District to open Rural Health Clinic

Pending achievement of certain financial stipulations, the Upper San Juan Health Service District Board of Directors recently voted to establish a Rural Health Clinic (RHC) in Pagosa Springs. Once open, officials say local healthcare costs will decline as services expand.

According to a plan the district finance committee recommends, the clinic will occupy adjoining Pagosa Mountain Hospital (PMH) space that once housed the former Dr. Mary Fisher Medical Center. Hospital staff will work alternating shifts between PMH and the clinic, with clinic personnel consisting of at least 50 percent midlevel providers. Midlevel providers include physician assistants, nurse practitioners and certified registered nurse anesthetists.

According to PMH Chief Executive Officer Brad Cochennet, establishing a RHC will provide expanded Medicare and Medicaid services to the community, while utilizing existing personnel and infrastructure. As a federally certified facility, a RHC improves access to primary care in under-served rural areas.

Based on a recent feasibility study, the clinic will receive two to three times the federal reimbursement of a private primary care facility. Reimbursements are fixed on allowable costs, thus reducing operating expenses and charges for patient care. Too, the clinic will likely see more efficient operation and improved patient flow through the use of midlevels.

To develop the clinic, only minimal additional equipment, such as stethoscopes, blood pressure meters, digital thermometers, reflex hammers and otoscopes (examination lights), must be acquired. More sophisticated diagnostic capabilities, including a full laboratory, x-ray, CT and MRI imaging are already in place at PMH. A portable ultrasound, state-of-the-art drug dispensing system and other equipment will soon be added.

Before purchasing equipment, however, the district must first apply for certification by today’s end. Then, it must meet the following self-imposed requirements:

• A minimum six months of anticipated clinic operating expenses should be in the bank or committed from a known source, such as grants. According to the feasibility study, that amount is $187,000.

• In the existing business office, net days in Accounts Receivable should be within 20 percent of the days receivable target and trending positively. While meeting the target collection rate, the rate should be obtainable through the PMH Dairyland billing software.

• Grants and/or donations are to provide all startup equipment.

• The full $300,000 line of credit must be available.

As for startup costs, the district will apply for a $500,000 Department of Local Affairs (DOLA) matching grant in July. To meet its share of the match, it will also seek other grants in April or May, including at least one totaling $50,000.

While the district obtained a $300,000 line of credit in December, it temporarily directed $75,000 of it to cover operating expenses in February. That money will be reimbursed in May or June, when the district receives its portion of the Mill Levy.

Meanwhile, Cochennet expects word on the DOLA grant sometime this fall.

“We’ll find out in September or October,” he said in a phone interview, “then we’ll know if we’re funded. After that, it’ll take about six months to get it (the clinic) open.”

In reference to pursuing a Rural Health Clinic in Pagosa Springs, Cochennet said, “This is the beginning of a series of additional steps to improve the overall healthcare system (in Archuleta County) by utilizing good community resources, with available federal funding, and new funds we expect to come from the Obama plan.”

If all goes according to plan, Pagosa Springs will have a Rural Health Clinic about a year from now. If so, what will it mean to local residents?

According to a recent RHC feasibility study, it’ll provide more timely primary medical care without resorting to the hospital emergency room, and increase facility reimbursement, while reducing patient expenses.