Southeast Georgia Health System has announced it will begin providing COVID-19 vaccines to individuals age 65 and over, as well as police officers, firefighters and other first responders, on Monday, Jan. 11, based on guidelines established by Governor Kemp on Dec. 30, 2020.

Vaccines are only available by appointment. Due to the current limited vaccine supply, prioritization will be given to first responders and high risk individuals. Those receiving the vaccine must be available for a second dose 21 or 28 days later, depending on the type of vaccine received. The vaccine is produced by private manufacturers and supplies are dependent on those manufacturers.

“The vaccine gives us the opportunity to stop the spread, so of course we want as many people as possible to get the vaccine,” says Michael D. Scherneck, president and CEO. “Our Health System team members have been given the opportunity to be vaccinated and now, based on the governor’s order, we are making plans to offer the vaccine to as many patients and first responders as possible given the number of vaccines available. We recognize that there are many people in our community who wish to receive the vaccine and, as more supplies become available, we will work diligently to ensure that everyone who desires a vaccine will receive one.”

Scherneck added, “We are exploring how we might partner with the Georgia Department of Public Health, Coastal Health District to increase access to the vaccine. As our supplies increase, we will offer an expanded vaccine schedule to the community, including weekends. We want to remind everyone, including those who receive the vaccine, that it’s extremely important to continue to wear a mask, social distance and avoid large gatherings for the health and safety of all of us.”

The Health System is currently contacting high risk individuals age 65 and older to schedule vaccine appointments—individuals do not need to contact the hospital or physician’s office. Scheduled individuals will be required to show identification. Due to the structured vaccine process, the Health System is not able to accommodate walk-ins and vaccines are not available at physician offices. A second dose will be provided 21 to 28 days later, based on the type of vaccine received.

Updated vaccine information will be available on the Health System’s website at sghs.org/covid-19.

About Southeast Georgia Health System
Southeast Georgia Health System is a not-for-profit health system comprised of two acute care hospitals, two long term care facilities, two comprehensive Cancer Care Centers and multiple specialty care centers, including orthopaedic and spine care, joint replacement, breast care, maternity, outpatient rehabilitation, sleep management and wound care. The Brunswick Campus Cancer Care Center is accredited by the American College of Surgeons Commission on Cancer and offers the only CyberKnife^® M6 with MLC technology in Georgia. Additionally, the Southeast Georgia Physician Associates medical group includes more than 140 providers working in 20 different medical specialties at more than 50 locations. The Health System is part of Coastal Community Health, a regional affiliation between Baptist Health and Southeast Georgia Health System forming a highly integrated hospital network focused on significant initiatives designed to enhance the quality and value of care provided to our contiguous communities. For more information, visit sghs.org.

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Jesup – An early Christmas present arrived this year for healthcare workers at Wayne Memorial –   the first installment of Moderna’s Covid-19 Vaccine. Among the first in the group to receive the vaccine was Dr. Bill Headley. He shares he has experienced no real side effects, lest a sore arm for a couple of days. “I encourage folks to get the vaccine, so that we can beat this virus quickly.” Headley will return 28 days from the shot date for his second dose of the vaccine. He added it was the “best early Christmas gift EVER!!”

Hospital Employee Beth Gorse also received the first of the two-part vaccine. She experienced soreness in her arm the next day, similar to a flu shot. She shared, “I have a sense of relief knowing that I’ve started this vaccine process.”

Fellow employee Janet Keith joins her coworkers in their excitement on receiving the vaccine. “All is well. Feeling appreciative! I pray it is available to everyone who wants the vaccine soon. I am more afraid of getting Covid-19 than I am of taking this new vaccine. Hopefully, this will be the beginning of a Covid-free 2021 for all. Roll your sleeves up…and get ready!” Keith also shared she has experienced no side effects.

Angie Jones, Assistant Chief Nursing Officer for the hospital, said, “We are excited to have the vaccine available for our healthcare providers and first responders.  The vaccine gives us all hope in a better year coming. We have had no serious reactions or issues reported in anyone who has received the vaccine to date.”    

