Texas rural and community hospitals can help Texas address COVID19 Crisis

Published 6:52 pm Saturday, March 28, 2020

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As Texas, like the rest of the country, comes to grips with the likelihood that the COVID19 pandemic means most communities will face overwhelming demand on our healthcare delivery system, state leaders should consider utilizing a long-neglected asset to help address the crisis. Texas rural and community hospitals are ready and capable of being a valuable contributor to the state’s response to the Coronavirus crisis.

Governor Abbott said as much in his Sunday press conference, noting the role that Texas rural hospitals could and should play in addressing the coming pandemic as the state sent out its all-hands-on-deck call. But for rural and community hospitals to contribute fully, the state must make plays today to include them in the contingency funding plans being put in place for an anticipated shortage of hospital capacity in the next 30 or 60 days.

Texas’ 157 rural hospitals have a licensed capacity of 7,500 hospital beds – although licensed capacity and actual beds aren’t always the same thing. Typically, these hospitals operate at only about 20 percent of capacity. So, if rural hospital beds are needed to be utilized for urban overflow, that could mean another 5,000 available beds.

But cash-strapped rural hospitals are already at their limits because of financial strain that was occurring long before COVID19. Staffing and supplies deficiencies, almost always an issue for rural healthcare providers in the best of times, have only been exacerbated by the current crisis and the near-record influenza season that preceded it Like everyone else, we are seeing an acute shortage in masks, gowns, gloves and other supplies. Additionally, the clearing of elective procedures in anticipation of surge leaves rural community hospitals without revenue, and many are scrambling to meet the current payroll cycle. 

With minimal COVID19 issues or a current patient surge in Texas rural areas, we have a small window to prepare for the coming surge – assuming the supply chain catches up. The conventional wisdom, at least today, is that any patient surge in rural areas will be 10 to 14 days behind urban areas. But to be braced for the surge, our rural and community hospitals need financial assistance right now. For decades rural health has been suffering from financial neglect and underpayments from insurance, Medicaid, and Medicare. Let’s not make that mistake now when we’ll need every single available hospital bed in the state available in the coming months.

There are other issues to consider, not the least of which is the impact of self-quarantines and school-closings, which can have the unintended consequence of crippling our workforce when nurses and other employees have to stay home to care for school-age children. Or the shortage of rural ICU beds and ventilators in the event urban hospitals fill and can’t accept critically ill transfers. 

But here’s the good news. We have over a hundred well-equipped hospital facilities that are staffed by talented, caring professional healthcare providers. Our nurses, doctors, therapists, and aides have a wealth of experience working in hospitals of all sizes. The people who make up our rural and community hospitals have always been a vital asset to their communities – they can be just as valuable to the state’s overall response to the COVID19 crisis.

Among our 157 hospitals, we have many contributions to make. Our member hospitals can help with everything from testing to treatment as we face this unprecedented challenge. Yes, it’ll cost money and it will require a financial commitment from the state and the federal government. We can’t afford to let the workforce in rural Texas that produces the food, fuel, and fiber for the state and nation to be left behind with less care than the consumers in the urban areas. If Texas doesn’t take advantage of the existing resource of its rural hospitals and provide some immediate financial stability, it will cost far more.


John Henderson is CEO and President of the Texas Organization of Rural & Community Hospitals