(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)
Good afternoon, everybody. I am Sarah – president and CEO of the Alliance for Health policy and I want to welcome you to week 6 of our covid-19 webinar series for those who are not familiar with the alliance welcome. We are a non partisan resource for the policy Community dedicated to advancing knowledge and understanding of Health policy issues. We launched this series to provide insight into the status of the covid-19 response and shed light on remaining gaps in the system that must be addressed.
to limit the severity in the United States The Alliance for Health policy gratefully acknowledges the National Institute for Healthcare Management foundation and the Commonwealth fund for supporting our covid-19 webinar series. You can join today’s conversation on Twitter at the hashtag all help live and follow us at all Health policy. Now, I’m going to introduce our panelists in a minute, but we want you all to be very active participants in the discussion. So please get your questions ready. Here’s how you do it.
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About one in five Americans or 60 million people live in rural areas research shows that these individuals are at a higher risk of both poor health outcomes and face more substantial socio-economic disadvantages than their Urban counterparts as covid-19 continues these Health disparities and barriers to healthcare access are making it more challenging for Rural Health Systems and providers to care for their residents today. I’m pleased to be to be joined by a group of distinguished panelists who will help us discover.
The unique challenges facing rural Health Systems and highlight current and future policy Solutions first. We are joined by. Dr. Michael bromage the medical director of Cabin Creek Health Systems. He is also the director of the preventive Medicine Residency program at West Virginia University School of Public Health and a medical officer at West Virginia University’s injury control research center. Next. We will hear from Scott Graham. Who is the Chief Executive Officer of not one but two rural hospitals.
Three Rivers Hospital in North Valley Hospital in Washington state finally. I’d like to welcome. Dr. Jacob Warren who is director of the Center for Rural health and health disparities At Mercer University in Macon, Georgia. Thank you all for joining us today. I am now going to turn it over to dr. Bromage for some opening remarks. Go ahead.
Thank you very much. And thank you for the opportunity today to talk about rural Health in the covid-19 pandemic next slide, please.
So rural Health was already in a precarious position before the pandemic with a reduced life expectancy of almost two and a half years relative to large metropolitan areas some of those drivers for this discrepancy in longevity include the opioid crisis and the other diseases of Despair has described by case and eaten from Princeton. We talked about the opioid crisis as an epidemic.
But really it’s an epidemic of epidemics more properly termed as endemic with Overdose deaths Hepatitis B hepatitis C which happens to be the number one infectious killer in the United States increasing amounts of HIV primarily from sharing needles from drug use injection drug use abandoned children neonatal abstinence syndrome and first responder burnout among many of other types of conditions with the opioid crisis.
We also have adverse childhood experiences that impacts mental and physical health well into adulthood and we have to pay attention to the social determinants of Health where people in rural areas are disproportionately affected in terms of housing Transportation education disparities economics and access to nutritious food next slide, please Hospitals closures are a really big problem throughout Rural America with 161 closures Nationwide since 2005 in 2019. 18 rural hospitals shut down and to rural hospitals in West Virginia. My home state have closed since the pandemic started something that’s really difficult to imagine to close a hospital in a pandemic.
Likewise the public health infrastructure has been hollowed out at the federal state and local levels the prevention and public health fund from the CDC uses roughly 200, excuse me, 625 million a year to State and local initiatives for things such as immunization of children grants for local needs and programs to respond to infectious diseases. According to a trust for America’s Health Report from 2013 to 27. The fun will receive nearly 12 billion less than the law had promised.
And we see now the cost of neglecting our Public Health infrastructure in the trillions of dollars next slide.
There are some bright spots. However, one of our safety nets include federally qualified Health Centers, which I’m the chief medical officer of one in West Virginia. It’s they serve one into a between 1 and 1 out of every 12 Americans Nationwide and one in for West Virginians. And typically these are underserved populations.
In states that expanded medicaid West Virginia being one of them we’ve seen some success West Virginia was among the most successful. If not the most successful with a 55% reduction and uninsured from 2013 to 2018. We were the last state to report covid-19 cases and therefore we had more time to prepare. So we feel somewhat of an advantage in that regard and so far.
