More than a year ago, the COVID-19 pandemic struck Northwest Missouri and the community had to react quickly. The task required not only manpower, but also heaps of cash.

Hospitals were forced to buy personal protective equipment, ventilators, supplies for testing and vaccines and also increase staffing.

Joey Austin, a spokeswoman for Mosaic Life Care, said construction that included an immediate build needed for respiratory clinics, COVID-19 overflow in the ambulance bay for COVID-19 patient capacity and adding negative pressure at the medical center was the biggest expense for the St. Joseph-based health system. At the height of the pandemic, Mosaic had more than two floors full of COVID-19 patients at its flagship location.

Austin said the hospital was well-positioned to handle the immediate financial needs of the pandemic. However, adjustments were made to ensure the hospital kept a strong financial foundation.

Losing money from elective procedures

Officials at Cameron Regional Medical Center saw millions of dollars in new expenses related to the COVID-19 pandemic and struggled when elective surgeries were cut. The hospital was able to qualify for around $4.5 million of Payment Protection Program loans as well as additional grants that totaled $11 million.

Joseph Abrutz Jr., Cameron Regional Medical Center administrator, said in April 2020 revenue was down at his facility by $7 million, and that trend continued into May and June before rising again in July. But the financial impact was still present.

“The first thing that we did in April (2020), we applied for the small business protection program and we qualified for that being a small business employer under the 500-employee threshold,” Abrutz said.

Abrutz said $4.5 million received from the payment protection program in the summer of 2020 was essential to helping the hospital stay financially sound. But now he is prepared to have to give up to $6 million back from a total of more than $11 million in grants received after he was informed that some federal funding would need to be repaid. He said the hospital still has money in reserves.

“Thank God the federal government and the presidential administration last year really thought that a priority was making sure hospitals received sufficient grants,” Abrutz said.

Abrutz said the money was definitely needed. While revenue was down, the hospital spent an additional $1.8 million in just one quarter on COVID-19-specific products.

At Mosaic Life Care, the decline in elective procedures left the hospital in a tough spot. In May 2020, News-Press NOW reported Mosaic was operating at half its usual capacity even though there was only one COVID-19 patient in the hospital. Elective procedures at that time were nonexistent.

That month, Mosaic had to cut jobs due to financial pressures. At the time, Austin said officials were not disclosing the total number of staff cuts but added there were positions available for some employees to be rehired immediately into other jobs. Along with the cuts, Mosaic implemented hiring freezes and executives took pay cuts to help the bottom line.

Mosaic Chief Medical Officer Dr. Davin Turner has described “elective” surgeries as more of quality-of-life procedures and not necessarily just cosmetic operations. He said those surgeries going away for a period of time not only put a financial strain on the hospital but also hurt the quality of life for some and created lingering problems for those who stopped receiving necessary care.

Times were tight at Mosaic as hospitalizations for COVID-19 neared 100 and staffing became an issue. During that time, Turner spoke candidly about how the hospital was struggling. He advocated continuing to do elective surgeries when COVID-19 cases were continuing to rise, as he said the procedures were essential and Mosaic could do them safely. As at the Cameron Medical Center, such procedures are a key source of income for Mosaic.

Abrutz said Cameron Regional Medical Center did not have to lay off nurses thanks to the PPP loans, which Mosaic as a bigger entity did not qualify for.

Former Missouri Department of Health and Senior Services Director Dr. Randall Williams, who recently left that post, said he believes there is an opportunity for hospitals to receive more funding. He said the state has been grateful for how hospitals have stepped up during vaccination efforts and in all COVID-related situations.

“We will be working with our hospital partners and our physician partners and our health department partners to look at helping resource them, especially since they were so great about stepping up when we needed them to,” Williams said prior to his departure from his job with the state.

Local government distributes

federal dollars

Outside the hospital, budgeting was happening at the county level as well. Early in the pandemic, Buchanan County commissioners received more than $10 million in federal CARES Act money and had to delegate funding around the area.

Commissioners started giving small businesses $5,000 grants and then took out a big chunk of $2.4 million for use by the St. Joseph School District. County officials also provided money to Mosaic for COVID antibody testing and later for the vaccination clinic at East Hills Shopping Center.

CARES Act top expenditures outside the school district included $1.5 million to Motorola for an emergency radio system and hospital radio systems, $493,725 to the Buchanan County Jail for quarantine cells for COVID-19, $401,472 for the Mid-Buchanan School District for COVID-19 mitigation, 369,830 to Buchanan County School District R-IV for COVID-19 mitigation, $267,450 to Missouri Western State University athletic testing, $264,455 to Mosaic for antibody testing and $250,000 to Triumph Foods for COVID-19 mitigation for employees.

Presiding Commissioner Lee Sawyer said officials had to distribute the money quickly as it was designed to be a stimulus and it wasn’t meant to stay in the county’s pocket.

“In the end, what we really had decided and talked about is how can we affect the most number of people in Buchanan County,” he said.

One of the recipients of CARES Act dollars was the St. Joseph Health Department as the demand for contact tracers became an issue. The money was used to pay the salaries of five additional contact tracers so the health department could meet the demand.

Debra Bradley, St. Joseph’s health director, said the summer and fall of 2020 required an all-hands-on-deck approach, and people were moved from different places to assist with COVID-19 tasks and handle contact tracing. The department also bought an additional refrigerator for vaccines as well as spent money on PPE.

“There were a lot of upfront costs that we didn’t anticipate ... with the combination of no revenue coming in, because even the contracts that we have, we didn’t do as much towards the contracts,” Bradley said. “When you have a person who is supposed to be doing health education to bill to a contract but they’re doing contact tracing, you can’t bill the contract because they’re not doing that job. So it’s kind of a double-edged sword that we had going on.”

Bradley said money from the CARES Act was crucial for the department and recovery is slow, but city health staff are getting back to giving a variety of immunizations, issuing death certificates, doing STD testing and providing other services that were all paused due to the pandemic.

“We want to make it through it and I feel like the CARES Act kind of gave people some hope. That (funding) was one thing I didn’t have to worry about for a while,” Bradley said.

Longtime impact from the pandemic

While a financial impact was felt by many, there is a lot gained knowledge that came from going through a pandemic, officials said.

Abrutz said staff at his medical center have learned a lot in the last year, and he is proud of how the hospital provided testing and vaccinations for more than 18 counties in Northwest Missouri. Cameron had a tent that served as a testing location for COVID-19 at the beginning of the pandemic.

While the hospital has gotten through the pandemic, Abrutz said there needs to be a change in the third-party payer system for people who cannot afford health care.

“For every bill we send out on Medicare, we receive 10 cents on the dollar ... and then there’s patients that don’t have any third-party payer program to help them,” he said. “We’re fortunate if one out of 10 people can pay their bill in full on the self-pay.”

Bradley said the health department had plans for a disaster set in place after emergency management meetings in 2001. When the COVID-19 pandemic hit, she said some of those plans held strong, but others had to be adjusted.

“This was too big for one entity, and we all know that everyone stepped up and did their part,” Bradley said. “It was a great partnership, we knew we could always call on Mosaic, or Northwest (Health Services) or anybody in the community if we needed anything.”

Bradley said she is proud overall of how the pandemic was handled by the community and said that agencies like hers now are more ready for another crisis.

“I believe we are better prepared, I believe we’ve learned a lot through this process ... we did have plans,” Bradley said. “We used to have meetings on these emergency preparedness plans weekly, then we had them monthly and then they just kind of faded away.”

Clayton Anderson can be reached at Follow him on twitter: @NPNowAnderson.

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