By Lindsey Bright
PagosaSUN.com staff
Wednesday, February 1, 2012

The year 2011 was a year of firsts for the Pagosa Springs Medical Center (PSMC).

It became the first medical center in the region to have a 128-slice CT scanner. PSMC hired its first surgeon, Dr. Dave Schaeffer, and its second, Schaeffer’s wife, Dr. Amber Reiss-Holt. Schaeffer performed the first surgery in Pagosa Springs. PSMC had a total net patient revenue over $1 million for the first time.

Thus far, it looks like 2012 will follow the trend of firsts. For the first time, telemedicine was successfully utilized to evaluate a potential stroke victim.

As previously reported in The SUN, in December PSMC signed a contract with Swedish Medical Center in Denver for service and equipment as part of the Collaborative Digital Online Consultant (CO-DOC) program. CO-DOC connects rural hospitals with stroke neurologists at Swedish’s Stroke Center to provide quality, specialty care through a site-independent, Internet-based telemedicine system.

Rosie, the affectionate name the PSMC gave the robot-like telemedicine equipment, is a portable telemedicine device equipped with two cameras, a screen, stethoscope, phone and wheels. If a patient comes to PSMC with stroke symptoms, Rosie is used to allow stroke specialists to remotely evaluate the patient.

Kathee Douglas, director of the ER, explained that the patient who came in three weeks ago was having trouble speaking as well as moving — definite symptoms of a stroke.

After the patient arrived at the PSMC hospital, Rosie was wheeled to the bedside and the CO-DOC number dialed. “Hello, we have a patient with stroke symptoms,” a nurse said to the technician on the other end of the phone.

“In less than five minutes, a neurologist will be on the screen,” Douglas said.

A reverberating cymbal sound is heard coming from Rosie’s speakers. Douglas describes it as similar to the sound on Star Trek when Scotty beams someone up.

“The neurologist beams in just like in Star Trek,” Douglas said.

In this case, it was Judd Jensen, M.D., who appeared on the screen. Once on the screen, Jensen had control of Rosie. He had the ability to zoom the cameras in and out, to show a variety of pictures and evaluate the patient’s responses to questions concerning the pictures. With the help of the Pagosa physician and nurse on duty, Jensen was even able to listen to the patient’s heartbeat. Jensen was also able to access the patient’s file, review the CT scan and consult with other physicians, all within minutes.

“After awhile, the patient doesn’t notice the robot anymore,” Douglas said, explaining that, since the physician on the other end has control, the robot takes on humanlike qualities. During the course of the evaluation, the patient, Douglas said, communicates and feels a connection with the physician.

The tests are being conducted for two reasons: to find out whether or not the patient is experiencing a stroke and, if so, whether the stroke is ischemic or hemorrhagic. If it is ischemic, the patient will be given tPA, a drug that will dissolve the blood clot. In this case, the patient would be able to remain in Pagosa. If the patient were experiencing a hermorrhagic stroke, the patient would have to be flown to a hospital specializing in stroke treatment, such as Swedish Medical Center.

The first patient, Douglas said, could not pass any of Jensen’s tests. However, after approximately 15 minutes, the symptoms began to clear.

“The patient’s symptoms cleared up on their own,” Douglas said, adding, “The patient did not get the clot-busting drug because it was not required.” However, just because a drug was not required and the patient was not having a stroke, does not mean that Rosie was not of use. The symptoms were that of stroke.

“Without Rosie, the patient would have been sent off, and not to Durango. Probably to Swedish,” Douglas said. To be flown to Swedish is an expensive trip, costing upwards of $20,000.

Instead, what happened was Jensen discussed what might have caused the symptoms with a consulting physician at PSMC. Together, they planned a course of treatment and testing.

“Telemedicine affords Pagosa a luxury we otherwise wouldn’t have,” Douglas said.