We are the least affected State overall relative to our population, even though we have the most At-risk population in terms of Age and comorbidities and to our according to a report from the Kaiser Family Foundation as of last night at 10 p.m. West Virginia had 929 cases in 26 deaths. However, we do know that the number of real cases that are out. There are vastly undercounted next slide.
Some of the strategies moving forward that were already have implemented and here you see a picture from of a tent outside one of our clinics. This is a former Middle School in clendenon West Virginia, and we use this tend to screen respiratory patients from non-respiratory patients and do actual covid testing inside this tent where there is more air flow. We have a big shift that telemedicine right now.
I would guess around 80% of our encounters are telemedicine the future revolves around Ding both molecular and serology testing tracing and with that tracing putting people who are ill and isolation and quarantine either close contacts, and hopefully we’ll have an effective and safe treatment down the road. And of course the Holy Grail is a vaccine which is there are several right now in human trials that concludes my opening remarks and thank you.
Great. Thank you so much. Dr. Mike rummage now. I’m pleased to turn it over to Scott Graham.
Thank you for having me and inviting me to speak today. I’ve been asked to speak about what it’s like as a hospital CEO in a rural community. And as I as was mentioned at the outset we have I am responsible for two critical access hospitals in rural Washington State. We have not seen the patient surge in.
The rural portions of the state like they are seeing in the more urban areas in our County. We’ve had 14 test positive and that’s been since April 21st, and it’s held steady at 14:13 have recovered or are in recovery. We’ve had no death.
So the net effect of the guidance to be Doing social distancing and stopping elective surgeries has been to essentially dry up our patient volume and as a result our patient Revenue are our financial revenue and it’s been an interesting response from the community.
We’ve seen folks who are exhibiting signs of panic and fear all the way to complete and utter disbelief that there’s a pandemic going on as dr. Bromage mentioned it there have been many critical access hospitals and Rural hospitals that have been on the brink of financial closure for a long time and Three Rivers Hospital the hospital that one of the hospitals that I’m at was one of those hospitals. That was really struggling.
And really didn’t have any depth in terms of financial reserves. And so when our patient volumes dried up we were really looking at what what steps we would need to take in the event that we needed to close all that happened in a breathtakingly fast-fashion one week. We were really concerned about how we were going to be able to ramp up make sure we had enough people.
Ee in and of equipment beds and so forth and really not thinking in terms of financial disaster, but thinking in terms of how do we make sure that we’re there and then enough numbers for our community, but when the social distancing affected the the patient volume to the degree that it did we were really faced with would we be able to stay in operation?
And as we looked at our days cash on hand we We’re essentially looking at about two week window before we would not be able to make payroll and it’s a bizarre place to be that in the middle of a pandemic. You’re worried about being able to stay open as a hospital.
So our our work has been a long to track those result.
We’ve been working with State canopy and federal officials to try to find ways to get funding to keep us going and at the same time we’re trying to ramp up and find make sure that we have plenty of equipment and so forth to keep ourselves in a position to be able Take on patients. Should there be that the surge we’re also coordinating throughout the county with all of our Health Care Partners and public health. We hold multiple round-robin calls per week and just assess where everyone’s at and share data, which has been really useful and we continue to work with the State Association who’s been very helpful and very supportive of our Three Rivers.
Hospital in particular and helping to find ways to keep some financial help of flowing to us. Also. We work very closely with Senator patty patty Murray’s office who’s been very helpful and we’ve been working with a variety of other partners to make sure that we can continue to find the PPE that we can get and testing materials we can get although much of that is still on backordered.
The supply chain problems that are present Lessons Learned so far again something that I would have never anticipated that when you’re in a pandemic and social distancing is required that your patient volumes are going to drop and as a result your revenues going to drop the lean methodologies that I was schooled in years ago in many of those don’t apply in a situation like this.
the just-in-time inventory puts us at a disadvantage in a time like this when we’re trying to get materials and can’t get them and one of the instincts that we’re trying to not indulge in his hoarding, but unfortunately this this sort of lends itself to wanting to be as self-sufficient as possible and hoard as much as you can we were also I think a lesson learned is how quickly things can turn either, you know to the point that you cannot operate with how quickly this pandemic spread.
