But for the McKenzie County Healthcare Systems hospital in Watford City, the opposite is true: emergency room volumes and elective operations are down. CEO Dan Kelly said since the pandemic began, the hospital has lost around $4 million in revenue.

“My real worry is that if this continues to be the case where the public are not coming back to the clinic or the public are not choosing to have surgery, and should this trend of reduced revenue continue, … it will create a problem for facilities such as mine,” Kelly said.

Rural areas like McKenzie County have long sustained their hospitals through grant money, Kelly said, working against consistent operating losses. Seeking medical attention at a more urban hospital would take a two to three-hour drive for McKenzie County residents, which Kelly said could be the difference in life or death in cases of emergency.

Amid the coronavirus pandemic, rural hospitals across the country are seeing a sharp decrease in patients, and outpatient appointments and elective procedures make up as much as 80% of revenue, the Los Angeles Times reported in May.

Submitted Photo The surgical staff at McKenzie County Hospital in Watford City pose with their PPE, including masks.

Though rural areas were not hit as hard by the virus, hospitals still had to purchase extra personal protective equipment and pay for additional cleaning staff, creating increased expenses amid decreasing revenue. Kelly said funding from the federal CARES Act kept the hospital’s doors open for the past few months.

North Dakota received $1.25 billion from the CARES Act to use throughout the pandemic, according to the state’s Office of Management and Budget. The funding can be used to help public safety, public health, health care, human services and other similar businesses.

Tim Blasl, president of the North Dakota Hospital Association, said the concern now is where funding will come from if the pandemic persists. He said many hospitals are not considered “hotbeds,” but are still treating virus patients, and they are seeing little of the federal money.

“I have big financial concerns for hospitals in this state,” Blasl said. “No hospitals have closed, but the longer this goes on, you know, those issues are going to be talked about.”

CARES money has also gone to assisted care facilities throughout the state to help with similar loss in revenue. Shelly Peterson, president of the North Dakota Long Term Care Association, said the state’s care facilities lead the country in staffing numbers, and they have maintained that thanks to CARES funding.

At Eventide Senior Living Communities, which has locations throughout eastern North Dakota, the funding has helped in purchasing PPE, providing additional pay to staff working directly with residents who tested positive for the virus, and in some instances, paying for hotel rooms for staff who have at-risk family members and worry about bringing the virus home to them.

“We had to do something to show appreciation to our staff,” said Eventide CEO Jon Riewer. “And, you know, it hardly scratches the surface of what that means to have committed staff members show up not really knowing what they’re walking into every day.”

Riewer said the facilities have lost additional revenue due to future residents choosing not to move into the facilities as originally scheduled, as long-term care facilities continue to be hotspots for the virus across the country.

While it’s unclear what funding will look like as the pandemic persists, Riewer said he hopes additional money will continue going toward healthcare facilities, especially those impacting vulnerable populations such as seniors.

“While this has been expensive for all of us, I would just continue to make a case that I think we know now we need to continue to invest in these very important services,” Riewer said.

“As expensive as it is, we know that the right place to spend it right now as we continue to work through this pandemic is on the frontlines of our senior living and in care centers.”