Wayne Memorial Hospital, whose mission is to provide high quality health care services to all patients, built a state-of-the-art facility in 2007. It is the third largest employer in Wayne County with 500 employees, 84 beds and is a three-time winner of the Georgia Alliance of Community Hospitals Small Hospital of the Year Award. 

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Southeast Georgia Health System’s Camden Campus was recently named one of the 2020 Top Hospitals in the state by Georgia Trend. This leading business and lifestyle magazine featured the hospital rankings in the December 2020 issue; the Camden Campus ranked 14^th in the small hospital category (fewer than 100 patient beds).

“It’s an honor to be recognized as one of Georgia Trend’s Top Hospitals,” says Glenn Gann, R.N., MSN, vice president and administrator, Southeast Georgia Health System Camden Campus. “We strive to meet the health care needs of the people we serve and are committed to bringing leading-edge technology to our community. This ranking affirms the hard work and commitment of our team members, especially after the challenging year we’ve all faced due to COVID-19.”

Located in St. Marys, the Camden Campus is a 40-bed hospital with extensive quality services in a friendly, warm setting. Recent additions to the Camden Campus include a new Wound Care Center and ROSA® Knee robotic surgery technology for knee replacements.

The Camden Campus medical staff includes over 130 community and employed physicians representing many major medical specialties. In addition to an emergency room with private rooms and HAZMAT decontamination units, services include bariatrics, breast care with 3D mammography, cancer care with radiation and medical oncology, cardiopulmonary, gastroenterology and endoscopy, intensive care, labor and delivery, orthopaedic surgery and joint replacement, outpatient rehabilitation (physical, occupational, speech and aquatic therapy), radiology, sleep management and surgical services.

For the 2020 Top Hospitals list, which includes hospitals that provide a range of services, Georgia Trend evaluated each hospital in Georgia that participates in the Centers for Medicare and Medicaid Services (CMS) Hospital Value Based Purchasing program. A total performance score based on information that included clinical process, patient experience, outcome and efficiency (CMS data downloaded on August 19, 2020) was used to rank hospitals of similar size and mission.

About Southeast Georgia Health System
Southeast Georgia Health System is a not-for-profit health system comprised of two acute care hospitals, two long term care facilities, two comprehensive Cancer Care Centers and multiple specialty care centers, including orthopaedic and spine care, joint replacement, breast care, maternity, outpatient rehabilitation, sleep management and wound care. The Brunswick Campus Cancer Care Center is accredited by the American College of Surgeons Commission on Cancer and offers the only CyberKnife^® M6 with MLC technology in Georgia. Additionally, the Southeast Georgia Physician Associates medical group includes more than 140 providers working in 20 different medical specialties at more than 50 locations. The Health System is part of Coastal Community Health, a regional affiliation between Baptist Health and Southeast Georgia Health System forming a highly integrated hospital network focused on significant initiatives designed to enhance the quality and value of care provided to our contiguous communities. In 2020, the Brunswick Campus was rated High Performing in COPD and Heart Failure by the U.S. News & World Report. For more information, visit sghs.org.

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As part of the nationwide effort to end the COVID-19 pandemic, St. Mary’s Good Samaritan Hospital received a partial shipment of the COVID-19 vaccine Monday and began administering it to front-line colleagues and providers this morning. Among those working to administer the shots was hospital President Tanya Adcock, a registered nurse.

“We are excited about the safety and effectiveness of this first vaccine and others that are going through the FDA review and approval process,” Adcock said. “These vaccines hold the promise to end the COVID-19 pandemic and save lives.”

Among the first colleagues and providers to receive the vaccine at Good Sam were Dr. Barry Baker, Emergency Department; Dr. Craig Colby, Chief of Medicine; Dr. Kristina Collins, Chief of Emergency Medicine; Tina Childree, RN, Emergency Department Manager, Dr. Dave Ringer, Medical Staff President, and Jacki Gruszynski, speech-language pathologist.

In these initial stages, while vaccine supply is very limited, St. Mary’s Health Care System is following state guidelines for determining which colleagues receive the vaccine first. At the top of the priority list are colleagues who provide face-to-face care to large numbers of patients with COVID, including physicians, advanced practice clinicians, and staff in areas such as the Emergency Department and Nursing Unit. Next priority will be patient-facing staff who provide care to large numbers of patients not known or suspected to have COVID.