According to Nicole Williams, Swedish Medical Center’s Assistant Vice President of Marketing, the HealthONE Telemedicince Network in Colorado is growing and expanding into more fields. “We are currently piloting Telemedicine in the Pediatric Intensive Care Unit with one of our doctors from the Rocky Mountain Hospital for Children,” Williams wrote in an e-mail, adding, “We are also currently piloting Telemedicine with Behavioral Health … We know that there is a great need among our 25 rural hospital partners for that service and are working diligently to develop it.”

Williams also said that, further down the road, HealthONE will be looking into cardiology and other services that are in short supply in the rural regional areas.

Douglas said that PSMC would be looking into expanding the telemedicine service into these other areas once their pilot programs are successfully completed. Until then, Rosie will continue to serve as a means for potential stroke patients in the Pagosa area to be evaluated by specialists, saving trips to larger hospitals and possibly, one day, even saving lives.

lindsey@pagosasun.com

Choose from these tests and screenings:

Diabetes Panel = Fasting Glucose + A1C $27
Hemoglobin A1C $17
Fasting Glucose $12
Glucose / 2 hour $27
Urine Micro Albumin $37

Thyroid
TSH-Thyroid Stimulating Hormone $27
FT3-Free T3 $22
FT4-Free T4 $22
Cholesterol
Fasting Lipid Panel $27
Pregnancy
Preg S $22
Preg U $22
Urinary Screen
UA Complete $12
Iron
Ferritin $27
Blood Type ABO/RH $27
Complete Blood Count $17

Complete Metabolic Panel $32
Basic Metabolic Panel $22
Influenza $47
Mononucleosis $17
Urine Drug Screen $47
Uric Acid $12
Liver Function $22
Prostate $32
Strep Throat $32
PT/INR Monitoring $12

Specimens collected before 11am will have results available for pickup by 1500 the same day.
Most fingerstick A1C and PT/INR results available immediately.

Keeping you close to home for your medical needs.

Tuesday, January 17th at 6:00PM. Held in the Pagosa Room @ Pagosa Springs Medical Center.

Dr. Buzz Polcznski, from Riverside Health Practice, will be speaking about the thyroid for this month’s seminar. It will be catered by Nello’s.

Don’t miss out on the opportunity to learn more about how the thyroid gland acan affect you and your health.

Please call the Wellness Center at 731-9545 or Email: wellness@usjhd.org to RSVP by Tuesday, January 10th.

By Lindsey Bright

PagosaSUN.com
Wednesday, December 14, 2011

The Pagosa Springs Medical Center (PSMC) has grown.

The clinic now has 12 providers. There is now a 24/7 Emergency Room as part of the Critical Access Hospital. The hospital has two surgeons, who performed a total of 63 surgeries in November alone.

However, in the past year, the physical space of the PSMC has stayed the same. The providers work in what is fondly referred to as “the dorm,” a single room with six desks. The break room serves as administrative offices for six employees, lunchroom, meeting room and is still the only break room.

Here, in this crowded space, enters the Master Facilities Plan.

After last month’s presentation by Bob Owens of Boulder Associates of preliminary plans and figures for clinic and hospital expansion, the strategic planning committee gave the Upper San Juan Health Service District (USJHSD) their recommendation. Board member Jim Knoll, speaking on behalf of the strategic planning committee, recommended what he referred to as “Plan 1 Phase A Light,” essentially an expansion of the present clinic.

“The clinic needs to expand to better accommodate the present staff and future applicants,” Knoll said.

CEO Brad Cochennet confirmed that the plan, capital and clinic needs had been reviewed and said there is a $6 million target estimate for the recommended clinic expansion. Cochennet mentioned that as well as expanding primary care, ideally the plan would also involve acquisition of Pagosa Springs Family Medical Center’s building, which is currently owned by board member Jim Pruitt.

According to Cochennet, the expansion would be financed by the district mill levy, grant funding and donations. Cochennet would like to wait until the PSMC completes a community needs assessment in May 2012 before asking for an extension of the mill levy. The community needs assessment is scheduled to be complete Jan. 10.

