Photo: Kamran Jebreili, STF / Associated Press

For the Rolling Plains Memorial Hospital in West Texas, the Sweetwater Rattlesnake Roundup means an emergency room filled with people seeking treatment for snakebites, cuts and bruises. This year, however, the 86-bed hospital has to contend with the possibility that someone among the more than 20,000 people who attend the annual event to catch rattlesnakes and enjoy the carnival could carry the coronavirus.

The coronavirus is testing hospitals and health care providers throughout the country and around the world, but it provides a particular challenge to small, rural hospitals such as Rolling Plains, which in the best of times struggle with staffing shortages, rising costs and tight budgets that leave little room for unexpected expenses.

A coronavirus outbreak could quickly drain these hospitals’ resources, pushing many into the red — or deeper into the red — and affecting care of other patients. Rolling Plains, for example, has staffing to handle only about 30 patients a day.

“We’d be quickly overwhelmed if we had an influx of patients,” said Donna Boatright, the hospital administrator.

Protective gear and planning treatment

Rural hospitals are preparing, even though the chances of an outbreak in their communities remain low. Boatright said she has regularly ordered supplies of protective gear such face masks, surgical gowns and face shields as her suppliers allow. Rolling Plains’ usual vendors have limited the amount that health care providers can purchase at one time because of high demand as the coronavirus spreads.

Rolling Plains hasn’t yet had a problem with running out of supplies, but Boatright worries that if the pandemic worsens, supplies run low and prices surge, it will affect hospital operations well beyond coronavirus care, threatening both financial stability and patient care — for example, not being able to perform surgery because the hospital is out of surgical gowns.

Over the last decade, 26 rural hospitals have closed in Texas, and 46 percent of the state’s rural hospitals have reported operating at a loss, according to the Texas Organization for Rural and Community Hospitals.

“Many of us just live on a very, very narrow margin of operation, and some of us with negative margins,” Boatright said. “One of the fears our small hospitals have is, how do we continue if we don’t generate the small amount of revenue we try to generate?”

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In Rankin, 55 miles south of Midland, the Rankin County Hospital has the same concerns. Its supplier did not entirely fill a recent order of masks and gowns despite its ordering before the panic, said Jim Horton, CEO of the Rankin County Hospital District.

Horton’s staff has started to stretch the supplies on hand in case another order is only partially filled.

“We are changing some of our habits to reduce the use of gowns as much as possible,” he said.

At the hospital district, staff have built a plan for taking in any highly contagious patients. Paramedics responding to a call will wear protective gear such as masks and face shields, which they will also place on patients at their homes. A potential COVID-19 patient will be taken into the hospital through a side door and into an isolation room that’s been negatively pressurized to prevent airborne pathogens from traveling through the hospital’s ventilation system.

Severe cases would be taken to hospitals in larger cities, Horton said.

Payment methods

Rural hospitals say they would treat any coronavirus cases, regardless of if patients can pay. Under federal law, emergency rooms must treat everyone before asking for proof of insurance or proof that they can cover the costs.

About 17 percent of Texans are uninsured — the highest rate in the nation — and the rate of uninsured patients is as high as 25 percent in some rural counties, according to the Texas Medical Association.

Rural doctors are worried about absorbing the costs of uncompensated care. Hospitals may get some of those costs for treating people without insurance or money to pay. Medicaid, the health insurance program for the poor, provides about 60 percent of the costs of charity care for hospitals.

Medicaid and many private insurers will cover coronavirus testing, state officials said. Rural hospital administrators are wondering who will pay for testing for people who don’t have insurance. The Trump administration is considering using a national disaster program to pay the costs of hospital providers’ care of uninsured people who have COVID-19, the name for the disease caused by the coronavirus.

Doctors also worry that fear of getting infected by the virus is driving away patients who have chronic conditions — even if they have insurance and can afford to pay for care.

“There’s a little bit of apprehension,” said John Henderson, the president of the Texas Organization of Rural and Community Hospitals, “that if any hospital were to care for a coronavirus patient, there would be patients with more significant chronic medical conditions that would avoid needed care.”

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But for hospital stays to treat a viral infection such as COVID-19, the costs get pricey. An inpatient stay is a little over $8,000 daily at the Rankin County Hospital District, for instance. Health care providers say they plan to treat first and ask questions about funding later.

“Regarding coronavirus, we are confident that the state and federal government will find a way to reimburse most of our costs,” Horton said. “They see us all working together to solve this crisis, and I truly believe they will take care of us. Sort of like the aftermath of Hurricane Harvey.”

gwendolyn.wu@chron.com

Twitter: @gwendolynawu