“It’s something of a miracle that science has delivered a safe and effective vaccine in just a year from the eruption of a deadly new virus,” said Dr. Jason Smith, St. Mary’s Chief Medical Officer. “The key was the work done on messenger RNA vaccines over the past two decades, driven by the need to fight other novel viruses such as MERS and SARS. That research led to the development of this new generation of vaccines, which use mRNA to teach the body’s immune system how to recognize and fight the virus without having to use any of the virus itself in the vaccine.”

The first doses delivered to St. Mary’s were manufactured by Pfizer. St. Mary’s has also requested hundreds of doses of a vaccine developed by the Moderna pharmaceutical company, which was approved by the FDA Friday for emergency use and does not require ultra-cold storage. In all, St. Mary’s has asked the State of Georgia to provide enough vaccine to vaccinate all colleagues, medical group providers, and credentialed physicians.

Adcock noted that vaccinating enough of the population to stop the spread of COVID-19 will take time.

“With the start of vaccination, we can see the light at the end of the tunnel, but we’re not out of the tunnel yet,” she said. “With the holidays starting and COVID rates continuing to rise in our state and region, it’s more important than ever for the whole community to redouble their efforts to fight this virus.”

Adcock said it will be necessary to stay vigilant for several months by continuing to wear a mask in public, keeping good social distance, and avoiding large gatherings. Other measures, such as washing hands often, sanitizing surfaces, and staying home if feeling sick, are effective at fighting all kinds of viral illnesses, including the flu, and should become a regular part of daily living.

“We know all these steps can slow or even stop the spread of COVID-19 and prevent hospitals from becoming overwhelmed,” she said. “We need to mount one last push to keep each other safe while our nation and world vaccinate billions of people, and then we can put this pandemic behind us.”

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On the morning of Dec. 22, the two nondescript delivery trucks backed up to the docks of Tanner Medical Center/Carrollton and Tanner Medical Center/Villa Rica, offloading the first doses of the vaccine that — along with continued public health measures — will give the region a chance to turn around the COVID-19 pandemic. 

The hospitals received almost 2,000 doses of the COVID-19 vaccine — enough to inoculate the frontline healthcare workers and medical staff who have battled the pandemic since the first cases appeared in March.  

The health system began to administer the vaccines Tuesday afternoon.  

“I think it’s important for people to remember — even if they’re low-risk — that we’re doing this for the at-risk people,” said Richard Warren, MD, a board-certified emergency medicine physician who was among the first to receive the vaccine. “The truth is, in the job we do and the place where we work, we’re natural spreaders. For us to protect our community, we have to be leaders.” 

Dr. Warren said the shot didn’t hurt and had no concern about the safety of the vaccine. 

“I had no concern about getting the shot,” he said. “I felt very comfortable.” 

Guidelines from the Centers for Disease Control and Prevention (CDC) call for administering the vaccine first to frontline healthcare workers — those at greatest risk of exposure to COVID-19 — and residents of long-term care facilities who are at the greatest risk of severe illness from the virus.  

Doses of the vaccine are allocated by the Georgia Department of Community Health (DPH), which decides when — and how much — of the vaccine will be distributed. 

The vaccine is manufactured by Pfizer-BioNTech and has strict cold-storage requirements. The health system has ordered additional freezers to safely keep the vaccine. To achieve better than 90% efficacy, the vaccine must be administered in two doses, 21 days apart. 

The health system is strongly encouraging staff to take advantage of the vaccine for their safety and the safety of their loved ones.  

Ultimately, Tanner hopes to roll out vaccination region-wide. 

“I feel so strongly about getting protected and getting back to some sense of normalcy for us,” said Laura Larson, MD, a board-certified infectious disease specialist, medical director of infection prevention and chair of the Carroll County Board of Health. “This has been a hard, hard year, and I never want to go through anything like this again. I want everyone to know that I felt safe about getting it, and the safety data is unreal. We haven’t had a vaccine that had 95% efficacy in a long time. We’re fortunate that we have this in our lifetime.” 

