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 © 2024 NEW MEXICO NEWS SERVICES  10/14/24

We must take care of our rural hospitals 

By Sherry Robinson

All She Wrote

     Last year three small New Mexico hospitals had only enough cash on hand to last a few days. That situation has improved a bit, said Troy Clark, president and CEO of the New Mexico Hospital Association, but four hospitals still have just 20 days of cash on hand. Others are losing money.

     "We must take care of our rural facilities," he said.

     Patients in rural areas are older, poorer and sicker; their hospitals rely more on Medicaid than on private insurance or other sources, and Medicaid reimburses them below cost.

      Legislators threw rural hospitals a lifeline in this year's session by passing the Healthcare Delivery and Access Act (HDAA). It allows the state to tax hospitals, pool the money and use it to receive a larger Medicaid match. The state will then distribute the larger sum among New Mexico's hospitals as Medicaid reimbursement. It requires no state funding.

     Large hospitals agreed to pay more to help rural hospitals. If a small hospital fails or can't meet local needs, it adds to the demand on larger facilities, which are already operating over their capacity. Our hospitals really are all in this together.

     "When those small hospitals do well, the entire hospital ecosystem does well," said Clark, who spent 17 years running small hospitals.

     "The HDAA... was monumental," Clark said told the Legislative Health and Human Services Committee recently, and the association's 47 member hospitals are grateful.

     The new law isn't a genie in a lamp, but many administrators can take a deep breath and envision having money for staff recruiting and retention or new equipment or employee education. The hardest hit hospital, Rehoboth McKinley Christian Hospital in Gallup, could receive up to $18 million after paying $1.9 million in tax.

     Clark said they are still waiting for federal approval to start the program.While that's welcome progress, it's not the top concern for the state's hospitals. At the top of the list is access to care, and that means staffing. In fact, Clark argues that New Mexico's number one issue is not crime but access to care.

      Baby boomers, who outnumber all other age groups, have aged into the segment that now requires more healthcare, and they’re driving demand. Right now postings for nurses statewide total 8,800. For comparison, Albuquerque’s three biggest hospitals employ 6,200 nurses. And the hospital workforce is short in all positions, not just doctors and nurses.

     One bizarre twist to this worker shortage is the use of hyper-expensive air ambulances simply because EMTs and paramedics are in such short supply. Clark said 67% of air ambulance trips in the state aren’t justified, but there’s no other option. For that reason and the fact that insurance companies drag their feet on authorizations, patients may stay longer in costly hospital beds (that somebody else needs) instead of being moved to another facility for after care.

     "Growing our own is critical," he said. "The entire nation has a workforce shortage."

     Clark told the committee that other healthcare bills will be introduced in the next session, "but if they don’t improve access to healthcare they should be set aside."

     As he delivered the hospitals' message, Think New Mexico released its 10-point plan to increase healthcare staffing.

      The bipartisan think tank reported that the number of primary care physicians in New Mexico fell by 30% from 2017 to 2021, and the numbers of ob-gyns, nurses, dentists, psychiatrists, pharmacists, and EMTs also declined sharply in recent years.

      "New Mexico has the oldest physician workforce in the nation, with nearly 40% of the state’s doctors aged 60 or older and expected to retire by 2030," the group reported.

     Think New Mexico's plan includes malpractice reform, better student loan programs, friendlier tax policies for healthcare workers, and higher Medicaid reimbursement rates. (See thinknm.org.)

     This is the state of healthcare in New Mexico. Talk to your legislators.