Utilizing a $1.5 million private inheritance donation, Heart of the Rockies Regional Medical Center (HRRMC) Board of Directors approved the Hospitality and Employee Housing Project last month, paving the way for the construction of several Americans with Disabilities Act-compliant transitional housing units next year that fund hospitality accommodations for patients’ families and employees on the hospital grounds.
HRRMC is a Critical Access Hospital (CAH) located about 100 miles west of Colorado Springs. The hospital covers a wide geographical area in Central Colorado, serving the towns of Salida and Buena Vista and the broader Arkansas Valley region.
As one of the largest CAHs in the country and primarily the main provider for healthcare in the region, the facility has 25 beds, employs a staff of 650, and offers a wide range of specialty care services.
HRRMC CEO Bob Morasko told State of Reform that the biggest challenge emerging from the pandemic has been the workforce. The community of Salida continues to grow as more and more people, many of them older retirees, settle in the region, attracted to its idyllic setting. High costs in the region have made recruitment difficult.
“We’ve experienced a lot of growth in the community, a lot of building,” Morasko said. “Housing prices have soared, and rental prices have soared. So another huge challenge for us is employee housing. That’s [been] a huge challenge [to recruitment].”
In order to retain and recruit employees, the hospital has had to raise wages by 15-20% and offer signing bonuses primarily to service staff and hard-to-recruit positions after the COVID-19 crisis drove many of its workers to leave their professions or seek better opportunities elsewhere.
Along with higher pay, HRRMC implemented an innovative temporary housing program for its recruits to attract them to the region.
“We actually built an RV park on site of the hospital here a couple of years ago seeing that that might be an option for patients because we cover such a large geography and so patients needing surgery could come in or if they have an inpatient stay and they’re living in Sawatch, it’s very hard to go back and forth,” he said.
“So we actually built an RV park as a start. We have 6 RV spaces with full hookups and that has been a huge success. We have employees with RVs living there. And we also have patients that come in and use the spaces.”
To address the high cost and lack of housing for new employees transitioning to the region, HRRMC built on the success of the RV program with the proposal to develop transitional housing on its campus.
While staffing has since stabilized, Morasko says costs and access to specialty and behavioral health care remain concerns for his rural community. Morasko says he would like to see more state support to address lack of access to specialty care in rural regions, including state incentives for specialists to provide care in these areas and improve regulations around emergency transportation.
Solvista established a new in-patient behavioral health crisis stabilization and detox center on HRRMC’s campus. Because it’s a behavioral health facility and not a hospital, state regulations do not require EMS to provide services to patients needing transport for long-term stays at the center. Morasko says ambulatory services in the region have also been reluctant to transport patients to the facility due to staffing shortages and inadequate Medicaid reimbursement.
Transportation remains a significant accessibility barrier for rural Colorado in the current inflationary climate. The hospital meets with Chaffee County’s EMS regularly to ensure ambulatory services are there. HRRMC also has an agreement with Reach Air where the hospital leases its facility to be used as an air ambulatory hangar in exchange for air transportation for its service areas and patients.
“The reason I chose Reach Air was because they offered an insurance package for people where they wouldn’t have to pay a copay,” Morasko said. “It costs somebody for their whole household like $65 a year. Then if they get flown out of here, because we are not a level one trauma center and we don’t have an open-heart surgery program or a cath lab. So if they get flown out of here, they can get on Reach with that benefit and we have the helicopter right here.”
HRRMC utilizes a local shuttle service to transport patients to and from its primary clinics and hospitals in Salida and Buena Vista. It also purchased a van in Westcliff, an hour’s drive south of Salida, for the same purpose of transporting patients from clinics who need specialty care.
Morasko says the state needs to transition back to cost-based reimbursement from the Enhanced Ambulatory Patient Groups that was implemented in 2016 and has devastated rural hospitals.
“Medicare pays costs for the rural hospitals,” Morasko said. “And the reason they pay cost is they understand that you don’t have the volumes here to support a per diem type payment system or per click, for example, if you have a little rural hospital in Springfield, Colorado.
We’re probably one of the larger ones so we could weather, but a lot of these little critical access hospitals, say you’re in Springfield way out on the southeast corner, and you’re having to cover your ER at night because you’re the only hospital within 100 miles. You might get 3 patients in that night. Well, you got to have nursing staff covering in-patient, you got to have a lab person in the lab. You have to have an x-ray person on call. You have to have a physician right there available. And you have to have nurses available.
So now you’re staffing all these people plus keeping the doors open with registration, and now you might get 3 people in that night. Well, you can see that if you’re going to keep that little hospital going in Springfield, that per [patient] reimbursement for 3 patients is not going to cut it.”