While mild side effects have been reported with the vaccine — typically as a result of the body’s immune response, indicating the vaccine is working — severe side effects from the vaccine have been very rare.  

As the vaccine became available, frontline healthcare workers lined the halls at Tanner Medical Center/Carrollton to get the first dose.  

“We’re grateful that we can offer this as a means to keep our frontline staff safe,” said Loy Howard, president and CEO of Tanner. “I’m looking forward to being able to offer this across our region, so everyone has the opportunity to be protected from this world-changing virus.” 

More information on Tanner’s vaccine plan can be found at tanner.org/vaccine.  

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As part of the nationwide effort to end the COVID-19 pandemic, St. Mary’s received a partial shipment of the COVID-19 vaccine Monday and began administering it to front-line colleagues and providers. Among those working to administer the shots was St. Mary’s President and CEO Montez Carter, a licensed pharmacist.

“We are excited about the safety and effectiveness of this first vaccine and others that are going through the FDA review and approval process,” Carter said. “These vaccines hold the promise to end the COVID-19 pandemic and save lives.”

Among the first of more than 50 colleagues and providers to receive the vaccine at St. Mary’s Hospital in Athens were Elizabeth Jean-Noel, a nurse practitioner with Infectious Disease Specialists of Athens; Margarita Osorito, Emergency Department nurse; Kelly Porter, respiratory therapist; Dr. Nehal Bhatt,  pulmonologist and critical care physician; Dr. Clay Chappell, interventional cardiologist; Barbara Kelley, nurse and director of St. Mary’s Intensive Care Unit, Dr. David Gaines, family practitioner, and Dr. Adam Traill, hospitalist.

At St. Mary’s Sacred Heart Hospital in Lavonia, where nearly 20 were vaccinated, the first vaccine recipients included Dr. Kenneth Carroll, OB/GYN; Paula Carroll, certified nurse anesthetist; Ruth Tellano Daniel, Emergency Department nurse practitioner; Diana Elliott, nuclear medicine tech; Brenda Powell, nurse and manager of the Mother/Baby Unit; Dr. Richard White, Chief of Staff, and Dr. Morgan Wood, Emergency Department medical director.

Because of the logistics of properly shipping and handling the Pfizer vaccine, which requires ultra-cold storage – 76 degrees below zero or colder – St. Mary’s Good Samaritan Hospital in Greensboro is planning to hold its first colleague vaccine clinic on Tuesday.

In these initial stages, while vaccine supply is very limited, St. Mary’s is following state guidelines for determining which colleagues receive the vaccine first. At the top of the priority list are colleagues who provide face-to-face care to large numbers of patients with COVID, including physicians, advanced practice clinicians, and staff in units such as the Emergency Department and ICU. Next priority will be patient-facing staff who provide care to large numbers of patients not known or suspected to have COVID.

“It’s something of a miracle that science has delivered a safe and effective vaccine in just a year from the eruption of a deadly new virus,” said Dr. Jason Smith, St. Mary’s Chief Medical Officer. “The key was the work done on messenger RNA vaccines over the past two decades, driven by the need to fight other novel viruses such as MERS and SARS. That research led to the development of this new generation of vaccines, which use mRNA to teach the body’s immune system how to recognize and fight the virus without having to use any of the virus itself in the vaccine.”

The first doses delivered to St. Mary’s were manufactured by Pfizer. St. Mary’s has also requested hundreds of doses of a vaccine developed by the Moderna pharmaceutical company, which was approved by the FDA Friday for emergency use and does not require ultra-cold storage. In all, St. Mary’s has asked the State of Georgia to provide enough vaccine to vaccinate all colleagues, medical group providers, and credentialed physicians. In addition, St. Mary’s is working with Farmer’s Drugs of Oconee County to provide vaccinations to residents of Highland Hills Village, a retirement community that provides memory care, assisted living, and independent living to senior adults.

Carter noted that vaccinating enough of the population to stop the spread of COVID-19 will take time.

“With the start of vaccination, we can see the light at the end of the tunnel, but we’re not out of the tunnel yet,” he said. “With the holidays starting and COVID rates continuing to rise in our state and region, it’s more important than ever for the whole community to redouble their efforts to fight this virus.”

