Rural hospitals with comparably low staff vaccination rates were expected to be most affected by CMS' Covid-19 vaccine mandate, but new reports indicate these health systems have only lost "a fraction of their staff" to the immunization requirement.

Background

Last fall, several GOP-led states filed a lawsuit over CMS' mandate, which requires health care facilities participating in Medicare or Medicaid to implement a vaccine requirement for their workers. The lawsuit stated that the mandate would "exacerbate an alarming shortage of health care workers, particularly in rural communities" and "foreshadow an impending disaster in the health care industry."

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Ultimately, the Supreme Court in January rejected the legal challenge against CMS' mandate and released guidance which said that health care workers would be required to get their first shot of a Covid-19 vaccine by Feb. 14 and their last primary vaccine shot no later than March 15. However, the guidance does allow exemptions based on religious beliefs or recognized medical conditions.

After CMS released the updated guidance, smaller rural hospitals and nursing homes expressed concerns that implementing a vaccine mandate could exacerbate staffing shortages.

These concerns led some health care facilities to urge the Biden administration to allow health care workers to be regularly tested for Covid-19, rather than requiring them to get vaccinated. In addition, multiple states asked the agency for flexibility on the rule's enforcement in rural facilities, Politico reports.

For instance, West Virginia Gov. Jim Justice (R) and Virginia Gov. Glenn Youngkin (R) warned CMS that the vaccine rule would have a "particularly acute" impact on rural facilities in their states and voiced concern that "access to lifesaving care could be threatened" because of staffing shortages tied to vaccine mandates.

How rural hospitals are faring under the CMS mandate

Although hospital officials in Arkansas, Colorado, Indiana, Maine, Montana, Nebraska, Nevada, North Dakota, South Dakota, Tennessee, Virginia, West Virginia, and Wyoming recently said they are currently facing significant staffing shortages because of long-term recruitment and retention difficulties, concerns that CMS' mandate would exacerbate staffing shortages in rural areas have been largely unfounded, Politico reports.

In fact, almost two dozen rural hospital officials and state hospital association leaders told Politico that they only lost a fraction of their staff to CMS' vaccine mandate when it took effect last week.

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"There was certainly a worst-case scenario that was, quite frankly, scary, and I'm just glad that didn't come to pass," said Brian Tabor, president of the Indiana Hospital Association. "I was pleasantly surprised."

When CMS' mandate took effect, Valley Health System, which includes several rural hospitals across West Virginia and Virginia, lost less than 3% of its staff.

Similarly, Clark Fork Valley Hospital in Plains, Mont., only lost 1% of its staff, and St. Luke Community Healthcare in Ronan, Mont., lost just three employees.

St. Luke CEO Steve Todd said he felt "surprisingly good" about the mandate's implementation. "I'm a little bit relieved that we didn't have a more dire situation," Todd said. "There was a lot of saber-rattling by staff … I'm pleased that they stepped up."

Despite requests for leniency in enforcing the rule in rural areas, many rural hospital executives argued that all hospitals should be held to the same standards, and that waiving CMS' requirement for rural hospitals would have done more harm than good, Politico reports.

"These attempted interventions by these two governors appear to be purely political and clearly put patients at risk," said Valley Health CEO Mark Nantz. "Losing people in these times is always a challenge but what we found was these folks were … not connected to our mission vision and values and we are much better off without them."

According to several rural hospital leaders, a divergence in the mandate's enforcement could exacerbate staffing challenges overall by driving unvaccinated staff from urban areas to rural facilities.

"Rural health does not want to be known as the place where people who aren't vaccinated go to get work. We have to have the same standard as the urban hospitals do," said Kevin Stansbury, CEO of Lincoln Community Hospital in Hugo, Colo.

"I honestly welcome both the state mandate and the federal mandate for the idea that if we're all subject to it, just like we are all these other vaccine mandates, it won't be used as a lever to say, 'Well, if you don't let me stay here, then I'm going to quit and go somewhere else.' It's a level playing field," Stansbury added. (Gooch, Becker's Hospital Review, 2/22; Messerly, Politico, 2/22)