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RANGELY | In a two hour meeting Thursday, May 23, the Rangely District Hospital board presented its case for requesting a mill levy increase on the November ballot. The hospital district’s current mill levy is 20.99, the highest mill levy assessed by any special district. countywide.
Present for the meeting were Chairman John Payne, Vice-Chairman Jason Kurrasch, Secretary/Treasurer Nathaniel Polley, Directors Stephen Petersburg and Shad Peters. Less than a handful of public citizens—not affiliated with the hospital—attended the meeting.
Family Medicine Manager Tammy Dunker introduced policy analyst Kelly Erb and outreach manager Matt Enquist with the Colorado Rural Health Center (Rural Health Association). CRHC supports the fragile healthcare delivery system in Colorado by providing programs to rural hospitals and clinics that improve quality of care, increase funding and reimbursement, workforce shortages, and assist with emergency preparedness.
Erb and Enquist featured Rangely in the production of a video series and worked with the Rangely Community Medical Health and Wellness administration.
“What you have here is incredible,” Erb said. Enquist said they have completed 15 videos in the series and “Rangely’s first video is the most viewed by far.” The duo presented informational material to the meeting attendees and board members. One specific handout compiled by the organization is called “Snapshot of Rural Health in Northwest Colorado” and provides various statistics in Grand, Jackson, Moffat, Rio Blanco and Routt counties related to public health and the health care services in those areas.
During the public input section of the meeting, long-time Rangely resident Frank Huitt asked why the board did not have an invocation or participate in the Pledge of Allegiance in the beginning of the meeting. Payne responded that he appreciated Huitt mentioning it and that it was something they were looking at doing.
Huitt went on to say, “I want this hospital to succeed.” He and his wife have built a home and planned on retiring in Rangely. Huitt is concerned that if the mill levy increase is approved, he will be assessed 35 mills on his property out of a total of 78. If the proposed bond mill levy passes, 45% of his property taxes will be going to the hospital district.
“I just don’t think it is going to pass,” Huitt said. He proposed to the board that they should “show the public that they are accepting part of the pain and not put everything on the taxpayer’s back” and that doing so “will give you a whole lot better chance of passing this.”
Huitt proposed a 5% pay cut for all employees and a 10% cut for upper management, and instead of asking the voters for 15 mills he proposed that they ask for 8 mills. Huitt reiterated his understanding that changes like Obamacare and a decrease in our assessed values had caused some problems, but said “that is all water under the bridge and there is nothing we can do about it and we need to look at what we have control over.”
He said he had researched support staff positions in Rangely and hospital support staff members pay scale is 25-50% higher than similar positions throughout the community. He also said he believes upper management pay scales are extremely high, stating the CEO makes $180,000 plus benefits, the CFO makes $116,000 plus benefits, and the CCO makes $116,000 plus benefits. Huitt went on to discuss the maintenance manager’s salary being more than $70,000 and that it’s much more than some of the nurses make.
Payne told Huitt the hospital uses a pay survey from across the state to determine employee pay.
“A lot of these things are out of our control,” Payne said, adding that they’ve been “working on this for years.”
Huitt asked how more/new revenue is being generated by upper management besides additional taxes.
“If 45% of our taxes will be going to the hospital I think that is going to be a hard sell. I know that Nick has raised hell with everyone up here and has pretty much gave them the riot act, or from what I have been told by former employees and current employees, that if they did not promote this and this failed they would probably be out of a job. I don’t really think that is a good way to manage but I guess that is not my call to make,” Huitt said, adding that he thinks the hospital district has a spending problem, not a revenue problem.
Before introducing CFO Jim Dillon for the financial presentation, CEO Nick Goshe said, “This is difficult and I wish I could make this easy. If Frank [Huitt] is right and I am the problem, I like it here but I do not need to be here. I have family in Ohio; I could go back to Ohio.”
“Changes in healthcare have happened so much in the last 10 years that people don’t understand and whoever says it is the bad guy. I hear what Frank is saying and I see the frustration in the people that come to me with complaints over the last several years. Their deductibles have went from almost non-existent to our average deductible is now $4,000. The cost of employees is a lot more expensive than people realize. Frank says we are on the high end, we are on the low end for almost everybody,” Goshe said.
Dillon then moved forward with the financial presentation titled: Rangely Hospital District Cost Structure, Critical Access versus Non-Critical Access.
“If you get a designation of a critical access hospital, Medicare covers your overhead and your cost for certain things,” Dillon said. “It does not cover services not directly related to the Medicare hospital stay. It does not cover the cost of the clinic, retail pharmacy, lab, X-ray department, Eagle Crest, long term care, ancillary services for the general public that is not connected to those Medicare hospital stays. It also does not cover any administrative services that are not similarly connected.”
