Hospital in Presidio County not feasible, new report says

PRESIDIO COUNTY – A forthcoming report out of the Big Bend Regional Hospital District concludes that it’s not feasible to operate a hospital in Presidio County. Even though there is broad community support and a definite need for more robust health care options, the problem lies in the financials: In order to receive funding from Medicare, the hospital would need to have an average of at least two inpatients at any given time –– a criterion it is unlikely to meet, according to the report.

“I would say this [report] confirms what we’ve always thought. It’s a challenging environment,” said J.D. Newsom, the executive director of the hospital district. “It’s not just about building a hospital, it’s about creating something sustainable too.”

The hospital district –– which is mandated to periodically consider bringing a hospital to Presidio County –– hired an outside firm, Capital Healthcare Planning, to conduct the three-month study. Newsom said that the board had informally discussed the possibility of having a hospital here, but had never commissioned an official study before. The firm drew on countywide demographics, EMS data and interviews with regional healthcare leaders to determine whether the county could support an “acute care hospital” or “micro hospital.”

At the beginning of the report, the firm stated that there are a lot of reasons to have a hospital in the area: there’s strong community support for more medical emergency facilities in the area; there’s limited competition; and with the Big Bend Regional Hospital District, there’s already existing infrastructure to support the potential facility.

That said, there are definite roadblocks. For one, it’s difficult to recruit physicians to this remote, isolated region. “A challenge with developing a hospital includes finding sufficient staff depth to provide call coverage (24/7) usually requiring a minimum of 2-3 providers in a specialty,” the report reads. Then the county’s tax base may not be able to support the development of a hospital. And the county’s population, which is already low, is declining.

“I think that’s pretty significant too when you’re thinking about this huge investment and from day one, the population is likely to decline. So you’re never going to grow,” Newsom said.

Given that the county’s two main population centers –– the city of Marfa and the city of Presidio –– are on opposite ends of the county and that Marfa is geographically much closer to the regional hospital in Alpine, the firm analyzed whether the City of Presidio could support a facility.

Right now, 72 percent of residents in and around Presidio travel either the 90 miles to Alpine or the 230 miles to Odessa when they need to go to a hospital, according to the report.  “If you get hurt in Presidio and have to go by ambulance, you’re looking at a two-hour drive to Alpine,” Newsom said.

For this hospital to stay financially solvent, it would have to rely on funding from the federal government through Medicare. Yet, it’s unlikely that the Center for Medicare and Medicaid services would approve appropriating money to the potential facility, as it most likely wouldn’t meet the agency’s statutory definition of a hospital. According to the report, in order to be considered a hospital, the potential facility must have an average of two inpatients per day. “If the facility does not have a minimum average daily census of two inpatients … the facility is most likely not primarily engaged in providing care to inpatients,” the report reads.

Through an analysis of population size and historical emergency room visits, the firm concluded that there would be on average only 1.5 patients being treated at the facility –– not enough to be considered a hospital in the eyes of the federal government. “It is unlikely that a hospital at these volume levels would be accepted by the Centers for Medicare & Medicaid Services as a Medicare-approved hospital,” the report says.

Even if the potential hospital were reimbursed through Medicare, Newsom worries it still might not be fiscally sustainable with so many Presidio residents relying on Medicare and Medicaid as healthcare providers. “The ideal payor mix would have a little bit more private insurance, because Medicare/Medicaid pays at such a lower rate than what you would be able to bill to a private insurer,” he said.

At the end of the report, the firm suggested that the hospital district and the county should instead look at bringing an urgent care center to the city of Presidio. “This report, at least for now, answers the question that a hospital is not feasible and hopefully it will turn the energy and conversation to what we know that the need is, which is urgent care,” Newsom said.

“After hours, when the clinic shuts down, the City of Presidio EMS basically serves as this after hours care and that’s not really their intention. They’re for emergencies. And they’re not necessarily trained or equipped to evaluate if a patient doesn’t need to go to a hospital,” Newsom said. “If there was an urgent care clinic or doctor there to triage that patient to assess that emergency, you’re going to be saving a lot of time and effort in transporting folks that don’t need to go to the emergency room in Alpine. And I think that’s the biggest need.”