Missouri’s senior U.S. senator, Roy Blunt, was in Houston on Thursday as he learned about a new surgical center at Texas County Memorial Hospital and healthcare challenges in the region.

Blunt, who earlier had visited the Missouri State University campus at Mountain Grove and its fruit station, received a tour of the partially completed surgery center that will greatly improve offerings at the county-owned hospital. Some equipment is already in place and its own maintenance staff also has done some of the work. COVID-19 hit and turned things upside down. More funds are still needed.

The hospital is aggressively working on funding sources — including a USDA Rural Development grant — that would allow completion. A Community Improvement District in TCMH’s neighborhood also provides a revenue stream.

TCMH CEO Chris Strickland told Blunt, who will next year finish his last term in the U.S. Senate because he is not seeking re-election, that had the space been available during COVID-19 outbreaks it could have been converted to accommodate extra patients, too. Additionally, the capital expenditures are seen as a good recruitment tool to attract new medical school graduates who train using the latest technology. In another portion of the hospital, replacement of the institution’s MRI machinery is underway.

Blunt toured the construction with aides and hospital administrators and later met for a sit down session in the Jayson Gentry Community Safe Room, another project funded by the federal government.

The southwest Missouri native who served as Missouri secretary of state, later in the U.S. House and now in the U.S. Senate, heard that nursing shortages continue to plague TCMH and other healthcare institutions.

Missouri saw the Delta variant take hold by early summer, leaving healthcare workers with a short reprieve from an earlier wave. Not only were cases rising unexpectedly, hospitals also were dealing with an influx of people who had delayed care or had been sickened by other infections that masks had previously kept at bay.

Strickland said the stress of the situation has taken its toll, but the hospital has tackled that by being sensitive to the situation with employees and offering some bonuses and other incentives.

Cracks remain. Some workers are switching to less stressful careers. Some have retired early. Others have left hospitals to become a temporary “traveler,” as massive demand for contract workers to fill gaps has pushed salaries multiple times what they would typically make.

The main reasons behind the shortage, area nurses and hospital officials say, are burnout, the lure of those traveler salaries and some feeling forgotten by the nearly half of Missourians who have not gotten vaccinated. Others on staff don’t want the vaccine and might leave.

Hospital leaders do not plan to introduce a vaccine mandate at the hospital, where about half are vaccinated. However, they believe eventually the Medicaid and Medicare programs may.

Hospital leaders highlighted to Blunt a healthcare system that is burdened by extra paperwork and with certain Medicare plans that often result in lower reimbursement. In some cases, Strickland said the patient becomes an “algorithm” and healthcare is taken out of the hands of physicians.

Administrators also asked Blunt to fight for a pharmaceutical plan that was designed as a price control program — generally hospitals like TCMH that serve uninsured and low-income patients in rural communities — to purchase outpatient drugs from manufacturers at discounted prices.  

Missouri’s nursing shortage

The latest workforce report by the Missouri Hospital Association, looking at 2020, found that by year’s end, job postings for registered nurses reached 35,690, up nearly 1,000 over 2019 and almost double the number in 2015.

Yet in 2019, Missouri’s 23 nursing schools only graduated 2,474 students. Nursing programs have to turn away a significant number of qualified applicants because of a faculty shortage, which the report blames on budget constraints, aging faculty and job competition. An additional 118 full-time faculty would have been needed to take all the applicants.

The pandemic also multiplied financial pressure on hospitals, the report found. Between canceling elective procedures and the high costs of preparing for and treating waves of COVID-19 patients, Missouri hospital operating margins were reduced by $1.8 billion compared to 2019.

The hospitals received $78 million through the federal Paycheck Protection Program and $1.2 billion in Provider Relief Fund payment in 2020, but “the relief funds did not make hospitals whole,” the report read.

In some cases, Texas County Memorial Hospital has introduced incentives to benefit its work staff as it toiled under two difficult years of pandemic.

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