COVID-19 stretches rural health safety net

While hospital beds are filling up across the country, rural hospitals have felt the brunt of the latest COVID-19 surge, new research shows.

About 40% of adult hospitalizations at rural hospitals were COVID-19 related as of Nov. 27, up from a median of 28% in late July, Chartis Center for Rural Health’s analysis of HHS data shows. The share of COVID-related hospitalizations at urban hospitals increased from 14% to 23% over that span.

Rural hospitals typically lack the capacity, equipment and staffing to best manage acute cases. There is one ICU bed for every 9,500 Americans who live in rural communities, where intensive care beds are hard to come by. Nearly two-thirds of rural hospitals don’t have any ICU beds, Chartis data show.

Of those that have ICU beds, 82% were occupied as of late November, up from 73% in August, according to its updated research. Many patients have had to be transported to metro areas, where capacities are similarly strained, said Michael Topchik, the national leader for Chartis.

“Rural patients are flooding their community ERs and hospitals, a portion of whom have to be moved to larger facilities that are not really in any position to take additional patients,” he said. “This is not just a rural problem, this is everyone’s problem.”

Arizona has the fewest ICU beds available at 95% capacity, with Oklahoma, Florida, Tennessee and Louisiana all above 90% capacity, according to the latest HHS data.

“It only takes one or two critically ill families to completely swamp a rural facility’s capacity,” Dr. Roger Ray, a physician consulting director at Chartis, told Modern Healthcare in April.

While COVID-19 stimulus funding has helped keep rural hospitals afloat, many—particularly in the South—have had to pare down services or close. More than three-quarters of rural hospitals’ revenue stems from outpatient settings, which were idled for several stints this year as non-urgent procedures were delayed or canceled, Chartis found.

Seventeen rural hospitals have closed so far this year—the second-highest annual mark since 2010, according to the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

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