Options, Opposition

Presbyterian Medical Center in Las Soleras expects to break ground later this summer, though an exact date has not been set yet. Helen Brooks, Santa Fe administrator for Presbyterian, tells SFR the not-for-profit hospital plans to serve patients there as early as 2018. The 285,000-square-foot facility will occupy a 40-acre plot of land in the developing Southside triangle between Cerrillos Road and Interstate 25.

Presbyterian opened a clinic on St. Michael's Drive last year, where a variety of primary and specialty care services are offered. The new facility will focus on outpatient services, including general surgery, orthopedics and podiatry, with a service list that includes imaging (MRIs and CT scans), behavioral health and a 24/7 emergency department with 20 exam rooms.

Approximately 30 inpatient beds will be reserved for short stays, Brooks says. Take, for example, someone who needs hospitalization for pneumonia, or an overnight surgery patient. For most longer-term, acute care procedures, such as brain surgery, Christus St. Vincent will remain Santa Fe's primary destination.

"The goals are to keep care in the community, provide choice, expand access, and also effectively use Presbyterian's experience to lower the cost of care," says Brooks.

Presbyterian's entrance into the hospital market has garnered support from community leaders, including Mayor Javier Gonzales, who say Santa Feans will benefit from more competition and health care choices. But some in the medical services community worry that the new hospital won't cover the region's most pressing health care needs.

One service that won't be initially available at the Las Soleras facility: substance abuse prevention and treatment. Santa Fe County's drug overdose death rate more than doubles that of the nation, while neighboring Rio Arriba has the highest rate. The subject arose during a county Health Policy and Planning Commission meeting in April. Presbyterian presented their hospital proposal and answered questions from health professionals and advocates on the other side of the table.

"They made a lot of effort to say they would look at the community needs, and I felt that was a pretty glaring example of a dire community need that they decided they wouldn't respond to," says Wendy Johnson, medical director of La Familia, who attended the meeting.

Not now doesn't mean not ever, Brooks suggests. Presbyterian Kaseman Hospital in Albuquerque provides a number of programs for people battling drug and alcohol addiction.

"We recognize that substance abuse prevention and treatment are important in this community," she says. "We're looking at what resources might exist, and we're looking to see how we might partner with those resources or supplement them."

In an aging county with stagnant population growth, the prospect of increasing saturation of the health care market isn't making everyone happy.

Christus St. Vincent Chief Administrative Officer Lillian Montoya chastised Presbyterian in an April column that appeared in the Albuquerque Journal, suggesting that its competitor's "entrance into this market signals its attempt to serve only the most profitable patients, which consists of their health plan members."

In other words, Presbyterian would be plucking away some of Christus' more lucratively insured patients, leaving the older hospital responsible for most of the city's poorer patients.

But Christus St. Vincent, which came under the control of a Catholic health conglomerate in 2008, is not exactly an underdog. The county is dotted with clinics and urgent care centers bearing its name, and in 2011, Christus acquired Physicians Medical Center, a smaller hospital originally aimed at providing an alternative for surgeries. Last month, Christus started work on a $40 million expansion of its medical center on Hospital Drive. The system also provides funds for some local nonprofits that provide behavioral health and substance abuse services.

Montoya suggests some of those amenities could be in danger. She posits that Presbyterian could one day direct its plan members to use in-house services, forcing Christus St. Vincent to make "difficult decisions about the types and complexity of services we provide and subsidize."

Brooks demurred when asked whether Presbyterian could one day insist its health plan members solely rely on its own system for health care needs. "We intend to complement existing services in the community," she writes in response to SFR's inquiry.

Presbyterian's health plan covers about 37,000 Santa Fe-area residents, including 15 percent of insurance payers and 23 percent of commercial payers at Christus St. Vincent's facilities. Presbyterian announced its new medical center in March, which it says is driven by demand for more choice from Presbyterian health plan members.

Along with its own coverage, Presbyterian contracts with most other insurance providers serving New Mexico.

The new medical center will not, however, accept plans offered by Humana or Molina Healthcare, the latter of which mostly serves Medicaid patients. Christus St. Vincent accepts both, suggesting some patients could still end up at the older hospital.

Presbyterian, for its part, estimates that in 2014, it provided more than $16 million in free medical care and more than $89 million in uncompensated care in New Mexico. Under federal law, hospitals with the resources to do so must treat anyone with a medical emergency.

As New Mexico's second-largest private employer, Presbyterian employs more than 10,000 people throughout the state. The organization estimates it will create 295 jobs at the Santa Fe medical facility, along with 214 temporary construction jobs.

Meanwhile, Entrada Contenta Clinic, an urgent and primary care center run by Christus St. Vincent, opened last year, just across the street from the future Presbyterian site. According to Christus spokesman Arturo Delgado, the clinic has been "very busy."

Santa Fe Reporter