Cerner, an electronic health record software company, launched a cloud-based version of its electronic health record (EHR) with the aim of helping rural and Critical Access Hospitals eliminate costs associated with traditional EHR systems. Many rural hospitals are now facing increased pressure to cut costs to stay afloat due to losses in revenue from cancelled elective procedures and patient attrition. Cloud-based EHRs help cut costs by lowering maintenance costs and fixed payments, allowing rural health systems to focus their budgets on operational costs. Many experts expect to see more rural health systems invest in this innovative technology and potentially use some of the funds from the $10 billion rural carveout of the Provider Relief Fund distributed by HHS to install cloud-based EHRs.

Rural hospitals are struggling during the COVID-19 pandemic, which has highlighted the importance of having adequate broadband to enable access to telehealth. As telehealth becomes more popular, broadband becomes increasingly essential. The July 15 Webinar, “COVID-19 Impacts on Rural Healthcare and Broadband,” the fourth webinar in the “From the Farmgate” series of webinars CoBank sponsors, presented speakers covering these issues. These presenters advocate for rural broadband and healthcare stabilization through policy action. In addition, this article highlights a struggling hospital and showcases communication companies that have signed the pledge to not disconnect anyone from broadband service due to the inability to pay for their service.

Senators Roger Wicker (R-MS), Tina Smith (D-MN), Doug Jones (D-AL), and Cindy Hyde-Smith (R-MS) have introduced bipartisan legislation that would waive the Small Business Administration’s (SBA) Affiliation Rules for the small health-care facilities, the PPP Access for Rural Hospitals Act (S. 4217). This bill would enable the facilities to qualify for Paycheck Protection Program (PPP) loans. The Coronavirus Aid, Relief, and Economic Security (CARES) Act established the PPP to give immediate relief to small businesses. In addition to the more immediate concerns related to COVID-19, hospitals have lost significant revenue because of having to stop non-emergency and elective procedures. Therefore, providing PPP to smaller rural hospitals will allow them to continue to employ healthcare workers and provide access to necessary healthcare services in rural communities.

The U.S. Department of Health and Human Services (HHS) released additional reporting requirements for healthcare organizations that received financial support under the CARES Act. The notice requires healthcare organizations that received more than $10,000 to submit reports detailing the use of the funds and compliance with payment terms and conditions. Providers must report on their expenditures through the end of the December. HHS states that more details about reporting requirements will be released August 17th. This announcement comes after months of questions from providers about how to use and report the funds they received; this includes Paycheck Protection Program (PPP) dollars. NRHA is working with rural health champions in the Administration and Congress to ensure that rural providers are not disadvantaged by these new requirements due to their unique payment structures.

Senators Richard Durbin (D-IL) and James Lankford (R-OK) discussed the challenges facing rural hospitals in the wake of COVID-19 on the Senate floor. These senators helped secure $175 billion to protect the health care system and meet the emergency needs of health systems during the pandemic. However, hundreds of rural hospitals, especially in downstate Illinois, are continuing to struggle. Rural hospitals were facing financial uncertainty even before the pandemic, and in Illinois, rural hospitals have lost $1.4 billion during the pandemic, most of which can be attributed to the cancelation of non-emergency and elective procedures. Nationwide, 76 percent of revenue for rural hospitals comes from these procedures. To address the closure crisis, Sens. Durbin and Lankford have introduced the Rural Hospital Closure Relief Act of 2019 (S. 3103). Their bill, which is strongly supported by NRHA, would allow a limited number of the nation’s most financially vulnerable rural Prospective Payment System (PPS) hospitals to convert to Critical Access Hospitals (CAH), even if they do not meet the 35-mile distance requirement.

On July 28, the HHS Office of the Assistance Secretary for Planning and Evaluation (ASPE) released an issue brief examining changes in Medicare fee-for-service primary care visits and use of telehealth at the start of the COVID-19 public health emergency (PHE). This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the PHE. The analysis found Medicare primary care visits dropped precipitously from mid-March at the start of the pandemic, at the same telehealth visits increased for primary care. However, telehealth use was lower in rural areas.