Arkansas Valley Regional Medical Center CEO Community Update 9/29/21

Description: AVRMC is a Critical Access Hospital located in La Junta, Colorado. The main building is licensed to house 25 acute care patients. The 129,300 (76,500 plus 52,800 new) square-foot main building began operations in 1971.

AVRMC CEO Community Update September 29, 2021

AVRMC Employees are a great bunch of folks. They have risen to the occasion during the COVID-19 crisis; but even before that, there were situations that tested the team, and they always exceeded the demands.

Before anything else is said, that needed to be said. Our employees are what makes the facility achieve the milestones that we achieve. Administration at AVRMC maintains a high degree of transparency with the employees. Information is regularly shared and published, and every employee can come to Administration and ask any question they want to.

Due to some recent misinformation on social media, AVRMC is publishing this document. Tearing down the institution that is the largest employer in town and pumps $53 million a year into the local economy is sure not revitalizing the town. So, let’s get to it.

ICU closure

During the middle of September, there were some employees in ICU who left from night shift jobs at AVRMC to take day shift jobs at other healthcare facilities. Since the pool of ICU nurses is sparce in southeastern Colorado, AVRMC turned to contract labor to fill those gaps, only to find there were no available persons to start a term with AVRMC. There was no staff to work the night shift, so AVRMC had no choice but to close the unit for a two-week period to construct a schedule. ICU is a unit that one cannot have open just part of the time. Whenever this decision was made, the CEO met with every ICU employee and explained what was happening and why. These employees were given the opportunity to work in other nursing units to maintain their hours. As of September 27, 2021, the ICU is open with patients after securing the services of three contract labor nurses, utilizing existing ICU staff, and floating RNs from OB and ER.

Contract labor

The use of contract labor (travelers) is avoided as much as possible. There is not a pool of specialized employees, nurses, lab technologists, radiology technologists, respiratory therapists, physical therapists, pharmacists to pull from when one of these specialized employees leaves employment for whatever reason. To continue operations of the unit or department, we must turn to contract labor. Usually, this is one or two contract labor personnel engaged until an employee can be hired. Sometimes, the traveler wants to convert to an employee because of a good fit. In addition, we have paid our employees double time to fill in extra shifts. We are cautious about doing this out of concerns with burn-out.

Our efforts are to utilize contract labor as little as possible. Our goal is to have none. Statements that administration is trying to replace the employees with contract labor are totally backwards.

Provider recruitment

During 2020, AVRMC recruited and placed ten (10) new providers in the community. Each one of those providers is responsible for $1 to $2 million* in downstream revenue for the local economy. Recruiting providers is a very hard job as we are in competition with every town like ours in the United States. Just ask the folks at Economic Development and they will tell you how hard it is to make it to the final list of consideration, let alone be the final choice.

Access to healthcare was one of the items identified during the Community Needs Assessments conducted every three years by AVRMC. Keeping provider practices open when a provider leaves the community sometimes demands that a temporary physician be brought in until a permanent provider can be recruited.

AVRMC now has a great group of physicians and nurse practitioners who are providing a great service to the community.

* https://coruralhealth-wpengine.netdna-ssl.com/wp-content/uploads/2013/10/2021_Regional_Snapshot_Citations_02162021.pdf

COVID-19 funds

During 2020, AVRMC saw revenue drop by 25% or $16 million. During that time, AVRMC did not lay off a single employee due to the pandemic. AVRMC did not replace some positions when employees left on their own, but we tried to maintain the workforce and maintain the salary base. We feel we did that.

During the pandemic, COVID-19 funds have been available from a variety of sources. All those sources, except for one, came with stipulations as to what the money was to be used for.

SBA Round 1-In April 2020, AVRMC received $3.8 million for payroll and other expenses. The money was used for 6 payrolls. AVRMC also used $312,000 of the funds to provide a bonus payment to 281 employees in June 2020. Raises had been provided to all employees during the period April 2019 through March 2020 but were put on hold for fiscal year April 2020 to March 2021 due to the uncertainty of the effect of COVID-19. Excluded in that bonus were physician providers and the CEO. This loan amount was forgiven by SBA on June 2, 2021.

SBA Round 2-In April 2021, AVRMC applied for and received $2,000,000 for payroll. This was used to fund 4 payrolls. This loan amount was forgiven by SBA on August 16, 2021.

Health and Human Services- Received $4,665,138 for COVID-19 use with 18 stipulations for non-use. Purchased a sterilizer, Powered Air Purifying Respirators (PAPRs), Ventilators, and used the balance to offset lost income. Submission of data is currently underway to the HHS portal for approval of expenditures.

Medicare Advance Payment-Received $4,050,879 in advance payments in April 2020. Payback started April 21, 2021. Medicare is withholding 25% of current payments for 11 months, and then 50% will be withheld for 6 months, and then a demand letter will be issued for the balance. The demand letter in September 2022 will be for $2,854,879.

Colorado Rural Health-Received a grant for $74,419.24 which was used to purchase a telemedicine license so AVRMC could conduct telemedicine visits with clinic patients, isolation gowns, gloves, face masks, UV boxes to sterilize N-95 masks, and UV lights for room cleaning. This spending was validated to Colorado Rural Health on January 14, 2021.

CHA- A grant for $28,180 was received from the Colorado Hospital Association. That money was spent for exam lights in ER/OB, a flammable storage cabinet to hold gallon jugs of hand sanitizer, and batteries and Hoods for Powered Air Purifying Respirators (PAPRs). Spending had to be validated by CHA and this was done in February 2021.

Colorado Trust-Received $25,000 for COVID-19 expenditures. Purchased UV lights for HEPA filters, Sterilization holders for small instruments, Exam gloves and N-95 masks. No validation was required for these funds.

COVID-19 Vaccination Mandate

The Colorado Department of Public Health and Environment issued an emergency rule on August 30, 2021, mandating vaccination of healthcare workers at a rate of 100%. Early on, AVRMC had many individuals who had declined or not taken the vaccine.

During his press conference on September 21, 2021, Governor Polis, when asked about making concessions for rural hospitals especially in Otero County, stated that the Biden Administration Mandate of accepting federal funds in the form of Medicare and Medicaid would require vaccination of the healthcare staff.

As of September 27, 2021, AVRMC has a 76% vaccination rate and has issued 11 Medical Exemptions and 36 Religious Exemptions. The Mandatory Waiver Application Form was filed by AVRMC with the Colorado Department of Public Health and Environment on September 21, 2021.

General operations/reimbursement

Most of the income for AVRMC comes from Government sources, that being Medicare and Medicaid. The table below shows what is received from each group for each dollar charged and what percentage that group makes up of our patients.

Everyone needs to be aware that hospital bills are not paid at 100%.

Thank you to all the people who support your hospital. I have heard from many of you during this time, and your words of encouragement are appreciated. To anyone who has questions, please contact me at (719) 383-6000. I will be glad to answer your questions and discuss your concerns.

Lynn Crowell

Chief Executive Officer

Arkansas Valley Regional Medical Center

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