I don’t think any of us were prepared for the speed with which this this pandemic moved throughout the state and throughout the nation and then finally I don’t think it’s in most CEOs DNA to talk about financial problems in the public and I was actually quite nervous about doing News interviews and talking about our concerns and what we were going through to be honest. There’s a lot of shame that goes with that you’re supposed to be successful. You’re supposed to be making a difference in terms of financial viability.
And we were on the brink of closure. We were talking with our attorney. We were talking with the State Association to find out what what has to be done in the event that we have to close.
But what I found is a lesson is that by being honest forthright Frank about these kinds of things that actually that was where we started to get the assistance that we needed the attention that we needed and actually the support that we needed the community has stuck by us our staff of stuck by Us we’ve seen a great round of support from partners that we’ve always collaborated with but there seems to be an even stronger bond has been formed as a result of this. So I think those are those are the lessons that I’ve learned so far, and I know I’m learning more as every day that passes. So, thank you.
Thank you so much Scott, and I look forward to getting into some more of those Lessons Learned and appreciate you’re really sharing your leadership perspective as well. So next I’m pleased to turn the mic over to dr. Jacob Warren Jacob. Go ahead.
Thank you, Sarah and thank you for the alliance for the chance to talk about what we’re seeing in the policy arena with regards to the effects of covid particularly on Rural America. I do want to mention this is a particularly personal issue to me right now is resident of Georgia. I don’t know if most of you are aware but we have one of the worst hot spots in the country and it’s not in metro Atlanta. It’s in rural South West Georgia where more people have died than in metro Atlanta. So next slide.
I’m going to talk a little about what Solutions have been put in place where we still have remaining issues and what the policy levers are that Can be activated for Rural America in particular before I go into that. I do want to highlight and just follow up on what Scott was mentioning that the impact of what we’re seeing covid in Rural America is too cold. We have the increased cost of preparing for the surgeon cases and the risk that’s placing our providers and that’s sort of the public face of the medical side of this outbreak. But the other side is that dire economic impact that is happening as revenue streams drive up dry off parole providers.
So the healthcare hit really is twofold. So Scott mentioned, it’s we’re asking people to solve the crisis at the same time that the weathering the same economic impact as other Industries, but to help whether this there have been a number of solutions that have been put in place at the policy level and I do want to highlight just a few of those. The interesting thing about these is that these are actually solutions that we’ve been proposing for many years in rural health. So these the reason that they are effective right now is that they solve some of the core issues. We see in rural Healthcare accessibility of Care Transportation Etc.
So It’s been good to see some of these these Role Models be implemented Nationwide. So one of the first big changes that we’ve seen of course is until l. So the first thing when they came out was reimbursement parodies that helps ensure the tell of encounters are reimbursed at the same rate as face-to-face that previously was not the case. A lot of people didn’t know that so that was a big change that there’s allow providers to expand out into Telehealth in place. They couldn’t financially it done before.
The other big change there has been allowing home to be a presentation site and even a distant provider site where you can have an encounter between patient who’s at home that position who said their homes and so having that is is dramatically expanding access to care previously that was only allowed specific diagnosis and situation. So this has been a big expansion Ivory the others mentioned Pharmacy. Most of us have probably been personally touched by this we’ve been allowed now to have early refills pharmacist have the authority to refill maintenance medications without physician.
Prior approval and then there’s a lot of Exchange in the delivery in three months fills its scripts. And so that’s been a big advancement the funding streams. I’m going to touch briefly on better when comment more on the next slide on these in terms of where we could see some improvement in the area. But one of the big things that happened pretty recently as the suspension of the 2% Medicare sequestration, and so that has directly brought fun back into providers and hospitals who have a Medicare senses.
So they are they’re receiving that cutback during this time the next to our ones that address sort of the secondary side of this the economic impact. So the FAA paycheck Protection Program and the economic injury disaster Loan program. I have stars Mexico’s because we all know that those funds of dried up but with the bill that passed yesterday the Senate was my loop back around and then the CMS Advance payment program has been a really critical tool that allows providers and hospitals to draw down funds early.
