When a Taos hospital announced layoffs last September, its CEO felt like he was under fire. But town residents didn’t shoot at him, they formed a study committee. Santa Fe is following suit.
The job losses came as a surprise to some in the Northern New Mexico community served by the small Holy Cross Hospital, and Taos formed a joint county-township committee charged with examining the state of hospital finances and making recommendations based on public meetings.
Peter Hofstetter was initially skeptical of the effort that was pushed by the labor union that represents some Holy Cross employees. As the CEO of the Taos Health Systems, he tells SFR he’s the one who “takes the arrows” when making the painful decision to lay off employees. The idea to form an intergovernmental committee first carried a negative connotation. People seemed set on proving that “the board, the CEO—people weren’t doing their job,” he says.
But over time, Hofstetter says the committee has morphed into “a nice vehicle” for the hospital to explain to the community “the peculiarities and difficulty in financing health care these days.”
In Santa Fe, Christus St. Vincent Regional Medical Center—a sole community provider hospital like Holy Cross—announced in November that it was laying off 36 employees and reducing hours for others employees.
District 1199NM of the National Union of Hospital and Health Care Employees brought the Taos studycommittee idea to Santa Fe leaders.
There are big differences between the two scenarios: Christus is a regional provider that serves 300,000 in northern New Mexico while OPPORTUNITY.
Holy Cross has fewer than 30 beds. But the idea behind the committees is the same. Both create a venue for citizens and hospitals to talk about the delivery of healthcare.
Still, a conflict emerged at Santa Fe City Hall over two competing resolutions drafted by councilors Peter Ives and Patti Bushee. Bushee’s resolution focused on the hospital itself, calling for the establishment of a 22-member panel “for the purpose of gathering information and making recommendations related to the current general state of” Christus. Ives’ proposal sought a smaller 15-member panel to “examine the effects of the Affordable Care Act on the delivery of health care services to the Santa Fe Community, the cost of health care in Santa Fe and delivery of health care services to the indigent.” Mayor David Coss says a fiscal impact report estimated the committee—whose meetings would be open to the public—would cost taxpayers about $10,000.
The mayor says the benefit will be worth the cost. He’s stood on the picket lines with nurses as they battled Christus management over staffing levels. He has agreed to be a co-sponsor of Bushee’s resolution, but he says that the committee shouldn’t be a forum for the union and nurses to duke out disagreements that belong in collective bargaining negotiations.
Christus St. Vincent CEO Bruce Tassin says he doesn’t have concerns that collective bargaining issues between management and the union will come up in the group, and notes the hospital’s focus is on the future of health care in the community.
“I think that’s both a legal-regulatory issue with the city, but also for us, you know, we will be going into negotiations shortly,” he says. “And negotiations should be between the two entities...1199 and the hospital. And we need to respect that.”
Now city officials are poised to consider a compromise resolution allowing the city, Coss says, to scrutinize the hospital through the prism of how it and other providers are delivering care in the changing landscape of federal health care reform.
“I think if you talk about it in the context of how do we provide healthcare to people? How do we make the Affordable Care Act reforms work here in Santa Fe?” Coss tells SFR. “Rather than just set up a forum where Christus says [the hospital is] safe and the nurses say it’s not safe. Then I think we have a better chance.”
A final vote on the resolution is scheduled for the Council’s Feb. 26 meeting. As of press time, there’s still a dispute about physician member ship of the committee. The current proposal calls for a membership that includes city councilors, county commissioners, hospital board members, consumer representatives and employees from other medical providers.
There is another sticky jurisdictional matter:
The city has little regulation over the hospital, Coss notes. Rather, county, state and federal governments regulate and subsidize medical providers like Christus. Any recommendations that come out of the committee might have little sway.
In any case, Christus says it’s on board with engaging the community in a healthcare discussion—an endeavor its already undertaken with the county and city in conducting a community health needs assessment whose findings were partly based on 24 town hall meetings.
“What we would like to get out of it is very straightforward,” says David Delgado, president of the hospital board of directors. “One is to better educate the community as it relates to the changing landscape. Two: Have an open dialogue between all the providers in relation to how we all lean on each other to essentially address the ACA and the goals of the ACA—which are very positive.”
In Taos, the committee has held a half-dozen meetings, says Town Manager Oscar Rodriguez. Despite previous misgivings from the hospital, he says the gatherings have gone “surprisingly well.”
“I learned a lot and I have a totally different appreciation for what the hospital is facing,” Rodriguez says.
The Taos hospital CEO, Hofstetter, has two pieces of advice for Santa Fe as it forms the committee. The committee’s membership should be well balanced, he says, and “they have to be really crystal clear that this is not a blame-game or whatever. This is an honest, intellectual…opportunity.”