It is agreed by the board of directors of the Upper San Juan Health Service District (USJHSD) and the staff of the Pagosa Springs Medical Center: the clinic must be expanded.
Last week, during a Wednesday night work session, the USJHSD board and many PSMC staff members discussed different options for a Master Facilities Plan.
Presenting two different plans with various optional phases was Bob Owens with Boulder-based architectural firm Boulder Associates.
The rough estimate for cost to complete either plan, with all options added on, is over $17 million.
“I’m aware after talking with Brad (CEO Brad Cochennet) today that the numbers are astronomical,” Owens told the crowd.
Plan A, phase 1 consists of expanding the existing clinic to the north to accommodate approximately eight providers in an open bullpen office. The estimated costs of this expansion alone were estimated at $1.8 million. The rest of the options for A-1 included temporarily moving administrative duties to Pagosa Springs Family Medical Center (PSFMC), renovating the pharmacy, expanding the laboratory to the southwest, and creating additional parking. The total estimate for phase 1 of plan A was estimated at $4 million.
Phase 2 of plan A is where the bulk of the money would be spent. This phase included expanding the clinic to have space for 12 providers in private offices ($2.6 million), expand the hospital to the east for administration and human resources ($1.9 million), expand the hospital to provide for a fixed MRI and mammography and bone density ($1.2 million), add 14 inpatient rooms to the hospital ($3.8 million), additional parking, and construction of a new EMS facility on campus ($1.2 million). The total estimated cost for phase 2 came to $13 million.
Plan B accomplishes much the same goal. By the end there would be a clinic housing 12 providers in private offices, as well as 14 new inpatient beds in the hospital. However, in plan B this is accomplished through constructing a new clinic ($6 million), demolishing the Dodie Cassidy building located to the north of the campus, adding additional parking, renovating the existing clinic to accommodate administration and human resources, and accomplishing the rest of what is done in plan A.
There was a consensus from the board that neither plan would be accomplished with all it’s options. While no formal decision was reached, the plan discussed most was the first option in plan A, phase 1: expanding the clinic to provide room for eight providers.
It should be noted that the USJHSD owns neither the Dodie Cassidy building nor the PSFMC. Owens clarified that the estimated cost provided by his firm did not include probable purchase prices.
Cochennet stated in an interview with SUN staff that, presently, PSMC is not in negotiations for either building; however, if a decision is reached by the USJHSD to pursue a plan which involves either building, that is when Cochennet will begin negotiations.
“If it’s not looking like there’s money in the budget, if the funds can’t be raised or if they don’t feel it’s a good value, they don’t have to choose all the options of either plan,” Owens said, adding, “In fact, the board could choose to do only one option.”
According to Cochennet, “First you decide what you need and then you go back and build a budget on what you can afford.”
Thus, the meeting was held to give board members a feel for the building options and potential costs.
The board and staff then launched into a lengthy discussion regarding the needs of the PSMC staff, the medical needs of the community, PSMC’s role in meeting those needs and how the future changes in healthcare structure might impact the USJHSD.
“Are we or aren’t we meeting the current community demand for healthcare? Is it escaping to other facilities? Or is the demand not there? I haven’t had answers,” board chairman Neal Townsend said.
“Are we expanding because we’re not meeting needs of community or because we need to?” Malcom Rodger likewise asked.
“We’re expanding because we need more space. There is no data from the community, but we’re providing a poor quality working environment for staff,” Jim Pruitt said.
Jim Knoll also added that longer patient waiting time means each provider sees fewer patients. If the number of exam rooms is expanded, the hope is that the providers will be able to increase their efficiency with patient visits.
In regard to how healthcare, along with funding through Medicare and Medicaid, may change in the future and impact the PSMC, adaptability seemed to be the key.
On Monday, it was announced that the group of legislators given the task of drafting a deficit reduction plan (a group commonly referred to as the Super 8 or the Super Committee) had failed to do so by the Nov. 23 deadline. It remains uncertain if large cuts to Medicare and Medicaid will be made in coming years, but it is certainly likely.
“If you have space, you can shift in it as government is changing. But if you don’t have the space, you can’t do anything,” Knoll said.
“If you build a space that is adaptable, you haven’t lost anything,” Rodger said.
“As long as the space can shift,” Pruitt added, explaining that additional construction, whether of an addition on the existing clinic or of a new facility, should allow for future expansion in its design.
Knoll suggested a development of a long-range planning committee with a representative from the staff.
“We operate theoretically, we need some reality,” Knoll said. After a long-range planning committee discusses a possible Master Facility Plan, that plan would then be given to the finance committee to discuss, and then would come back to the board.
This strategy received a general consensus from the board.
“We are going to have to take small bites,” Mark Floyd said.
To fund the expansion of the clinic, or the possible construction of a new clinic building and facility, Cochennet explained that a capital budget campaign will be created. It will then be decided how much money is needed and those funds will be raised, whether through grants or donations.
It is expected the committees will report back to the USJHSD board at the Dec. 13 meeting, detailing their discussions and presenting ideas of how to move forward.
“The best defense is strong offense,” Cochennet said. “Not just additional space for today, but space to grow and meet the needs of the community, “