RBC | Rangely Community Medical Health and Wellness Center (formerly Rangely District Hospital) CEO Nick Goshe and Hospital Board Director Stephen Petersburg gave their presentation about the need for a mill levy increase at the Rangely Area Chamber of Commerce board meeting on June 20.
Currently the hospital provides several services: Rangely Family Medicine clinic, laboratory services, inpatient/skilled nursing stays, the Rangely Pharmacy, physical therapy, radiology services, Eagle Crest Assisted Living (with 14 current residents), an extended care unit for elderly (with 14 current residents), home health, Meals on Wheels, a college clinic, EMS service with critical care, cardiopulmonary services, and an emergency room and trauma services. They also boast visiting specialists like Dr. Morse who treats patients in the specialty clinic and does general surgery consults and specialty procedures like colonoscopies, audiology Specialist Jim Carlson, and Dr. Laws who specializes in cardiology.
Why is a mill levy increase needed?
According to the hospital’s presentation, since 2010 rural health facilities have closed at a rate of about one per month. Unfunded Affordable Care Act mandates, such as electronic medical records, take up one-third of the operating budget in Rangely. Private insurance is becoming prohibitively expensive, forcing patients onto payers like Medicaid, which does not pay enough to cover costs. The Rangely Hospital District receives 65% of its funding through Medicare and Medicaid, and is required to comply with those programs’ regulations.
Another important source of funding is the mill levy, but those revenues have been cut by more than half since 2010. In 2010 they received $2.7 million from property tax revenue and that dropped to $1.2 million in 2018. An additional $1.4 million dollar loss in income is expected because the government is planning to cut the 340(b) and provider fee programs
What is the proposed solution to save all of the services and employees at the Rangely Community Medical Health and Wellness Center?
According to their presentation and handouts, a small mill levy increase will allow the Rangely hospital to move forward without a dramatic loss. By voting to increase the mill levy, the monthly cost of property taxes on a $100,000 home would be $23.83, an increase of just under $10 of the current tax rate.
The proposed increase would only last through 2025 when the new facility is completely paid for. In 2025 the levy for the building would drop off and the effective tax rate would end up being slightly lower than it is currently.
What are the ramifications if the mill levy is not increased?
According to the presentation, the Rangely Community Medical Health and Wellness Center has 119 full-time employees, with 150 employees total. Without the mill levy increase, they speculate they will lose 80 full-time employees in addition to services.
Services Petersburg says are not “money makers,” like the clinic, pharmacy, Eagle Crest Assisted Living Facility and the Extended Care Unit for the Elderly, are just a few of the current services that will be unfunded and will have to go. Petersburg believes CNCC would move programs to the Craig campus and the population of Rangely would decrease. Small businesses will take the brunt of the tax increase if the mill levy passes, according to Petersburg, but if it doesn’t pass those businesses will have fewer customers. “They have the most to lose,” he said.
Chamber board member Andrea Brannan said clearly the hospital saw this coming and asked, “what the hospital administration had done to advocate and be proactive to help the situation?”
Petersburg said they have put a lot more burden on the employees, and according to presentation materials, nursing, ancillary services and one physician position have not been filled. Cost of living raises have been withheld for four years. Employee retirement matching has been reduced, and employees’ contributions for health insurance have increased significantly.
Rangely resident Dusty Moreno asked “how long ago did you rebrand the hospital, including renaming it and buying the new sign out front?”
Goshe responded saying, “It was last year but at the last board meeting Frank Huitt didn’t know that we did the retail pharmacy. If we are going to ask voters to vote for this if they don’t realize the hospital is a small piece of what the people use after the ER and the inpatient, a big piece is the clinic, the things that aren’t reimbursed by the critical access status.”
Moreno continued, saying the hospital will not get the vote because “they have such a bad name.”
“You sir, when I took a complaint to you, you told me that you did not care because this town could not survive without the mine and the college and the hospital had to be here to have those,” Moreno told Goshe. “You do not have my vote.”
Goshe responded saying “I have never said I don’t care about this community.”
