Just a month ago when the coronavirus struck Alabama, medical facilities lost elective procedures to save resources for COVID-19 patients but soon the pandemic revealed a diamond in the rough.
The downfall of such measures as the pandemic unfolded meant loss of profit centers and declining revenues in other healthcare operations. Mike Bruce, CEO of Ivy Creek operating 13 healthcare clinics and hospitals in Dadeville and Wetumpka, said revenue in the clinics had fallen 50% and the only profit centers with insurance reimbursement is elective procedures. The fallout forced drastic measures.
“The only profit centers we have in rural hospitals anymore is in elective procedures,” Bruce said. “Frankly that was part of the need to lay people off. You can’t have 10 nurses sitting here that were specialized in elective surgery and not having any business. A month ago with the impact, patients needed to stay home, and rightfully so. It directly impacted us with revenue. I implemented a 20% cut across the board for our staff which has been extremely painful. Employees went to 32-hour work weeks. ”
Just as things were getting bad, Bruce said rural hospitals came up with a plan to serve an ailing public without patients seeking help in large medical centers. The first positive cases of COVID-19 were starting to appear in long-term care facilities.
“About three weeks ago, nursing homes reached out to me telling me the dilemma they were in as far as residents,” Bruce said. “We discussed how rural hospitals could fill that niche. They were struggling with residents who were COVID positive and symptomatic.”
Instead of transporting nursing home residents an hour or more away, Ivy Creek’s two hospitals found a solution to help stop the spread of the coronavirus in nursing homes while caring for the aging residents who tested positive.
“We started taking patients about that same time,” Bruce said. “It was helpful from both sides. We were treating patients that were sick and nursing homes were trying to avoid spreading to the rest of the population they had. We have been able to take and improve their health conditions with the understanding we are better suited to transfer those patients to ICU facilities if needed.”
Bruce said as his hospitals saw empty beds, an opportunity arose.
“We have the space available to allow for isolation and better treatment and care,” Bruce said. “When the patient comes in, the work required for COVID patients is so much more. The nursing homes were getting overwhelmed. We can treat them for the acute care setting and get better services that fit the real niche rural hospitals can fill.”
It started with just a few patients but has grown.
“We have been doing that progressively for the last three weeks,” Bruce said. “We are still taking patients (Friday).”
The influx of patients created a need for staff Bruce had to lay off just a couple weeks ago.
“The employees that have had to be laid off or reduced hours, we have been able to bring them into the hospital setting and get them back to work,” Bruce said.
The staff wasn’t new to Ivy Creek and its facilities.
“They were already on staff working in clinics, home health or hospice before,” Bruce said. “For example, in hospice, some of the nursing homes wanted to limit the number of people coming into their facilities. Hospice nurses who were not able to go see their patients in the nursing home were able to come into the hospital and treat those patients and treat new patients in the ER and the COVID wing.”
The patients Ivy Creek has been treating at Lake Martin Community Hospital and Elmore Community Hospital mostly needed to be treated in a hospital setting to start with.
“Especially in the beginning, 90% met inpatient criteria of regular acute care admission,” Bruce said. “There were a lot of comorbidities tied to those patients. They needed additional acute care as East Alabama (Medical Center) and Montgomery were battling the epidemic.”
Bruce said those COVID-19 positive residents really needed medical treatment to start with and have greatly improved.
“Most of the patients that have come in so far have needed acute care services first,” Bruce said. “We have gotten them where they are asymptomatic and now we are treating them for the skilled nursing services.”
The issue moving forward comes as the recovering patient needs to move from acute care to skilled nursing. Centers for Medicare and Medicaid (CMS) handle licenses for rural hospitals to have multipurpose beds.
“We are working on a swing bed waiver with CMS to get it,” Bruce said. “It’s a great example where rural hospitals found a niche of value. I’m hoping this will translate to when the immediate crisis dies down a little bit, I’m hoping rural hospitals will be remembered for their contributions to help funding to get to a level we really need.”
Alabama Nursing Home Association director of communications John Matson said Ivy Creek’s service to nursing homes is unique for now.
“It’s a smart use of facilities,” Matson said. “It is great coordination of available medical options in the area.”
Matson said nursing home staff keeps patients in mind before doing anything.
“You have to make the best decisions you can for the residents,” Matson said. “If someone tests positive for COVID-19, you make sure they can be transported first before making the move.”
Bruce said his staff deserves all the credit for the success in caring for COVID-19 patients.
“I can’t say enough of how people wanted to jump in and help,” Bruce said. “Nurses are the backbone of rural hospitals. Especially nurses aides, they became essential. The housekeepers, they were willing to go into the rooms and work and take care of the patients. The ambulance (staff), they are the frontl ines taking care of patients.”
Bruce credits staff and emergency management agency directors Keith Barnett in Elmore County and Jason Moran in Tallapoosa County for helping locate supplies in the crisis.
“We had kind of gotten short wondering where supplies were going to come from,” Bruce said. “Both EMA directors have been exceptional in helping us find ways to get through this.”
One thing has sort of surprised Bruce in serving COVID-19 positive patients.
“Not one of the more than 400 staff we have has gotten positive COVID labs,” Bruce said. “It’s a credit to our staff to get the supplies, the training they went through and it started a long time before this started. We were well prepared for it.”
The ability to change course on a dime seems daunting for a medical institution for someone looking in from the outside. Bruce said it is what rural hospitals do best.
“We have had to find ways to adapt throughout the years and adapt quickly,” Bruce said. “I can’t take credit for this. Lots of credit needs to go to a lot of people. It’s what we trained for.”