Senator John Hickenlooper visits Prowers Medical Center to discuss rural health care challenges with representatives from area hospitals

Pictured, left to right (back row):  Roger Stagner, Dr. Richard Book, Dr. Anthony Brocato, Senator Hickenlooper, Karen Bryant, Beth Bell, and Joe Spitz.  In front row are, from left, Tina Sandoval,Rita Bastian, and Kirk Crespin

Rural health care is facing a financial crisis in 2027.  New federal legislation will significantly alter Medicaid financing, administrative requirements, and eligibility processes. Because rural patients in Colorado are disproportionately covered by Medicaid, even minor funding drops will threaten total hospital stability.  It is predicted that rural hospitals will face up to a 21% decline in Medicaid reimbursement and paperwork hurdles could cause more patients to become uninsured.  As patients lose coverage, they tend to use emergency rooms for basic health needs, further compounding facilities’ financial burdens.

Senator John Hickenlooper visited Prowers Medical Center on September 3, taking a tour of the facility and then meeting with representatives from area hospitals to discuss rural health care challenges.  Present for the meeting were:  Karen Bryant, CEO at PMC, Dr. Richard Book, Chief of Staff at PMC, Rita Bastian, Nursing Manager of New Beginnings Birth Center at PMC, Tina Sandoval, Chief Clinical Officer at PMC, Beth Bell, CEO at Weisbrod Memorial Hospital in Eads, and Dr. Anthony Brocato, CEO at Southeast Colorado Hospital District in Springfield.  Also present were Joe Spitz, Board Chairman for PMC, Lamar mayor Kirk Crespin, and Prowers County Commissioner Roger Stagner.  Amber Thompson, Executive Assistant to CEO Karen Bryant, was the moderator for the discussion, presenting the questions and introducing the speakers.  Ms. Bryant opened the discussion by thanking Senator Hickenlooper for reaching out and asking if he could come to Lamar and hear them talk to him about rural health care in southeast Colorado.

Hickenlooper told the group “My main point in being here is to gather stories and express gratitude.  Thank you all, for not just coming today, but for being part of the solution.  As humans, we’ve always got problems; we’re always trying to sort through things. The only way we can do that is by coming together and hearing and actually listening, so I’m here to listen”. Speaking of the divide in government in Washington, he said “Health care is going to be THE battle.  I’m sure Karen (Bryant) has told you, come January 1 and really so on April 1, we are going to see many cuts in Medicaid and we will have real challenges.  It’s a reality that we all share and the more good stories I can take back to D.C., the higher the probability that I will have a story that will catch hold of some appropriator.  It’s stories, not just the cold facts, but the stories that help us.  In the past, we were pretty successful in getting our share of federal support and I think we can get back to that.  Your stories are helping.”

Speakers were allowed two minutes each to share their thoughts with the senator on two topic. The first topic was “Potential strain on rural hospitals and safety net providers”.  Tina Sandoval spoke first, telling the senator a bit about PMC’s emergency department. She told him PMC was both a level 4 trauma center and also had the distinction of being a COPPER certified facility.  “As a critical access hospital serving a large rural region, our ED designations represent far more than certifications – they demonstrate that patients experiencing serious injury or illness can receive high- quality emergency and trauma care close to home when every minute counts” she told him.

Rita Bastian told a story of a patient who was a high-risk maternity case, with a history of preeclampsia who arrived in hypertensive crisis and with pulmonary edema, both life-threatening situations.  “Because we had an OB unit, she came straight to us, it was rapidly recognized and our team got her transferred out where she delivered emergently that same day in Pueblo.  She later told us had it not been for the specialist training of the OB doctor and the team of nurses, that the outcome could have been very different for her and her baby” Bastian said.  “Our Labor and Delivery unit is essential – OB care is very limited in this area.  The vast majority of our patients are Medicaid, so without a local service, they may not have the resources to travel two hours to a larger hospital”.

