Federal funding helps to alleviate COVID-19 strain on rural hospital and clinic finances through pandemic shutdown across the Heart of Texas
CLIFTON – The hospital halls are empty – no patients, no visitors, no support staff. Instead of the regular daily hustle and bustle from the influx of potential patients, the clinic waiting room remains empty; the hospital halls stand eerily quiet.
Income from normal operations came to a grinding halt while expenses soared in order to prepare and stand ready for communities as the novel coronavirus COVID pandemic crisis gripped us all. In the meantime, Bosque County Hospital District ’s Goodall-Witcher Healthcare continues to do everything it can to keep staff on payroll and comply with state and federal mandates.
For many other rural hospitals like Goodall-Witcher, receiving federal aid does not represent an added bonus, it proves to be an absolute necessity.
Just when walk-in clinic numbers, added elective surgical procedures, new specialists appointments, and increase in patients for pre-natal care and child birth were showing success making March look like a potentially positive month financially, the COVID-19 mitigation protocols hit.
“Who would have thought that a virus would shut down healthcare?” Goodall-Witcher Healthcare President and CEO Adam Willmann said in an interview with Chisholm Country on May 7. “There has not been a service line that hasn’t taken a hit. Some were hit 100 percent, like cardiac rehab, pulmonary rehab and stress tests. We completely shut those service lines down. The operating room has taken a huge hit. And everything else trickles down.”
But babies are still being born, people still suffer heart attacks or get crushed by a hay bale. So well before social distancing was in place, the local healthcare facility started dealing with the possible impact of COVID-19 on different levels.
While keeping vital services available for the community, Goodall-Witcher Healthcare stocked up on N-95 face masks and sanitizing hand gel on the basics level, they secured supply chains for testing kits and other essentials, they started testing possible COVID-19 cases off premises in a camper trailer, all while keeping the public informed every step of the way. While just naming a few measures taken, all of the additional mandates, protocols and procedures cost extra money.
GETTING FINANCIAL ASSISTANCE
On April 24, the Bosque County Hospital District administration finally heard that they were eligible to enroll in the Payroll Protection Plan through the Small Business Administration under the CARES Act. Before that date, two-thirds of Texas hospitals did not qualify.
“This is wonderful news for GWH and all public healthcare institutions that were left out the first round,” Willmann said. “Not to be too political but we must send a ‘Thank you!’ to Congressman Roger Williams for working hard and supporting us to be in this program.”
The Payroll Protection Plan relieves a lot of the payroll financial burden for the next eight weeks.
“We fought for that because the biggest expense is payroll,” Willmann said “We’ve had to reduce our operations by limiting our elective procedures, in the operation room and everywhere else. So our operations took a 55 percent decrease in revenue from February to April.
“We have never needed to furlough or lay off any of our employees. Our goal was to take care of everybody and put them in a place where they were needed.”
For example, when the Goodall-Witcher Fitness & Wellness Center closed to the public, its manager Ratonia McClement went to work screening visitors to the clinic and hospital facility. To remain available for the public, the Business Office was relocated in the fitness center and hospice office personnel were moved to the former Windmill Café. Temporarily relaxed regulations opened up the path to offering telemedicine for around 100 patient visits per week.
The 25-bed, critical access hospital also received $950,000 through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, in which U.S. Congressman Roger Williams (R-TX25) was also instrumental.
Initially, the CARES Act allocated $10 billion to rural community hospitals and clinics in underserved areas nationwide. An additional $165 million was added April 17. These grants allow hospitals maximum flexibility in responding to COVID-19, including testing and laboratory services, along with the purchase of personal protective equipment (PPE) for employees.
“Our rural health providers give essential care to communities across the 25th District,” Rep. Williams said. “Due to the COVID-19 pandemic and the catastrophic challenges these hospitals are facing financially, it is crucial we provide assistance at the federal level so they are able to continue serving Texans.
“I was proud to support the CARES Act in Congress giving hospitals maximum flexibility in determining what fits their needs best to most effectively serve their patients. I will keep working with my colleagues and the Administration to ensure they are equipped with the resources needed to provide lifesaving care to our families.”
Another $84,317 grant issued by the United States Department of Health and Human Services through the Health Resources and Services Administration is to provide direct support and funding to combat COVID-19. Goodall-Witcher Healthcare represents one of the 130 rural hospitals receiving this additional funding.