“We’re not going to the public to ask one penny more,” said Knoll, adding that the USJHSD may ask for what money the public already gives through extension of the mill levy.

Also, to help with the funding, a development director is slated to start work Jan. 6, and would be delegated the duty of raising certain funds.

The board unanimously approved moving forward with the Plan 1 Phase A Light clinic expansion plan.

PSMC is growing in more ways than expanding services, physical space and increased patient numbers. The USJHSD board agreed to meet with Centura regarding possible affiliation, with a prior work session to discuss other possible affiliations and what PSMC would hope to accomplish in the agreement.

“We need to move forward and meet with Centura,” recommended Knoll, clarifying that the meeting would be with Centura and not Mercy Hospital.

According to Cochennet, Centura has shown interest in affiliation and has been waiting several months for a meeting. Other interested institutions interested in affiliations, Cochennet said, were Health One and Denver Health.

“I’m up for a meeting, but we need to meet with our own people first,” Pruitt said.

Dr. Dave Schaeffer suggested that the medical staff be present at the work session, “because they are the ones interacting with the other providers and institutions.”

The board agreed to meet with Centura, with a prior work session scheduled for a yet to be determined date in January. The work session, according to Board Chair Neal Townsend, will be for the purpose of creating a clear, uniform objective agreed to by board members, providers and PSMC senior staff.

lindsey@pagosasun.com

By Lindsey Bright,
PagosaSUN.com staff
Wednesday, September 28, 2011

While expansion and the addition of services and staff was the protocol at the Pagosa Springs Medical Center (PSMC) this year, the proposed budget for 2012 does not provide the same room for growth.

Chief Financial Officer Dennis Wilson based the draft budget on an anticipated 26-percent decrease in tax revenue due to an anticipated decrease in property tax revenues. This could translate to a loss of $600,000.

There are also potential federal cuts that could affect the reimbursement funding through Medicare and Medicaid that PSMC receives as a Rural Access Hospital and Rural Access Clinic.

CEO Brad Cochennet said at Tuesday night’s USJHSD board meeting that the focus for next year will be quality, efficiency and adding volume to programs already in place.

“We want to add volume to already existing programs,” Cochennet said.

Thus, Wilson in calculating the budget did not add any significant new items or programs.

The numbers from last month’s financials show that the PSMC is already well on its way to adding volume. August was a record breaking month for clinic visits, the number reaching 1,170.

The budget for next year, though, is based on a monthly visit average of 1,500 visits. Dr. Nick Kurz does not anticipate that number being a problem. The clinic, which at this time last year had only one doctor, now has a team of four full-time providers and, Kurz said he has noticed a rise in patient satisfaction and return visits.

The anticipated numbers of users in 2011’s new programs, such as CT scanner and surgery, have met, and in most cases exceeded, expectations. In the month of September, as of press time, 11 surgeries had been completed. The lone program that is lagging behind is the eye surgery program. PSMC contracts with the Four Corners Eye Clinic, and opthalmologists Dr. Eric Meyer and Dr. Joshua Zastrocky.

Cochennet spoke with Dr. Zastrocky and Dr. Meyer concerning the low numbers. According to Cochennet, the doctors kept the numbers purposefully low during the introductory phase of eye surgery service. However, Cochennet said they see no reason why they wouldn’t be able to amp up the numbers in the upcoming year.

Finance Committee chair Karl Irons approved of the budget. “I think it is a conservative budget,” Irons said. “But it is a wait-and-see year.”

Board members Jim Pruitt and Michelle Visel expressed concern with the budget having too little “wiggle room.”

“Looks really, really tight,” Pruitt said, pointing out that the amount listed for self-pay might be too low. That number, however, will most likely be affected if unemployment continues to rise.

The board approved the budget for public comment.

Cochennet brought the donated business plan for mammography and bone density before the board. The program’s demographic focus would be women who are currently not having mammographies.

