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By Kimberly Gazda, Sharon, Illinois.

Rural hospitals are struggling to survive in the face of the COVID-19 emergency, which has highlighted more urgently than ever the importance of access to high-quality broadband connectivity for rural communities—not least because of its importance for what is now being called “telehealth.” With more patients seeing doctors from home, high-quality connections are necessary to allow robust, real-time video-conferencing, and to allow the transfer of data-dense medical files.

A July 15 webinar on those issues was hosted by Kevin Oliver, lead relationship manager at CoBank, part of the Farm Credit System that supports key initiatives in both rural broadband and healthcare. Titled “COVID-19 Impacts On Rural Healthcare and Broadband,” it is the fourth in the “From the Farmgate” series of webinars sponsored by CoBank. The speakers were Rick Breuer, CEO of Community Memorial Hospital, located in a rural area of Minnesota just west of Duluth; and Catherine Moyer, CEO of Pioneer Communications, which provides connectivity services in western Kansas via coaxial cable, copper wire, fiber and wireless.

Oliver said many rural communications providers have pledged not to disconnect users for nonpayment during the coronavirus crisis. He said 163 rural hospitals have closed and about 600 more are vulnerable, or a third of all rural hospitals in the United States.

Communications companies have speeded up their investments in rural broad-brand infrastructure. Moyer said Pioneer has signed on to the Federal Communications Commission’s “Keep America Connected” pledge and is devoting “a big part” of its capital expansion budget to building out fiber-optics in its service area. Pioneer has installed “a ton” of new customers, increased speeds and created more hot spots, especially in response to the needs of health providers. While working from home is not as widespread in rural areas as in cities, Pioneer did notice that its peak usage hours changed from the evening “entertainment” hours to workday hours. COVID infection rates among its customers have risen since June.

Breuer’s hospital is the principal health-care facility and largest employer in his rural county of about 35,000 people. About 80% of its revenues disappeared when all surgeries were cancelled. At the same time, it incurred extra costs related to COVID. It added more beds, installing some of them in the cafeteria area. “We had to stand up a lot of stuff very fast,” said Breuer. Surgery nurses were cross-trained to become ER nurses. “Most of rural America is not yet in the first wave of COVID,” he said. “Those early days were unnerving, but now it’s more a marathon than a sprint.” The hospital had recently bought a local family medicine clinic; a platform integration between the two originally planned to take place over a year had to be accomplished in two weeks.

Oliver noted that the cost dynamic was different for health care facilities and communications. Health care facilities saw a simultaneous increase in costs and decreases in revenue. On the other hand, communications companies have added customers and grown more quickly than they might have otherwise. While some payments are in arrears, “most of those arrears will be collectible,” said Moyer—whether from customers, or by laws like the Critical Connections Act that reimburses communications companies. Moyer said Pioneer had “donated” about $500,000 worth of connection services that may or may not be reimbursed.

Breuer said he doesn’t expect revenues at the hospital to return to anything like their full levels for at least a year.  The hospital has managed to avoid layoffs or furloughs, “but we’re getting [through] by the skin of our teeth.” Whatever happens with COVID, he said, “telehealth will definitely be part of our future. Home and hospital connections are equally important, since telehealth often happens from home.”

Breuer noted that until recently, he had to drive his kids into town to access hot spots so they could do their homework. One hospital sectioned off part of its parking lot for customer parking to use its hot spot, whether for medical tele-visits or other reasons. He also noted the vulnerability of rural networks, with little or no redundancy. He said one gnawing squirrel recently took down connectivity for a 50-square-mile area.

His hospital could not have kept its doors open without help from 10 separate funding organizations, said Breuer—but that in turn created a lot of documentation paperwork. He said independent clinics have been the worst-hit by the COVID crisis, especially those that service mostly rural populations but that don’t technically qualify as rural health clinics for one reason or another. Breuer supports changing those designations to allow more clinics to be helped.

Moyer supports what she calls contribution reform. Bill surcharges are based on an outdated model of long-distance service, now that texting has taken the place of phone calls for many. Fortunately, “the COVID crisis has focused the attention of many in Congress. I’ve been talking about all these connectivity issues for 20 years,” she said. “The silver lining is a lot of other people are focused on this issue now too.”

The webinar is available at https://farmcredit.com/FromtheFarmGate

David Murray can be reached at journal@hpj.com.

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