Goshe reviewed a spreadsheet comparing yearly revenue and expected revenue. Operating expenses in 2017 were $19,333,136 and increased to a projection of $21,113,990 in 2022. Based on projections, the hospital district will run out of cash as of January 2021.
According to Goshe, even if they cut everyone’s pay by 10%, the hospital will still run out of cash in 2022.
Huitt interjected, “What I am implying is that a pay cut would show a good will gesture towards the public, that the Rangely District Hospital board is willing to take some responsibility and not put it all onto the taxpayers. I didn’t say it was going to balance the budget, that was not my intent.”
“I am scared to death that this mill levy will not pass,” Goshe said. “If we are bought by another entity I worry that they will maybe put a clinic here and pilfer patients for surgery.”
Huitt asked if the retail pharmacy was profitable. Goshe said that it is profitable with the other services and 340B (a federal drug discount program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices), but added, “If we cut the clinic and leave the assisted living, the retail pharmacy is not profitable.”
Goshe said if the mill levy increase fails it would be irresponsible not to take immediate action, including finding accommodations for the 28 seniors who live at the hospital in the long term care unit and at Eagle Crest Assisted Living.
“Am I perfect, no. Do I make mistakes, absolutely, but from the bottom of my heart I believe if we do not pass this, I believe the town is going to suffer because I believe that towns without health care shrivel up and go away,” Goshe said.
Payne said, “For the last five or six years they have tried to bring in healthcare that is needed and wanted. There were cuts in the hospital’s income that they had no control over.”
The board agreed they need to keep the services they currently offer, which means asking for the full 15 mills. Petersburg said Goshe is the best administrator he has ever worked with in Rangely during his 28 years involved with the board.
There are 110-115 full-time staff members and Goshe believes that they will be forced to cut down to 40-50 employees if the mill levy does not pass. “Most of the employees are multi-talented,” said Radiology Director Nancy Droste. “You’re not going to get the employees you have right now if you cut our wages and we leave. I could make the same amount of money and more in Texas and just do directive. I don’t have to work ER, I don’t have to take calls, I don’t have to do mammograms, I don’t have to do CT, and X-ray. I can do just one job.”
“This matters to the community and it will affect my friends, my family, and the businesses that I like to go to. Nobody is excited about increasing taxes. It matters and if we don’t pass this it can make the community succeed or shut it down,” commented Rangely resident Tarrah Patch. Director of Nursing Sharma Vaughn spoke about the future of the hospital and said that “this is worth investing in.”
Family Medicine Manager Dunker worries about asking for a lower mill levy and then having to go back to the public to ask for more every couple years.
In regular business, the board:
– Heard a medical compliance report from Chief Compliance Officer Bernie Rice, included discussion about upcoming computer upgrades. The Office Inspector General has determined that EMRs across the country do not communicate with each other. There is uncertainty about what this means for the future. Rice believes that they are going to want all of the computers to communicate which will come at a price.
– Dillon reported that revenue is 2% less than last year, total expenses are 6% less than last year, cash balances are as expected given the Medicare payments, and activity is as expected.
– While reviewing the check register, Payne questioned the three Locum nurses (contract health care providers) and clarification was given by Dillon and Goshe.
– Goshe asked if they should consider setting up a political action committee for the mill levy vote. He would also like to set up a table at Septemberfest, and present information at staff meetings at the school district.
– He also spoke about Senior Life Solutions, which is a mental health evaluation service for Medicare. He reported that the district would have to buy an ADA van for transport and put in a door for their services. This would bring three new jobs into Rangely (psychologist, nurse and aide) and it would be profitable for the hospital if there are seniors using it. Petersburg said “it is prudent to wait until after the vote.” Peters said that they should do anything to generate more revenue. Payne and Goshe agreed to look into the service further.
– Goshe reported that Sharma Vaughn and EMS/Ambulance Director Shanna Kinney received a grant for $11,757. They intend to use the grant money for a CPR chest compression. Vaughn said there is a better outcome with the use of this device, it also frees up a medical provider to push medications and attend to other duties to help care for the patient. Goshe asked the board for authorization to make up the difference for the device which is $5,721.21 Petersburg moved to approve the amount and Polley seconded the motion.
The Rangely Hospital District Board meetings are held on the last Thursday of the month at 6 p.m. at Rangely District Hospital in the executive boardroom, room 1211 in the Rangely District Hospital, 225 Eagle Crest Dr.
By Roxie Fromang | Special to the Herald Times