HERMANN — It might seem to be the perfect example of irony: A hospital working hard to shore up its finances turning away patients.

Yet, that’s the situation that occurred in August at Hermann Area District Hospital (HADH). Administrator Bill Hellebusch told the hospital’s Board of Directors that such action was taken because the healthcare facility had no choice, thanks to a shortage of employees in key positions, such as nurses.

“I bet you we passed on 10 patients” during August, Hellebusch said.

Those patients could have been accepted, he explained, but he didn’t feel confident that, because of the employee shortage, a high level of care for those patients and the ones already in beds could not have been guaranteed.

As of the board’s monthly session on Sept. 22, HADH remained three nurses short, Hellebusch said. Two of the three openings are on the night shift — the shift that not many people want to work, he added. Having those nurse positions filled “would allow our hospital to be at physical capacity,” the administrator said, referring to having all beds filled.

“We’ve never been to capacity physically since I’ve been here,” he noted.

That’s why, he explained, the hospital needs to continue to recruit new hires.

“We’re going to have to continue to staff up,” he said, especially regarding the nursing staff.

Meanwhile, Hellebusch told the directors that a trip to the nation’s capital to meet with federal legislators left him optimistic about limiting the economic effects of the so-called “One Big, Beautiful Bill” pushed by President Donald Trump. Among other things, that law would revamp Medicaid funding allocated to hospitals. It’s especially concerning to rural hospitals such as HADH.

However, rural hospitals appear to have a friend in Missouri Republican Sen. Josh Hawley, who broke with Trump in criticizing the overhaul of Medicaid payments, voicing concern that smaller hospitals could face dire financial situations.

The new law is interpreted to mean that Missouri would lose $1 billion over a 10-year period.

“It’s a drop in the bucket” of the total $50-billion to be cut, but still can amount to substantial dollars lost by rural hospital. The saving grace for HADH, as he earlier explained, is that the hospital receives little Medicaid money. Rather, most patients have either private insurance coverage or are self-pay patients. Others similar to HADH won’t be as lucky, he told the board.

“We know that independent rural hospitals are at risk,” he said.

Hawley has said he would work to delay the start of the Medicaid cut as long as possible and he was instrumental in having the law include a provision creating a fund for rural hospitals.

“He did a great job going to bat for our hospitals,” Hellebusch said.

Board President Dale Ridder said HADH is benefiting from being part of the discussion regarding the effects of the signature piece of legislation of Trump’s second term.

“It’s good that we’ve been involved and stay involved,” he said.

Hellebusch said HADH representatives were able to speak with their members of Congress about the 340B Program, which provides hospitals with a rebate of dollars spent to purchase pharmaceuticals for their patients.

“I came away feeling encouraged” about getting more funds through the 340B Program, he said.

Also, the administrator reported that he’s gathering more information about a possible consortium of small rural hospitals that could result in higher payments from such programs as Medicaid and better rates from insurance companies. Called Clinically Integrated Networks, the organization provides a strength-in-numbers approach to discussions with insurance companies and others by negotiating on behalf of several hospitals rather than each hospital negotiating on its own.

The networks have been established a while in the Northern states and just recently reached into the Midwest, he said. “It has shown a lot of success” for obtaining higher payments to hospitals, Hellebusch said.

The administrator said he would keep researching the Networks to see how HADH might benefit if it should decide to start a local consortium.

“We’re still in the very early stage of this,” he said.

Ridder supported further research by Hellebusch.

“Any kid of volume leverage in dealing with insurance companies has got to be a benefit to us,” the board president said.