The funding is provided by the federal Small Rural Hospital Improvement Program under the Department of Health and Human Services. The much-needed emergency funding will ease the financial burden local healthcare facilities face as the pandemic continues. Rural hospitals are often the only critical care option for Texans in these communities.
“This money is a lifeline for our rural hospitals and the folks who depend on their medical care,” said Commissioner Sid Miller of the Texas Department of Agriculture. “Many of these hospitals have only weeks of funding left and this money will make a huge impact their financial survival. It’s not all they need, but it’s what they need right now.
“Rural hospitals are a vital part of the healthcare capacity for Texas and we’ve got to keep them open. I want to keep the door open to rural hospitals today, tomorrow and forever.”
EPICENTER OF THE COUNTY
Like many rural healthcare facilities, the Goodall-Witcher Healthcare hospital and clinic serves as the epicenter of Bosque County, in no small part due to being the county’s largest employer.
“It would leave just a big black hole here,” Goodall-Witcher Healthcare Auxiliary volunteer receptionist and regular clinic visitor Sue Fielden said in a recent interview celebrating 30 years of Texas Organization for Rural and Community (TORCH) hospitals. “Because of the medical care, because of the people who work here, and contribute to this community in many ways.”
Both Sue and her departed husband Sherrod Fielden survived critical medical issues thanks to the local Emergency Room at Goodall-Witcher Healthcare. They were able to be stabilized before being transported to special care units in larger regional hospitals.
There are many testimonials like these, of grateful patients. On the flip side, ask any manager, doctor or employee at Goodall-Witcher – they will do everything in their power to keep the doors open for their patients, their community.
Whereas the CARES Act funding will go towards mitigating revenue losses, the SORH grant will go towards practical matters like purchasing laboratory supplies, test kits, K-95 medical masks and equipment. An emergency room ultrasound machine was purchased which helpful in diagnosing secondary effects of COVID-19 right now and will be helpful with diagnoses of other diseases in the future.
Both financial grants will help the Goodall-Witcher Healthcare system weather the COVID-19 storm.
MAKING THE NEED KNOWN
The National Public Radio’s podcast “The Indicator from Planet Money” regarding the economic impact of the COVID-19 pandemic on Texas rural hospitals interviewed Willmann recently.
Willmann said Goodall-Witcher is “hanging on for now,” but the bottom line is starting to get pretty bleak. The hospital has reached out to suppliers to negotiate payment grace periods.
“Do you go out and spend $20,000 on N-95 masks, or do you keep that $20,000 so you can meet payroll in two to three weeks?” Willmann said illustrating the decisions he, his management and board face.
Willmann also explained the Catch-22 the hospital finds itself in. Not having COVID-19 patients as yet is both blessing, and a negative thing for the hospital. Because more CARES act reimbursement goes to hospitals actually dealing with COVID-19 patients.
“I’m here waiting for patients, praying we don’t have any, because you don’t want to wish this on anybody,” Willmann said in the interview. “But we are not getting any additional reimbursements for taking care of those patients. So, where do you go with it?”
In another interview with Cerner, Willmann also talked about the unique challenges facing the Bosque County hospital. Cerner is the healthcare facility’s information technology partner.
“We’re the only health care facility for Bosque County’s 18,000 residents, and we only have two ventilators,” Willmann said. “So if we don't follow the social distancing guidelines, we’ll be overwhelmed. We’re an older community with a lot of retirees in that high-risk category. I’ve been frank with them, saying, ‘You stay home. If you need something from the grocery store, call me.’
“Not all our employees have a strong internet signal at their home, so we have to find alternate sites for those team members to safely complete their work. We have unique challenges, but we also have a unique community that’s willing to step up and help each other.”
APPRECIATION FOR THE RESPONSE
Willmann is highly appreciative of the immense support by the community, and the support by local government.
“We’re all making our decision based upon the information we have,” Willmann said. “We’ve worked closely with our county government throughout this time, and we are seeing the fruits of our labor. Not from over-reacting but doing what needed to be done to take care of each other.”
Some examples of the community helping out “their hospital” are the cloth masks individuals and groups are making to use over the N-95 masks to help keep them clean; receiving meals from community members and local restaurants because the hospital cafe is closed, and local hotels providing rooms for staff members to give them a place to shower, relax and sleep after their shifts instead of going home and possibly spreading the virus to their families.
