Officials and staff members with Southwest Memorial hospital met with U.S. Rep. Scott Tipton about local health care services last week.
Tipton toured the new $32 million expansion that includes a modern patient wing, updated women’s health center, and two-story medical office building that consolidated physician services.
Southwest Health System CEO Tony Sudduth spoke about the difficult financial crises last year that led to 40 layoffs, and the hospital’s subsequent recovery efforts that are seeing success.
“A year ago there was a large potential of closing, but we are back on track,” he said. “Patient satisfaction has gone from three star to four star.”
Sudduth said one of their biggest challenges securing funding for an estimated $12 million in infrastructure upgrades needed in older parts of the hospital built in the 1970s.
Tipton was engaged in questions and conversations ranging from high costs of insurance and reimbursements, to the challenges of physician recruitment, and the crisis of mental health and substance abuse.
A big concern for residents are high-cost insurance premiums under the Affordable Care Act that can be three times higher than in the Denver Metro area, Sudduth said.
“Solving that problem is important to keep patients insured in our area,” he said.
More family practice physicians are needed in Montezuma County, and recruitment is ongoing. There are waiting lists to see a family doctor for primary care. Two new internal medicine physicians were recently hired, and recruitment continues for general surgery and orthopedics.
“We’re not saying Cortez is a difficult place to recruit to, a lot of people show great interest in working here,” Sudduth said. Caution is needed, he said, to avoid hiring people moving here just to retire in a few years.
Tipton wondered whether telemedicine technology has been tapped into at Southwest. Sudduth said overall they have not explored those options, but there is potential for it in the future, potentially for behavioral care.
Tipton asked about whether reimbursement for Medicaid and Medicare patients at rural Southwest Memorial compares fairly with larger urban areas.
Sudduth said there was not a large disparity, but he cautioned that a proposed Medicare for All program could force more than half of rural hospitals to go out of business.
He said 72% of Southwest’s patient base is Medicare and Medicaid supported.
“Overall there is nothing to make a margin on, and when you are trying to replace infrastructure it becomes quite a challenge,” he said.
Tipton was also critical of the Affordable Care Act.
“It is a big frustration because rural America is paying a premium for the insurance, compared to urban, and we have lower per capital income,” Tipton said. “The requirement is that poorer people will pay more. Insurance costs is one of the most punitive things people face.”
Southwest also serves a lot of Medicaid and Medicare patients coming from other Four Corner states, said CFO Rick Shrader. On the way here, they drive by some New Mexico medical centers who do not accept certain government benefit plans because they lose money.
“We provide the care regardless, but the reimbursement rates are awful,” he said.
Shrader urged Tipton to help get rid of a sequestration rule that became part of the federal budget a few years ago.
“Getting rid of it would help rural hospitals,” Shrader said.
On opioid substance abuse and mental health, Tipton said The Western Caucus made up of rural legislatures is lobbying to make sure rural areas get a fair share of federal grants to deal with opioid abuse and mental health issues.
Access to low interest federal loans and grants is essential for the hospital district to cover the backlog of infrastructure maintenance, said MCHD board member Robert Dobry. Tipton said he could provide letters of support for grants and loans and pass on funding information.
On veterans’ care, Tipton said Congress passed the Choice Act and the Mission Act that give veterans the choice on medical services and the payment structure follows them. He urged hospital officials to contact his office if veterans were having difficulty with their claims, and hospital staff said they have a list they can send him.
Southwest’s family birthing center was improved as part of the hospital upgrades.
“It is an essential service,” said a physician. She said studies show if expecting mothers have to travel for care, problems increase.
“Our hospital has a real commitment to continue the service,” she said. “It has far-reaching economic impacts, because when you bring in the family to have a baby, they are introduced to the facility and all the care available.”
“That proximity is so important,” Tipton said. “When my daughter was born, the OB/GYN service was not available in Cortez, and we had to drive to Durango in a snowstorm.”
Staff discussed a future shortage nationwide for family practice physicians because the business model and reimbursement rates make it more difficult to make a living.
Most new medical school graduates are seeking specialized shift work that pays well, rather than as a family physician. Often they are facing $200,000 to $300,000 in student loan debt.
Tipton said offering debt forgiveness if a medical graduate serves in a rural area might be a solution for the shortage in primary care family doctors. It was mentioned that the National Health Services Corps offers free tuition for medical students and graduates if they serve in a high-need area. The program pays student tuition and a stipend, and provides a wage.
“For solutions we have to think out of the box. It used to be, wherever you were, your policy would be accepted, but now there is too much out of network (denials), and surprise bills” Tipton said. “Each community has different challenges. The common ground is that we all agree that costs are too high, how do we create competition to lower those costs.”
He cited a case where medical imaging was expensive at a hospital in Eagle County. But when another business offered it for 80 percent less, the hospital dropped its price.
Another idea discussed was giving employers within a trade incentives to partner with peer companies to negotiate a better price for insurance with price savings passed on to employees.