Carter said it will be necessary to stay vigilant for several months by continuing to wear a mask in public, keeping good social distance, and avoiding large gatherings. Other measures, such as washing hands often, sanitizing surfaces, and staying home if feeling sick, are effective at fighting all kinds of viral illnesses, including the flu, and should become a regular part of daily living.

“We know all these steps can slow or even stop the spread of COVID-19 and prevent hospitals from becoming overwhelmed,” he said. “We need to mount one last push to keep each other safe while our nation and world vaccinate billions of people, and then we can put this pandemic behind us.”

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Northeast Georgia Health System (NGHS) is now offering nearly 5,000 doses of the COVID-19 vaccine to frontline staff and physicians.

            “It feels like Christmas came early,” says Carol Burrell, NGHS president and CEO. “It’s been a long eight months for our organization and our community, as we continue to see record numbers of COVID patients. We still have a long journey ahead of us, but simply having a vaccine in our hands is a tremendous and positive step forward.”

The first shipment of the Pfizer vaccine arrived at Northeast Georgia Medical Center (NGMC) Gainesville Thursday morning, where it is being stored in specially ordered freezers to maintain the proper storage temperature. Doses are being offered to employees in a prioritized order based on risk, with more vaccinations continuing at NGMC Gainesville and NGMC Braselton. Future vaccine shipments are expected to begin on a regular basis soon, though no official timeline or cadence has been set.

“We hope other COVID-19 vaccines developed by different companies and research groups will receive federal approval soon, which would allow us to vaccinate our workforce and people in our community, faster than planned,” says Supriya Mannepalli, MD, NGMC’s medical director of Infectious Disease Medicine. “I’m amazed at how quickly our team has worked through detailed logistics to make this possible – just like they have with so many other challenges during the pandemic.”

The first employees vaccinated Thursday night include:

• Rachel Brunner, RN – Critical Care Nurse at NGMC Gainesville and Braselton
• Andy Cason, RRT – Respiratory Therapist at NGMC Gainesville
• Tamika Johnson, RN – Charge Nurse in the Mobile Medical Unit at NGMC Gainesville
• Elizabeth Larkins, MSN, RN – Director of Critical Care at NGMC Gainesville
• April McDonald, MD – Pulmonology and Critical Care Medicine Physician with Northeast Georgia Physicians Group, practicing at NGMC Gainesville and Braselton
• Terry Phillips – Environmental Services Technician at NGMC Gainesville
• Seth Scott, RN – Nurse in the Emergency Department at NGMC Gainesville

Important information about COVID-19 vaccines, including details about when they may be available to the general public, answers to frequently asked questions and more, is available at nghs.com/covid-vaccine.

“It’s important to remember that vaccination isn’t a magic bullet that will end the pandemic immediately,” says Dr. Mannepalli. “People need to continue following the 3Ws – wear a mask, wash your hands, watch your distance – even after getting the vaccine, at least until herd immunity is achieved.”

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The COVID crisis has worsened the plight of the state’s most vulnerable hospitals.

When the doors closed at Cuthbert’s Southwest Georgia Regional Medical Center (SGRMC) last month, Randolph County lost more than a hospital. Jobs and one of its few remaining lures for economic growth disappeared along with the ability to treat patients close to home.

“Rural hospitals are vital parts of the communities they serve,” says SGRMC’s former CEO Kim Gilman, “and when they close, those communities suffer lasting negative impacts.”

The 25-bed critical access hospital had been struggling for years, even with help from the Phoebe Putney Health System, which managed it for the county’s hospital authority. But the COVID crisis did it in.

“COVID-19 reshaped our healthcare delivery model overnight,” says Gilman, who also serves as CEO at Phoebe Worth Medical Center in Sylvester. “The reality of the virus and its impact were far worse than we could have imagined. COVID-19 truly exposed our vulnerabilities as a rural hospital – related to our minimal staffing structure, limited physicians, limited supplies on hand and our aging facilities.”

The very same month Cuthbert lost its hospital, Commerce lost Northridge Medical Center, a 90-bed facility. They were the eighth and ninth rural hospitals to close in Georgia since 2010.

