Hammered by COVID and Financial Storms, Community Hospitals Must Adapt to Survive

By Dr. Mark Pratt, Chief Medical Officer, Allscripts Hospitals and Health Systems
Twitter: @Allscripts

Community healthcare organizations are facing challenges to their very existence, but their dire situation also gives them the impetus to adapt to changing expectations and radically revamp how they offer care.

The previous 10 years were a rough patch for smaller healthcare organizations, particularly those that are primary sources for care in non-metropolitan areas. And in 2020, the COVID pandemic made the road even bumpier for community hospitals, commonly defined as those with 250 or fewer beds with an average length of patient stay of 96 hours or less.

Challenges to this segment have been growing for years, leading toward consolidation of freestanding hospitals into larger organizations or systems. Even so, more than 100 rural hospitals closed between 2013 and February 2020. And financial pressure from the COVID pandemic added to the duress of this segment, with at least 20 hospitals having closed in 2020. Bottom lines have been pressured because of reduced patient flow and elimination of elective services related to the pandemic.

The impact on communities served by shuttered or scaled-back providers is doubly devastating. Care capacity is reduced, even as populations struggle with COVID or other conditions associated with aging populations. Also, community health organizations are major employers in their service areas, and financial impacts associated with the pandemic can add to rising unemployment figures already high because of COVID-related effects on the economy.

With the distribution of COVID vaccines on the rise, there is growing optimism that the country will return to a semblance of pre-pandemic normality. But many experts contend that organizations have had to make expensive adaptations and that financial losses attributed to the pandemic will linger, as patient confidence returns slowly and provider capacity recovers.

However, community health providers demonstrated flexibility in adapting care delivery to meet restrictions imposed by the pandemic and the need to keep patients safe. Many shifted to telehealth and other digital health approaches to interact with patients, with some research indicating that about 30 percent of all visits during the pandemic provided via telemedicine, with a 23-fold increase in the weekly number of visits, compared with the period before the pandemic.

Other uses of technology have been adopted into workflows, such as automated scheduling for patient appointments or text messaging and other forms of asynchronous communication. And the exchange of patient information through electronic health records systems proved invaluable in improving the sharing of patient information during the pandemic.

Many of these changes that take advantage of digital health will not disappear after the pandemic. They will be locked into the expectations of both consumers and practitioners – they will have 18 months of experience with these new forms of care delivery by this fall when (hopefully), the worst of the COVID pandemic will be behind us.

However, many expect that COVID won’t be the last pandemic that will occur, and community health organizations can’t afford to revert back and forth in their care delivery approaches in a cyclical fashion. Lessons learned from coping with COVID must be parlayed into changes that will ensure successful outcomes, both for patients and provider organizations.

Community healthcare providers are critical to the care of millions in their service areas, and they need to flex with the times and challenges to ensure the survival of their organizations.