Willmann is highly appreciative of his staff during this emotional and physical roller coaster.
“We are so fortunate with our staff,” Willmann said. “They have taken this in stride. I know everybody is worried, including myself at times, about the ‘what ifs,’ ‘is today the day?’ ‘what’s going to happen if they come in?’ There is a lot of emotional stress. I’ve always said our staff is the best, but it is amazing to see them change, and take this and show up to work every day, ready to do what is necessary to take care of our patients and our community. Goodall-Witcher would not be prepared the way we are, if it wasn’t for the amazing staff we have.”
CHALLENGING TIMES FOR FAMILIES TOO
And last but definitely not least, Willmann sees the invaluable support of his wife, Heather. They are a family, like many families, weathering this storm, adapting to the “new normal the best they can.
While Willmann pitches in every now and then, Heather doing her job from home and homeschooling their two young sons has given him the leeway to come into work every day to deal with the complicated world of healthcare facility management in the COVID-19 battleground.
PREPARING FOR WHAT LIES AHEAD
Now, as Texas reopens to business with more people congregating together again, the hospital and clinic staff brace for a surge in cases. And the administration has sleepless nights, wondering how long fragile financial card house can hold up.
Bosque County has a relatively isolated position in Central Texas. Opening up the state meant, opening up Bosque County to people from other areas enjoying the countryside, Meridian State Park, Lake Whitney. There are concerns that the decision to open up Texas will impact the county’s current “low cases” status.
Willmann trusts data that federal and state experts relied on when making their decisions regarding the next steps in the COVID-19 battle. And he stressed that the situation remains fluid, and the course of action can change within the hour.
The virus has an incubation time of anywhere between five and 14 days.
“If our case level stays the same across the nation or across Texas – where we still will have positives but we don’t have a huge spike in them – then I think ultimately it was a decent decision. On May 15th, we can start casting the stones on the decision making. I hope and trust in good faith that we’re on a good path.”
Willmann and the Bosque County Hospital District board continue to follow the Centers for Disease Control and Prevention (CDC) recommendations and Texas Governor Abbott’s orders, making sure the guidelines are followed and putting the protections in place for employees and the citizens of Bosque County.
“I have a higher person to answer to, my grandmother and my mom,” Willmann said jokingly as his grandmother resides in the Goodall-Witcher Nursing Facility. “So ultimately, we are doing the best we can. And I think we’ve done an excellent job with taking the information we have, deciphering that, putting in the resources we have.”
BEGINNING THE REOPENING PROCESS
As restrictions related to COVID-19 were relaxed across the state May 1, the Bosque County Hospital District began carefully resuming “non-essential” healthcare in a manner that balances the safety of their staff, patients, and community, with the realization that many procedures and visits that are for wellness purposes and “elective” reasons are essential to the long-term health of their patients.
The Goodall-Witcher Healthcare clinics in Clifton and Whitney began scheduling appointments while following policies to protect the patients during their visits until further notice:
- No visitors are allowed in the nursing home or hospital.
- Each patient, visitor and employees entering any parts of the facility will be screened – their temperature will be taken and they will be required to fill out a questionnaire.
- Patients and visitors will be required to wear masks within the facility. If they do not have their own, they will be provided with one at the screening station.
- Social distancing of at least six feet among people not living within the same household will be required in all areas, including waiting rooms. In the event that delays have resulted in too many patients in a waiting room at one time to practice effective social distancing, patients will be asked to wait in their vehicles until they are called.
- Chairs in waiting rooms and common areas will be disinfected each time they are vacated. Frequently touched surfaces in these areas such as tables and hand rails will be disinfected at least every hour.
But until the COVID-19 health scare has subsided, rural hospitals like Goodall-Witcher will be sitting in the COVID-19 waiting room, anxiously biting their nails, hoping for good news, but fearing the worst.
Will the financial aid be enough to help them through this period of heightened alert and preparedness and stress on the resources? Or will the economic impact lead to extreme cutting of costs, including laying off personnel and even hospital closure?
“After the eight weeks, then we’ll see,” Willmann said. “Hopefully, we’ll be back to business.”
Photos by SIMONE WICHERS-VOSS & BRETT VOSS
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