Gloom Inside and Out for Healthcare Panel

FORT COLLINS — Outside the offices of Elevations Credit Union in downtown Fort Collins, Tuesday morning was gloomy and wet. Inside, it wasn’t much less dismal as health care executives at a BizWest CEO Roundtable bemoaned a landscape of rising costs, lowering reimbursements, governmental roadblocks, professional burnout  — and even workplace violence.

“There’s almost an expectation that if you go into healthcare you’re going to be hit or spit on or pushed or whatever that may look like, ”said Kevin Unger, president and CEO for UCHealth’s Northern Colorado region. “So trying to create the safest work environment we can so it’s still an attractive place to seek employment is going to be incredibly important.

“Anybody who enters our facility has to check in,” Unger said. “That’s all new. It used to be an open campus.” Adding metal detectors and other screening methods are part of that process, he added, “but that also increases costs.”

The Northern Colorado Long-Term Acute Hospital is largely immune to such a threat, noted its CEO, Christina Salas, because “we get to choose the patients who come to us. The other hospitals don’t get that choice.”

In those other facilities, the reasons are as varied as the types of patients that come through their doors, the executives said.

Alan Qualls, Unger’s Northern Colorado counterpart at Banner Health, attributed the incidents of violence to “a combination of behavioral health and substance abuse,” while Cyndi Dodds, CEO of SummitStone Health Partners, cited “intellectual and emotional delays,” and Marilyn Schock, president and CEO at UCHealth Greeley Hospital, mentioned aggression triggered by the effects of Alzheimer’s disease and dementia.

“Sometimes, that’s the reason they are brought in,” Schock said. “They can’t handle it at home.”

Dr. Jeff Donner, president of Elite Stem Cell Institute, offered a more chilling assessment.

“It’s the culture,” he said. “If you kill someone in cold blood, you can be a folk hero.”

Such a stressful workplace can contribute to the increasing levels of burnout, which extend all the way from top-line physicians to the housekeeping staff, roundtable panelists agreed. Scott Kenyon, executive administrator of the Women’s Clinic of Northern Colorado, called burnout a prime issue in health care, as did Crystal Goodman, executive director of the Northern Colorado Medical Society, and Wayne Fraleigh, CEO of the Orthopaedic and Spine Center of the Rockies.

And when the word gets out about how stressful a health care workforce can be, said Jeff Christinson, CEO of Summit Pathology, it can make it hard to fill positions.

“A lot of smart kids coming up through the educational system are looking at this and going, ‘I don’t want to go into a service-oriented industry, namely medicine, and have to deal with all this BS that’s coming at me every day — and then being spit at, being kicked, not understood,” he said.”

He singled out the orchestrated misinformation about medical care that erupted on social media during lockdowns for COVID-19 and was spoon fed to malleable potential patients.

“The pandemic threw everything sideways,” Christinson said, “and the residue that really hasn’t been talked about is that there’s a lack of trust in the medical community for health care. On top of that, you’ve got social media. That smartphone is changing the way people think. You can go to ‘YouTube University’ and in seconds become a ‘doctor.’ Now you’re calling into question the doctor’s care team, you’re self-diagnosing, you’re saying ‘Why am I not getting that treatment?’”

As health care professionals, he said, “we need to push back and say ‘We deserve to have your trust. We’ve gone and done this work to build it.’

“This ties into burnout,” Christinson said, “because what I’ve seen from physicians and frontline staff is that, when you don’t feel appreciated, it’s not so much your paycheck and your salary  — those things are important — but when you don’t feel appreciated for your dedication to the community and taking care of people, that’s a really tough place to bein as a human being, especially with the amount of time you’ve invested.

“I don’t want to sound like I’m a socialist,” he said, “but we’ve got to address this system of taking care of people so we can do both service and business simultaneously, or the whole thing’s going to collapse.”

It calls for “investment in your people and investment in what needs to happen,” Schock added.

The cost of living in Northern Colorado presents a continued challenge to recruitment and staffing, the panelists agreed.

“In the first half of my experience at the Women’s Clinic, we never got an offer turned down,” Kenyon said. “In the last three or four years, about 10% of the offers we make get turned down, and the reason is always cost of living. They’ll take a Texas job or an Alabama job. If they have families, any of those less expensive areas, they end up there.”

Even so, Kenyon added, “we still have a lot of people wanting to come here. We just interviewed 100 people for a job at the physician level. We can choose high-quality providers, but we have some turnover in the offers because of the cost of living. And these are physicians that are going to make$250,000 to $400,000 a year, depending on the type of practice.”

Staffing issues “have shifted a little,” Schock said. “It used to be focused on nursing and the clinical piece. It’s much more global than that now.”

SummitStone has had to recruit “travelers”, short-term contract nurses, to fill in some of the gaps, Dodds said. “It’s very, very expensive,” she added, “but it helps us fill those critical shifts where we’re not able to find people.”

Schock noted that “with a hospital open 24/7, “work-life balance comes into play. Night staffing is a big challenge, and some entry-level positions are very difficult. That goes for surgical technicians and even housekeeping.”

The area’s burgeoning growth has exacerbated the problem, she said. When a facility expands from 51 to 88 beds to meet the demand, Schock noted, “you have to find the folks who are going to staff your new places.”

Qualls said the state’s new family-leave act has led to “double the number of call-offs” among staff. “We were getting away from contract labor, but then we had to add back contract labor.”

At the Women’s Clinic, Kenyon said, “we’ve added staff at our provider level just to handle the days off that our providers want, so we’re paying more for providers but generating the same work.”

