Those who live in small towns and rural areas have always relied on their local hospitals, but the COVID-19 pandemic put a spotlight on that vital connection.
“It really showed us the need for access in a small community,” said Heather Smith, CEO of Conemaugh Meyersdale Medical Center in Somerset County.
“As other hospitals were experiencing full capacity and not able to open their doors to take additional patients, we were exceeding what our average daily census usually is,” she said. “We are very appreciative as a rural community hospital that we were able to be here to support our patients during that time of need.”
With major medical centers at capacity, the small hospitals were lifesavers, said Tom Kurtz, president and CEO of Chan Soon-Shiong Medical Center at Windber.
“One thing it actually did was prove your rural hospitals need to be in existence to take care of pandemics like this,” Kurtz said. “You need to put care where the patients are. It is not always good medicine to transport this patient to a large medical center.”
The local leaders listed most of the same rural health issues being addressed statewide and nationally in a CNHI report called “Rx for Rural Health”: Physician recruitment, transportation access and limits on telemedicine due to internet access.
“Rural hospitals are so important to our patients,” said Dr. Elizabeth Dunmore, chief medical officer for Conemaugh Health System. “Those are really lifelines to our patients. A lot of the time, the hospital is a hub for the community, just like the schools.”
‘We saw the need’
Some programs instituted during the pandemic illustrate innovations to improve rural health care.
Because the Meyersdale hospital relies on local primary-care doctors to oversee the care of those hospitalized, the surge of COVID-19 patients both in the hospital and from the physicians’ own practices required additional hospital staff, Smith said.
“We saw the need to have providers in our hospital on a more consistent basis to care for these patients,” Smith said. “We just started a hospitalist program here at Conemaugh Meyersdale. We now have two certified registered nurse practitioners. They are in the hospital anywhere from eight to 12 hours, depending on how many patients we have in the facility.
“We are able to keep patients that maybe previously we transferred out.”
Meyersdale also instituted a telemedicine connection with Conemaugh Memorial’s infectious disease specialist, Dr. Uchenna Okereke, who was able to consult with Meyersdale hospitalists and primary-care doctors overseeing COVID-19 patients’ care, Smith said.
The program allowed patients to remain close to home and still receive expert care in real time.
It’s one of a growing number of telemedicine programs connecting local hospitals with medical specialists in larger institutions.
‘Utilization of telemedicine’
Doctors treating COVID-19 patients at UPMC Somerset connected with experts in Pittsburgh through the tele-ICU program, hospital President Andrew Rush said.
“The good thing about this pandemic is it has expedited the utilization of telemedicine,” Rush said. “The tele-ICU provided our doctors with so much assistance with treating those patients, managing those patients.”
The pandemic forced insurance companies and government payers to recognize the value of telemedicine and begin paying providers appropriately, Indiana Regional Medical Center CFO Robert Gongaware said.
“Patients prefer it in many cases,” he said.
It was not just the payers who had to reexamine telemedicine. The Indiana hospital was also challenged, Chief Nursing Officer Wendy Haislip said.
“Telemedicine had been a challenge for us pre-COVID, but then when COVID hit, it essentially forced us to look at how we deliver care differently,” she said. “Now there are a lot of providers that have adopted it, are excited about it and want it to stay. I think it is certainly the wave of the future.”
Through UPMC Home Healthcare nurses, rural patients have direct connections with their primary care doctors, Rush said.
“The home health nurse is going in, setting up an iPad and having that visit right there with the physician,” he said. “It’s going to be instrumental for just overall quality of care for that patient who may or may not have transportation.”
Getting to the doctor
Transportation remains an obstacle in most rural areas, but local agencies provide some relief.
For Cambria County residents, CamTran’s 21 fixed routes include a park-and-ride on weekdays between Ebensburg and Altoona.
Its Reserve-A-Ride service provides trips to locations throughout Cambria and Blair counties and the northern areas of Somerset and Bedford counties.
“Our services are safe, affordable and reliable,” said Josh Yoder, assistant executive director.
“If the shared-ride trips are scheduled within the operating hours of service, there is never a time where we are unable to provide transportation for customers who are scheduled.”
Somerset County Transportation System is operated by the Community Action Partnership for Somerset County Tableland Services Inc. It provides daily service in several rural communities, with connections to larger hubs on a daily, weekly or bi-monthly basis.
From Confluence, for example, there are trips to Somerset two times a month and trips to Uniontown two times a month.
Mike Villeneuve, operations director, concedes it’s not the perfect solution.
“For us offering a low-cost option, we are unable to meet everybody’s needs in the county,” he said. “I am sure there is a gap. Somerset is a big county and not everybody lives in communities.”