So since we draw down three months of an advance payments in Medicare funds But there’s some limitations again to that that hit rural areas in particular. They’ll talk about on the next slide, please.
So the remaining issues that we see is of course, we have the lapse in funding. So the paycheck Protection Program and E IG L. The the funds have elapsed currently. Then there is a burden Beyond covid care has been mentioned. So the fact that we’re trying to figure out how to make payroll in the middle of the healthcare crisis, but then there’s also some aspects of the health care uniqueness. So under the patient protection program that forgivable portion of the loan doesn’t apply to salaries in excess of $100,000 will tend to healthcare industry. That means you can’t use it to cover.
Providers salaries because of that cat so that it does still provide some relief but not at the same level it could in other Industries, but then on the upper right side of here we see some of the lingering issues that are kind of real specific. So I mentioned the early crawl down this available through CMS now, but the issue there is that in three months those costs are going to start to be recouped and so for hospitals and providers who are already on the brink and we know that over 40% a girl Hospital.
Operate on a negative margin the cost effective three months from now having to not receive their Medicare reimbursements because Medicare is reimbursing this or is recouping this cost is something that while it might provide an answer in the short-term. We could see some real long-term disastrous effects of these straw bales. The next type 2 is the next side of this is the fertility of the provider system.
So when you’re working in a rural community that has one Hospital in that hospital closes we have lost care entirely and so The system itself is so much more sensitive to these types of changes. If a local provider becomes exposed and have to sell quarantine for 10 days and they’re the only provider in the community. All of medicine Medical Care has been lost if after shutter their doors because they don’t have the income stream the whole system is closed. So there’s a lot more fragility of the system and we need to look at how we’re specifically stabilizing the moral aspects. I just briefly mention broadband and Equity.
This is something that’s pretty widely known but we do have Broadband gaps in rural communities far beyond what we see in Urban and some of the solutions that we’ve been implementing the on Healthcare so Healthcare education from home work from home is really highlighting the fact that we have to build up Broadband infrastructure and really rapid ways and then just an afterthought for most people but there are some liability questions with the expansion of Telehealth is unclear how the ftca protects if you HD providers if they are practicing from their homes, for instance, there are still some lingering questions there next slide.
So these are some of the policy leaders they are available for implementing Solutions. I do want to comment briefly about the accident passed yesterday. So Health Care enhancement act had passed the Senate yesterday is heading to the house tomorrow. We will provide 225 million dollars specifically to rural fqhcs and rural health clinics. It is allocated for testing related expenses.
Unclear what kind of support this school have for the broader financial needs that were mentioned earlier in this webinar, but that Is some good news coming out of Washington so system brief options that I mentioned here at the 11:15 and 1135 waivers that are under CMS. 1135 is how Telehealth has been expanded. This was the authority that was used to say, we will reimburse the same from it home. We can play some Provisions that car event Telehealth but 11:15 are state-led demonstration projects and there are some opportunities there for states to potentially look at say for instance in Georgia where we did not expand Medicaid under the ACA. Are we able to explain?
Educated those who have lost their jobs because of covid. So that’s some options that are there. We already have the existing fqhc rural health clinic and critical access Hospital designations. Are we able to potentially expand those out an emergency situation to stabilize hospitals that aren’t currently labeled as critical access hospitals. There’s the coronavirus economic stabilization act. So for the reserve funds that are held up by the treasury, so strategically distribute, we can look at how we disseminate those in a way that’s not a further supports the stabilization of the Healthcare System.
The loan repayment program is another option to support provider’s refunding the PPD IDL programs to ensure that businesses including Healthcare can keep their doors open and potentially looking at ways to prioritize your organization so that we don’t have a vacuum. What’s the band in it resolves will be really critical the advance payment program if we can look at base to expand out that Horizon that the recoup period so under PDT agencies are being given ten years as repayment if we do something.
Similar with CMS Advance payment that could help prevent some of the backend Negative X we could be coming and the one thing I really did just want to mention as I stated earlier. A lot of these solutions that are being implemented things. We’ve been calling for Rural healthcare for a long time and outside of the painted it they would be helping dramatically stabilized what’s happening in rural Healthcare.