Such smaller, independent providers continue to struggle to compete with the ever-larger chains such as UCHealth and Banner.

“Independent practitioners are a dying breed. We can’t keep up, ”Donner said. “We don’t have the facility fees we can count on. It’s not a fair playing field out there right now; the hospital systems are dominating. They control the costs. That’s very frustrating when you’re an independent and you have overhead and you have employees that you have to pay insurance to keep them and compete with the other facilities.

“Then you have startup companies like I do with interest in stem cells and research that we do,” he added, and “it makes it very difficult to grow your business.”

Christinson said he felt Donner’s pain, and related it to recruiting.

“There’s a shortage of pathologists right now in the country, ”he said. “Not a lot of people want to go into pathology right now, and that has an impact on the market. But pathology remains essential to health care. You can’t really have a hospital without a laboratory, so having really strong oversight of that lab is critical.

“For years now, we’ve essentially run an apprenticeship program,” he said. “The work we do is really labor intensive and very specialized, so we have to train those people up. But it’s confusing to patients when they get a bill from both the health system and Summit Pathology.”

Perhaps the biggest headache, the panelists agreed, is dealing with insurance companies, especially the Medicare Advantage providers — with the added pressure of wondering what will become of Medicare and Medicaid under the new presidential administration.

It’s enough to deal with “overregulation by our state Legislature,” Qualls said, “but now at the federal level, they’ve got us concerned about what they’re going to do with Medicaid, and that’s a huge source of all of our funding.”

Around 90% of Pathways Hospice’s reimbursement comes from Medicare,” said its president, Evan Hyatt. “They want to actually get out of the insurance business and not take any risk anymore,” he added, “so that by a time in the future, at least by 2030, they’re going to put all the risk on commercial payers like Medicare Advantage and other insurance sources.

“There will still be a Medicare program, but who will be running it will be different as well as where the funds will come from. They’re running out of money, as everybody knows, so how do they mitigate their risks? And that’s going to be with these Medicare Advantage programs which have much more challenging rules around how to get paid.”

Challenging indeed, Kenyon said, especially when it comes to getting prior authorizations for treatment.

“There are a lot of costs in our practice chasing the money that seems unreasonable because we already signed a contract that defines how our relationship would be, all the way down to the codes that we charge and what those codes are supposed to reimburse us,” Kenyon said.

“Prior authorization makes me laugh because you’re asking a doctor to call a doctor at an insurance company and say, ‘Hey, we really want to do this for this person because it’s the right thing for the person.’ And most of the time, they say yes. But we still have to hire someone to manage the prior-authorization process. I have three people who spend a quarter of their time each doing prior authorizations.”

“With Advantage plans,” Salas said, “it’s a huge challenge getting those authorizations in a timely fashion.”

Donner lamented the frustration of “spending so much of your time filling out a form that’s not benefiting a patient.”

Fraleigh said he has seen a 20% decrease in reimbursement from Medicare in the last five years, but his costs keep rising.

“We rely on having commercial payors,” Schock said. “The system is not going to support having just governmental payers.”

Still, she added, “we need to make sure that we’re doing our part on what the cost is. Around 70% of the hospitals in Colorado have an unsustainable margin. And when you think of that number, it comes back to what’s reimbursed to start with.”

In Northern Colorado, Unger noted, UCHealth spends $3.8 million a day “just on salaries, and reimbursement is not keeping up with that.”

On top of all those issues facing health care providers is the uncertainty of the Trump administration’s ever-changing tariff policies.

“Tariffs are already affecting our supplies,” Kenyon said. “Pretty much everything we buy comes from outside the United States.

“IUDs already are $1,000 each, and who knows what level of tariff will hit that. We can’t react to price changes that quickly because most of our revenue comes to us from contractual obligations from a payer,” he said. “There’s no real solution to that.”

Insurance providers are dealing with those uncertainties as well, said Kendra Johnson, a broker with Flood and Peterson, given that many pharmaceuticals come from outside the United States.

“Pharmacy is a big deal,” she said. “The cost of medications is the biggest complaint we have, and we have to understand how can we source these things differently. We try to find all the patient-assistance programs available. We’ll go to manufacturers directly who internationally source. But we have to figure out how to get prices down and quality up, because people need care.”

“We don’t know what to expect,” Unger said, “and we don’t want to cry wolf.”

Schock summed up the group’s general mood:

“There’s so many unknowns,” she said, “so how do you make a move when that’s happening?” 

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Attending Tuesday’s BizWest CEO Roundtable on challenges facing the healthcare industry are, from left: Evan Hyatt, Pathways Hospice; Alan Qualls, Banner Health Northern Colorado; Crystal Goodman, Northern Colorado Medical Society; Wayne Fraleigh, Orthopaedic & Spine Center of the Rockies, Marilyn Schock, UCHealth Greeley Hospital; Dr. Jeff Donner; Elite Stem Cell Institute; Scott Kenyon, Women’s Clinic of Northern Colorado; Jeff Christinson, Summit Pathology; Christina Salas, Northern Colorado Long-Term Acute Hospital; Kelly Kozeliski, Plante Moran; Cyndi Dodds, SummitStone Health Partners; Christopher Otto, Plante Moran; Kendra Johnson, Flood and Peterson Insurance; and Paul Watkins, Elevations Credit Union. Attending but not pictured is Kevin Unger, UCHealth Northern Colorado. Christopher Wood/BizWest

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