DAYTON—At the Columbia County Health System board meeting last week, CEO Shane McGuire shared his concerns about financial stability, emergency preparedness, and possible impact on patients and health system staff, in light of the potential for a serious local outbreak of COVID-19.

McGuire said, “We have stopped all non-essential visits in physical therapy, imaging, and the clinics. This volume generates about half of our monthly revenue. . .This is happening at the same time that we are spending increasing amounts of financial and human resources to prepare for a historic surge in volumes related to COVID-19.”

The Health District currently has only thirteen days operating cash on hand, down six days from the month of February.

Add to that the higher cost if overtime hours are increased, and if extra agency providers are needed.

“There is no inexpensive way to look at this response, and it’s only going to compound,” he said.

McGuire told the commissioners about some measures he has taken to help stop the budgetary outflow.

He said a consortium of public hospital districts, including CCHS, just received a $150,000 boost from the state Health Care Authority. That figure represents an additional three days of operating cash on hand.

“Three days on top of thirteen days is quite a percentage increase in days cash on hand, when you look at it,” he said.

McGuire said he has spoken to state Rep. Skyler Rude about his concerns, which were then shared with state Reps. Ellen Cody and Joe Schmick, who are responsible for much of the legislation regarding health care.

He also spoke with U. S. Rep. Cathy McMorris-Rodgers during a Port of Columbia conference call on March 10, and has reached out to state Sen. Maria Cantwell’s office, as well.

McGuire is hoping the recent passage of a federal stimulus package will help.

“We are going to be depending on whatever solution the Feds are going to come up with to help shore us up through this,” he said.

Protecting patients and staff

“The first order of business is to protect ourselves and our communities and try to get into a position to respond to COVID on our own, if we had to,” McGuire said.

He said creating a good foundation is essential.

CCHS team members are currently working on refining emergency preparedness procedures, and the Human Resources Department is working on an emergency staffing plan.

McGuire said some employees are still recovering from the recent flood and are still on high alert, without this compounding factor. Some are now afraid of contracting COVID-19 and the possibility of infecting others, including their loved ones at home.

He said two employees are currently in self-quarantine because of possible exposure at one of the clinics and one caregiver is also self-quarantined.

“This is how bad it can get, quick,” he said.

The hospital’s Acute/Swing Bed Care unit has been modified to accommodate eight isolation and negative air environment spaces. Changes have also been made to the screening and triage spaces.

The inpatient census, a daily count, is currently low at Dayton General Hospital, which is also true for other hospitals, he said.

“I have only anecdotal information that patients across the state are sitting in hospitals because discharge planners are not able to get nursing homes or swing bed facilities to accept them. . . There are likely some patients in hospital beds that should be discharged to step down facilities, but we are all protecting our beds in anticipation,” he said.

Securing Personal Protective Equipment

“I can say our community is amazing,” McGuire said.

He told the commissioners Seneca Foods Inc. has donated three cases of N-95 masks. He said there are a number of people with sewing machines ready to make additional masks, however, they would not be USDA approved so cannot be accepted.

Gloves and gowns are in good supply. But procedure masks have been “impossible” to find.

McGuire said CCHS has rented two Philips Respironics V60 ventilators and is already in possession of one Philips Trilogy 100 portable ventilator.

In addition, County Emergency Management Director Ashley Strickland has located a Hamilton Medical Inc, Galileo Ventilator for use at the hospital.

CCHS is working with Strickland who is responsible for procuring the county's Personal Protective Equipment supplies.

McGuire said getting supplies from National Strategic Reserves will be difficult, unless there is an actual outbreak.

Relying more on virtual medical appointments

Chief of Staff, Dr. Kyle Terry can now assess patients through the use of a video cart in his office, keeping him and his patients safe from possible infection. That’s good news for staff and patients but not necessarily for the financial health of CCHS.

McGuire said none of the rural federal waivers have allowed rural health clinics to bill for virtual visits.

He has been watching the progress of a U.S. Senate Bill, which would allow Medicare payments for virtual medical appointments in the clinics where Medicare patients make up 50-percent of all visits.

Rural critical access hospitals in jeopardy

“To say our rural hospital infrastructure wasn’t under stress before COVID would be a fallacy,” McGuire told the commissioners.

McGuire said the University of North Carolina is tracking nation-wide, rural hospital closures, and 160 have closed their doors since Jan. of 2005.

Pat Justis, executive director of the state’s Office of Rural Health, has said one third of the Washington State’s 39 rural hospitals are doing well, one third are walking a fine line, and the last third are financially challenged, and are at risk of closure

While rural Critical Access Hospitals, like Dayton General Hospital, are allowed the use of federal and state funding such as cost based reimbursement for Medicare, grants and loan programs, these resources often fall short of providing enough support for them to survive. Some function precariously on local levies.

McGuire said the value of a recent Washington Post article about Dayton General Hospital is in generating additional interest from other national news outlets, and in shedding light on the plight of rural hospitals, which could help stop what he referred to as “the creation of healthcare wastelands” across rural America.

Stimulus Package

McGuire isn’t sure how the $2 trillion stimulus bill which President Trump signed into law on Friday, will help the health district’s finances.

“That’s a magic eight-ball question right now,” he said.

The stimulus package includes $100 billion for hospitals. There is also funding for telehealth programs, as well as funding for  Personal Protective Equipment, ventilators and masks for the Strategic National Stockpile in the stimulus package.