And so we have a real opportunity here to memorialize some of these changes as we bring it nice the way they do expand access to care and ensure access to quality affordable care for all Americans including And just like on this. Thank you.
well, thank you so much Jacob, and I want to follow up on the last comment you made because it seems like all of your comments that this covid pandemic really exposes and magnifies all of the paradoxes and inequities that rural Health Systems have faced for years that many people have tried to solve have tried to work on and whether that be keeping your doors open and being there for Or your community when they need it, but grappling with you know, the low volume that comes with a you know, spread out population that kind of thing similarly Scott as you mentioned the just-in-time inventory model versus The Surge capacity, you know, the the public health funding all of those things that you mentioned. So I wonder and I love to start with you Jacob and then hear from Mike and Scott.
Can you speak to the Solutions that are needed versus how do you see these lessons perhaps being applied in the longer term even if longer term is the next few years, but how do you see that sort of immediate emergency kind of response versus how do you see these Lessons Learned applying to what we were already struggling with when it came to rural Health Systems.
I think a lot of what we can do in the immediate is expanding out our concept of stabilization. And so while we are having a particular role crisis here in Georgia, some of the other states aren’t having that same effect. So as we send funds down through the existing mechanism, so if you excuse a receiving support funds hospitals are receiving support funds if we can be sure that those are disseminated in a way that allows them to put them toward what they need.
If it is that they need a PP stockpile great if that’s Need to maintain their personnel because they’re going to have to shutter their ER without it. We need to realize that that is a broader effect of coded and so being sure that we’re expansive and how we are implementing these policies I think is is one of the key steps. Thanks Scott or Mike. Would you like to jump in?
I can speak as a administrator of a hospital that you know for me first and foremost is making sure that we have the revenue to be able to continue to pay our staff and to be able to make sure that we have the equipment that we need and you know, that’s been the everything that I have worked on for the last 10 years because of the situation that rural Health has been in.
We we you know, if we can’t keep the doors open then all the rest of that is academic. And so I think there has to be a different way that we view critical access hospitals particularly ones that are located in more rural parts of the country instead of thinking of them as all equal in terms of their ability to function critical access hospitals that are closer to urban areas tend to do better.
Other than critical access hospitals or rural hospitals that are located more out on the frontier the two hospitals that I run are really out on the frontier and so volumes are never going to be what you know, you’re going to see in the in the urban areas or in the critical access hospitals that are closer to urban areas.
There are plenty of challenges that go along with that such as provider and nursing Recruitment and Retention and The cost of being able to bring those folks on board which is much higher than you might find in an urban area. So there has to be a recognition that rural hospitals are vital to their communities and that they’re they’re going to need assistance and support in order to be there. I often liken it to regarding us as more like a fire station. You don’t necessarily want to think about the fire station, but you’re sure glad that the fire.
Oceans there when there’s a fire and I think that’s what we’re seeing. Now. At least that’s what I’m feeling. When I raise the flag with our State Hospital Association about our concern about closing the effect of doing that was immediate and Swift I had calls from State officials and federal officials within the hour.
Wondering what they need what they needed to do in order to help us because their comment was we cannot have a hospital go down in the midst of a pandemic and so That was heartening but it sure would have been great to felt that the last 10 years and I think again maybe part of what if there’s a silver lining here, maybe a part of what folks are recognizing is that every one of these hospitals plays a vital role in communities help.
Thank you. I’m sorry. This is Mike and I wanted to also jump in here for just a moment.
I think that having an increased reimbursement for telemedicine wood pulp many facilities both fixed and outpatient facilities to have better income during this this time when we’ve just had to shut off so much of our routine care so that our capacity is vastly underutilized, but I think also Having a bigger plan a bigger vision for what health and Healthcare will look like in the United States and to designate rural hospitals among many others as critical infrastructure and not only hospitals but industry producers of personal protective items Pharmaceuticals vaccines, all of those things together requires some foresight and really there’s only one organization that can do anything like that and that’s the federal government.
And so I think moving forward we have to to use this pandemic as it magnifies the defects within our Healthcare System to go back and fix things because again, we see the enormous financial and human consequences of failing to have a better public health system and our critical infrastructure in our Healthcare.
