Southwest Health Systems reports higher patient use, stable Medicaid funding and plans nurse care coordination

Joe Thine, a representative of Southwest Health Systems, told the Montezuma County Board of County Commissioners at a workshop that the hospital is seeing higher use and improved cash collections so far this year.

"The short answer is, pretty well at the moment," Thine said, summarizing operational performance. He told commissioners patient activity in most clinical areas exceeded forecasts at the end of last year and that the first two months of 2024 show growth beyond the plan.

Thine said the system expects to collect about $85,000,000 in total revenue this year. He said Medicaid directly accounts for about 17% of those collections; when a state provider-fee program and its federal match are included, the hospital expects to receive about $20,500,000 — "almost 24% of our revenues this year." He added that the Joint Budget Committee and federal budget negotiations remain a watch point for future funding.

The hospital reported several operational and financial details: - Patient-days-adjusted: the hospital planned for 4% growth for the year; the first two months show a 12% increase compared with the same period last year. - Employee retention: nursing retention finished the prior year at about 90% and overall staff retention is just under 80% over the last 12 months. - Operating cost: the hospital estimates daily operating cost at about $211,000 (roughly $78,000,000 annually). - Capital plan: the hospital plans about $1.25 million in capital equipment purchases this year and still lists roughly $3 million–$4 million in outstanding capital needs. - Cash position: the hospital reported about 80 days cash on hand; management said bondholders generally expect at least 60 days.

Thine described quality and access initiatives the board recently approved, including merging the hospital and clinic electronic health records (timed for later this year or next), targeted HVAC work paid from a building infrastructure fund, and efforts to increase access to primary care and emergency care locally.

On emergency and inpatient care, Thine said the hospital is reviewing transfer patterns. After initiating chart reviews of patients transferred from the emergency department several months ago — without making operational changes at that time — the hospital is now keeping more patients in-house and transferring fewer to other hospitals. He said the work will continue and could identify additional training or equipment needs.

The hospital plans to contract with Community Care Alliance (a subsidiary of the Western Healthcare Alliance) to provide nurse care coordination for Medicare beneficiaries (Medicare Part A/B). Thine described the program as virtual nurses embedded with local primary care clinics to support chronic care management and to coordinate discharge-to-primary-care transitions.

Thine also described expanded services in Mancos: prenatal care was added there, the clinic is now open Monday–Friday, and ultrasound equipment donated by the hospital foundation is in place.

On Medicare Advantage, Thine said the system has estimated it collected about $2,000,000 less over two years from Medicare Advantage plans than it would have under Medicare Part A and B for equivalent services. He said hospital leadership has reviewed local Medicare Advantage plans and "right now, we don't think it's in the community's best interest or the hospital's best interest to end any of those agreements," but that the system will press plans to reduce delays in care and to pay more fairly.

Asked about federal budget pressures, Thine noted Congress passed a continuing resolution that maintains funding through September and said he was concerned about proposals in the House that could reduce health program funding. He thanked elected officials who have advocated for rural health funding.

The board asked questions during and after the presentation; Thine offered to provide additional information if commissioners had follow-ups.

Thine concluded by reiterating there are no planned changes to Medicare Advantage contracts for 2026 on the hospital's side at this time and that hospital leaders will continue to monitor Medicaid and federal budget developments.