[Editor's Note: The Grant County Commission work session meeting on Oct. 10, 2023, lasted just shy of 3 hours, so readers can expect several articles. The third one begins with updates.]
By Mary Alice Murphy
The continuation of the Grant County Commission work session on Oct. 10, 2023 began with an HMS (Hidalgo Medical Services) update from Chief Executive Officer Dr. Dan Otero.
He said he would report on the Senior Services that HMS provides contractually for the county-owned Senior Service facilities and on Tu Casa, as well as on HMS itself.
To begin he said all 1200 federally qualified health centers are required to provide an annual very comprehensive report called the Uniform Data System. "We have to provide specificities, such as demographics, ages, illnesses, and many others. What I want to focus on is at a high level. We all know that the pandemic had a pretty significant impact on health, as well as a significant impact to health systems. I'll go back to the triple aim goal, which is to increase care to those we serve, reduce the cost of care per capita and, of course, improve quality."The first graph was on the impact to quality over the past 5 years, back to 2018. "We are 8th out of 16 federal qualified health centers in New Mexico, but what I want to point out is that we had an 8 percent decrease, while others had up to a 30 percent decrease in unique patients. This next graph shows the cost of care per patient over the five years, and we were fifth lowest of the 16, with a 19 percent increase. This is total cost of care per patient. Some had up to an 80 percent increase per patient. In the quality of care composite, we were seventh, so we had a strong showing. And the last graph shows how HMS did in 2022 coming out of the pandemic, rebuilding workforce and systems. HMS was fifth out of 16. The purpose of these graphs is to show how proud I am of our staff at HMS. I hope the community is proud of HMS and the work we are doing to serve the community."
HMS has 18 medical division providers, including two M.D.s, six physician associates, nine nurse practitioners. one chiropractor and one dietitian.
His update included statistics of patients served by HMS in September 2023
For medical services, Grant County had 2027 unduplicated patients with 2434 total visits. Hidalgo County for the same month had 562 unduplicated patients with721 visits.
For an update on the family medicine residency program, Otero said the program is fully accredited by the Accreditation Council of Graduate Medical Education, as a sponsoring institution. The director is John Andazola, MD; the designated institutional officer is Oliver Hayes D.O.; site director is Don Stephens, M.D.; and HMS is interviewing for an FMRP program coordinator and recruiting for core faculty. The program is currently funded by New Mexico Graduate Medical Education Expansion Grant.
For behavioral heath services, HMS has one M.D. psychiatrist, five psychiatric nurse practitioners, two psychologists, one psychologist intern, three licensed clinical social workers, four licensed clinical counselors, two licensed substance abuse associates and two licensed alcohol and drug addiction counselors.
A graph showed that the number of behavioral health patients served in Grant County totaled 1871 visits for 871 unduplicated patients; in Hidalgo County they had 141 total visits for 88 unduplicated patients.
"For dental services we have four dentists on staff, two doctors of dental surgery and two of dental medicine, with three of them being full-time and the fourth half-time and one hygienist." Otero said. "There is a shortage of hygienists across the nation, and we are heavily recruiting. We are thinking of going to dental expansion where they can provide some of the services of hygienists."
Dental visits in Grant County totaled 639 visits for 569 unduplicated patients, and in Hidalgo County 113 visits with 101 unduplicated patients.
Family Support services, which include enrollment in Medicaid and in social determinants of health, had 174 visits in Grant County with 149 unduplicated; in Hidalgo County, they had 29 total visits with 18 unduplicated.
Otero invited the HMS Director of Senior Services Steve Chavira to report on Senior Services.
Chavira noted that in Grant County September HMS served 335 seniors, with 3578 congregate meals, 3874 home-delivered meals and 192 using transportation services. In Hidalgo County, HMS served 71 seniors with 299 congregate meals, 38 home-delivered meals and no transportation. "We are in line with what everybody else is doing in the state. Our main goal is making sure we are serving seniors and getting our reports done.
"Our Compassion for Seniors program ended at the end of the fiscal year," Chavira said. "It was funded by junior money intended to support our older adult population who are living on a limited income and whose lives would be improved through basic need services," Otero said. "For fiscal year 2023, we had$50,000 legislative funding available and we used $37,775,21 serving 109 seniors. The range of services we provided included all sorts of things. We helped with rent, we helped with ramps, improvements on their homes. We helped with reimbursements on medical expenses and with transportation to appointments. There is a greater need than there was funding, but we were able to get a lot done. We made a stab at helping a lot of people.
"What I wanted to do is jump into the ICIP (infrastructure capital improvement plan), we provided to the county," Chavira continued. "Essentially, we are working through current awarded funding on renovations to the Gila and Mimbres centers. We also received a grant to purchase a hotshot vehicle to transport meals at the Gila Senior Center. We received $67,000, but the first estimate we got was $80,000, so we are exploring options. We are also looking at future work that needs to be done. We are hoping to seek funding to get them approved."
District 1 Commissioner and Chair Chris Ponce asked if HMS was doing anything to try to get more seniors involved in their senior centers. "Some seniors don't have access to broadband and aren't computer savvy. Are you doing anything to help them have access to telehealth for instance? Interacting socially is great for their wellbeing, so what are you doing to attract them into the centers?"
