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Directors consider hospital expansion, budget realities

While expansion and the addition of services and staff was the protocol at the Pagosa Springs Medical Center (PSMC) this year, the proposed budget for 2012 does not provide the same room for growth.

Chief Financial Officer Dennis Wilson based the draft budget on an anticipated 26-percent decrease in tax revenue due to an anticipated decrease in property tax revenues. This could translate to a loss of $600,000.

There are also potential federal cuts that could affect the reimbursement funding through Medicare and Medicaid that PSMC receives as a Rural Access Hospital and Rural Access Clinic.

CEO Brad Cochennet said at Tuesday night’s USJHSD board meeting that the focus for next year will be quality, efficiency and adding volume to programs already in place.

“We want to add volume to already existing programs,” Cochennet said.

Thus, Wilson in calculating the budget did not add any significant new items or programs.

The numbers from last month’s financials show that the PSMC is already well on its way to adding volume. August was a record breaking month for clinic visits, the number reaching 1,170.

The budget for next year, though, is based on a monthly visit average of 1,500 visits. Dr. Nick Kurz does not anticipate that number being a problem. The clinic, which at this time last year had only one doctor, now has a team of four full-time providers and, Kurz said he has noticed a rise in patient satisfaction and return visits.

The anticipated numbers of users in 2011’s new programs, such as CT scanner and surgery, have met, and in most cases exceeded, expectations. In the month of September, as of press time, 11 surgeries had been completed. The lone program that is lagging behind is the eye surgery program. PSMC contracts with the Four Corners Eye Clinic, and opthalmologists Dr. Eric Meyer and Dr. Joshua Zastrocky.

Cochennet spoke with Dr. Zastrocky and Dr. Meyer concerning the low numbers. According to Cochennet, the doctors kept the numbers purposefully low during the introductory phase of eye surgery service. However, Cochennet said they see no reason why they wouldn’t be able to amp up the numbers in the upcoming year.

Finance Committee chair Karl Irons approved of the budget. “I think it is a conservative budget,” Irons said. “But it is a wait-and-see year.”

Board members Jim Pruitt and Michelle Visel expressed concern with the budget having too little “wiggle room.”

“Looks really, really tight,” Pruitt said, pointing out that the amount listed for self-pay might be too low. That number, however, will most likely be affected if unemployment continues to rise.

The board approved the budget for public comment.

Cochennet brought the donated business plan for mammography and bone density before the board. The program’s demographic focus would be women who are currently not having mammographies.

“The women that don’t get mammography screenings, they’re not concerned about radiology, not worried they’re going to find something, they just don’t have the money,” Pruitt said.

The discussion moved on to what type of funding would be available, not only for the cost of the machine, but for patients.

Dr. Dave Schaeffer, new surgeon at PSMC, discussed his experience at his previous post. He worked at a clinic that had a program with a funding program to assist women seeking screening. However, the funding ceased.

“We got a lot of bad press for having to send women away,” said Schaeffer, advising that, if the USJHSD decided to move forward with a mammography program, it should search for a way to offer comprehensive funding that would last throughout the patient’s need for care, not just the screening phase.

The board did not make a final decision regarding a mammography business plan, but instead opted to wait until a copy of the Master Facilities Plan was given to the board — expected some time in November. The Master Facilities Plan will detail the cost and different possibilities of physically expanding the PSMC facilities.

“Primary care needs to be step one,” Visel said.

The current issue facing primary care is limited space in the clinic.

“It’s a very tiny work space,” Cochennet said. If there is no hope for change, the situation will become demoralizing.”

Kurz agreed. All new programs and doctors require space to accommodate and, as of now, there is no more space.

The MFP cost is likely to be in the ball park of millions of dollars.

The Mary Fisher Foundation will take the helm fund-raising for the MFP or mammography plan. But, as Visel, board representative to the foundation, said, the board must direct the Mary Fisher Foundation concerning the top fund-raising priority. Is it the MFP or mammography?

“We need more fund-raisers,” Visel commented.”It is a job and it is a lot of work.”

For next year, Cochennet has budgeted for a director of development position, the main job of which will be to raise funds. As of now, though, there are no candidates for that position. If filled, the director of development will be charged right off the bat with raising $200,000.

After the board members look at the MFP and compare it to budget numbers, a decision will be made as to priorities and what the next step will be. Right now, it seems the focus will be on accommodating the expansion that has occurred to this point in time.

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