“It’s really kind of a story about where we’ve been, and where we’re going…”
Upper San Juan Health Services District (USJHSD) board president Greg Schulte was addressing a work session of the Archuleta Board of County Commissioners on the morning of June 15, 2021. His topic was the new 20-page 2020 Community Report for the Pagosa Springs Medical Center… arriving a few months later than expected.
“This is actually at the printers. It’s going to be mailed out to everyone in the District — which, just as a reminder, includes all of Archuleta County and parts of Mineral and Hinsdale counties. So this is going to me mailed out to everyone. It’s something we’ve wanted to do, for a little while… but finally, like everyone else, we got sidetracked by COVID. So…”
Dr. Rhonda Webb, PSMC CEO, was sitting next to Mr. Schulte, and she offered her comment on the “sidetracked” report.
“We couldn’t afford it…” she offered, with a smile. “But this is our first ‘community report’. So it really summarizes what services we offer, and our financial contribution to the community.”
The report includes, for example, this graph:
As with many visual presentations of statistics, by governments and businesses, these graphs can be a bit misleading. The ‘Oncology Clinic Visits’, for example, appear to have increased by perhaps 60% — from about 900 in 2019, to about 1,400 last year. In this case, the graph gives a pretty accurate representation of the year-over-year growth.
The ‘Primary Care and Urgent Care Visits’ appear to have declined rather drastically, in 2020, to about 33% of what they were in 2019, if you only look at the size of the bars. A drop of… what?… about 66%?
If you had that impression, you weren’t looking closely enough… because the graph doesn’t start at ‘Zero’. The chart starts at ‘18,000’. The year-over-year drop was from 23,500 to 19,800. That’s a decline of about 16%… not 66%.
The same illusion plays out in the ‘Emergency Room Visits’ graph, where the actual drop was about 8% in 2020.
‘Surgeries’ increased by about 5%… but that’s not how it looks, if you’re glancing casually at the graph.
I’m not sure why statistics are sometimes presented in a visually-misleading manner. But it’s actually a fairly common practice.
Mr. Schulte continued his June 15 presentation to the BOCC:
“And the second part is, that we’re in the process of doing our strategic plan, which is basically a three-year plan. We had talked about a five-year plan, but with the way healthcare is these days, going out five years is… not smart. Things change too much.”
Indeed. Change has been the state of affairs for the tax-supported Upper San Juan Health Services District for many years now.
And for ‘healthcare’ in general, as well…
Archuleta County readers of the Daily Post can expect to received their copy of PSMC’s 2020 Community Report in their mailboxes sometime in the next couple of weeks, but in the meantime, you can peruse a ‘flip-book’ version of the report on the FlippingBook.com website.
From the introductory message in the report:
We are happy to report that despite the pandemic, PSMC is financially stable and beginning to change its focus from a public health crisis response to a renewed focus on continued growth and improvement of services. From the earliest days of the health district’s formation in 1981, to voter approval of the mill levy in 2001, opening the hospital in 2008 and the new outpatient clinic in 2017, PSMC has seen tremendous growth not only in the facilities it operates, but in the services it provides. We see that continuing.
While Pagosa Springs Medical Center is still a relatively young and small medical center, it has been fortunate to attract a diverse group of medical providers committed to caring for our community. Under the current leadership, medical staff turnover has been low. This stability is one factor that has allowed PSMC to operate from a relatively stronger financial position than in previous years. We say “relatively stronger” because finances for small, rural hospitals are inherently challenging, and PSMC is no exception. Compared to other businesses, rural hospital margins are very thin, and the debt incurred to build our facilities was significant…
As noted, the Medical Center opened its doors (originally, as Pagosa Mountain Hospital) in 2008, just as the Archuleta County economic was entering a serious economic downturn during to the Great Recession. Over the next couple of years, property values and property taxes declined, sales tax revenues dropped, and the real estate and construction industries nearly ground to a halt. Archuleta County found itself experiencing one of the highest per-capital foreclosure rates in Colorado, and the community population declined for the first time since the 1970s.
Pagosa Mountain Hospital had opened in 2008 as a Critical Access Hospital, a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS). Congress created the CAH designation in 1997, in response to a string of rural hospital closures during the 1980s and early 1990s. Congress has since amended the CAH designation and related program requirements several times, through additional legislation.
Eligible hospitals must meet the following conditions to obtain CAH designation:
- Have 25 or fewer acute care inpatient beds
- Be located more than 35 miles from another hospital
- Maintain an annual average length of stay of 96 hours or less for acute care patients
- Provide 24/7 emergency care services
The main attraction of the CAH designation, for Pagosa Mountain Hospital, was the ability to bill for Medicare reimbursements at 101% of the cost of service. This meant that, theoretically, PSMC did not lose money serving Medicare patients, as do most healthcare facilities due to the federal limits on Medicare reimbursements.
And considering the demographics of Pagosa Springs — median age, 50 years old — a decent rate on Medicare reimbursements is probably the only way a rural medical center like PSMC could hope to survive in the vastly-overpriced, bad-debt-burdened, dog-eat-dog world of American healthcare.
Even with starting salaries at $14 per hour.
If only the reimbursements for Medicaid were similar…
Bill Hudson began sharing his opinions in the Pagosa Daily Post in 2004 and can’t seem to break the habit. He claims that, in Pagosa Springs, opinions are like pickup trucks: everybody has one.