Posted: 4/07/2020

I work in a solitary community hospital in a relatively rural area of South Carolina and for us, the Covid 19 pandemic is a bit different than what people in places like New York are dealing with. It’s still stressful, just in a much different way. My family is either involved in healthcare or education, both of which are hugely impacted at this time.

With the school system shut down, our teachers are working to try to provide educational materials for the children stuck at home. Many of these children do not have families who are actively engaged in their education and food security is a major issue. My daughter got in trouble for adding healthy snacks to many of her students back packs to take home prior to this because her principal told her that she could not do it for every student so she was not allowed to do so for the ones she knew in particular were not eating except at school. Many of the children in Title One schools have limited or no access to the internet and the teachers worry on a daily basis about what is going on with their students, in many cases knowing that the parents are not following up on the work they are sending home to the students.

Most of the schools are still providing meals for pretty much anyone who shows up and says they have children. Thousands of meals are being sent home to cover breakfast and lunch. School busses are being used to set up delivery sites or in some cases, provide home delivery for many of the rural areas. Teachers across the country are finding ways to connect with their students either remotely through technology or through appropriately socially-distanced in person visits. You see examples on the news every day of teacher parades by their students’ neighborhoods, teaching from the porch through the glass door, or many other examples of trying to keep connections to their students. At least the school system has continued to pay their salaries even though they are not at school in the normal sense.

Currently, our hospital has two confirmed COVID-19 cases admitted and a few others waiting on testing, but suspected. Certainly not overwhelming the system yet but the peak in South Carolina is not expected for a few more weeks. Our current issue has nothing to do with being overwhelmed but rather the lack of volume. Current hospital census is 50% of normal with no elective surgery and an Emergency Room seeing 40% of the normal volume. Our system owns a large number of the physician practices and those are off by 30-60% depending on the type of practice. Overall, the revenue is currently down by 40% and has not bottomed yet. Outpatient revenue is down even more which has a higher profit margin so the bottom line is that there is no bottom line.

Starting next week, we will be furloughing a significant number of employees. We currently have two nursing units (64 beds) closed due to lack of volume and the remaining floors are not close to capacity. The daily news conferences from the State have people talking about how hospitals are not furloughing front line people in direct patient care roles. This may be a true statement, but they are certainly being down-staffed from one to three shifts per week. The stress of knowing that they do not have a secure income weighs heavily on the staff, adding to the concerns that they know they will be exposed and have a significant risk of carrying the infection home. Even our administrative team is taking time off without pay. With the expectation that this will likely extend into at least mid-May, our employees are very concerned about how they will pay their bills with a significant reduction in income. Many have depleted their paid time off. And, even though the hospital has agreed to advance up to 80 hours against future time, it would mean months before they actually worked off the time and they have to hope that they don’t actually get sick if, or when, we see a surge.

On a personal note, I am writing this from my home office having been exiled to work from home for two weeks now. I miss the daily interactions with the Case Management staff and even the opportunity to interact with the medical staff to discuss issues over lunch or at least to allow them to vent about what discharge planning problem we had or why the patient with no payer could not go to an inpatient rehab facility. I left clinical practice just over six years ago after doing every other night call for over thirty years as an OB/GYN to take on my current role as Medical Director of Case Management and Physician Advisor and never looked back. I have found my place in life as this has really been my dream job. I actually enjoy dealing with the payers and regulatory issues. The downside of becoming intricately involved with hospital revenue cycle is that I logically understand the necessity of adapting to the significant decline in revenue. But, at the same time, I understand the impact we have on the lives of those employees affected by the furloughs and down-staffing.

We will get through this and hopefully, months from now, will have appropriate therapeutics or vaccines to prevent a recurrence of the steps we are currently taking to slow the progress of this pandemic. Stay strong and hopefully avoid the infection. Also, remember that we expect a lot of the women and men that serve on the front lines in our facilities, often without recognition and currently perhaps without a dependable source of income. You can’t hug them but you can tell them they are appreciated. One last thought for all you physicians out there, the best comment I have heard lately was one person from one of the hard-hit areas saying what they really needed was nurses, not doctors, because nurses where the ones actually caring for the patients and all the doctors did was write orders. Maybe that is why we have nurses week and doctors day.

R. Phillip Baker, MD
Medical Director Case Management and Physician Advisor
Self Regional Healthcare
Greenwood, South Carolina