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Bankrupt hospital group Americore Holdings LLC was in a precarious spot before the coronavirus ripped through America’s heartland. Now, in part due to federal aid, it is looking for buyers, Bloomberg News reported. The group is seeking bids on St. Alexius Hospital in St. Louis, Ellwood City Medical Center near Pittsburgh and Izard County Medical Center in Arkansas, according to bankruptcy court papers. The Americore facilities are drawing some interest — six potential buyers had signed non-disclosure agreements as of April 21, the papers show. Americore filed for bankruptcy late last year amid a feud with lenders and a federal investigation into billing practices at one of the hospitals. The coronavirus pandemic, the company’s poor record keeping and limited access to cash have complicated efforts to stabilize operations, but CARES Act funds hit Americore’s books this month and provided a “breakthrough” for the hospitals, an attorney for court-appointed Trustee Carol Fox said in a hearing last week. St. Alexius Hospital received about $834,000 of aid, Izard County Medical Center some $250,000 and Ellwood City Medical Center about $1.8 million, said Jimmy Parrish of Baker & Hostetler LLC, who represents Fox. The funds relieved Americore’s cash woes and will allow the Lauderdale By the Sea, Florida-based company to focus on selling the facilities, he said at the hearing.

Two bankrupt Maine hospitals have warned that they could both have to close their doors by the end of June if they don’t receive funding through a federal loan program meant to help small businesses keep their staff employed through the coronavirus crisis, the Bangor (Maine) Daily News reported. Both Calais Regional Hospital and Penobscot Valley Hospital in Lincoln have been denied access to the Paycheck Protection Program because its rules disqualify entities that have filed for bankruptcy protection from receiving funds. But in separate lawsuits filed this week as part of their chapter 11 bankruptcy proceedings, both hospitals argued that those rules are unlawful because they’re not in the federal legislation that originally created the program last month. The two hospitals are now facing steep revenue shortfalls after following state and federal guidance to delay elective and outpatient services during the pandemic, even though those types of services bring in large portions of their revenue, according to their legal complaints.

Across the U.S., hospitals serving rural areas have spent decades trying to provide medical care and produce enough revenue to stay open. They have closed in increasing numbers in recent years as local populations have declined. About 170 rural hospitals have shut down since 2005. Some nonprofit or community-owned hospitals, like the three Alecto had bought in West Virginia and Ohio, turn to for-profit hospital chains as a lifeline, hoping that a focus on generating revenue could help them survive. But for-profit hospitals are more likely to close than the others, one recent federal study showed. It found that for-profit facilities accounted for 11 percent of rural hospitals but 36 percent of closures among the group. Within the past year, rural hospitals have closed in Pennsylvania and Tennessee after selling to for-profit chains. Michael Sarrao, Alecto’s general counsel, said the company had done everything it could to turn the three hospitals around but ultimately found the financial challenges insurmountable. Slow reimbursements by health insurers and cuts to Medicare reimbursement rates were factors, he said. He contended that the institutions would have closed years ago had Alecto not purchased them, and that the company lost tens of millions of dollars investing in the facilities.

The U.S. House of Representatives overwhelmingly approved a $484 billion coronavirus relief bill yesterday, funding small businesses and hospitals and pushing the total spending response to the crisis to an unprecedented near $3 trillion, Reuters reported. The measure passed the Democratic-led House by a vote of 388-5, with one member voting present. House members were meeting for the first time in weeks because of the coronavirus pandemic. Lawmakers, many wearing masks, approved the bill during an extended period of voting intended to allow them to remain at a distance from one another in line with public health recommendations. The House action sent the latest of four relief bills to the White House. Republican President Donald Trump, who backs the measure, said he would probably sign it into law on Thursday evening. The $484 billion aid bill was the fourth passed to address the coronavirus crisis. It replenishes funds to small businesses and provides hospitals struggling with the economic toll of a pandemic that has killed almost 50,000 people in the United States and thrown 26 million out of work, wiping out all the jobs created during the longest employment boom in U.S. history. Read more. 

In related news, a Reuters analysis of Small Business Administration data shows Utah, along with heartland manufacturing powers and key political battlegrounds like Ohio, Pennsylvania and Wisconsin, punched above their weight in the race to get loans from the $349 billion “Payroll Protection Program” that ran out of money in under two weeks. A comparison of local industry mix and payroll against national averages signals that important sectors in a handful of places — manufacturing in the heartland of the country, construction and oil and gas in the West — mobilized quickly and helped their states receive billions of dollars more than otherwise expected. Utah, for example, received about $600 million in SBA loans beyond what would have occurred if its firms had borrowed at national averages. In Indiana, with a heavy manufacturing presence, small businesses overall received about $1.2 billion more than if their industries had borrowed the same share of payroll as national firms. Read more. 

Hundreds of members of the U.S. House of Representatives will gather in Washington today to pass a $484 billion coronavirus relief bill, bringing the unprecedented total of funds approved for the crisis to nearly $3 trillion, Reuters reported. The measure is expected to be approved with solid bipartisan support in the Democratic-led House, but opposition by some members of both parties forced legislators to return to Washington despite stay-at-home orders intended to control the spread of the virus. The Republican-led Senate passed the legislation on Tuesday, so approval by the House will send it to the White House, where President Donald Trump has promised to quickly sign it into law. The bill — which would be the fourth passed to address the crisis — provides funds to small businesses and hospitals struggling with the economic toll of a pandemic that has killed more than 45,000 Americans and put more than 22 million out of work. Read more.