Chavira replied: "We're always trying to get people in and bring them to activities. We have an active group of senior center employees, who have a passion for seniors and making sure they have what they need. We have activities, such as bringing in providers to give them information. We want to provide pool tables and bingo for the centers. The challenge is getting them willingly to come into the centers. They always like to see the commissioners come out, so they can talk to you. We just installed a donated 65-inch TV. And yes, they have requested telehealth services."
Ponce said it goes along with the transportation. "Do you give rides to people to get to appointments?"
Chavira said the centers do provide transportation for a senior from the home to the center. "We're trying to get more staffing to get them to the pharmacy or to appointments."
Ponce asked if the commissioners could help by going to the Legislative session and asking for transportation and staffing funding for the centers. "I hope we can coordinate."
District 3 Commissioner Alicia Edwards said she was curious to know more about the program Compassion for Seniors, "some of it was one-time expenditures such as ramps. Some were likely ongoing needs such as rental assistance. I'm curious to know if you evaluated all the things you did with that $37,000 and if they were on one-time costs or on on-going needs."
Otero said that it was exactly something they are evaluating right now. "We spent the $37,000 which had to be spent by the end of the fiscal year, and we had to send a small portion back. We also accept donations and we still are accepting some applications. We expected great demand, so at first the limit was $500 and then we expanded it to $2500. We would be more than happy to bring back the program."
Edwards said she would like to see the data. "I believe that a lot of challenges of seniors are on-going rather than one-time needs. I'm not criticizing the one-time fixes, because obviously they need to be done. I think we need a comprehensive knowledge of how people are spending their money on on-going needs."
Otero said they thought of it some years back as a potential "adopt-a senior," but the financial aspects got complicated, so "we simplified it with this program."
The following report came from Dr. Teresa Arizaga on Tu Casa. "I would like to add a bit on seniors. and mental health. As you were asking your questions, it made me think about how covid made us realize to a greater degree about how social isolation has an impact on seniors' physical and mental health."
"We have access to devices, such as iPads, for those in more rural areas to have access to telehealth," she continued. "Then there's the issue of them not knowing how to use them and how to connect. A lot of people have qualified for care coordination programs, so that someone can go to their homes in remote rural areas and will help them with how to connect and to a telehealth event. We've had one of the care coordination programs since before I was at Tu Casa. Unfortunately that program just ended. You hit on something that's very important and that's transportation. It's different. We can help if the person is on Medicaid, but not if they are on the regular Medicare. Social isolation has a great effect on mental health. We are trying to figure out if home visits would help to those in remote areas, especially if they don't have internet. We have been doing telephonic visits, but payers are paying much less for them, and even eliminating paying for them."
On Tu Casa, she said in September 2023, they booked 915 appointments, with about 50 percent of them completed. "We had 196 unique patients, which is pretty steady over the past few months. For MAT (medication-assisted treatment), we had 44 booked, with 26 completed. The numbers have decreased, although we expect an increase, as we no longer need a waiver to prescribe suboxone. We recently had an interview with a family nurse practitioner whose primary interest is behavioral health and wants to be here back home in Silver City, specifically for MAT patients."
"Also related to our 14-day treatment program, we've been meeting with Dr. Lindstrom, trying to learn more about our community, our law enforcement, our detention center, our emergency department at the hospital and how they all play a part in our 14-day stabilization treatment at Tu Casa," Arizaga continued. "He spoke to the community a few weeks ago about crisis intervention that we will be providing in the future."
Ponce thanked her for everything she does. "It's an uphill battle and it will take all of us to get a handle on it. Whatever we can do as a county, please reach out to us to help. You are doing a fantastic job for us."
Edwards went back to seniors and devices and social isolation. "Are you collecting data on how many devices we provided to people who don't have access to something beside telehealth and how many people are struggling to access those services because they don't have enough broadband? This all is part of the projects that the county is thinking about. Any data you have would help us. And then the other thing is the significant community assessment. Will Dr. Lindstrom have access to that information? It's been a really long time since we had a community assessment done, which gives us a bigger picture of what's happening in the community."
Arizaga said it is definitely important to connect. "I think the information will be ready in November."
Ponce said he thought that Dr. Stacey Cox would have more information in her report.
Otero said he appreciated the time provided them. "We are also working on an assessment. Thank you for the partnership. We do see ourselves as one of the larger employers in the area. We have 217 active employees. We also have openings up into the 250-260 range. We are bringing on more contract providers and we have nine right now. We provide $1.5 million in employment salaries and fringe benefits monthly on average. Anything we can do, please reach out to us."
Dr. Stacey Cox of the Grant County Community Health Council and Centers for Health Innovations will present the next report in the next article.
For the previous articles, please visit: https://www.grantcountybeat.com/news/news-articles/80944-grant-county-commission-holds-work-session-101023-part-1 ; and https://www.grantcountybeat.com/news/news-articles/81097-grant-county-commission-holds-work-session-101023-part-2 .