“These hospitals had been in bad shape for quite some time,” says Monty Veazey, president and CEO of Georgia Alliance of Community Hospitals, an advocacy group for not-for-profit facilities.

“Unfortunately, there are probably eight to 10 others across the state that are on life support, too, having a tough time meeting payroll, a tough time meeting the need for capital projects,” like renovations, improvements, even a new roof.

Complex Challenges

Most of Georgia’s 72 rural hospitals are struggling. Revenue from an affiliated nursing home, outpatient clinic or rehab center helps many, but that isn’t always enough. Some larger rural hospitals, like Coffee Regional Medical Center in Douglas, are helped by elective surgeries; but that avenue isn’t open to all.

“We have ongoing issues we can’t control,” Veazey says, “such as a declining population, an aging population, an uninsured population, which has been increased because of COVID and the resulting unemployment that means many who had health insurance lost it.” This is compounded by a high Medicaid rate, since payments from Medicaid – and Medicare – are less than those from private insurers.

“What you see in these communities [is] generational poverty,” Veazey says, “where some who need to go to the hospital do not have transportation – that’s a big issue.” So is a lack of doctors, especially specialists. “You combine all of those together, and you’ve got a crisis on your hands,” he says, even before the COVID crisis brought more, typically sicker, patients.

“Everything is complex and has been for a while,” says Chuck Adams, executive vice president of the Georgia Hospital Association who heads its Center for Rural Health. “COVID added to that complexity with all our hospitals, but especially rural hospitals because so many of them operate on such a thin margin.”

Overall, he says, federal money made available during the pandemic from the CARES Act and other programs has been a tremendous help, “nothing that has made them flush, but able to maintain, keeping the hospitals paying their bills, keeping their staff.”

There has been help from the state, too, during the crisis, notably when the Georgia Emergency Management Agency stepped in with assistance in staffing. Coffee Regional President and CEO Vicki Lewis calls that “a godsend.”

Adams says some hospitals may have bought some time with the federal funds, but it wasn’t sufficient to fix their long-term problems. “The challenge on the back side of that,” he says, “some of the money has payback provisions. Instead of grants, they were loans. While it’s helped them get through or get to this point, when the payback provisions start kicking in, things like that are going to impact them on the back end as well.”

Rural hospitals have been feeling the squeeze since the 1990s. As far as their ultimate survival, Adams says, it depends on a couple of things: “How quick they can ramp back up volume and get a revenue increase or how they can get some help either to partner with some other facility or get local government help. We’ve seen that before, where counties have stepped in and helped with some financing for hospitals. We know we’ve got a lot of counties that are financially struggling as well. How much can you get out of a county government that has the same problems the hospital is having?”

Jimmy Lewis, CEO of HomeTown Health, a network of rural healthcare providers and organizations, says hospitals were ill prepared for a pandemic. In addition to personal protective equipment (PPE) shortages, capacity and staffing were out of sync. “Hospitals were overwhelmed by bed consumption, and [in some cases we] had the crazy situation we had available beds but no skilled services to man the hospitals to provide care. July and August and the first part of September, we had real problems,” he says.

But there is no doubt the government’s infusion of cash saved patients’ lives, he says.

Downward Spiral

In Cuthbert, Gilman says “a sparse and declining local population” in a very poor county was a major factor in the SGRMC closing. Randolph County has a population of 6,700 that is projected to decline another 12% in the coming years. The poverty rate is nearly 31%, and the number of uninsured patients is high.

“Fewer insured patients equates to less available cash,” Gilman says. “There’s not enough available cash to invest in needed infrastructure, building improvements, equipment, or staffing recruitment and pay increases, and barely enough to cover day-to-day operations.”

Engineering reports showed that the Cuthbert hospital needed more than $10 million in improvements, but the hospital authority was unable to secure funding.

“Health issues and consumer choices don’t support a facility where the building and its infrastructure are failing and where [patients] know they’ll not be able to obtain all the care they need due to gaps in equipment, technology and the services offered,” Gilman says. “Once patients begin seeking care from other places, the sources of cash are even more negatively impacted, and the downward spiral just continues.”