While the House is expected to approve an additional $320 billion for the Paycheck Protection Program today, there are concerns by lenders and small-business advocates that the funding still won’t be enough to meet demand for the coronavirus aid, the Wall Street Journal reported. Banks, credit unions and community-based lenders say that they have a backlog of applications for the PPP loans, after the roughly $350 billion allocated for the program ran out last week. “We believe our members have as many applications pending as they submitted during the initial round of funding, and the funds Congress is set to approve this week will likely all be used,” a spokesman for the Consumer Bankers Association said yesterday. Read more. (Subscription required.) 

Many of the small rural hospitals that are the first line of defense are being pushed to the brink, and federal dollars are not getting through to help, WSJ Pro Bankruptcy reported. Chronically under pressure, those small hospitals have been hit hard as preparations for the pandemic have forced them to cut back the outpatient services that account for more than three-fourths of their revenues. Rural hospitals have, on average, operating margins of less than 1 percent, according to the Chartis Center for Rural Health, a Chicago health analytics company. “Now you are looking at 79% of your business going away. I don’t think it takes much math to understand how precarious that situation is,” said Michael Topchik, a Chartis national leader. But the Small Business Administration’s Paycheck Protection Program, the federal government’s premier remedy for small businesses trying to stay on their feet in the pandemic, doesn’t work for more than half of the nation’s small hospitals, hospital advisers say. SBA regulations say Paycheck Protection Program funds can be used to cover payroll, rent, and utilities for businesses with fewer than 500 employees. It is money that, spent within the guidelines, doesn’t have to be paid back. But Paycheck Protection loans are out of reach for many small hospitals because of measures they had taken to stay alive in the pre-pandemic days. Some resorted to bankruptcy protection to gain breathing room to right themselves financially. Others forged strategic alliances with larger health care systems that offered clinical, managerial and sometimes financial lifelines. Bankruptcy and these alliances would disqualify these hospitals from getting the small business loans.

A federal bankruptcy judge has rubber-stamped a $40 million offer from AHMC Healthcare Inc. to acquire two hospitals in the San Francisco area and use them to treat coronavirus patients, WSJ Pro Bankruptcy reported. Bankruptcy Judge Ernest M. Robles said yesterday that he would approve AHMC’s purchase of Seton Medical Center in Daly City, Calif., and sister facility Seton Coastside in Moss Beach, Calif., from their bankrupt owner, Verity Health System of California Inc. AHMC has agreed to keep both facilities open and assume care of Covid-19 patients. Judge Robles also has approved the sale of two Verity hospitals in the Los Angeles area in recent weeks. Verity has been trying to sell its collection of California hospitals since filing for chapter 11 in 2018. State authorities have turned to Verity for help in battling the coronavirus, offering to pay to use its Seton Medical Center and to lease space at St. Vincent Medical Center in Los Angeles. Last week, Verity closed the $135 million sale of St. Vincent to Patrick Soon-Shiong, the billionaire owner of the Los Angeles Times. St. Vincent is now operating as a surge hospital for the city as California fights the pandemic.

The Senate passed a $484 billion deal yesterday to replenish a small-business loan program that’s been overrun by demand and to devote more money to hospitals and coronavirus testing, the Washington Post reported. President Trump said he would sign it into law. The legislation, which came together over days of intense negotiation that followed a bitter partisan standoff, would increase funding for the Paycheck Protection Program by $310 billion. It would also boost a separate small-business emergency grant and loan program by $60 billion, and direct $75 billion to hospitals and $25 billion to a new coronavirus testing program. The House is expected to approve the measure on Thursday. The Paycheck Protection Program was designed to help firms with fewer than 500 workers, but a number of larger companies found ways to obtain the funds in the past two weeks, leading to bipartisan outrage. Treasury Secretary Steven Mnuchin said yesterday that larger firms would now be blocked from using the program, and Trump called on some big companies that had already obtained taxpayer-backed loans to return the money.

Even before they became deadly petri dishes for the worst pandemic in generations, many nursing homes were struggling to stay afloat and provide quality care, the New York Times reported. But since the start of the coronavirus outbreak, nursing home operators have had to spend more money on protective equipment for staff and technology to connect residents with relatives who are no longer allowed to visit. Their revenues have shrunk because they are admitting fewer new residents in hopes of reducing the risk of infection. The result is that some nursing homes, which often run on razor-thin profit margins, may be unable to pay their rent and other bills without government help. “It could be a huge economic mess,” said Charlene Harrington, a professor emerita of nursing at the University of California, San Francisco. “It is possible that many nursing home chains could go bankrupt with the virus.” Presbyterian Homes and Services, a Minnesota-based nonprofit operator of 16 nursing homes, estimates that the average 72-bed nursing home is spending an additional $2,265 a day on personal protective gear and an additional $1,500 a day on extra nursing staff. At Meadow Ridge, a retirement community in Redding, Conn., with 62 nursing-home beds, executives have been forced to use Amazon or outside vendors to buy protective gear, said Kimberly Held, the community’s director of nursing.