Administrator discusses ETMC issues with Crockett Lions Club
Houston County Courier
By Lynda Jones
ETMC Administrator Terry Cutler’s presentation to the Crockett Lions Club on Tuesday, June 26 might have been titled “FAQs” (Frequently Asked Questions). Cutler said he wanted to provide some general information about ETMC Crockett when he spoke to the Crockett Lions Club. He began by saying people drive by the hospital every day, but many don’t realize exactly what goes on at ETMC Crockett. Cutler went on to cite statistics showing the growth in usage of the Crockett medical facilities. He compared numbers from 1995 with those of Fiscal Year 2011. According to Cutler, the emergency room has shown “a huge dramatic growth” since 1995 when there were 8,000 ER visits in one year, compared to 14,600 visits in FY 2011. He added, “It’s a great focus for our country, too. It’s simply our dollars in Congress and the feds . . . healthcare is changing. The recent cuts for us is from Medicaid.” Cutler explained that due to recent legislated changes, non-emergency trips to the emergency room by Medicaid recipients will not be paid for by Medicaid. “That’s about $40,000 per month less for that facility because of Medicaid,” Cutler said. Cutler said he recently has heard comments about transfers from the Crockett emergency room to other facilities. He said that of the 14,600 patients who went to the ER in FY 2011, only 384 were transferred to other hospitals. “So, not everybody gets transferred,” Cutler said. The use of the intensive care unit also increased, but not as dramatically as emergency room usage. According to Cutler, there were 745 intensive care days in FY 2011 as compared to 507 in 1995. He also discussed surgical cases. There were 801 in 1995 and 1,271 in 20ll. “But those cases have dropped dramatically (since 2011),” Cutler said, “We have some competition in town with the Renaissance (Surgery Center). That’s why they’ve (number of surgical cases) dropped.” Houston County’s population has not grown dramatically from births at ETMC Crockett, according to Cutler who said 112 babies were born at ETMC Crockett in 1995 and 195 were born in FY 2011. In addition to the growth ETMC Crockett has seen in its emergency room usage, the rural health clinic (ETMC First Physicians Clinic that adjoins the hospital) has experienced dramatic growth. Cutler said the clinic staff saw 6,400 patients a year in 1995, and in FY 2011 they saw 21,600 patients. “That’s astronomical growth in the clinic,” he said. While patients are accustomed to doctors prescribing lab panels, the medical center measures its laboratory use by individual tests. Cutler said the ETMC Crockett laboratory completed 71,333 tests in FY 2011, up from 32,000 in 1995. “The advance in technology has pushed those numbers up,” he explained. Cutler said he didn’t have the number of employees at the facility for 1995, but there are about 170 employees now. As for charity care, the medical center provided $5.9 million (based on gross charges) for charity care in FY 2011. A lot of that comes out of the emergency room, Cutler said. Cutler also addressed the challenge of recruiting physicians to work in Crockett. He specifi cally discussed the efforts to fi nd an internal medicine physician or a family practice physician to replace Dr. Perry Ramsey who is leaving for a position with the Veterans Administration after 32 years of service at ETMC Crockett. As for replacing Ramsey, Cutler said, “It’s going to be diffi cult. Every physician recruit into Crockett, TX is very, very diffi cult. We don’t have a mall. And I say that kind of lightly . . . but it’s the amenities that the physicians and their families want where they want to practice.” Cutler continued, “We’re working as fast as we can there. It’s going to be a longer recruit than I like or expect.” Cutler’s appearance at the Crockett Lion’s Club fell just as the news broke about ETMC’s fi ling for a tax exemption for ETMC Crockett, and Cutler commented on that subject, also. “The tax exemption - that goes back to money. We talked earlier about Medicaid and cuts. we need some relief from the taxes,” he said. He also discussed the quality of emergency room services. “The emergency room is really where we get judged a lot of the time . . you go to the emergency room and if we don’t get to you as promptly . . . it’s because we get 15,000 visits a year. We’re trying to decompress that. We’ve got new personnel in there,” he said. According to Cutler, the facility’s scores that rate how nice