Salem Memorial District Hospital has a protocol in place for handling requests for COVID-19 testing and is also limiting visitors to the hospital during the current health crisis.

Any visitors coming in will be stopped at the nurses station, asked a series of questions and have their temperature taken before they are allowed to see a patient, SMDH board members were told at the March meeting.

Visits are limited to one per patient per day in acute care. No visitors are allowed in the long-term care section of the hospital. “In long term care it’s pretty much a lockdown,” SMDH Administrator Kasey Lucas said.

Older adults and people who have chronic medical conditions including heart disease, lung disease, diabetes, cancer and hypertension are at higher risk for more serious COVID-19 illness and death, according to the National Foundation for Infectious Diseases.

SMDH is also trying to separate sicker patients from those who only need services like imaging or an x-rays and rerouting incoming patients away from passing through the emergency room if they are not there for emergency services.

The hospital has an established protocol for COVID-19 testing, but has not had to test anyone yet, Lucas said, as of the March 17 board meeting.

SMDH has a special quarantine area set up to handle residents requesting a test. If someone calls in, asking to be tested, they’re asked a set of questions. If a visit is deemed necessary, they are met by a nurse at the quarantine area and checked, Chief Nursing Officer Debbie Hines said.

A flu test is administered first. If it’s negative, they meet with a doctor. At that time, the state is contacted to see if they qualify for COVID-19 testing. If they are approved, the testing is done and the sample sent to the Missouri State Public Health Laboratory for analysis.

“It’s a nasal swab like the flu,” Hines said. “Just because they want to be tested, at this time, that’s not an option. You have to qualify as per state guidelines and the CDC.”

Lucas added, “We haven’t had to make that call to the state yet.”

But COVID-19 is on everyone’s mind. “I know there’s frustration out there,” he said, noting the numerous posts about the virus locally on social media.

Board member Ray Bruno called the guidelines for testing “very frustrating because basically you have to be in severe acute respiratory syndrome (SARS) or live with somebody that’s already tested positive before you get tested,” he said. “Symptoms alone don’t get it, at least not from what I’ve seen.”

The idea behind the strict criteria appears to be a desire to conserve the number of available tests and not overwhelm the labs with possible cases, he said.

With construction set to begin soon on the hospital renovation and expansion project, officials are talking about a screening process for the construction workers every day as they come in, Lucas said. “We’ve even kicked around that screening process for employees every day as they come in, focusing pretty much on temperature,” he said. Vendors haven’t been discussed yet, but there are food vendors who come in fairly often to deliver food for patients.

“There’s going to be a time when every time you come in, we’ll be doing screening,” he told the board. “We’ve not seen a lot of the volume. As we see those things show up, as we see positives in this area, we definitely will ramp that up at that point.”

COVID-19 efforts are being coordinated by Cathy Dean, who heads up employee health and education and infection prevention, and ambulance director Mike Gruenberg. “They do a fantastic job, work very well together, and they’ve put in a lot of time making sure we stay on top of the ever changing, several times throughout the day, situation,” Hines said.

Lucas said administrators spent much of the day of the meeting talking about the hospital’s coronavirus response. “It is our plan to meet every day and talk about changes to what’s happening,” he said. “At least a member of administration will meet with Cathy and Mike to review what’s changed, what are the new reports for the morning.”

SMDH will apply for any federal money that becomes available to critical access hospitals, he said. The government is reintroducing monthly payments to those hospitals to help even out cash flow. Lucas has also been on conference calls with a group of critical access hospital and what can be done about the crisis and what are concerns for hospitals. He said vendors are starting to ration supplies like masks and flu swabs. SMDH, like Phelps Health, has also discontinued elective surgeries for the time being.

In other business, the board heard an operations summary from Lucas, who noted a decrease in cash and an increase in accounts receivable in the past month.

Inpatient volume and admissions were up last month, with a 50.3 percent occupancy rate in acute care and an average of 12.6 patients per day. Those numbers for the year so far are 51.9 and 13.6.

Outpatient registrations were well above budget at 2,157, lab tests were higher than normal at 10,794 and rehabilitation treatments were a near record 831 in February, he reported.

SMDH brought in $5.6 million in patient revenue but due to higher deductions, had only $2.2 million in net operating revenue and $2.29 in net expenses, resulting in a $30,660 loss before tax revenues of $38,053 were added in to produce a small profit.

Due to decreased cash flow, the hospital currently has only 35 days of cash on hand, the lowest number since 2015. Last year it averaged 52 days of cash on hand.

“AR (accounts receivable) is high and cash is low,” he told the board. “Toward the end of February we did get about $1.3 million in accounts to Extended Business Office to start working those. That’s a big amount and we should see some activity, some dollars rolling in, from them having that to work.” Most of those accounts are from the July-December time period.

The drop-in receipts for the month brought a decrease in cash of about $440,000, he said. The ending cash balance of $2.5 million translates into the 35 days of available cash. “That’s not someplace we want to be and we are working on that,” Lucas said.

He noted that accounts receivable continues to climb, reaching $19.9 million last month, an increase of just under $2.6 million from January. Much of the overall total, $8.9 million, is in private pay, with about $7 million over 90 days past due. “A year and a half ago that was almost our total AR, that $7 million,” he said.

In her report, Hines said flu cases treated at the hospital totaled 135 in February and 137 in March as of March 9. The Dent County Health Department has reported 285 cases in the flu season so far.