Dr. Book said “It’s about saving rural medicine. I’m all in on that one.  The real truth is that keeping and treating patients locally takes immense financial resources, specialized equipment and very skilled staffing.  We have to be ready 24/7 for anything that walks into our emergency room or into our clinic.  We have to have the knowledge to take care of them and what to do with them.  I really do think we have the model for rural health. Our goal is simple – take great care of our community and ask ourselves ‘how do we take the best care of this patient, from the time they get seen to the time we take care of them or transfer them’?  Rural health care is huge”.

During a four-minute open discussion, Ms. Bell said “We obviously don’t have a labor and delivery unit, so we’re very fortunate to have one in Lamar. This past year we had a mother who was having twins and started delivering at home in the shower. She called our ED who immediately dispatched our ambulance. We had to pull our on-call physician for the ED and send him to the home which left our hospital unmanned, which is a very scary situation.  Our ambulance staff, with the aid of a Nurse Practitioner, delivered these 2 babies at the home. We’ve seen it first-hand (funding cuts) with Arkansas Valley closing their L&D unit in La Junta.  I will advocate at any meeting for this group (PMC) to keep their L&D unit”.

Prowers Medical Center CEO Karen Bryant gave Senator Hickenlooper a tour of the facilities before the meeting with area hospital representatives

The second topic was “Administrative Burdens”.  Ms. Bell, in her two minutes, told the senator that Colorado’s HTP (Colorado’s Hospital Transformation Program) is an excellent example of the administrative burden that has been put on facilities, saying that her hospital had to take a variance of almost $20,000 just to hire people because of the HTP in order to attend meetings, understand  guidebooks, and to make sure they were coming up with strategic plans in order to write the 127 page application for funding.  She talked about the age and condition of her hospital. “I really need money not for operations, not for growth and development, but the way our HTP application is structured, the cap for the facility was $200,000 per year which is not meaningful at all. When you look at what the most important thing for us to be able to provide health care for future generations is, it’s not IT infrastructure, it’s the building that we’re operating out of”.

Dr. Brocato said one of the lessons his hospital learned from COVID was being hit hard with contract labor costs due to having to hire travel nurses and CNAs. “We’re getting CNAs with these contract labor organizations that are wanting to charge us $30-40 an hour.  So, that’s a concern, as are labor shortages, but these companies are really taking advantage of our situation just because they know we have to have a certain level of staffing here. Because of the reporting we have to do, we have to hire extra employees just to cover that reporting. But we are rural health and we are strong.  We are very determined as a group to work this out.”

Byant was the last speaker on the topic, telling the senator “So, I think you heard from my colleagues that we’re a very vital infrastructure for the success of our communities and that working together, staying together and keeping a common voice is important.  When we stood our ground during COVID and said that everyone needs to have that vaccine, we lost a large number of our nursing staff for that unit (L&D) and had to shut it down for safety purposes.  When we reopened, we had to do it mainly with travel nurses and one of the things that we asked for was that they have a minimum of 6 years experience in L&D so they could help train as we were hiring staff to take over that unit.  We also had to make sure we had the physicians to take care of the babies being delivered.  So that comes at a cost also.  I think what you’re hearing from us is that we’re doing everything we can to sustain those service lines.  I think we do a very good job in SE Colorado being innovative, but federal support is very important and as we’re getting ready to face some of those reductions, it is going to get harder. We appreciate you being here listening to us and for the support you already are giving us, because it’s important for the success of this community”.

The open discussion that followed included the nursing shortage as well as those contract labor costs. Senator Hickenlooper said he felt that there needed to be new ways to train nurses, including developing programs that start in high school. Brant said that PMC is on pace to spend $11 million this year just for contract labor in addition to the $17 million for salaried employees, which is a huge burden for the hospital. She said they feel they need to have the physician staff levels that they do because “we never know what’s going to be coming through our doors. It’s just really important to make sure you hear our story.  We’re in rural America.  We’re it. As we talked about on the tour- the OB-GYN that’s here or the surgeon that’s here, they’re it.  They’re 24 hours for the two weeks they’re on, so we’ve got to support them to care for patients”.

Hickenlooper concluded the discussion, telling the group “Your stories are so valuable.  We have to have healthcare in these rural areas. Thanks so much for being here – you’re doing God’s work”.

By: Barbara Crimond