To some healthcare leaders, the idea of physical therapists staffing a hospital kitchen may seem like a step backward. However, this is just one change Chris Thomas, CEO of Colorado West Healthcare System in Grand Junction, made that paid off during his more than 10-year tenure as CEO of one of the state's last independent hospital systems.
Mr. Thomas joined Becker's to discuss the ins and outs of running an independent health system, how he grappled with the challenges of the pandemic and how running an independent group of ASCs and hospitals compares to that of a chain.
Question: What do ASCs need most right now?
Chris Thomas: Right now, one of our biggest struggles is contracts and payers, and the difficulties of getting paid and getting contracts. We've had lots of discussions with the payers because we own both the hospital and the surgery center. It's like if we can't get reasonable contracts in the surgery center, we'll just do those cases in the hospital. And that's not good for us. That's not good for anybody — not our patients or the system. It's such a drastic difference in reimbursement and trying to get reasonable contracts on the front end was just getting nowhere. Then on the back end, when we do send a bill, the denials and the difficulties in trying to get paid for the services that we provide has become almost unbearable.
Q: Why do you think there's so much resistance?
CT: We are absolutely willing to move and we're starting to do some of our total joint replacements in our surgery center. We are actively pushing as many cases to the surgery center as possible, to make sure we have all our time for inpatient surgeries and other things at the hospital. If we can't make the procedure go to the surgery center, then we'll ultimately just do them in the hospital.
The biggest challenge we're facing is staffing, just like everybody else. Right now, the cost of staffing and the pressure to find staff is also a challenge, but we're doing pretty well. Western Colorado is a pretty popular place, so we've got quite a few people moving to the area. So we've been pretty successful at recruiting from outside of our community, but it's still a challenge and then having to augment our staffing with travelers. And so while we love them, and though they're making sure we can keep going forward, they are just really expensive.
We're a community of about 150,000 to 160,000 people. We've probably seen 300,000 people in our primary and secondary service area, but there are four hospitals and two surgery centers. So there's a lot of competition locally for staff. That's putting pressure on wages. So we're trying to not "steal" staff from the other facilities but to recruit new people in the community because it doesn't help to take a nurse from the other hospital. It doesn't help our community and it doesn't help the overall health of our system to pass employees back and forth. We're working really hard to try to bring in new staff from outside of the area.
Q: What recruiting tactics have you used?
CT: One thing that we've done that's been really successful is using an organization called A&M Staffing that has a very reasonable fee as far as recruiting, but they recruit for us on a national level. Last year, we had about 1,300 employees between the hospital, our clinics and the surgery center, and we recruited 105 people from outside of the community using A&M last year. So it's been successful for us. I think we hired 400 people last year, 125 percent of those came through that partnership and from outside of our community. We're doing pretty well with our staff, we have our voluntary turnover rates about 20 percent, and from what I understand, the industry average is about 37 percent. So on one hand, we've been doing pretty good, but 20 percent turnovers is tough. Pre-pandemic we were at about a 9 to 10 percent voluntary turnover rate, and now we've doubled that. To keep up with that, I've gone to orientations to welcome new employees and things like that.
Q: How did the pandemic affect your staffing strategies?
CT: We were pretty committed [to our staff]. We didn't lay people off, we didn't get caught up in the mandates for vaccines and such because I always felt it was just kind of counterintuitive for healthcare organizations to be laying off staff during a pandemic. We had financial challenges with that, but I think that we did not have as big of an issue because we didn't do it during the height of the pandemic. We were probably one of the only hospitals in the region if not the tri-state area of New Mexico, Utah and Colorado, we were able to staff all our beds throughout the pandemic and now we really haven't had any staffing issues, other than constantly trying to recruit. We made a real conscious effort not to lose our employees during the pandemic and I think that's paid off.
Q: How did you manage not to lay off any of your employees?
