CEO Shane McGuire and his team at Dayton-based Columbia County Health System have successfully kept this rural network of two clinics and one hospital from the brink of closure over the last few years, but the coronavirus pandemic is threatening that work.
CCHS is operating at about 50% of its normal revenue, and patients who desperately need medical care are avoiding the hospital for fear of either being exposed to COVID-19 or burdening the health care system, McGuire reported this week.
The drop in regular hospital visits has led to eight patients being flown from Dayton General Hospital via Life Flight with severe issues in the past four weeks. Normally, McGuire said, they would fly no more than two in that time span.
The chief executive spoke to the U-B in March about his concerns regarding coronavirus and how the virus and related shutdowns could hurt the hospital’s own health and finances — now it’s becoming reality. Patient numbers have decreased, federal funding is lagging and funding models for rural hospitals haven’t been resolved.
“On a more ominous note,” McGuire said via email, “if we do not get permanent solutions in place, it could lead to health care wastelands and reduced regional resources that are absolutely necessary during a widespread, active pandemic.”
McGuire informed Columbia County leaders and residents in a Port of Columbia Economic Development Steering Committee meeting Tuesday of the dire situation.
The 50% loss of income is just one reason McGuire and the CCHS administration backed a decision Monday for a variance request from Gov. Jay Inslee’s office.
Columbia County was one of 10 rural counties Inslee listed that would be eligible to potentially move from Phase 1 of his economic reopening plan to Phase 2 on a faster timeline. The primary hospitals of those counties have to confirm the proper amounts of beds and personal protective equipment for the requests to be approved.
That formal request has jumped through its initial hoops on Columbia County’s level, and now the county, including staff at Dayton General, are awaiting the governor’s response.
“We started 2020 with great positive momentum from 2019 that this crisis really redirected,” McGuire said. “Within a few short weeks, we were in a worst-case scenario of high cost of operation, responding to the possible pending wave of COVID-19 patients, and running with very low volumes (of visitors).”
However, with only one person testing positive for COVID-19 on March 8, Dayton General has not seen that major wave, save for the 80-plus patients getting tested for coronavirus. There were some tests that took up to 12 days at first, but now tests are being turned around in about 24 hours, said Columbia County Public Health Administrator Marthan Lanman.
“I am confident that we can handle any outbreak that comes along,” Lanman said, in reference to getting the county up to a Phase 2 reopening. “As long as we stay within guidelines, that sets up some stepping stones for us moving forward. ... I sure don’t want to step backwards.”
McGuire said he thinks people saw closed doors and stop signs in front of the hospital and heard of long wait times for test results and this discouraged regular patients from visiting.
With a large number of residents over age 65 in the county, the hospital and its community are at a critical point in time. With fewer patients, there is less income, and with fewer visits, there are greater health hazards.
The spike in Life Flight transports at Dayton General tells McGuire that people are simply waiting too long to receive care, likely because they are afraid of multiple factors that aren’t actually issues at the rural hospital.
“From the community’s perspective, it likely looked threatening,” McGuire said of their COVID-19 precautions. “We have not really seen COVID-19 in our community, but we have seen cardiac events, sepsis and respiratory failure ...”
In his opinion, the uneven rollout of testing and the lack of widespread testing has led to a death rate that is likely estimated too high. Although, he admits, it is still a very lethal disease compared to most others.
Lanman said the severity of the disease can’t be underplayed.
“People need to understand that there are people on ventilators who are 20 years old,” Lanman said. “We don’t put people on ventilators for measles or chickenpox.”
Dayton General and Columbia County Public Health will be working closely together to monitor any potential outbreaks during a potential Phase 2 opening.
One question McGuire keeps fielding is about whether visitors from surrounding communities dashing to Dayton if the restrictions are lifted.
He said the local response from people in places like Dayton and Waitsburg has proven that they can handle other challenges the pandemic could throw their way during a throttled reopening.
“We are optimistic that we can open while remaining health conscientious,” McGuire said. “Just like before, it will take the efforts of the entire village to keep us healthy.”
However, even if Phase 2 does happen sooner for the county and things go well, there are long-term problems that need to be fixed before another crisis hits, McGuire said.
Funding from the CARES — or Coronavirus Aid, Relief and Economic Securities — Act has been delayed — very delayed.
The first round of CARES Act funding came through, but that only helps float what was already lost, not the here-and-now. McGuire said they are eager for Round 2 of funding and another small amount after that, but he has no clue who he can talk to about getting that money.
CCHS has received Medicare funds through the Accelerated and Advance Payment Program, but this is a loan with a very high interest rate if it’s not paid back within a year.
“None of these are really solutions to the problem of funding rural health, which was already in a state of failure before COVID-19,” McGuire said.
McGuire knows of 128 rural hospitals that have shut their doors for good since 2010.
The U-B ran a series focused on Dayton General Hospital in 2018 that laid out its uphill battle and how McGuire, the administration and hospital district board of directors were able to handle it.
Some of the problems McGuire mentioned in those pieces still exist, and fuel is only being added to the fire during the pandemic.
Currently, Washington ranks second-to-last among all 50 states when it comes to federal funding for hospitals, despite being No. 13 in population, according to data from the Washington State Hospital Association.
The state ranks 46th in Medicare disbursements.
McGuire says Dayton General is not in danger of closing in the immediate future, but there are long-term problems not being addressed.
“We’ve seen several instances both nationally and globally of overwhelmed healthcare systems where emergency standards of care had to be implemented making for very tough decisions for medical staff,” McGuire said. “Rural health is not just healthcare for their immediate community, it is a part of the regional response.”
But if some rural hospitals can’t recover financially, it could paint a picture of those health care “wastelands,” where someone with COVID-19 would have to leave home and drive miles and miles to another city in hopes of getting testing and treatment.
It’s not a pretty picture, but it’s a necessary one to paint, McGuire said.
“If (coronavirus) exposed the vulnerability of our national rural health and public health systems, which leads to some solutions to shore them up, then that will be good.”