Q&A: Bob Crumb discusses issues facing rural upper peninsula hospitals

Bob Crumb is the CEO of Schoolcraft Memorial Hospital in Manistique, Michigan. The critical-access hospital on the Upper Peninsula (UP) has 12 in-patient beds and serves a rural community in Schoolcraft county. Crumb told State of Reform about how his hospital has dealt with the pandemic and what issues rural hospitals like his own are facing at the moment. 

Mansur Shaheen: Are rural hospitals like your own struggling during the pandemic?

Bob Crumb: “Rural hospitals are actually struggling the most. As an example, here in the UP of Michigan we did not see a lot of COVID patients in the first wave, and yet we had to close all of our clinics. So it was very difficult and patients are still somewhat reluctant to come back. We’re just now starting to see our surgery numbers returning to normal and our clinic volume is picking up.”

MS: Is there anything the government, whether federal, state or local, can do to help hospitals like your own?

BC: “Well, we were able to get some CARES Act money and some of the PPP money. But that was a year ago and this pandemic still continues. So, any financial support that we could get would be much appreciated.

We have gotten federal help, but the state could perhaps do something as well.”

MS: How has the vaccine rollout gone for your hospital?

BC: “We’re pretty proud of our little hospital to be number one in the state of Michigan per capita for immunizations. But we haven’t had a direct shipment of the vaccine in well over a month.

Vaccines have been going to our health department. They distribute a few immunizations themselves and distribute the rest to hospitals. The health department represents four counties. They have to take what they get and divide it among the four counties.

We used to be able to place orders. Now, even the health department here is not allowed to place an order, you get what the state chooses to send you. And the amount we have been sent in recent times has been less.

It’s also very difficult to manage. You’d like to be able to schedule your workforce and your appointments for these weeks in advance. That would be nice, but we never know till Monday of that week how many vaccines we are going to get. So it’s always a surprise. ‘Oh, you’re going to get 100 or you’re going to get 180 or oh, we didn’t get any this week.’ So you can’t schedule ahead. You can’t line up people ahead so we’re always scrambling to try and get staff to cover the vaccine clinic and then rush to fill the appointment.

The state has an algorithm of some sort that allocates the vaccine. It’s partially based on population, it’s partially based on inpatient amounts and, of course, as a critical access hospital we have very few inpatients. So, we lose on those scores.”

 

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MS: Has staffing been an issue for your hospital during the pandemic?

BC: “Yes, because what happens is some of our employees get exposed and then they have to go home for two weeks. So when we were seeing a rush we were also having some of our own employees out. And I have heard of other hospitals in the UP that actually had a bunch of people out in their hospital. That was making them quite nervous.”

MS: What can be done to help support rural hospital staffing ahead of the next potential COVID-19 surge?

BC: “I think that the best thing we can do as hospitals is encourage our staff to get vaccinated. And sadly I think statewide it’s around 50 to 60% of staff receiving the vaccine. Our own hospital is at a little over 70%

I think it’s pretty universal that it’s around 50% of the people are interested in getting the vaccine and 50% of them are leery. We have seen here in our own hospital that initially we were around 50%, but as others saw that everybody who received the vaccine is okay, we had sort of a second wave of people willing to receive the vaccine.”

MS: Do you fear that not enough members of your community will be willing to receive the vaccine in order to reach herd immunity?

BC: “Yeah, I think that that is a concern. We’re running ads to encourage people in the community to get it. I know the state is running ads to try and break down concerns people may have about the vaccine as well. But I think it’s going to be all about word of mouth and people talking to their primary care doctor. I think that’s as much a solution as running ads. If we can get people to their primary care doctor and their primary care doctor encourages them to get the shot then I think more of our people will do so.”

MS: Are there any issues facing rural hospitals that you feel are being underreported?

BC: “This may not seem to have much to do with health care, but this has been an issue. People were reluctant to come to see their primary care doctor in the clinic during the pandemic, so we went to telemedicine. Well, a lot of people in the UP don’t have broadband, they can’t get a tele-visit. So, broadband access has become a bigger problem for us because we tried to move to telemedicine. There’s a lot of places that don’t even have cellular service up here.

There have been some efforts to expand the internet here. The college in Marquette, Northern Michigan University, has an effort out there to expand broadband. My understanding is there was some money allocated for rural broadband development in the December COVID Relief bill.

So, I think there’s money out there. But very few people here have access to cable TV or cable internet because the houses aren’t close enough together to make it worthwhile for the companies. So even if broadband is ‘quote unquote’ ‘coming to rural America,’ I’m still not sure how they’re going to get us broad connectivity.

I think our patients may get left behind. A number of our patients just can’t access it. So it’s more our fear that if another pandemic comes, and they’re afraid to go to the hospital and they can’t access telemedicine, they’re just not getting care at all.”

This interview has been edited for length and clarity.