Ernst checks on local health needs during pandemic

Tuesday, July 14, 2020
Photo by Seth Boyes

No face was left uncovered as local officials met Wednesday with U.S. Sen Joni Ernst at Lakes Regional Healthcare. Healthcare providers, hospital board members, local legislators and others answered the senator's questions about COVID-19's local impact and needs.

LRH President and CEO Jason Harrington said hospital surgeries — typically a significant portion of LRH's revenue — have seen patient volumes drop by half over the last three months or so. However, he said, thanks to the federal Paycheck Protection Program and the Coronavirus Aid Relief and Economic Security Act, the hospital has been able to fill income gaps rather than resorting to layoffs or furloughs. The CEO doesn't expect the current federal influx to be sufficient long term, but he said he feels the hospital is financially fortunate at this point. By comparison, he said an estimated 9-17 hospitals statewide are at risk of imminent closure.

Ernst said a majority of her time on the CARES Act was centered on paycheck protections — the original legislation did not include protections for hospitals. Ernst also said she hopes to include a tax holiday for all front-line workers — from doctors and nurses to truck drivers — in the federal government's next round of COVID-19 relief.

"If we want to maintain our rural communities, we have to have access to health care, and if we're not being supportive, they will go away," Ernst said. "We can't allow that to happen."

Brandon Rohrig, director of Dickinson County Population and Public Health, said local health officials have relied on a supply of personal protective equipment from both the state and other sources so far during the pandemic. He said securing the PPE was a relatively smooth process, thanks to Dickinson County Emergency Management Coordinator Mike Ehret and Chris Yungbluth, who serves as both the Arnolds Park-Okoboji Fire Chief and as part of the Lakes Regional Healthcare Ambulance service.

While PPE hasn't been a major hurdle for providers, Harrington said access to testing may be.

"If surveillance is about how we respond to the virus, then we have to be able to do surveillance, and you need tests to do it," Harrington said. "That's probably been our single, biggest frustration— the availability of testing."

A state Test Iowa site opened in Dickinson County earlier this month and is expected to remain in operation through at least Friday this week. Rohrig said officials expected a significant spike in confirmed cases after the site opened, but that has fortunately not been the case — he estimated 40 new cases have been confirmed since the site began testing. Dickinson County had 309 positive cases recorded as of Tuesday night — 58 since the month began. A total of 101 confirmed cases have yet to recover, and three Dickinson County residents have died.

"We're still anticipating yet another increase because of the Fourth this past weekend," Rohrig said. "But, I guess, only time will tell with that."

Harrington said access to rapid testing would be a significant asset to county. He said local health officials have been promised 100 rapid tests, but there is no promise of receiving more. He said potentially limited testing may cause challenges as local employers are attempting to get their workforce back in place while confirming workers aren't spreading the virus.

Dr. Zach Borus, an LRH physician and member of the hospital's COVID-19 task force, said many providers saw patient visits plummet following the confirmation of the county's first case of COVID-19 in late March — from 20 patients per day to less than 10 in some cases, he said. Patients began to defer care as local residents began to isolate themselves, and Borus said it took about a month for Medicare to relax its guidelines on telehealth appointments. However, he said, now that it's become more widely used, physicians are able to see patients where they are, and satisfaction ratings are generally high. In fact, he said a telehealth appointment can be particularly efficient for those in long-term care facilities or similar situations where a nurse on site can perform portions of the exam.

Harrington said Medicare's support of telehealth will be important moving forward. A number of private pay insurance plans as well as Medicare have agreed to continue paying for telehealth services up to a point, according to Borus, but Medicare had at one point expected to make a 28 percent cut in reimbursements for telehealth services starting in August — Ernst said Wednesday she had already reached out to Medicaid officials and asked for that date to be pushed back, but did not confirm if the agency had agreed to do so.

"I think we have just seen the real need — to really bring this online as part of the normal practice of care," Ernst said.

In the same vein, state Rep. John Wills said the Iowa House recently passed a bill which requires insurers to reimburse telehealth visits as they would a typical, in-person visit.

"In the House, we see it as required for our rural hospitals," Wills said.

Wills said the bill had yet to make its way out of the Senate before this year's stunted legislative session — another side effect of the current pandemic — ended, and he expects it will be taken up when the new session begins.

Ernst noted the issue of telehealth is coupled with rural access to broadband internet.

"This whole thing — COVID-19 — I've called a great awakening of America as to the needs of rural America," Ernst said. "There's just so much that has been highlighted through this pandemic that gives us a little bit of an edge when we're talking with our colleagues about why it's necessary to have rural broadband."

Around 2,000 of Dickinson County's 17,000 residents don't have sufficient access to broadband, according to Angela Kofoot, executive director of the Voluntary Action Center. Ernst hopes to pass a rural broadband bill through the Senate Commerce Committee so that it can be rolled together with a transportation bill and a water resource bill — which she said unanimously passed out of committee. Should the triune infrastructure bill move forward, she said many of the improvements could actually be funded through the U.S. Department of Agriculture in the form of grants.

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