Sault Ste. Marie, Michigan, had only two confirmed COVID-19 cases by early May, but the pandemic was still hitting its healthcare system hard. With the small city’s War Memorial Hospital mostly shut down and elective procedures postponed, the hospital was on shaky financial ground.
“My biggest concern is how all of this will impact the overall financial viability of our hospital,” said David Jahn, War Memorial president and CEO. In early May, the hospital was projecting revenues would be down for the year by 40%, or $35 million, if the coronavirus shutdown continued. The loss is not sustainable, Jahn said.
Eighty percent of the hospital’s revenue is from outpatient services, which declined by 53% in April. That tracks with the national average—79% of rural hospital revenue is from outpatient care, according to the Chartis Center for Rural Health. The center is part of the Chartis Group, a healthcare advisory and analytics services firm.
As states shut down across the country, elective procedures and surgeries stopped. And while War Memorial’s emergency room was open, “people are just not coming in at this time—maybe because they are afraid or maybe they are delaying much-needed care, which will exacerbate itself in the coming weeks and months,” Jahn said.
Rural hospitals are essential for people with kidney diseases. While small hospitals do not often do transplants, they provide a nearby lifeline for transplant and dialysis patients experiencing complications or needing routine follow-up care. In addition, some hospitals provide outpatient dialysis.
War Memorial Hospital’s outpatient dialysis center remained open this spring, implementing physical distancing rules and requiring everyone to wear masks. If finances forced the hospital to close permanently, it would be disastrous for the facility’s 47 dialysis patients, said nephrologist Mohammed Haider, MD, director of the dialysis center. “You cannot close this unit, whatever happens to the hospital,” he said. “The community has to run this center; otherwise, people will die.”
Sault Ste. Marie sits on Michigan’s Upper Peninsula, nearly 350 miles from Detroit. If the hospital closed, patients would have to travel much farther for care. The next nearest dialysis center is about a three-hour roundtrip, according to Haider. “This is a rural place. Driving three times a week will be very difficult,” he said. “It’s not sustainable.”
Haider said he worries that patients would stop going to dialysis regularly because of the distance. Older, sicker, and/or poorer patients often rely on other people to drive them to appointments, he explained. “Dialysis not only affects the patient,” he said. “It affects the whole family. It becomes a big burden on the family, too.”