It’s no secret that SGRMC was able to hang on as along as it did because of Phoebe’s help, including no-interest loans and some services provided for no cost. The hospital authority paid only $5,000 a year in management fees, substantially lower than other hospitals pay for similar services elsewhere.

Federal money from the CARES Act helped but could not go toward physical plant needs. A hospital management company’s assessment confirmed that the model was not sustainable. Ultimately, Gilman says, the difficult decision to close the hospital was made.

Remaining Viable

In Douglas, Coffee Regional is facing difficulties, but is clearly in better shape than many other rural hospitals. “We’ve been dealt a better hand,” says Vicki Lewis of the 88-bed facility. The county has a substantial population – about 43,000 – and is even seeing some growth. “We have business and industry in Coffee County, with jobs,” she says. “We’ve got businesses and industries that are hiring and large employers who provide insurance options.”

The hospital has an active outpatient rehab facility and a high surgery volume, as well as a thriving orthopedic practice and busy cardiology and oncology services.

Nonetheless, it took a financial hit from COVID. “We have an unfavorable payer mix,” she says, “made up of a lot of patients who are uninsured, a high percentage of self-pay, high percentage of Medicaid, high percentage of Medicare.”

The hospital stopped doing elective surgery for a while, which Lewis calls devastating. “We are very much dependent on surgical procedures and diagnostic procedures. We shut down elective procedures and diminished pretty dramatically some of the tests we were doing. That created a revenue deficit,” she says.

The crisis made a difference in the hospital’s day-to-day operations, too. “We have had a high census of COVID patients,” she says. “The numbers of staff members and numbers of bedside caregivers required for each patient is higher than it was before COVID. That’s because the patients are so ill. These are patients who have crises – a lot of respiratory symptoms, sometimes they go into kidney failure.

“The stress of the overall level of illness of each patient does take a toll. Many patients on ventilators are quite ill. We’ve been very, very fortunate that the vast majority of patients we’ve cared for have been discharged and gone home, but we have had several patients who have died. So that stress is there. Some of our staff have been ill as well.”

The hospital also saw changes in the emergency room. Creating a separate ER and ICU for COVID patients helped, but she says the volume of patients in the regular ER is still down. “Surgical volume is almost back. Cardiology volumes – we have an interventional cardiac cath lab – are back,” she says.

Vicki Lewis says the hospital is preparing its budget for next year and projecting a further erosion in the payer mix. She expects some of the changes brought by COVID will be permanent. “Once the vaccine rolls out, we’ll take the lessons learned and create a future pathway. We all have learned so much about this, and we’re going to take that to heart.”

Medicaid Expansion Needed

Ask the experts what would help rural hospitals most and you typically get a two-word answer: More Medicaid. Several studies have found that rural hospitals do better financially in states that have expanded Medicaid.

Georgia governors and legislative leaders have been reluctant to go the route of full Medicaid expansion provided by the Affordable Care Act, saying it was too costly. But the state applied for – and was granted by the federal government in October – help in the form of waivers that will allow some flexibility in how coverage is added. Estimates are that some 50,000 Georgians will be added to Medicaid rolls in the next two years, but approximately 350,000 will still be without coverage.

GHA’s Adams says the organization supports any effort to ensure access to affordable healthcare for all Georgians. “That does include [the] waivers,” he says. “That’s going to add additional citizens to an insurance roll that will ultimately help hospitals and providers. Anything we can do to help support access to affordable health insurance we are behind.”

Veazey says the waivers will “move the needle” a bit, but he favors full Medicaid expansion. “That would be the best thing we could do. If you want to see these hospitals continue to close, those populations continue to be underserved, then you don’t expand,” he says. “But to expand it would mean everyone would be insured in that [low-income] population group. They’re the ones that need it the most. Some have to drive 30 miles to see [a doctor]. They just don’t seek care. Then they get sicker. When they get sicker, someone finally gets them to the hospital, then we have our hands full.”

Technology Lifeline

It’s hard to find much good in a crisis that has claimed lives and sickened so many, but the pandemic has boosted the use of telemedicine significantly.

“The telehealth-telemedicine programs we have been talking about for years and years and years but just couldn’t quite get up and running have been huge during this time,” says Adams. Part of the problem of early adoption was some payers’ refusal to reimburse physicians and hospitals for telemedicine visits. But that changed when the Centers for Medicare and Medicaid began to allow it.