“The women that don’t get mammography screenings, they’re not concerned about radiology, not worried they’re going to find something, they just don’t have the money,” Pruitt said.

The discussion moved on to what type of funding would be available, not only for the cost of the machine, but for patients.

Dr. Dave Schaeffer, new surgeon at PSMC, discussed his experience at his previous post. He worked at a clinic that had a program with a funding program to assist women seeking screening. However, the funding ceased.

“We got a lot of bad press for having to send women away,” said Schaeffer, advising that, if the USJHSD decided to move forward with a mammography program, it should search for a way to offer comprehensive funding that would last throughout the patient’s need for care, not just the screening phase.

The board did not make a final decision regarding a mammography business plan, but instead opted to wait until a copy of the Master Facilities Plan was given to the board — expected some time in November. The Master Facilities Plan will detail the cost and different possibilities of physically expanding the PSMC facilities.

“Primary care needs to be step one,” Visel said.

The current issue facing primary care is limited space in the clinic.

“It’s a very tiny work space,” Cochennet said. If there is no hope for change, the situation will become demoralizing.”

Kurz agreed. All new programs and doctors require space to accommodate and, as of now, there is no more space.

The MFP cost is likely to be in the ball park of millions of dollars.

The Mary Fisher Foundation will take the helm fund-raising for the MFP or mammography plan. But, as Visel, board representative to the foundation, said, the board must direct the Mary Fisher Foundation concerning the top fund-raising priority. Is it the MFP or mammography?

“We need more fund-raisers,” Visel commented.”It is a job and it is a lot of work.”

For next year, Cochennet has budgeted for a director of development position, the main job of which will be to raise funds. As of now, though, there are no candidates for that position. If filled, the director of development will be charged right off the bat with raising $200,000.

After the board members look at the MFP and compare it to budget numbers, a decision will be made as to priorities and what the next step will be. Right now, it seems the focus will be on accommodating the expansion that has occurred to this point in time.

Published in the Pagosa Sun
PagosaSUN.com staff

The dream began 30 years ago with the formation of the Upper San Juan Health Service District (USJHSD).

Just three years ago, the Pagosa Springs Critical Access Hospital was built, complete with an operating and procedure room. Until this month, though, neither of those rooms had been used for their intended purposes.

On Monday, Aug. 1, for the first time in its history, surgery was performed at the local hospital.

Dr. Dave Shaeffer, the new general surgeon at the Pagosa Springs Medical Center (PSMC), performed the first surgery at the facility — a hernia repair. He was assisted in the operating room by his wife, Dr. Amber Reiss-Holt.

Judy Cole, director of surgical services at PSMC, said that, “As prepared as we were, I was still a little nervous.” However, she continued, “The team was very prepared and works very well together. We were very pleased.”

Cole was not the only one who thought the surgery went well.

Dr. Shaeffer was extremely satisfied with how the surgery was performed and was satisfied with the subsequent five surgeries that he and the PSMC surgical team have performed. As of publication date, Shaeffer has completed three hernia repairs, a bowel resection and removed a gall bladder using a laparoscope.

“We are very excited to offer this service to the community,” PSMC CEO Brad Cochennet said. “We are excited to get some basic needs addressed here so people don’t have to drive so far away.”

There are more hernia repairs scheduled at the center this month, and the PSMC staff anticipates appendectomies to be scheduled in the future as patients’ needs are served.

lindsey@pagosasun.com

Pagosa Springs will soon be the only hospital in Southern Colorado to have an advanced 128-slice CT machine. Starting in late August, patients who need a CT scan for internal injuries, cardiac scans, brain profusions or other types of trauma will be able to be scanned right here in Archuleta County.

Currently, the Pagosa Springs Medical Center has a 4-slice CT machine that they purchased when opening in January 2008. At a recent board meeting, the Upper San Juan Health District approved the replacement of the hospital’s CT machine. When researching options and talking with vendors, staff realized they could acquire a state-of-the-art, 128-slice machine at a comparable price to a 64-slice machine.