Thanks Mike, and we already have some great audience questions coming in. So please keep them coming. I want to let me address a couple of them and just kind of on this capacity issue. You know, Mike you mentioned telemedicine one question or ask so much of rural Health Care is based on outpatient procedures. And so now with the many of the elective procedures limited or prohibited how quickly do you think patients are going to return to the hospitals or the provider?
Is like fqhcs for these kinds of services that are perhaps less time-sensitive. Do you see the telemedicine sticking as far as a model going into the future Michael? It’s let’s start with you and then we’ll go to Scott.
Certainly expanding telemedicine Beyond a pandemic is going to be a great solution and that’s why I think it solves so many issues. You can reach people remotely and right now our patients are typically staying away pay out of their own concern many of our elderly patients don’t want to come anywhere near a health care facility or congregate anywhere. So people are self selecting to stay away from our health centers.
Right at the moment, but that I think that’s a really important piece as is being able to do this more in the future.
Thanks, Scott. Any any thoughts on your end as far as whether people are going to return how quickly do you think people are going to return still totally up in the air? Yeah, I think it’s going to be slow. I think people I think for the folks that are fearful. I think that they’re going to be cautious.
I also think that telemedicine it has been somewhat of a forced Discovery and I think some people are finding that they really liked it and I think they’re going to want to continue that but we have a very in least in our area. We have a very elderly community and many are not interested or particularly able to use technology.
We have quite a number of folks that we’ve been trying to get signed up for our patient portal through our EHR and it’s a bit of a struggle we all I immigrant Community because we’re a rural agricultural area and many of those folks are suspicious of technology and and particularly telemedicine. So at least for us I think that it’ll be a gradual increase in volumes and a gradual acceptance of telemedicine though. I think there will be a segment who will embrace it now and want to continue it.
Thank you. And so so let me ask you there was there’s one other question Scott. I want to stay on you because the there’s a question around Personnel needs and the the question or highlights kind of another side of the surge capacity Paradox, which is that is volume goes down the Personnel needs change, but have you heard of shortages of personnel around your state and and maybe Jacob and Mike you can weigh in at here as well, but how our Personnel needs kind of changing throughout this.
pandemic I do think is changing. I do think that there’s more Personnel available because we’re seeing indicators of health systems that are furloughing folks and and reducing their payroll expenses by decreasing, you know, the the salaries of folks. So I think I’m getting calls now and emails.
Probably five times more than what I usually get for agency nurses and and other temporary staff. So I do think that there’s more availability in this current crisis, but I think when things go back when we start to see increased volumes, I still think that the nursing shortage and the physician shortage is going to continue to be an issue for us.
I think the the amount that we’re seeing now in terms of abundance is short-term.
All right. Thank you. So I just want to remind everybody we have about 10 minutes left. This is a slightly extended webinar. So we have till 12:45. So if you still have questions feel free to send them in I want to turn to what’s been going on with capitol hill and in the administration and Jacob, I’ll put you on the spot here. We’ve gotten a couple of questions here around the tears app. And then the health care enhancement act. Can you just share a little bit more about?
How do you see that funding working? Do you think it’s been sufficient or will be sufficient to meet The Current financial constraints for the rural hospitals and then an additional question around you have thoughts yet around the distribution of the funding. Is it more likely to go to large Hospital systems or versus rural hospitals? Can you speak to that?
Sure. I was relieved to see in the the Senate bills that there is a specific allocation for Rural health clinics and fqhcs. I did not see a similar provision for Rural hospitals or for critical access hospitals that are located in rural community. So it’s unclear how this will filter down. I think if we look at what rolled out with the general paycheck Protection Program, we know that a substantial amount of those funds did go to larger agencies rather than smaller. So I think there are some logistical issues to work through in terms of how we prioritize small businesses.
Typically how we prioritize small Healthcare businesses because that’ll help us keep our Primary Care Providers open or smaller rural hospitals open because those that don’t have some type of federal designation.
