Health care providers

March marks a year of the COVID-19 pandemic, and while vaccinations and relaxed restrictions have brought back a sense of normalcy for many people, area health care providers are still in the thick of it.

But as they continue to adapt to the ever-changing regulations prompted by the public health crisis, doctors and dentists are finally seeing the light at the end of the tunnel.

Patients are returning and finances are rebounding, many said. And through it all, employees have proven up for the challenge.

“We’ve learned how to adapt and flex what we do very quickly, and to be able to come together and have people step into roles they’ve never been in before,” said Cynthia McGuire, president and CEO of Monadnock Community Hospital. “It’s really given people opportunities to shine in different ways.”

Hospitals still recovering

The Peterborough hospital’s safety protocols have been mostly the same since the early days of the pandemic last March, according to McGuire. In addition to masking and social distancing, this includes screening all patients and staff for COVID-19 symptoms, testing all inpatients for COVID-19 before admission and enhanced disinfecting.

When it comes to procedures, telemedicine has played a huge role over the past year, McGuire said.

“We were gradually moving into a telemedicine approach for some of our services ... and we are still using it now for about 20 to 30 percent of our physician office visits for people who have difficulty coming in,” she said.

Patient numbers are back to about 85 percent of what they were before the pandemic, she added, which has helped with the hospital’s financial status.

Like other hospitals nationwide, Monadnock Community Hospital took a major hit due to the cost of treating COVID-19 patients and the revenue lost when the state required elective procedures to be postponed for months.

In May, the hospital furloughed 100 employees for 90 days, and by late July, 21 of those positions were eliminated.

To help offset the financial losses, hospitals received several grants and loans from government programs throughout the year.

Still, by the end of fiscal year 2020, Monadnock Community Hospital had lost about $500,000, according to spokeswoman Laura Gingras.

But McGuire said recent months have looked promising.

“The last two months we’ve been quite successful, and actually broke even in January and February with no [federal] dollars, though we do still have some of those dollars in reserve,” she said. “We’ve budgeted really cautiously this year ... so we are expecting to break even by the end of the year.”

Cheshire Medical Center is also doing better financially, according to Chief Operating Officer Kathy Willbarger.

The Keene hospital is expected to break even in the next six to 12 months, she said, though it is currently still running at a loss.

From March 16 to the end of April, Cheshire Medical was losing $2 million weekly, a spokeswoman said previously. Prior to the pandemic, the hospital had a $2.6 million, or 1.6 percent, positive year-to-date operating margin.

The hospital was unable to provide an updated figure Thursday.

Patient numbers are also coming back, though Willbarger said they continue to ebb and flow.

“We are not yet consistently back to ‘normal’ in the outpatient areas where some patients continue to be reluctant to come in for care,” she said in an email. “Yet certainly better than last spring, especially with so many virtual visit options available to patients.”

The Dartmouth-Hitchcock Health affiliate is also continuing its COVID-19 safety precautions, such as mandatory masking, limited visitation and daily screenings for patients and staff.

Area practice in ‘very promising place’

For Monarca Health, a direct primary-care facility on West Street in Keene, this year was a bit different than for hospitals.

The practice opened in the fall, right as COVID-19 cases in New Hampshire were starting to rise again after hitting a low in mid-August. But despite this, co-owner Aurora Leon said Monarca’s patient numbers have continued to grow.

The practice’s model allows patients to pay a monthly fee directly to their provider for services, rather than the provider billing the patient’s insurance.

As members, patients can call, text, video-call or email Leon or co-owner Dr. Joaquin Carral; have extended doctor’s visits, averaging about an hour; book an appointment within 48 hours; and attend classes on healthy cooking or altering chronic disease progression.

The practice has about 80 patients, according to Leon. At most, Monarca could have 800 patients split between Leon and Carral, but to break even, it needs 100.

“We are in a very promising place,” Leon said.

She added that part of the reason for Monarca’s continued patient increase is that many people feel safer at the small practice, which intentionally employs only herself and Carral.

“The problem was hospitals were overwhelmed with things like COVID, so the regular things ... were left out,” she said. “So a lot of people after six months of the pandemic were still lost, still having drug overdoses, having a lot of issues with anxiety, not sleeping, and definitely needed primary care.”

The practice offers telehealth services, but Leon said in-person visits are Monarca’s main focus, to understand the full patient. So rather than allowing in-person visits only when necessary, she said Monarca adapted to ensure patients could come into the office more often.

“If the patient was very nervous, of course we could do telehealth; it’s the decision of the patient,” Leon said. “But we also don’t book patients back to back, so we could clean in between them, and our clinic, since it’s really low overhead ... we’ve decreased the risk of contact.”

Dental offices see plenty of patients

For area dentists, the pandemic started off rocky, with many practices shutting their doors, furloughing employees and performing only emergency procedures for months due to safety concerns.

By summer, most had reopened, with new, strict protocols in place.

At Noble Dental Care — formerly known as Keene Smiles Dental — at 69 Island St., those same safety protocols continue, according to owner Dr. Thomas “T.J.” Filip.

When patients come in, he said, they are screened for COVID-19 symptoms and have their temperature taken at the door. All staff wear N95 face masks and face shields.

The number of people in the treatment rooms has also been limited, Filip noted.

Additionally, he said all of his employees are now fully vaccinated, and Noble Dental Care is also seeing an increase in patients who’ve been immunized.

This has led to the practice seeing a record number of patients.

“Last year we saw no patients in the second half of March. That continued until we began to reopen in late June,” he said in a text. “This March we’ll have more patient visits than we’ve ever had. For the first time we’ll have more than 400 patient visits.”

And financially, Filip said the practice is doing well.

Noble was in the “strongest possible financial position” prior to closing last March, according to Filip, and while three months of no revenue certainly hit the practice hard, it’s started to recover.

“Crazy things happen in this world. I had no idea a global pandemic would be one of them,” he said. “But I know there will be more crazy things to come!”

At Montshire Pediatric Dentistry in Keene, patients are required to complete an electronic prescreening form prior to their appointment, the waiting room is no longer used and surfaces are constantly disinfected, according to owner Dr. Jonny Norris.

The office also alternates which exam rooms are used, he said, to allow the rooms to “breathe and get a break.”

Some dental procedures have been adjusted as well, Norris said, with less invasive techniques employed when possible.

“Ultimately our patients have been the benefactor of these new practices because we had to get creative,” he said in an email.

These protocols are now second nature, but Norris said at first it was a lot of trial and error to determine what worked and what didn’t, based on guidance from several state and national dentistry and health associations.

“In the early stages, their recommendations were not congruent,” he said. “However as months passed, they became more aligned.”

The practice is continuing to see more patients, which is partially due to Montshire’s move over the summer to a new location on West Street that is four times larger than its previous one, according to Norris.

“This has allowed us to see more patients, practice [social distancing] ... all while helping more kids,” he said.

Montshire sees about 40 patients daily, Norris said, compared to only 12 at its lowest point amid the pandemic.

Like Noble Dental Care, Norris added that financially the practice is doing well, despite the pandemic’s hardships.

“We are fortunate,” he said in the email. “Expenses have all increased, across the board, but we are still taking care of patients, staff, and servicing loans. We could be better but we could certainly be a LOT worse.”

Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.