Over the past three years, the development of faster and better CT equipment has made the 4-slice CT nearly obsolete. Many Archuleta County citizens have been directed to drive to Mercy in Durango for a higher quality scan on their 64-slice CT. Due to vendors being motivated to open up the 128-slice equipment market, General Electric Medical Systems has allowed Pagosa Springs Medical Center to purchase the latest technology at a competitive cost to a 64-slice machine.

“We are fortunate to be able to provide the latest technology to our community at a reasonable cost, help patients get the best diagnostic screens close to home, and allow an equipment vendor to showcase their latest technology,” expressed Brad Cochennet, CEO of Pagosa Springs Medical Center.

The GE GoldSeal Certified Lightspeed technology provides greater detail with much faster processing speed. Pagosa Springs Medical Center will now be able to perform coronary artery scans or brain profusions. In addition, the high-end machine gives patients a less expensive and less invasive option to evaluate cardiac issues.

“If a patient presents chest pains and EKG irregularities, most other hospitals need to perform a heart catheter procedure to determine diagnosis. However, the 128-slice CT allows doctors to scan the heart without a heart catheter. This saves the patient money, time and radiation exposure,” said Chris Savoy, Director of Ancillary Services at Pagosa Springs Medical Center.

In the 128-slice machine, patients are scanned in only 3 seconds. The films are then sent to Denver to be read by a radiologist within 5 minutes, and read within 15 minutes. With the hospital’s current CT machine, this process takes more than an hour.
The 128-slice machine will also help with early detection by offering a quality screening tool. The advanced CT machine is scheduled for delivery in early August and will perform their first scan in late August.

Brad concluded, “Our new CT machine is just another step in our mission to become a sustainable integrated health care resource system though service, leadership and community partnership. We take great pride in our part of health service district, and strive to help people with their health needs. “

By Brad Cochennet — CEO, Pagosa Springs Medical Center

Originally published in the PagosaSun on Friday, July 8, 2011

In February 2011, the Upper San Juan Health Services District board approved a multi-year strategic plan which established a frame work for our future.

Since then, strategic plan tactics are continually being indentified, evaluated and selected by management, and then presented to the board for approval. Our community’s dynamic health care environment not only requires an active management/governance process between the board and staff, but it also demands a vigilant eye to determine the best new ideas for our health district. The goal of being the finest health care provider for the community today, while establishing a sustainable foundation for tomorrow, continues to be the focus.

At a recent board meeting, the board approved the replacement of the hospital’s CT machine. When the hospital opened in January 2008, a used, GE 4-slice CT was purchased from Mercy Regional Medical Center. The original purchase was funded by a grant from the Caring for Colorado Foundation. Now, Pagosa Springs Medical Center can provide more comprehensive scans for patients with an advanced machine.

Over the past three years, the development of faster and better CT equipment has made the 4-slice CT nearly obsolete. Many Archuleta County citizens have been directed to drive to Mercy in Durango for a higher quality scan on their 64-slice CT. However, the board of the Upper San Juan Health Services District approved the acquisition of a 128-slice CT for Pagosa Springs Medical Center!

Better yet, three equipment vendors have made the latest technology available for us to acquire at the same cost as a 64-slice CT. The vendors are motivated to open up the 128-slice equipment market with their new tool, and have selected us (and only a few other smaller markets) to introduce these machines. We are fortunate to be able to provide the latest technology to our community at a reasonable cost, help patients get the best diagnostic screens close to home, and allow an equipment vendor to showcase their latest technology.

By keeping our equipment up to date and offering a quality screening tool, the strategic plan vision to become an integrated delivery system is being successfully met.

Pagosa Springs Medical Center will continue to provide services locally that are clinically sound and convenient for our population. Our new CT machine is just another step in our mission to become a sustainable integrated health care resource system though service, leadership and community partnership.

We take great pride in our part of health service district, and strive to help people with their health needs. Thank you for the opportunity to serve!