transformation. Um, and it's no longer going to be a, a nice to have, but are required and required very quickly. My concern is that we've had a growing health divide in this country for a long time, along many different lines, and that this is really gonna exacerbate the access to healthcare crisis that's not just in rural communities, but also in urban communities that goes beyond insurance. Um, also people who have been who, who are insured, who just can't get there. They can't get there for a variety of reasons for their chemo or whatever the case may be. So Devon's earlier point that this is really a wake up call that we have a transformative change in how we deliver care in rural areas. And what we've been piecing together to date, um, has been on, you know, life support for too long. And that's where I think the opportunity will be to think differently and where hopefully telehealth can play a major role and if we can get the investment in the infrastructure, um, to, to transform the way, way folks get access to care, um, because it's not gonna go back. And even the way it was wasn't great. Um, and my concern is that it's really broken, but there's opportunity.
Speaker 1:Well, I wanna thank all of our panelists. Um, as I mentioned, I know you all have, um, clients who are actively fighting this pandemic, so we appreciate your time, your experience, your perspectives. I I hope that this was helpful for our listeners. Um, I found it really interesting, um, and I hope that you are able to access some of the other great resources that D H L A has both on podcast, um, and via webinar, um, and some and via webinar, excuse me. Um, as we all, uh, try to deal with our new.