So there are a lot of hospitals and providers who aren’t in rural health clinics that are rural are critical rural providers, even if they’re not federally designated as that, so it’s unclear how that will go out and what it can be used for because even in the even in the the bill that passed yesterday the funding is still / the Words of the bill allocated for testing and related expenses and so it’s unclear how that can be used for the broader stabilization needs of the groups. All right. Thanks and Scott, you mentioned, you know talking to your state and your federal legislators. And you do feel like there’s more that can be done and maybe I’ll go back to both of you. I mean, are there any solutions that you feel like we’re going to have you know, some bipartisan support multi stakeholder support that as we go forward.
We can think about for the rural areas.
Yeah, I’ve been pleasantly surprised with the response that we’ve gotten both sides of the aisle folks.
I think have been very supportive of wanting to keep a Hospital’s hole through this and so as I mentioned earlier, I think there’s been a recognition of how vital hospitals are to the health of rural communities as well as larger communities, so I have not received any negative or any kind of pushback from congressional leaders. The only thing that I would say is that I think people are grappling with the amount of help that is likely going to be needed and trying to figure out how they’re going to fund that the state has.
Essentially communicated to us that they’re they’re out of tactics that they can utilize and that they’re really going to rely on the hundred billion dollars that was passed for through the cares act and future funding that may be coming. So I don’t know that the county or the state has the resources to to help us in the short term or even long-term.
So we’re really looking To the feds to to make the difference here.
So one of the things that that comes up this I think complicates this discussion is very often. This is what place out when we look at allocation of resources for Rural communities the larger systems with the larger numbers get the larger eyes. And so the proportionality of what’s occurring in rural is higher, but we’re not seeing that same proportional allocation of resources out into URLs. So for instance our operate that we have in Southwest Georgia, it’s not getting anywhere near the attention of the larger City outbreaks even though the death rate.
Higher than in New York city in Southwest Georgia. So it’s kind of important to be sure that we’re raising this this call all the time the same don’t forget about the rural aspects of what’s Happening Here and that we need to be sure we’re protecting and all these Provisions how this can go out to rural communities and their Federal systems in place to look at allocating me, you know, we know that three-quarters of rural counties are health professional shortage areas and there it’s a scores that could be used potentially and how we allocate some of these funds out and there’s privatization that it could happen in.
testing structures Thanks, Jacob. And and you know, if you could comment maybe briefly on this this idea of like this interconnectedness between the rural and the urban and the rest of the country because I think there’s one thing that spend on that cuz has shown us is that if we think about things in isolation, we’re not going to be successful. So what what are your thoughts there about how do you how do you elevate that concept or is that a concept that should be elevated like, you know if we can’t contain and reduce the severity.
In these rural areas. What does that look like not only for them but you know for everyone else and for the course of the pandemics.
Exactly. We’re seeing that play out in Georgia. We have our Emergency Management Association for Georgia. Jima is then releasing situation reports of ICU beds. And when you look at the ICU beds capacity in the region that I live in in Macon, even though we don’t have the high proportion where the tertiary center that is the catchment area for a large rural region of the state and one yesterday. We were down to seven available. I see you guys in the region even though we don’t have a local outbreak.
And so, you know, I hate to try and put it on its going to come for you if you don’t fix it in rural, but that’s part of the dynamic that is playing out in a state like ours and we have been hit hard in rule, even though the urban areas haven’t been hit. They’re having to take in two capacities at the local hospitals can’t handle and so it does really affect us all at the system. Thanks. All right, we got a couple more questions. I want to I do want to ask about this question around institutional settings in rural areas other institutional settings.
So maybe Nursing homes, or kind of other post-acute kind of things. Do you think and Jacob will just start with you or their expanded roles? Do you think we’re rural hospitals to play in supporting people living in these institutional settings either with infection control surveillance, testing quarantine isolation and in place treatment, like what is the what is the outlook look like for the interconnectivity between those settings?
That has been part of what’s been discussed in these bills. I haven’t seen a lot of it come out in language even is how we can utilize this new tell Health infrastructure as a stabilization. So increase the volume by doing Telehealth encounters facilitated in these long-term care facilities nursing homes Etc. So it is definitely an option for how we we stepped up from the way we View Healthcare currently and make it a systems level approach of how we can integrate hospitals local cares long-term facilities into a care.
