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Health services: picture brightens

We humans are resistant to change, especially when it comes to healthcare. Nevertheless, as the Upper San Juan Health Service District continually evolves, local medical services are quickly improving.

In recent years, the main and most obvious local healthcare concern has been the steady outward migration of local primary care physicians and midlevel providers to other points beyond. It began in 2005 when Dr. John Picarro left Pagosa Springs to join a practice in Durango.

Since then, the community has lost Buzz Bricca, Tim and Beth Mazzola, Mark Wienpahl, Joanna Estes, Dan Keuning and Elizabeth Volz. The reasons for their respective departures are many, but at least some grew disenchanted with the long hours and relatively low pay that increasingly plagues many primary care providers as more and more Medicare patients flood the system.

Today, Dr. Jim Pruitt is the only remaining healthcare provider at Pagosa Family Medical Center, as Drs. Robert Brown and Evette Polczynski, and Susan Kuhns, C.N.P. provide family medical services at Riverside Health Practices, downtown. The situation is not unique and, in fact, is becoming commonplace across the country, as private practice Medicare reimbursements fall far short of what practitioners earn in the service of third-party (privately insured) or self-pay patients.

Hold on, though, things are turning around.

The new Pagosa Mountain Clinic (PMC) is a certified rural health clinic, which receives two to three times the federal reimbursement afforded a private primary care facility, thus expanding Medicare and Medicaid services, while reducing costs and subsequent patient charges. It’s located adjacent to the Pagosa Mountain Hospital (PMH) on South Pagosa Boulevard, and serves patients five days a week, with hours and services continually expanding.

As clinic hours increase, so does the need for more staff. Therefore, several new practitioners have joined the district team in recent months, bringing with them assorted fields of expertise.

Even before the clinic became reality, though, many local docs covered shifts in the PMH emergency room. Various Southwest Emergency Physicians personnel filled in on a contractual basis, as certain dedicated midlevel providers either moved to Pagosa Springs or began commuting from nearby communities.

Dr. Al Caccavale, D.O. joined the staff last October, and now serves as the ER and district medical director, while managing the clinic and other providers.

Martin Neubert, P.A. still commutes from Dolores and has done so since November 2008. As a full-time staffer, he covers shifts in the clinic and hospital ER.

Robert Gruver, P.A. came from Idaho Falls in February and works full time covering clinic and ER shifts.

Both Neubert and Gruver are midlevel providers, or licensed clinical professionals who examine patients, diagnose injuries or illness, and prescribe treatment under the direct supervision of a physician. Midlevels include physician assistants, nurse practitioners and certified registered nurse anesthetists.

Dr. Robin Galloway joined the district in March, followed by Valerie McKinnis, M.D. in April. Galloway moved from Limon, Colo., while McKinnis came from Durango. McKinnis’ practice focuses on women’s services, such as pregnancy and birthing.

Dr. Matt Phillips has worked for the district three to four days a week since June, having come from Shiprock, N.M. He currently lives in, and commutes from, Dolores.

Dr. Nick Kurz, D.O. came from Pueblo in July. While assisting with family medicine, he also works in occupational medicine, particularly in workman’s comp cases. Such a practice focuses on the manipulation of skeletal and muscular tissues.

Fran Shriber, P.A. is a midlevel provider from Cheyenne Wells, Colo. and works in the clinic full time. She arrived on scene earlier this month.

Peter Marshall, M.D. is scheduled to join the district staff next week with a sideline focus on sports medicine. He’s formerly of Longmont, Colo. and will work in the clinic full time.

Dr. Jack Cartier now works the hospital ER two to six shifts a month. Having originally worked with Southwest Emergency Physicians, he commutes to Pagosa from Durango.

Dr. Mori Krantz is a Denver cardiologist and director of the prevention department at the Colorado Prevention Center. Beginning in November, he’ll serve the district one to two days a month as a long-range consultant.

Pending board approval next Tuesday, Drs. Rick Zak and Eric Meyer will also serve the district part-time, by the first of the year. As specialists in their respective fields, Zak will perform procedures in gastroenterology two to three days every six weeks, while Meyer will perform cataract surgeries and other eye-related procedures every other month.

In a Tuesday interview, PMH CEO Brad Cochennet said he is also talking with other docs and a general surgeon with hope of expanding hospital and clinic services even further over the next several months. Meanwhile, free lipid panels (cholesterol screening), glucose (blood sugar) screening and blood pressure checks are available now, by appointment.

No doubt, healthcare in the U.S. and our local district is changing rapidly and it’ll take a little time for patients and providers to grow accustomed. Nevertheless, with a little “patience,” district patients are better served than ever before, while finding it easier, faster and more affordable to address healthcare concerns.

chuck@pagosasun.com