HERMANN – As the chief executive of Hermann Area District Hospital, Bill Hellebusch is committed to putting the acute-care facility on a long-term solid financial footing, fully aware of what it might mean for the community if he falls short.

All of his efforts to right the HADH ship during his two years at the helm are hinged to one particularly nagging number: 200.

Since 2005, there have been 200 rural hospitals close their doors across the country, including some in rural Missouri. He is intent on not having HADH be among the next batch of hospitals to shutter. A key to that could be legislation Missouri U.S. Sen. Josh Hawley has introduced. The bill would make available to rural hospitals $1 million a year for 10 years.

But, as Hellebusch explained last Tuesday morning to his fellow directors of the Hermann Regional Economic Development Corporation, the bill a long way from becoming law.

“It has a hill to climb,” the HADH administrator said during the group’s regular monthly session held July 7 in the Board Room of the Gasconade County R-1 School District’s Administration Building.

That legislation is the latest federal financial moves that could help small, rural acute-care hospitals like Hermann’s to pull themselves up to a more-solid fiscal footing. Others that, quite frankly, are being developed on the fly include one that groups the state’s counties into districts with a “hub” that coordinates healthcare efforts throughout those districts. HADH is applying to be the hub of District 21, which includes Gasconade and Osage counties. There are 27 such districts throughout the state.

If approved to be the hub, HADH would receive, along with money, a coordinator and a health navigator — two positions aimed at improving healthcare for the residents of the district. Hellebusch has said it makes sense for HADH, being the only hospital in District 21, to be named as the hub. But, according to the language of the law creating the program, the hub does not have to be a hospital. For instance, a Federally Qualified Health Center (FQHC), such as the one in Montgomery City, could serve as the hub. Beyond that, the hub of a district does not have to be located within the district itself. That means a hospital or FQHC outside of Gasconade or Osage counties could apply to be named the hub.

When asked about a timeline for receiving the designation — and money — for being a hub, Hellebusch said it’s not known. That’s one of the questions remaining about the program.

“It has to be soon,” he told the HRED board, pointing out that the deadline to apply for the designation — and to apply for another, larger grant program — was early June but added, “we didn’t see an application (form) until eight weeks ago.”

The other, broader program is the Rural Infrastructure Transformation Program, which is aimed at “financially vulnerable” hospitals in rural parts of the country. This is another effort by lawmakers to try to offer a measure of compensation for the loss of money through cuts to Medicare in President Donald Trump’s so-called “One Big Beautiful Bill.” It also could help these hospitals deal with the increase of patients who no longer have insurance coverage through the ACA — the Affordable Care Act. Congress failed to extend subsidies that were used to keep down premiums for those covered by the ACA.

Under the Rural Infrastructure Transformation Program, which provides $215 million to Missouri, a hospital can receive up to $2.5 million for physical plant improvements. Hellebusch, who spent hours cloistered in his office focusing on the two programs’ 100-page applications, said HADH is seeking funds for an elevator upgrade, a new nurse call system, a better lighting system and other infrastructure improvements. Those items make for a total request of $2.9 million, he said.

As for the hub program, Hellebusch said he wants HADH personnel involved in the oversight of the project. “We need to be at the table,” he said.

Efforts being made by Hellebusch thus far seem to be taking hold as the numbers show an increase in patient volume.

“Our hospital is busy,” he said, noting that in June the hospital saw patients in 20 of the 24 acute-care beds. There is also more activity in addition to that on the floors of the hospital. He mentioned an oncologist who provides service on-site one day a month.

“I think that will quickly grow to two days a month,” the administrator said. The hospital also is looking to increase service at its infusion center, working with Missouri University Healthcare to build out the infusion service. In addition, HADH officials are having discussions with a pain management group to bring services here. There’s also a focus being put on bringing orthopedic services here and discussions about having a wound care center available at the hospital.

But while being optimistic about the hospital’s chances of success regarding new services, Hellebusch remains cognizant of one overriding fact that affects all rural hospitals.

“We work in the time of constant Medicare and Medicaid cuts,” he said.