On April 19 the Flex Monitoring Team hosted a public webinar focused on answering the research question: What factors have impacted Critical Access Hospitals’ capacity to meet the challenges presented by the COVID-19 pandemic? 

Critical Access Hospitals (CAHs) are often more financially vulnerable than other hospitals, at heightened risk of closure, and more vulnerable to health care professional shortages. Many of these challenges have been exacerbated by the COVID-19 pandemic, which has stretched hospital capacity, physical space constraints, and health care workers. Taking these circumstances into consideration, the Flex Monitoring Team decided to investigate how CAHs have responded to COVID-19, including to what extent hospitals have taken advantage of federal funding and regulatory relief. 

The Flex Monitoring Team conducted a survey of CAH CEOs in eight states with high prevalence rates of COVID-19. For the period of February to August 2020, the survey covered five main topics: federal financial support and regulatory policies, capacity for treatment, workforce, finance, and partnerships. 

Highlights:

• The CARES Act was the most common source of federal funding, with 92% of CAHs receiving funding. Other sources included the $10 billion rural hospital allocation from HHS, the paycheck protection program, accelerated advanced payments, and funding for increased COVID-19 testing. 
• Many CAHs also took advantage of regulatory flexibilities, especially telehealth flexibility, which was used by 90% of participants. Many CAHs also used waivers allowing for reuse of face masks, relief from the 96-hour length of stay limit, and reduced administrative paperwork requirements. 
• Most participating CAHs had relatively low volumes of COVID-19 patients during this time period, and most had both adequate supply of ventilators and PPE during the February through August 2020 period. 
• Being affiliated with a hospital system assisted Critical Access Hospitals in responding to COVID-19. Benefits included help with access to resources, enhanced coordination, policy guidance, staffing support, and efficient transfers of COVID-19 patients.

 

CAHs also provided examples of innovative strategies to respond to COVID-19, such as using iPads for admitted patients to talk to family, using separate clinical teams to treat patients, starting COVID-19 hotlines and retraining nursing staff. As a result of these innovations combined with the use of federal funding and policy waivers, relatively low patient volumes, and sufficient supplies of ventilators and PPE, participating CAHs were largely able to meet the challenges presented by the COVID-19 pandemic

A complete recording of the April 19 webinar and copies of the presentation slides can be found here.