The afternoon visit on June 28 by U.S. Senator John Hickenlooper and his staff — to the Pagosa Springs Medical Center, and to Pagosa Springs High School — was essentially three hours of storytelling.
Pagosa folks sharing their achievements and struggles, and the Senator sharing stories about how the sausage is made in Washington DC.
As the Senator noted, storytelling is essential to the political process — the process of developing governmental solutions to America’s problems.
We shared a bit of the story told by Pagosa Springs Medical Center (PSMC) Chief Executive Officer Rhonda Webb in Part Two, yesterday. She concluded her story this way:
“Health care is broken. We know the health care payment model is broken in our country. And we want to be part of the solution. But I don’t know exactly what the solutions are?
“And I guess I want to finish up by saying, where you live shouldn’t affect if you live… And we love living rural. There are farmers here, and ranchers and people who want to be taken care of, here.”
I sympathize with the story Dr. Webb is telling, and the sentiment behind it. But I suspect we all knew, when we moved to Pagosa Springs — or when we grew up here, and chose to remain here — we all knew we were trading certain urban amenities for a rural lifestyle, and that we would never have all the social conveniences and cultural opportunities that are found in a big city.
You can’t have your cake and eat it too, as my father used to say. But you can still wish.
If indeed the American health care model is broken, Senator Hickenlooper and his fellow legislators in Washington might be able to fix this or that detail… but to fix the whole system? President Obama and the Democrats proposed a fix in 2010 — the Affordable Care Act — and it may have simply made the problem worse.
For one thing, the ACA subsidies were funded in part by reducing the amount of Medicaid reimbursements paid to medical providers like PSMC.
Here’s Chelle Keplinger, Chief Financial Officer at Pagosa Springs Medical Center, explaining how PSMC used the emergency medical funding during the COVID crisis:
“We’ve got some more ‘negative pressure’ rooms in the building. We built a separate entrance so clinic patients could enter safely. We really tried to use the money for the right reasons…
“The reimbursement that we get, for the services we provide — 70% of our business is Medicare and Medicaid.”
Senator Hickenlooper: “Wow.”
CFO Keplinger continued:
“Medicare, we get 99% of allowable costs, so we don’t get even the full cost of providing the service. Medicaid, we get roughly 60% of what it costs to provide the service.
“So 70% of our business, we’re already losing money on.
“Unfortunately, what that does is put the rest of that 30% on the backs of the commercial insurance companies, who are trying to meet their own metrics and that type of thing.”
We understand, of course, that the commercial insurance companies then shift the extra burden onto the backs of employers, and employees, and other purchasers of private health insurance.
CFO Keplinger mentioned a proposal to further reduce Medicare reimbursements:
“We’re very proud to serve Medicare patients, but it’s getting more and more difficult… and now, they are taking off an additional 4%. That would put us at 95% of allowable costs, and that just makes the problem worse…”
Senator Hickenlooper:
“I don’t think that’s going to happen. Speaking as a careful observer, when I hear the Senate talking about it, I don’t think that’s going to happen.”
CFO Keplinger discussed plans to move the EMS from its current location at the Fire Station on North Pagosa Boulevard, to a new location at PSMC, which would, she said, provide a number of benefits for patients. She also talked about oxygen — something precious to us, living at 7,000 feet.
“Oxygen generation is a huge project for us. It costs us a fortune for oxygen, and we can’t always get it, because if there’s snow, the passes are closed, we may not be able to get a shipment. So we’re building, in-house, our own oxygen generation, so we can always serve this community. At a time when there’s an electrical outage, we can fill people’s tanks…
“I know a lot of people feel like, if [PSMC] were not here, they wouldn’t live here.”
We also heard about the financial and logistical struggles faced by our tax-supported ambulance service, from EMS Chief Paramedic Jason Webb. (No relation to CEO Rhonda Webb.) He noted that certain medical patients need to be transported to larger hospitals to receive emergency treatment, and our County airport is sometimes snowed in, necessitating an emergency ambulance drive to Durango or Farmington airports.
“There is a gap in getting people to those Level One centers, directly related to what the capabilities are, at our airport.
“So it can be kind of challenging. But if anyone is here to visit or to live here, we want to give them the best shot at surviving whatever the incident is. And we have to depend on the infrastructure of the system, and an airport is a very big part of our infrastructure…”
A very expensive part, too, we might add. From the Archuleta County Budget, 2021:
Our County airport is not self-sustaining. The County will have to transfer about $1 million during the next 7 years, to support some of the operational costs and the County share of capital costs.
The fund balance is projected to 2027, long enough to capture the effect of the next large airport improvement project, being the $6.5 million rehabilitation (2” mill and fill) of the runway.
To put the situation in comparative terms, the Archuleta County airport is by far the most expensive two miles of pavement in the community. But it is used by less than 1% of the population.
If the airport is going to be expanded or improved, who best to pay for the improvements? The taxpayers?
Or the pilots and private jet owners who use the airport regularly?
I ask that question… because I rarely hear it being asked, or considered, by our Board of County Commissioners.
Meanwhile, the most interesting little story I heard during the half-hour session in the PSMC Board Room came from Senator Hickenlooper himself…