It’s almost harkening back to the accountable care organizations that not in the exact same vein. But just how can we really systematized that effect by bring everyone to the table? And that is one thing that’s happening with this outbreak is those people are having to come to the table to discuss how we solve this. So I’m hoping that that becomes a long-term long-term strategy.
Right. All right. I want to spend our last few minutes going to some broader public health issues and these were touched on in the beginning but as we know several States, Georgia South Carolina, Tennessee and Texas have all expressed that they wish to partially he’s social distancing in the next few days.
We certainly know these states will have significant Health disparities between rural and urban areas so want to ask each of you to speak to that but since we only have a couple of minutes I’m going to Combine that with some things that Scott said at the beginning around, you know, the response of the community from panic and disbelief to to to you know complying I guess what social distancing can you each speak to? How do you think that dialogue needs to go with with the rural communities and listening to their concerns, but also kind of communicating the public health guidelines might can we start with you?
Yeah, thank you. I think there’s a lot of things that come to mind with just a couple minutes we have but what we’ve not done. Well, I think at a national level is really this whole idea of risk communication expressing what the risks are to everyone and the plethora of this information that’s out there that’s driven. Sometimes by people with legitimate concerns about their livelihoods, but other times people with nefarious intent is a real problem.
Elam and I think we need to really our leaders. I would hope would need to go back to the drawing board and look at risk communication. And that’s something I think that that our state government in West Virginia has done better. They’ve really gotten their message to the population. That’s what really can help inform good policy is having good information and without that we’re kind of lost.
Scott any thoughts about how you see the conversation going with your communities in the next coming weeks and months.
Yes, we have local newspapers that run the gamut of being very supportive of these measures that we’re taking to contain the virus to ones that are calling for the abolition of all of the measures and calling what’s happening a hoax and so we find ourselves often being asked to respond to that. And so we’re working with our Public Health Department.
We’re working with each other as health care entities to present a unified voice of science-based reason about why the things need to be the way they are I think beyond that we have to set a good example of practicing the very techniques that we’ve been advocating everyone else practice both each hospital but in our personal lives, and and I think again, it’s It’s more communication. The right kind of communication is better. And if you think you’re communicating enough you’re not so it’s just constantly making sure that you’re out there helping to reach those folks that either haven’t gotten the message or are skeptical of the message and helping them to understand what what what we really need from them.
Thanks, and Jacob will give you the last word as you look to the coming weeks and months. What are you looking for? As far as you know how to book help the populations in rural areas, but also kind of communicate the risks and the trajectory of the of the disease.
So this is kind of on everyone’s Minds right now didn’t in Georgia for anyone who’s been watching the news, you know that our tattoo parlors bowling alleys etcetera will be opening in two days. And that’s why Governor decreed that has overridden local ordinances. So there’s a lot of discussion now about the voice of rural communities in that process particularly given our Global outbreak. So the the case example is the in Dowry County.
We’ve had a hundred and three deaths among 88 thousand residents as opposed to That’s had a hundred and six desk for 1.8 million people and we were starting to Institute a one-size-fits-all approach within our Say by opening opening businesses in a staggered manner, but it does not allow for local control over that process. So I think it’s just really important to recognize we talk about it or do we have to George’s we have Metro Atlanta and they have rural Georgia and so it’s important to recognize that we’re probably going to need different strategies in this process and risk Communication in resumption of activities, and I think I’ll be really important for all states.
To keep that in mind that this needs to be driven by local data and local information and local municipalities Etc. Need to have a voice in the process of what they believe is in the best interest at their communities.
Well, thank you Jacob. And that’s a that’s a perfect segue into the next webinar in our series which will take place this Friday April 24th from 2 to 3 p.m. And we will talk about the surveillance infrastructure the testing and isolation surveillance infrastructure that is needed to safely reopen so Scott Michael Jacobs. Thank you so much to all of you for joining us to our audience. Thank you for staying with us and for listening and a record.
Of this webinar will be available at all Health policy dot-org very soon. We wish you all well and be safe and healthy and thanks again.
All right. This concludes the webinar 500.