CT: It was hard on our finances for sure. I knew it was the right thing to do long term, but we're an independent hospital, so we're not part of a system. We have challenges that we're kind of on our own to fix as we make these decisions, but I think, with our volumes up 18 percent this year, people appreciated that we were here when they needed us.
Q: In order to retain staff, what did you do to cut costs elsewhere?
CT: Little things like travel and extra splurges were always nice to do when things were doing all right. We basically had to just stop all of those. And we actually were pretty creative. A lot of our nurses didn't have patients because they shut down our surgery center and some of our other locations. So, we took a lot of our nurses over to our medical records department, and they went through old charts and were able to help us purge a lot of the old charts, and because of that we saved about $200,000 no longer having to store those extra charts. We paid the nurses to do it but year after year, we've really reduced our storage fees. We had our physical therapists working in the kitchen of the hospital and everybody just kind of moved around to do what we could and we made it. We're pretty lucky. In Western Colorado, the pandemic never hit very hard compared to some of the metropolitan areas, so we were really only shut down for about three months. We were able to kind of bring it back and ramp up pretty quickly after that. So we were pretty fortunate on that front. I think having a paycheck throughout the pandemic while others were struggling or getting laid off or getting their wages cut increased the loyalty with our physicians and our staff. We took care of them.
Q: Did the pandemic force you to make any other major changes?
CT: We had three major construction projects queued up prior to the pandemic. Obviously, we had to step back, look at our waiting room, look at our open space to make sure that we weren't having everybody kind of on top of each other. We looked at how we have a lot more people working from home in our coding and billing departments and our support services than we ever have. That made an impact on some of our designs and we were fortunate enough that we were in a place in the construction process that we were able to make those changes and get pretty aggressive about our air handling designs and our waiting rooms and common areas.
Q: Did you see an uptick in patients after you reopened your surgery centers?
CT: The pandemic didn't mean cancer was cured or sore knees got any better. So we saw a pretty big uptick right after that because of that pent-up demand. Unfortunately, when it comes to some of those cancer patients, boy, they were sicker by the time they got to us though. They put off screenings, they put off other treatments.
Q: Have you seen any changes in patient volume among other providers?
The surgeries and office visits are getting as normal as you can expect. People are coming back from using telemedicine, too. We jumped on telemedicine right away and now that people can come back and see their physician, we have not seen the telemedicine side of the pandemic stick. I don't know if that's just Western Colorado, but we are back to basically where we were as far as telemedicine versus in-office visits.
We've got a very high senior population. You know, so a lot of them didn't really want to come and see their doctor and not do it over a screen or an iPad. So we have seen that go back to normal and I don't know if that's the same everywhere else in the country, but telemedicine is not kind of stuck as we thought it might have.
Q: How do you think being one of three independent hospital systems in Colorado has helped your management success?
CT: I'm the second-most tenured CEO now in the state of Colorado; I'm in my 15th year of tenure. I think we're just a lot more nimble. As a small organization, I report to a 12-member board of directors. It's made up of seven bankers and lawyers from town and the other five members of medical staff, so we're really agile. When the pandemic happened, we were able to pivot quickly and move into telemedicine or move where we needed to go.
Ten years ago, we were approached by five local oncologists who said they wanted to join Community Hospital, and we had a cancer center 100 days later. I think that's just the result of being nimble and having a low hierarchy of command, that when something presents itself we can get it done.
But feel pretty positive on that front that there's a place for the independent hospital in the future of healthcare.
Q: Do you think you would ever go back to leading a larger health system?
CT: From a professional standpoint, my job is so much more rewarding running an independent hospital than just being a branch manager at a system hospital.
I have a lot more autonomy to do things. That's why I'm still here, it's just so rewarding to be able to have an idea, see it to fruition and not have to ask permission. I can make decisions in the best interest of the community, not the system.
That's what I tell when we recruit new physicians. We are very proud to be an independent hospital, but who knows where healthcare is gonna go? I can't promise you we will be independent forever, but we're going to fight like hell to stay independent as long as we can.