Becker's ASC Review

9 THOUGHT LEADERSHIP 'We're going to fight like hell': Colorado West CEO on adapting as an independent hospital By Paige Haeffele T o some healthcare leaders, the idea of physical therapists staffing a hospital kitchen may seem like a step backward. However, this is just one change Chris omas, CEO of Colorado West Healthcare System in Grand Junction, made that paid off during his more than 10-year tenure as CEO of one of the state's last independent hospital systems. Mr. omas joined Becker's to discuss the ins and outs of running an independent health system, how he grappled with the challenges of the pandemic and how running an independent group of ASCs and hospitals compares to that of a chain. Question: What do ASCs need most right now? Chris omas: Right now, one of our biggest struggles is contracts and payers, and the difficulties of getting paid and getting contracts. We've had lots of discussions with the payers because we own both the hospital and the surgery center. It's like if we can't get reasonable contracts in the surgery center, we'll just do those cases in the hospital. And that's not good for us. at's not good for anybody — not our patients or the system. It's such a drastic difference in reimbursement and trying to get reasonable contracts on the front end was just getting nowhere. en on the back end, when we do send a bill, the denials and the difficulties in trying to get paid for the services that we provide has become almost unbearable. Q: Why do you think there's so much resistance? CT: We are absolutely willing to move and we're starting to do some of our total joint replacements in our surgery center. We are actively pushing as many cases to the surgery center as possible, to make sure we have all our time for inpatient surgeries and other things at the hospital. If we can't make the procedure go to the surgery center, then we'll ultimately just do them in the hospital. e biggest challenge we're facing is staffing, just like everybody else. Right now, the cost of staffing and the pressure to find staff is also a challenge, but we're doing pretty well. Western Colorado is a pretty popular place, so we've got quite a few people moving to the area. So we've been pretty successful at recruiting from outside of our community, but it's still a challenge and then having to augment our staffing with travelers. And so while we love them, and though they're making sure we can keep going forward, they are just really expensive. We're a community of about 150,000 to 160,000 people. We've probably seen 300,000 people in our primary and secondary service area, but there are four hospitals and two surgery centers. So there's a lot of competition locally for staff. at's putting pressure on wages. So we're trying to not "steal" staff from the other facilities but to recruit new people in the community because it doesn't help to take a nurse from the other hospital. It doesn't help our community and it doesn't help the overall health of our system to pass employees back and forth. We're working really hard to try to bring in new staff from outside of the area. Q: What recruiting tactics have you used? CT: One thing that we've done that's been really successful is using an organization called A&M Staffing that has a very reasonable fee as far as recruiting, but they recruit for us on a national level. [In 2022], we had about 1,300 employees between the hospital, our clinics and the surgery center, and we recruited 105 people from outside of the community using A&M last year. So it's been successful for us. I think we hired 400 people last year, 125 percent of those came through that partnership and from outside of our community. We're doing pretty well with our staff, we have our voluntary turnover rates about 20 percent, and from what I understand, the industry average is about 37 percent. So on one hand, we've been doing pretty good, but 20 percent turnovers is tough. Pre-pandemic we were at about a 9 to 10 percent voluntary turnover rate, and now we've doubled that. To keep up with that, I've gone to orientations to welcome new employees and things like that. Q: How did the pandemic affect your staffing strategies? CT: We were pretty committed [to our staff ]. We didn't lay people off, we didn't get caught up in the mandates for vaccines and such because I always felt it was just kind of counterintuitive for healthcare organizations to be laying off staff during a pandemic. We had financial challenges with that, but I think that we did not have as big of an issue because we didn't do it during the height of the pandemic. We were probably one of the only hospitals in the region if not the tri-state area of New Mexico, Utah and Colorado, we were able to staff all our beds throughout the pandemic and now we really haven't had any staffing issues, other than constantly trying to recruit. We made a real conscious effort not to lose our employees during the pandemic and I think that's paid off. Q: How did you manage not to lay off any of your employees? CT: It was hard on our finances for sure. I knew it was the right thing to do long term, but we're an independent hospital, so we're not part of a system. We have challenges that we're kind of on our own to fix as we make these decisions, but I think, with our volumes up 18 percent in 2023, people appreciated that we were here when they needed us. Q: In order to retain staff, what did you do to cut costs elsewhere? CT: Little things like travel and extra splurges were always nice to do when things were doing all right. We basically had to just stop all of those. And we actually were pretty creative. A lot of our nurses didn't have patients because they shut down our surgery center and some of our other locations. So, we took a lot of our nurses over to our medical records department, and they went through old charts and were able to help us purge a lot of the old charts, and because of that we saved about $200,000 no longer having to store those extra charts. We paid the nurses to do it but year aer year, we've really reduced our storage fees. We had our physical therapists working in the kitchen of the hospital and everybody just kind of moved around to do what we could and we made it. We're pretty lucky. In Western Colorado, the pandemic never hit very hard compared to some of the metropolitan areas, so we were really only shut down for about three months. We were able to kind of bring it back and ramp up pretty quickly aer that. So we were pretty fortunate on that front. I think having a paycheck throughout the pandemic while others were struggling or getting laid off or getting their wages cut increased the loyalty with our physicians and our staff. We took care of them. Q: Did the pandemic force you to make any other major changes? CT: We had three major construction projects queued up prior to the pandemic. Obviously,

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