the hospital staff is to patients and how they treat people while at the hospital have gone up. He explained that a rating system called HCAPS involves a set of questions for patients that ask about doctor communication, manners of the nurse, whether the hospital is noisy, etc. These scores are tied to money the hospital receives from the federal government, Cutler said. In reference to allegations from some Houston County Hospital District directors that ETMC is reducing services, Cutler said, “It’s defi ned reduction of services. Social services (for example) – that person no longer works there, but someone else picked up the load, a registered nurse case manager.” According to Cutler, the RN case manager performs the work the former social worker position performed. “Those are sound bites,” Cutler said, “What I mean by that is, we need an orthopedic surgeon, we need a cardiologist, we need a helicopter . . . reduction of services. “Those are things you can’t say ‘no’ to, but the reality of that is ETMC is well within its contract. The contract doesn’t say you have to have an orthopedic surgeon, you have to have a cardiologist, you have to have a helicopter. “We tried a cardiologist twice . . . they couldn’t make a living based on volume in this county. We tried an orthopod one time . . . but we couldn’t get enough patients through that door to make the salary that he wants. “These guys make a lot of money and they expect to make a lot of money and they need the volume and the resources to do that,” Cutler said. “I wanted to get in front of you today and just get out some information. There’s two sides of every story. You know, the sound bites are just sound bites. And I apologize for that . . . . “That’s what they wanted to do and that’s fi ne with us. We’re going to be here for the next three years and I know there’s some noise out there about RFPs (Requests for Proposals). The board (Houston County Hospital District) has said they want to go out for RFPs for another hospital system. We honor that. That’s fi ne. That’s their decision to do that, but for the next three years, ETMC is going to run and operate the hospital,” Cutler said. When he took questions from the audience, Cutler said the hospital did not make a $6 million profi t last year. He explained that the $6 million dollar fi gure included approximately $4 million in UPL (Upper Payment Limit) funds being used to complete the surgical suite at ETMC Crockett. Those funds were not ETMC money, Cutler explained. The Houston County Hospital District (HCHD) sent $1.5 million to the federal government, which provided matching funds, then routed all the funds through ETMC to the HCHD for the construction project. Cutler was asked what the Supreme Court decision on national healthcare would mean to rural hospitals, whether the court ruled the Affordable Healthcare Act (AHA) is or is not constitutional. (On Thursday, June 28, the Court ruled 5-4 the AHA is constitutional.) Cutler said that about three months ago he heard a speaker say, “There’s no money in Congress; there’s no money to fund these programs (legislated by the AHA); there will be cuts. We don’t know how much; we don’t know when.” Cutler commented that from one perspective, with the AHA, more people will be insured and that would help. On the other hand, no one knows where the money is going to come from for the new programs. “Healthcare today is not what healthcare will be tomorrow,” Cutler said. He also responded to a question about what happens to the property owned by ETMC in Crockett if the HCHD contracts with another hospital instead of renewing the ETMC Crockett lease. “It’s like throwing the baby out with the bath water,” Cutler said. “The big two story building on the right is the MOB (med offi ce building). It belongs to ETMC . . . the xray, the lab, emergency room . . . .” ETMC owns everything to the right, from six inches to the right of the center of the doorway to the grand entrance to the hospital, Cutler said, and the HCHD owns everything to the left. It would not be practical to close off the hall, Cutler said, as he added that part of the lease agreement says Houston County can purchase those assets that currently belong to ETMC. In reference to ongoing friction with the HCHD, Cutler said, “This is not good for healthcare in this community. . . . It’s hard enough to keep healthcare open and when you’re pulling in two different directions, it’s not going to be pretty for anybody. There’s no winners here. Nobody’s going to win,” Cutler said.