Why Rural Health Clinics Are Cutting Staff, Services Amid COVID-19 Outbreak

If someone gets sick in a seven county swath of the Ozarks of southeastern Missouri, the closest place they can go for care is a clinic run by Missouri Highlands Health Care. Highlands operates in some of the least populated and poorest counties in the state. Now, it’s cutting back.

“We just shuttered our dental clinic. We have three of them operating throughout the organization plus a mobile dental," says Highlands CEO Karen White. She says dental care, a major source of revenue, is now restricted to emergency procedures.

She’s had to furlough 20 employees so far — about 10 percent of the staff. And she reduced hours for many others.

“We have several who are single parents. That’s not a decision that comes lightly," White says. "Because you do know that a lot of times ... you are truly affecting the economic outcome of that family unit."

There have been about a dozen confirmed COVID-19 cases in the area, and one Highlands patient died. There could be more. Many people in the area are still working in logging and wood processing, because it’s seen as an essential business.

White also worries about her staff. Like other providers, Her clinics need protective equipment and COVID-19 tests. But while hospitals are being prioritized for shipments from the state, Highlands has had to reach out to local manufacturers for donations.

The COVID crisis comes as rural hospitals have been closing — 10 in Missouri since 2014. So places like Highlands are often the only convenient option for care. They go by an unwieldy name: federally qualified health centers, meaning they serve high-poverty areas and the government pays a flat fee per patient. They serve some 29 million people nationwide.

COMTREA Health center is another one in Missouri. It’s 100 miles north, in rural Jefferson County, which has had three confirmed COVID-19 deaths.

COMTREA CEO Sue Curfman says 59 staffers are furloughed, 14 are unable to report to work due to childcare or caring for an elderly relative, and 49 are working reduced schedules. One of her staffers was exposed to COVID-19 outside of work and quarantined.

While things are tight now, she hopes to bring some staff back soon to help with the clinic’s new telehealth offerings.

That’s one avenue these rural health centers have for funding, as the federal government has opened up Medicaid and Medicare to cover remote visits. There are also new provisions for accelerated payments to providers.

Joe Pierle directs the Missouri Primary Care Association, which represents a dozen of these providers with some 200 locations. He says the money won't go as far as it needs to. “The important thing to really understand from that funding is we think it buys us maybe three to four weeks."

He says they saw Medicaid revenues drop from $13 million between late February and mid-March to $5 million from mid-March to now. So he's working with the state on getting gap payments for clinics.

"We’re trying to find every resource we can to sustain our operations because we believe we will be the backbone to keep pressure off of the hospital systems and emergency departments," Pierle says.

With COVID-19, that could mean increased movement of patients seeking care, and increased chances of the virus spreading. Missouri governor Mike Parson addressed those concerns at a recent news briefing.

“Are we worried about small towns with a clinic there being able to handle that? Yes we are," he said. "But do I think just because you live in rural Missouri you’re going to flood the hospitals in the urban areas? I do not think that."

For weeks, Parson resisted issuing a statewide stay-at-home order. He repeatedly noted rural areas hadn’t had any cases.

Now, confirmed cases in rural counties are on the rise.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

This story is part of a collaboration of Institute for Nonprofit News members examining the effect of COVID-19 on rural health care. Partners are Carolina Public Press, Iowa Watch, Side Effects Media, Wisconsin Watch and Reveal from the Center for Investigative Reporting. Read the collaboration’s work here: Slammed: Rural health care and COVID-19.

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