by George Gramlich,
News and Analysis

WESTCLIFFE, Colo.

When our Sentinel reporter Ann Barthrop got back from the last West Custer County Hospital District (“WCCHD” or for us locals, the “Clinic”) Board meeting a few weeks ago, she had a lot of questions about the proposed “take over” of the Clinic by Salida’s
Heart of the Rockies Regional Medical Center (“HRRMC” or the “Heart”). It was the major topic of discussion at the meeting, but some things didn’t quite fit together.
So, instead of just passing it over, Ann decided to ask the Clinic’s Director, Lisa Drew, if she could come over to the Sentinel for a meeting and lay it out for us. Lisa graciously said yes and she, I, Ann and Fred Hernandez met last Tuesday, December 3rd. It was
truly an informative meeting.

Lisa brought with her a document called the “Custer County Health Center Business Plan” authored by the CEO of HRRMC, Mr. Bob Morasko, which outlines the overall proposed plan for HRRMC to replace our current Clinic with their own rural health clinic (RHC). which would operate within the
corporate framework of HRRMC. The new name of the clinic would be the Westcliffe Health Clinic (WHC).
The discussions and negotiations between the WCCHD Board and management have been going on for years but finally, with the
arrival of Lisa last year as the new WCCHD Director, progress is
being made.
To boil it down, the proposed plan is for the WCCHD to get completely out of the RHC business and rent the building and grounds to HRRMC and have them run their own RHC there. In essence, the WCCHD’s future business functions would solely be as a landlord to HRRMC and to run EMS. (We will get into EMS later.)
So why is the Heart of the Rockies interested in establishing their own RHC in Custer County?
First, to enlarge their customer base. Salida/Chaffee County has only about 20,000 residents and as HRRMC expands its physical plant and staff more customers/patients are needed. Secondly, they have already taken over another RHC (Buena Vista) a few years ago, and after some serious initial issues, have it running well and making money.
On the flip side, why is the WCCHD interested in having the Heart come in and replace our Clinic with their own RHC? The answer, as supplied by Lisa and Mr. Morasko’s business plan, has numerous components.
With regard to Medicaid and Medicare clinic reimbursements/payments, our Clinic is defined as a “fee schedule reimbursement RHC”.
The Heart will be setting up a “cost-based reimbursement”, “hospital-based RHC”. This type of RHC classification will receive a much, much higher reimbursement rate than the current WCCH, which will help the bottom line greatly.

The Clinic has been struggling financially for years and has not been able to find a full-time doctor. The Heart takeover answers these questions.
As part of the agreement, the Heart agrees to supply a fulltime primary care physician who will, in all probability, also be the Medical Director. They will agree to provide 1.5 Nurse Practitioners. (60 hours.) The Heart also agreed to hiring all of the current employees as long as they meet HRRMC’s employment guidelines.
HRRMC will also continue the Radiology services and will probably enhance them with mobile CT and MRI offerings. They also agreed to continue to provide Rehabilitation services and will probably enhance those offerings.
Laboratory services will continue with complex tests to be completed at HRRMC, as they are now. A great new feature will be Retail Pharmacy services. Prescriptions will be electronically ordered from the WHC to the Hearts own retail pharmacy in Salida and prescriptions would be delivered to the WHC the next day, and possibly the same day for some.
Another great benefit of the future Westlcliffe Health Clinic (WHC) would be the availability of specialty providers from Salida coming here, some in person and some via telemedicine.
So, let’s talk the money part of the deal. The WCCHD will rent the building and grounds to the Heart for $1 per year. WCCHD will maintain the building and grounds at their own expense. The WCCHD agrees to pay/subsidize HRRMC a minimum of $175,000 per year. This would come out of the current WCCHD mill levy money. This could go as high as $300,000 if the HRRMC experiences a loss exceeding the initial $175,000 subsidy. Either party can terminate the agreement within the first year without cause.
During the course of our discussion with Lisa, an interesting point came up. The WCCHD Clinic side mill levy generates around $410,00 (2018 data) per year. Let’s say the new WHC is doing fine and the WCCHD only has to pay the Heart the yearly $175,000 it agreed to. And let’s also suppose that it takes maybe $50,000 to maintain the buildings and grounds for the WHC. That would leave the WCCHD with around $185,000 in the bank. They can’t give that money to the EMS District (not allowed). And next year the same thing happens and now they have $370,000 in the till. Obviously not quite right. The appropriate and fiscally responsible route is to REDUCE THE MILL LEVY TO ONLY WHAT THEY NEED. They might need an extra $125,000 or so in the bank in case WHC has a bad year (remember their maximum loss reimbursement liability is $300,000). So, it is very possible, that if this plan succeeds, our clinic mill levy can be reduced in the future. (In essence, privatization will reduce our tax burden.)
There are a few issues going forward. HRRMC must apply to several governmental agencies (including Medicaid and Medicare) in order to get permission to open up the
“hospital-based” WHC RHC here. Lisa indicated that the process might take as long as one year. The Heart has already done it with the Buena Vista clinic so it shouldn’t be a problem, but you know big government. Also, both Boards must ratify the proposed contract. A plus side to the delay is that the HRRMC is slowly installing various computer systems at the current Clinic so that when the transition finally comes, everything has been up for a while and thoroughly tested.
All in all, we don’t see any serious downside to this deal. In fact, it would dramatically upgrade the health care quantity and quality in the area. Kudos to all involved.
Lastly, while we had Lisa’s attention, we asked about the status of EMS. Lisa said there is a working group looking at the future of EMS and basically there are four options: 1.) Status quo with WCCHD continuing to run it; 2.) EMS splitting off and running their own special district; 3.) WCCHD hires a private EMS provider such as AMR to service the county; and 4.) EMS mergers with our outstanding fire district, the Wet Mountain Fire Protection District. All agreed that the merger with Wet Mountain Fire would probably provide the best and most efficient service. We will see soon what the group recommends.
Many thanks to Clinic Director Lisa Drew for spending a few hours with us so we could get the story straight. Thanks to folks at WCCHD and The Heart who have worked hard to make this happen. It could be a huge boost for our community.