“In an instant, telehealth became the buzzword and the tool to use,” says Jimmy Lewis, a long-time board member of the Blackshear-based Global Partnership for Telehealth. “Doctors started to realize it works, it really works,” and they became more comfortable using it.

He believes the technology will be used even more for monitoring patients with chronic conditions like hypertension and diabetes. It’s a real benefit for rural Georgia, where there is a shortage of specialists – heart, pulmonary, urinary. With telemedicine, a rural patient can “see” (and be seen by) a doctor hundreds of miles away.

Even obvious obstacles for rural hospitals – cost and connectivity – are not so formidable as they once were, thanks to technology. A few years ago, for example, a telemedicine “cart” might have cost $40,000, Jimmy Lewis says. “That same equipment today has gone to cloud-based; you can do it for less than $10,000. The cost of implementation has plummeted.” And he believes broadband access will continue to improve.

Post-pandemic Solutions

For many rural facilities, partnerships or affiliations with larger hospitals and health systems are likely to improve their situation.

Those affiliations can work in several ways, says GHA’s Adams. Take, for example, a shared service model where a larger health system can provide specialty services that a smaller hospital lacks.

Such arrangements would benefit both the smaller and larger facilities, he says. “Larger hospitals are the ones that tended to be near capacity even before COVID, based on the ability for them to offer numerous services rural hospitals can’t have. That’s the type of business that’s going to go to those hospitals,” Adams says. “For those other acute care needs, our rural hospitals are perfectly capable of providing that quality and access to care. The road travels both ways – hospitals that develop those relationships have figured that out.”

But things are not going to be easy for the rural hospitals. Adams says ones that are struggling are going to continue to have problems and are going to have to rethink their service models. “It may be that what some of our rural hospitals have to do is kind of retool themselves to provide the care the community desires and needs – but maybe not in the traditional sense we know.”

Yet Adams remains a steadfast advocate of rural hospitals: “I think the pandemic has proven the need,” he says. “Without these hospitals, without the extra capacity to take care of patients when censuses are going through the roof, when patients are not able to travel – I can’t imagine what kind of issues we would have if we were not to have the rural hospitals we have.”

Northeast Georgia Medical Center (NGMC) Barrow and NGMC Braselton were recently certified for the first time as Primary Stroke Centers by DNV GL Healthcare, shortly after NGMC Gainesville was recertified as a Primary Stroke Center.

“Our health system continues to prove that it is dedicated to ensuring stroke patients in our region are offered the best care close to home,” said Dr. Sung Lee, NGMC’s medical director of Neurointerventional Surgery. “With three of our hospital campuses now certified as Primary Stroke Centers, patients can rest assured that if they arrive with stroke symptoms, they will receive quick care from a skilled and passionate team.”

Primary Stroke Center certification means that a hospital can provide treatment to a broad range of stroke conditions along with some acute therapies, and admit patients to a designated stroke unit specifically assigned for stroke care. Primary Stroke Centers also act as a resource center for other facilities in the region, including being a main transfer site for stabilized stroke patients.

“We work hard to make sure our community is educated on the signs and symptoms of stroke,” said Tina Johnson, Stroke Program coordinator at NGMC Barrow. “That way, if someone sees a person suffering a stroke, or feels like they’re suffering one themselves, they know exactly what to do and where to get treated.”

Before their certification, NGMC Barrow and NGMC Braselton were designated Remote Treatment Stroke Centers by the Georgia Department of Public Health.

Along with NGMC Gainesville’s recertification, the hospital recently completed construction on a new, state-of-the-art Neurointerventional Lab, furthering its stroke treatment with the ability to perform mechanical thrombectomies.

“Time is of the essence when it comes to stroke,” said Tracie Withington, Stroke Program coordinator at NGMC Braselton. “We’ve worked diligently to ensure that we provide stroke care in a timely manner and now, being recognized as a Primary Stroke Center, patients can trust that even more.”

To learn more about NGMC’s Primary Stroke Centers in Barrow, Braselton or Gainesville, visit nghs.com/stroke-care.

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