It has been suggested that FCH can simply add various outpatient and inpatient services to help subsidize current LTC operations. Unfortunately, the short answer is no; it is not possible to add services to help subsidize LTC.

Adding services that generate revenue requires market demand, growth driven by data and weighed against feasibility, significant investments, additional staffing, physical space to operate, and time to bring them online. Revenue generated from existing or new services must be reinvested into the FCH workforce, its services, and facilities and not allocated to support and supplement one service for a limited number of community beneficiaries.

The simple and definitive answer is YES! The COVID-19 pandemic has impacted FCH finances. Below is a brief breakdown of how:

First, it is widely known that in the early days of the pandemic and through 2020, hospitals and clinics across the U.S. had to cease most operations that generated the revenue that pays for staff, supplies, and essentially keeps the lights on, and doors open. As a result, rural and remote hospitals like ours especially were highly concerned about the losses, and rightfully so.

In response to the crisis, the Federal government recognized the need for organizations like ours to sustain health care services while many of their operations were interrupted for a prolonged and uncertain period.

Significant financial relief to rural hospitals came in the form of approximately $32 billion in federal support, primarily from the Provider Relief Fund (PRF), to compensate for the loss of revenue and increased expenses from the pandemic, as well as funding through the Paycheck Protection Program (PPP.) Although this support during the pandemic temporarily helped many struggling facilities, financial challenges remain across rural health care systems. For FCH, the funding was not intended to supplement for the losses in our LTC services; instead, to ensure critical aspects of the care we provide, both inpatient and outpatient, could continue.

Another significant way the pandemic has impacted FCH financials relates to our workforce. Again, it’s obvious but worth stating. Without our nurses, techs, business office staff, clinical staff, and everyone who ensures the care you need is there when you need it, FCH would be nothing but empty.

In May of 2022, the Bipartisan Policy Center published a comprehensive report focused on “The Impact of COVID-19 on the Rural Health Care Landscape.” The report sheds important light on rural workforce challenges, which were substantial before 2020, and have gotten considerably worse since the pandemic. In their report, they offer, “Rural health care systems consistently report that retaining workers and ensuring adequate staffing levels is one of their most vexing challenges. Key problems during the pandemic include staff burnout, the need of providers to leave the workforce to care for family members, and wage pressures that made it difficult for financially strapped rural hospitals to compete with other employers.”  This last part is particularly relevant for FCH.

Although resources and additional funding are available to address staff burnout, fatigue, recruitment, and training, these efforts do not change the fact that FCH struggles to be competitive in compensation and wages compared to other hospitals, including other small rural hospitals, in the state. For as much as we’d like to be able to be a higher-range wage provider, our LTC losses directly impact our ability to do so. In other words, there is a direct connection between our recruitment and retention efforts and the millions of dollars in LTC losses. 

No amount of relief dollars will bridge the gap of the increased wages we must pay staff to be competitive and fair. For FCH to be competitive with wages and benefits is to:

• Stem the massive and accumulating financial losses due to our LTC operations.
• Grow our provider base and recruit new providers to meet the demands of our population and increase the utilization of existing services.
• Grow our services to capture (recapture) market share, leaving our community to receive their care elsewhere.

The gap between revenue from Medicaid and self-pay and the cost of operations is simply too large. LTC’s primary expense is payroll, and labor costs have been escalating steeply for several years. Minimizing the loss would require severe staffing cuts that would be detrimental to resident care and quality. In previous years we kept labor costs lower by paying lower wages. In today’s fiercely competitive health care workforce market, and considering the remoteness of our location, and faced with a nationwide shortage of nursing staff, for example, FCH must be prepared to offer higher wages and benefits to avoid being understaffed.

The community did indeed rally behind the expansion of LTC beds back in 1984 by passing a $600,000 General Obligation Bond to construct and purchase equipment for the addition of the LTC wing of the hospital facility. They did so because, since the founding of FCH, the West End community has shown it cares deeply about taking care of each other at every stage of life. But unfortunately, the General Obligation Bond does not fund maintenance, operations, staffing, and all required to manage care for our long-term patients.

It cannot be overstated that FCH is a lifeline to care. It’s a place that offers comfort, welcomes new babies to the world, and provides a wide range of essential health services to all those who call the West End home.  The FCH Board of Commissioners, leadership team, and staff want to do everything possible to ensure that FCH can continue its tradition of caring in an ever-changing and complex rural health environment. However, the investment made in 1984 was never anticipated or intended to sustain the LTC operations.

There is no debate, FCH is not in control of how its LTC patient care beds are reimbursed by Medicaid. Like every other CAH in the United States, (FCH is one of the last in Washington to make this transition) we must address the financial losses that prohibit us from being innovative in how we meet the greater care needs of all in the District.