Three Rivers Hospital in Brewster has not seen a confirmed case of COVID-19 yet, but the outbreak is having an impact on the hospital that threatens its survival.
The public hospital, which has operated on the financial edge for years, is seeing lower revenues due to a significant drop in the number of patients visiting the hospital. Under directions from Washington’s governor, hospitals around the state are postponing all non-urgent medical procedures and elective surgeries during the coronavirus outbreak. And social distancing requirements that are intended to slow the spread of the virus mean fewer people are coming into the hospital for non-emergency services.
At the same time, the hospital is preparing for the possibility of treating patients with COVID-19, which is creating additional expenses. As of Tuesday (March 31), Three Rivers Hospital had tested 11 patients for COVID-19. Six results were negative, and five are still pending, according to hospital officials.
The hospital’s emergency room normally cares for about a dozen patients a day. Recently the average census has been about seven patients a day, said Jennifer Best, business development coordinator at Three Rivers Hospital. That lower number means the hospital can’t break even on its emergency room costs, she said.
Scott Graham, chief executive officer of Three Rivers Hospital, began “sounding the alarm” last week about the impact of COVID-19 on his hospital and small rural hospitals across the country. He shared his concerns with Gov. Jay Inslee and the Washington State Hospital Association, as well as with the American Hospital Association during an online national press conference.
“With the social distancing that’s taking place and with the governor’s order on stopping elective surgeries, in effect it’s shut off the valve to patient care and our revenue,” Graham said in a video by the Washington Post.
“Over the last few years, we’ve been able to stabilize the hospital’s finances and even begun to grow a little, but we’ve been operating paycheck to paycheck,” Graham said in a press release last week. “I’m sounding the alarm now with the hope that we will be able to secure additional financial resources to weather this storm.”
Three Rivers Hospital got some welcome news soon after Graham began talking about its financial distress. The state provided a one-time allotment of $143,000 in emergency funds, enough to tide the hospital over for one more payroll cycle, which is two weeks, Graham said.
The Washington Health Care Authority recently announced additional funding from several sources that will be provided to Washington hospitals struggling to deal with the COVID-19 response.
“Our hospitals — particularly smaller and rural hospitals — provide a safety net for vulnerable populations, and we must ensure they remain financially viable as they respond to the COVID-19 pandemic,” said HCA Director Sue Birch.
The money that the HCA is making available is either new funding or expedited payment of existing funds. They include supplemental hospital payments to several rural health care facilities around the state, including Three Rivers Hospital, Mid-Valley Hospital in Omak, and Lake Chelan Hospital in Chelan. The payments come from the state Disaster Response Account.
The HCA will also expedite $46 million in “disproportionate share” payments to qualifying public hospitals and eligible low-income and small rural hospitals. Three Rivers Hospital has already received its payment under that program, which totaled $68,000, hospital officials said.
Payment of an additional $2 million in state hospital safety net funding will be accelerated for 19 Critical Access Hospitals. These are hospitals, like Three Rivers Hospital, that serve residents who would otherwise be a long distance from emergency care.
In addition, Washington state is working with Medicare and Medicaid to expand accelerated and advanced payment programs for health providers, including hospitals, during the public health emergency related to COVID-19. A $2 trillion coronavirus relief package passed by Congress last week is also expected to provide financial help to hospitals.
“We’re still working out the results of the advanced Medicare payment that we hope to receive this week, and we have not heard yet precisely how much we’ll receive from the federal relief package, or when,” Best said.
Graham said the $2 trillion rescue package will provide about $100 billion for hospitals around the country. “We’re trying to work with the state to put the pressure on and make sure that funding gets here in a reasonable amount of time to tide us over,” Graham said. “I’m checking in daily with the state — sometimes multiple times.”
Three Rivers Hospital is a public, nonprofit hospital that serves the largest geographic hospital district in Washington — an area of 2,500 square miles that includes the Methow Valley. About 15,000 people live in the district, Graham said.
For Three Rivers Hospital, the impact of COVID-19 comes at a time when the rural hospital is already facing a seasonal slowdown inpatient care. The Brewster facility is usually busiest in summer months with the influx of migrant workers who come to work for the region’s tree fruit growers, Best said.
“It caught us during a time of year that’s normally a little slower at our hospital,” she said. The social distancing restrictions have created additional financial hardship, forcing the hospital to delay the launch of two new programs for patients — an outpatient physical therapy program and new mammography services. Programs like these provide revenues for hospitals and “help offset the cost of having an emergency room,” Best said.
“We really trust and adhere to the idea that social isolation is needed,” Graham said. “But in our case, where the virus has not surged, it’s had the … effect of reducing the number of people coming to us for care, so that’s really restricted our revenue.”
Three Rivers Hospital has been making preparations for a possible surge in COVID-19 cases — assessing inventory of medical supplies and developing procedures to protect staff and patients, Graham said. Three Rivers Hospital is also working with other regional hospitals, particularly Confluence Health’s Central Washington Hospital in Wenatchee, to develop plans to transfer patients who need intensive care to those hospitals, and to move less critical patients to Three Rivers Hospital to alleviate the burden on larger hospitals caring for a surge of COVID-19 patients.
“As larger hospitals get more pinched for time and space and staff, they will shift their less critical patients to us,” Graham said.
Community members are stepping up to support their local hospital, sending donations of handmade masks and gowns, said Best. “And our general surgeon, Dr. Rosie Dhillon, received a donation of face shields from an acquaintance in Minnesota, where she completed training at the Mayo Clinic. We’re incredibly grateful for these donations and for the continuous support of our communities,” Best said.
Three Rivers Hospital announced new restrictions last week on visiting the hospital and strengthening screening for employees, patients and visitors. To reduce the risk of COVID-19 exposure to other patients, the new policy prohibits all visitors except for one parent or guardian for a pediatric patient under the age of 18, and two visitors at a time for patients on end-of-life care.
The hospital also requires all patients, employees and visitors to enter through the front lobby entrance or the emergency entrance and use an external phone located between two sets of entry doors to contact nursing staff inside hospital. A nurse or aide will come out to conduct a health screening before anyone is cleared to enter.
The policy is consistent with the Centers for Disease Control’s mitigation strategies to fight the spread of COVID-19, and similar policies have been implemented at hospitals around the country.