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by Brenda Grose
Covid 19–the impact and Ringgold County Hospital and Mount Ayr Medical Clinic’s response and preparedness—were the points of discussion outlined at the RCH board of trustee meeting, held Monday, April 20.
Within one week, in response to the Covid 19 pandemic, Ringgold County Hospital administration and staff were able to develop and put into place, procedural changes, policy changes and changes to the physical set up of patient rooms, creating a specific area reserved for Covid 19 patients, as well as informing and training staff in new procedures.
RCH administrator Gordon Winkler outlined the hospital’s newly created “surge” plan, in order to be prepared for a potential surge in Covid 19 patients needing different levels of care. The hospital identified six levels of care with the following responses for each need identified.
• Level 1 – Transfer COVID-19 patients requiring hospitalization to MercyOne or Unity Pointe Des Moines dependent on capacity.
• Level 2 – Admit patients to RCH respiratory care unit with five beds. Rooms 158, 157, 156, 155, and negative pressure room 154.
• Level 3 – Hold patients in three COVID-19 rooms 159, 160, 161.
• Level 4 – Utilize eight rooms in non-infectious patient unit – rooms 102, 106, 108, 109, 111, 112 and 151.
• Level 5 – Overflow into five OR pre/post surgery bays. Non-infectious patients first.
• Level 6 – PACU beds.
• Level 7 – Acquire costs through county Emergency Management Coordinator to set up in four visiting physician clinic exam rooms.
The maximum patient number for the 16 bed hospital would be 26 when utilizing the additional spaces. In administrator Gordon Winkler’s words, “We have lots of things in place that we hope to never have to use.”
Nursing and med students are no longer doing clinicals in the hospital and patient visitor restrictions have been tightened. Kathy Schuster, director of nursing, stated the hospital does not allow any patients visitors with the exception of one parent allowed to be present with a minor child and flexible restrictions on visitors for patients with end of life care.
Visiting physician clinics have also been suspended for now with the exception of treatment for cancer patients and urgent orthopedic visits. Senior Life Solutions program continues to follow up with patients through regular interaction via Zoom as possibilities are sorted through to continue patient care in this program.
As has been reported, Ringgold County Hospital did receive a call from the State Hygienics Lab, Monday, April 13, asking if RCH would consider receipt of the 15 minute rapid response test for Covid 19. On Wednesday, April 15, the test instrument was received; however, the test was received with the agreement that it was to be used to perform testing for long term care, assisted living and nursing home residents – high priority cases – and not for use in the general population screening at this time.
On the clinic side of things, patient visits have also changed. Patients are screened upon presentation to the clinic and then roomed accordingly as either Covid 19 risk or non Covid 19 risk. Many routine clinic visits are now being held via tele-health, in the parking lot and curbside as well as traditional in-clinic visits, as care providers strive to meet the needs of their patients while working within state and national recommendations. Staff at MAMC have also changed scheduling times to avoid mixing healthy, regular checkups and routine health care with those who are sick. Mornings are reserved for the routine and regular appointments and afternoons are set aside for care providers to see patients who are sick. Nursing home visits are also mostly done through tele-health. A new requirement as of Tuesday, April 21, will be masks to be worn while at work for all hospital and clinic employees.
With regard to the supply of personal protective equipment, Winkler stated with the help of emergency response coordinator, Mel Burton, RCH and MAMC have received 3-4 deliveries from the National Guard. Additionally local residents have responded to the call for masks and have provided handmade masks for use at both facilities. Known contributors to the mask effort include: Taylor Greene, Meredith Dredge, Fran Rouse, Linda Huntsman, LaDonna Prime, Barb Vaal, Jeannine Greene and daughters, Shayna Mason and Shayla Collier.
While RCH and MAMC have responded quickly and efficiently to the task of being “Covid 19 prepared” to care for potential patients—the financial picture for this past month tells the same economic story being felt nationwide. With the loss of visiting physician clinics and elective surgeries and fewer patient visits, all related to the Covid 19 pandemic, the hospital experienced a nearly 18% drop in revenue compared to March 2019. Missy Walter, chief financial officer, explained the month, stating, “We started off strong, Covid hit and things fell off from there.”
With a $254, 000 loss for the month and a $246,000 loss year-to-date, according to Walter, “it will be a rough road going forward until the end of the year.”
However, Walter also shared several avenues being explored to lessen the financial impact by taking advantage of current options provided through the Cares Act/Stimulus bill and other strategies.
Under the Cares Act, $100 billion was released with $30 billion targeted for Department of Health and Human Services. Ringgold County Hospital received $735,000 on April 10. This money does not need to be repaid and will be treated as deferred revenue.
Ringgold County Hospital applied for the HRSA SHIP Grant which would provide approximately $90,000 to each facility. This money is expected to be received in 2-4 weeks.
Medicare accelerated payments approved $5 million for the hospital based on out patient, in patient and swing bed numbers. This payment provides an accelerated payment of 125% of a six month cost report. This money must be fully repaid within 7 months. If not paid within the 7 months, a demand letter will be received from Medicare with 30 days allowed for full payment. If full payment is not possible at that point, Medicare will begin charging interest on the unpaid amount at interest rates that could reach 10%. This money will be placed in a separate banking account and used only if absolutely necessary.
A Small Business Administration paycheck protection plan also offered under the stimulus funds has been applied for and denied based on stipulations and definition of eligible small businesses. With recent explanation and/or changes to eligibility a second application for funds will be made. If approved, this plan could provide 8 weeks of payroll expense, or approximately $2 million. Seventy-five percent of the money must be used for payroll expense and the additional 25% can be used for bond payments and utility expenses. If the money is not used as indicated it must be repaid within one year at 1% interest.
Loan deferments have also been explored with both the USDA and Great Western Bank.
$3300 was received for supplies and expenses through a grant through the Iowa Hospital Association.
Additional impact to the hospital and clinic included the current hiring freeze, possible reduction in hours, and possible furlough of employees in the near future. Winkler indicated no layoffs have occurred at this point, but it most likely is coming. Winkler added administration will first look at reduction of hours, will continue to provide benefits for furloughed employees and will look at defining how PTO (paid time off) may be used.
Construction and expansion are on hold at this time, however the state required pharmacy remodel is still within a waiver for completion extended to April 2021. If an additional waiver is needed, that will not be approved until 90 days prior to the existing extension waiver.
With many things put into place in a short amount of time, Ringgold County Hospital and Mount Ayr Medical Clinic feel prepared to provide care for a possible surge due to Covid 19, however, short term and long term financial relief, billing processes for the now more common tele-health visits and other questions remain in the ever changing landscape of life within the pandemic created by Covid 19.