St. Claire Regional Medical Center in Morehead, Kentucky. (Source: Facebook)

At one point during the pandemic, St. Claire Regional HealthCare system in Morehead, Kentucky, had four temporary ICU units outside its main hospital to help with the surge of people needing care for Covid-19. Like other rural hospitals, St. Claire Regional had to adapt to handle the influx of patients, CEO Donald Lloyd said.

Now, as the world returns to something that resembles a pre-pandemic normal, some of those changes will stay, he said. In other cases, the pandemic’s lessons will continue to affect the hospital’s operations.

During the height of the Omicron surge, Lloyd said in an interview with the Daily Yonder, St. Claire regional had more than 160 Covid patients at one time. Recently, in mid-May, the hospital had no Covid patients for the first time in more than two years. 

Covid “hot zones” have gone away, and things are returning to normal, Lloyd said. The temporary ICU tents have been packed away, ready for the next emergency, he said.

“I think one of the biggest lessons we learned was that we need to be more flexible and adapt more quickly,” Lloyd said. “We had to learn how to be nimble and how to be innovative, and gained the ability to develop, test, and implement procedures quickly.”

Another shift that will likely stay, he said, was reliance on telehealth. Before the pandemic, telehealth visits weren’t common at his hospital. Now telehealth visits account for nearly 20% of hospital visits.

Some specialties, like surgery, he said, have very low rates of telehealth use (for surgery, it’s 8%). But in others, the numbers are staggering. More than 80% of behavioral health visits are via telehealth, he said.

“Overall, of our 350,000 clinic visits per year, 18% are via telemedicine,” he said.

Telehealth is more convenient for rural residents who might have transportation issues, but it helps with rural hospitals’ labor shortage as well, he said.

But who will pay for that once the public health emergency ends is still up in the air. While legislation ensured those visits would be covered the same as an office visit during the pandemic, now many insurers are opting to pay less for telehealth visits, while healthcare professionals are lobbying for them to be treated the same as an office visit. 

At the start of the pandemic, when hospitals were forced to shut down some services, St. Claire offered patients the option of coming to the hospital and using the hospital’s tablets and smartphones, as well as its WiFi, to connect to telehealth appointments. But those services, he said, are not as needed anymore.

“We do offer that as an option,” he said. “But the patients themselves, now that they feel safe, are migrating back to in-person visits.”

Brock Slabach, COO of the National Rural Health Association, said rural hospitals are now evaluating procedural changes in anticipation of the end of the state of emergency that was declared by the federal government at the beginning of the pandemic.

Procedures like checking temperatures for visitors before allowing them to enter the hospital are labor intensive and most likely will go away when the public health emergency ends, freeing up labor for other things.

Now, he said, rural hospitals are looking for Congress to act in order to allow them to maintain the flexibility granted during the pandemic that helped them stay above water financially.

“Those flexibilities were a real godsend for many facilities, especially early in the pandemic, but all of those flexibilities for rural providers are expiring at the end of the [public health emergency].”

Additionally, work is being done to ensure that telehealth visits continue to be covered by insurance and Medicare/Medicaid.

One of the lessons learned from the pandemic, Slabach said, was the diverse effects Covid had on different communities – particularly those of color. Investigations into social determinants of health and how to address those inequalities will continue, he said.

The pandemic also pointed out how important rural hospitals are to the healthcare landscape, he said. The healthcare system came very close to exceeding its capacity to care for severely ill Covid-19 patients. Because rural hospitals were able to care for some highly acute patients, they were able to prevent those patients from being transferred, releasing some of the burden on urban hospitals in the midst of capacity issues.

“Rural hospitals played an integral and important part in making sure that we had enough care for patients nationwide,” he said. “Now that the pandemic is easing and maybe one day will be over, I hope that we don’t put rural hospitals back on the back burner and underfund them and continue to… not value them as important parts of the healthcare system in times of disaster or pandemic.”

The pandemic also brought to light the value of healthcare workers and their resiliency, Lloyd said.

“One of the big positives that has come from this very unfortunate thing is a recognition of the resiliency of our workforce,” he said. “We have to be more cognizant of the impact that so much trauma has on our healthcare workers. Those doctors and nurses train to deal with death, but I don’t think anyone has trained for a disaster that has lasted for more than two years.”

While Covid seems to be waning, he said, hospital administrators and healthcare workers are looking at what happened in order to be ready for the next disaster.

“We’ve been fooled four times now,” Lloyd said. “Every time we think this is the end, we see another variant that just surges. We’ve been through five now.”

But each time, he said, healthcare professionals and healthcare facilities have learned from the experience and moved forward. The focus now is on preparing for the next disaster.

“I think we’re better prepared now,” he said. “And we continue in our preparations for the next emergency. We’ve gotten better and better every time.”

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