Chamber board president Jennifer Barker said, “I understand what you are saying about people taking on more burden, but don’t tell me that when I work in the oilfield and every single one of us have taken a hit and some of us wear multiple hats because we only have one or two people in the department, we all have that problem…We have went and done our medical stuff in Vernal for a long time because of s*** that was going on up here and then we decided to come back. My husband was mauled by a mountain lion and we went up here and we had to get in our truck and drive to Vernal because they couldn’t care for him up here. So it is a little hard to sell me on you wanting more tax money. You want to tell a coal miner or oil field worker that is trying to support four kids on limited funds now because he’s had his hours cut or because he has been laid off, he’s lost his house, his vehicles, and you want to try and sell him on this? It’s hard to sell when people aren’t working at their full capacity that they were three years ago. Oil is not coming back and you talk about who this is going to hurt the most. Who is going to be hit the hardest? The oil field is going to pay the highest taxes. When they start having to do that they are just going to do the very bare minimum that they have to do for government regulation and they are going to take their business to Texas, because that is what they are doing right now. It is cheaper for my company to get the oil out of the ground in Texas than it is to get it out here. So when they start getting double taxed they are the ones that will be hit the hardest. They are going to pack their stuff up and leave. The oil field will say it is not cost effective for us to do business here.”
Goshe said, “I honestly hear the frustration and I believe it but I think that as a community we have a choice.”
Asked if he had taken a pay cut and when he received his last raise, Goshe said he has not taken a pay cut and his last raise came with his last contract, about four years go. “I have been here for 10 years, I didn’t ask to be the CEO and I have never asked for a raise, not once. But if I go somewhere else I can make more money in this role. I like it here but I think the community has a choice of what services they are going to offer because health care in rural areas like this, they are not going to be here.” Chamber Director Konnie Billgren commented, “You all had a choice when you did your rebranding a year ago when you knew this was coming down the pipe, why would you go and spend that much money on an electric sign that is not even on Main Street? The only people who see it are the Eagle Crest residents on a daily basis.”
Goshe responded, “The 26,000 prescriptions that we fill and the 6,000 clinic visits that come up there a year, there is a lot of traffic that sees that. We cut out a lot of advertising in the paper because that is where we are advertising things now. We are trying to create the awareness of what your taxes are supporting.”
Billgren added, “When the community hears that all of the employees got new jackets but you all are struggling, a couple of thousand dollars is still a couple of thousand dollars. You all need to explain why you could spend that money last year and this year you are coming to the voters.”
Goshe said “if we don’t have recognition for nurses’ week and we don’t have employee appreciation our turnover will go up.”
“If you want the community to back the hospital then you have to make the community believe that you are doing everything you can on your end to handle things and not go out spending willy-nilly and then when the money runs out come and ask us for more,” Barker said. “That is the perception of the hospital in this community. They see things and hear things and they think that the hospital is mismanaging funds. I am all for giving more money but not if I am not going to get the service. In my personal opinion when I depended on my hospital up here to handle my husband’s medical care, I had to get in a car at 1:30 in the morning and drive to Vernal. If it ends up being that we only have an emergency room up here for the oil field, coal mine and the college, maybe not everyone is OK with that but I’m OK with it because half the time I have to drive to Vernal anyhow.”
“When I got to town we didn’t have any doctors on contract,” Goshe replied. “They were all Locums [visiting doctors]. We had no physical therapy, no retail pharmacy, you can’t tell me that it is worse now than it was 10 years ago when I got here, because it’s not true. We have been very fortunate because when people from the outside come here—and not just Eide Bailley—they say wow this is really nice, this is nothing like we expected.”
Brannan asked if they had looked at going with a larger university health center out of the front range. Petersburg said, “The only time they are interested is when they can make money out of it and the clinic, the physical therapy, the assisted living, all of those are money losers. What happens with the big hospitals like that is they wait until you’re down to an ER and a couple of inpatient beds, where those are money makers, then they will come in and try to get you.”
Chamber board member Angie Miller said, “I try very hard to stay in town, going to the grocery store, buying gas here, but blood tests should not cost me an exorbitant amount of money. When I had to have a CT, that took me over a year to pay off up here. I went out of town to Denver and it was a whole different story. Why so much more, why? My copay was $1,700 from you guys.”
Goshe responded by saying, “Your private insurance tells us what they are going to pay us, I can look into your case and find out.”
“I have no ill will towards the hospital,” Miller continued. “They did great with my mom while she was dying, they went above and beyond. I just want to know why, why the difference in the cost? All within the same year, a month apart, and the same insurance, why was a CT and blood work half the price elsewhere? I would love to give you more money and I have no problem giving you more money, but make it worth it. I want you to explain to us, town-wide, why the price difference?”
Goshe replied saying, “Medicaid and private insurance also has a rate called contractual adjustment and they tell you what they will pay.”
Billgren asked Goshe, “How can we justify paying twice as much?”
“If you want it in your community that is what the cost is going to be,” Goshe said.
Petersburg told the group before they ran out of time that they would “chase that and look at some examples,” referring to the cost of services at other facilities.
By ROXIE FROMANG | Special to the Herald Times