Mancos health clinic gets MCHD support

Mancos health clinic gets MCHD support

May 24, 2001

By Jim Mimiaga
Journal Staff Writer

Deciding there is a need for better access to health care for its constituents, the Montezuma County Hospital District voted unanimously Tuesday night to move ahead with efforts to purchase a building for use as a community clinic.

"It must be the liberal Democrat in me," said board member Susan Keck. "It would be great to fill that void in Mancos and surrounding areas."

Mancos has been without medical services for one year, and a small citizens group has been negotiating to secure the former clinic building on Railroad Avenue for use as a health clinic again.

The district’s five-month lease-purchase agreement commits the board to paying $12,500 in total lease payments to the owners of the building, Alice and Michael O’Traynor. At the end of the contract, which is still pending owner review, the district has the option to purchase the $245,000 building, which board members indicated was likely.

"I think this is very do-able," said board chairman Randy Smith, adding that Valley-Wide’s presence at Tuesday’s meeting was a key factor for gaining board support.

Five employees of Valley-Wide were on hand to answer board questions. Valley-Wide operates a dozen clinics in the San Luis Valley, and recently purchased three clinics in Durango from Mercy Medical Center. Valley-Wide CEO Marguerite Salazar credits their success to staff expertise in the bewildering maze of government bureaucracy regarding health-care financing and federal grants.

"Our on-site eligibility screeners take patients and fit them in somewhere," allowing consistent reimbursement for services rendered, Salazar said. "There are a lot of people who qualify for state or federal programs who do not realize it."

Valley-Wide has a policy of accepting all patients, regardless of health status or insurance. Those with low family income and no insurance will be charged on a sliding scale, or not at all. Private-pay, group-insured, Medicaid and Medicare patients and American Indians are accepted, including people living across state lines. The clinic would be accessible to anyone in the county.

"We take care of anyone who walks through the door," Salazar said. "Typically when we arrive in a new community, people come out of the woodwork seeking medical attention. There is a lot of pent-up demand and many have not had regular visits in a long while."

In the absence of such a clinic, sick or injured patients without insurance generally check into the emergency room, an expensive last resort ultimately paid for by taxpayers under charity write-off laws that Colorado hospitals must follow.

Once on-line, the clinic will be staffed according to demand, Salazar said, which is expected to be adequate. But because of so-called "kickback" laws, Valley-Wide cannot promise that all patient referrals would go to Southwest Memorial, a concern of the board.

To encourage referrals to Southwest over other hospitals, CEO Bob Peterson and Valley-Wide are working to recruit a physician who would staff the clinic part-time and work part-time with a local practice in Cortez loyal to Southwest.

Dental services will also be offered as part of the clinic. Dentist Dale Strietzel plans to sublease a portion of the building and is the dentist preferred by Valley-Wide to provide those services.

Valley-Wide was instrumental in having Montezuma County designated as a medically under-served region and as a health-professional shortage area. The designations show a high percentage of poverty here and a high patient-to-doctor ratio, paving the way for substantial federal funding for the clinic.

Valley-Wide is in line to receive a $500,000 start-up grant from the Department of Health and Human Services, but will not know definitely until Aug. 31, when the next round of funding is distributed.

Responding to board concerns that operations relying on grants can be unreliable, Salazar said the grant is renewed on an annual basis once awarded.

More work needs to be done before the doors open, and financing is not expected until later in the year. Approximately $100,000 worth of remodeling is required in the building. But federal money is also available for such projects.

"The money is out there, and these health clinics are very well-supported and funded by the Bush Administration," Salazar said.

The board discussed how to finance the final purchase of the building if that option is exercised. One option debated would be to obtain a USDA, 40-year revenue loan established for such ventures. Interest would be 4 to 5 percent.

But citing the $1.4 million that has been collected already in tax revenues, MCHD attorney Kelly McCabe pointed out that the district could afford to put up the cash outright.

"Having all of those tax dollars sitting there has been a common criticism of the board," he said. "There would be enough left over for other projects."

The district collects approximately $300,000 per year from its mill levy. Of the $1.4 million, $800,000 must stay in emergency reserve, but the amount, established by the Montezuma County Commission, can be negotiated.

Fears that the clinic would unfairly compete with private practices are unfounded, Salazar said. The clinic works not in competition with local physicians, rather in cooperation with them, she said.

"We pick up overflow, and people without insurance, because (private practice) can’t afford to do that," she said. "Our clinics relieve pressure on the ER, and focus on preventive care so health problems do not become so acute.

"This is what we do," Salazar said. "But we need partners to be successful, so we are very pleased that the district is on board."