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Bobcats show Homecoming spirit
9/28/2007 By: Carole McWilliams
Although the football team lost Friday’s game to Del Norte 47-0, Bobcat spirit could not be diminished for Homecoming week activities.
Luke Adair leads a miniature pony Friday in the Future Farmers of America float, left.
Homecoming queen Natacia Becker was crowned Friday night during the game, and king was Timmy Velasquez. Other royalty members are first attendants A.J. Vigil and Kenny Guffey and second attendants Brittainy Self and Blake Knoll. Freshman prince and princess are Pedro Vigil and Mariah Pena, sophomore prince and princess are Jessica Candelaria and Trevor Dean, and junior royalty are Emmylou Covey and Abel Velasquez.
La Plata County needs more doctors
A health care consultant has confirmed what locals have said for several years - La Plata County doesn’t have enough primary care doctors and other providers to meet current, let alone future, needs.
Reesa Webb from RSI Research presented study results and draft recommendations Monday at forums in Ignacio, Bayfield, and Durango. The meetings were to get community response to the recommendations.
Those include continuing and expanding the stop-gap clinic created in the spring to replace some of the services previously provided by Valley Wide Health Services. It is in the same place as Valley Wide’s defunct Durango Primary Care clinic, next to where Mercy Medical Center used to be.
The clinic is subsidized this year by funds from the county and the City of Durango, Southwest Mental Health, and space and support services from Mercy Medical Center. Webb said 86 percent of patients at the stop-gap clinic are on Medicare or Medicaid. Most if not all local private practices are not taking new Medicare or Medicaid patients because of low reimbursement rates, which doctors say don’t oover their ccsts.
“We felt the stop-gap clinic would be the best place for new providers because it’s a collaborative effort,” Webb said. “Growing that clinic would meet the primary care needs.”
RSI recommends the clinic should not provide free service, but should charge a sliding fee scale. They recommend seeking assorted outside funding to help support the clinic - including taxes from a health services district. They also recommend providing care in outlying areas once the clinic is fully staffed.
Other recommendations are:
• Get four qualifying clinics certified as federal Rural Health Clinics, meaning they get higher reimbursements for Medicare and Medicaid patients. The four clinics already have enough of those patients to qualify - Ignacio Family Medicine (Dixie Melton), the stop-gap clinic, Durango Family Medicine, and Southwest Pediatric Partners. Designation of the county earlier this year as a federal Health Professional Shortage Area opened the way for the Rural Health Clinic desiignations.
• Recruit new primary care doctors, physician assistants or nurse practitioners with things like help paying medical school debt or help with housing. Add them to the expanded stop-gap clinic. Encourage those already here to stay, with things like help negotiating insurance contracts and help with billing and administrative services.
RSI suggests a Nov. 2008 election on forming and funding a health services district. County voters rejected a proposed district in May 2006. Based on earlier forums this year, RSI determined the previous attempt failed because voters didn’t understand how the money would be used, they thought a lot of the money would go to the disliked Valley Wide, or they just didn’t want to pay more taxes. The marketing campaaign for the ballot issue didn’t provide enough specifics, and it didn’t include a sunset clause.
RSI concluded that if those issues were addressed, the district would be more likely to pass.
At the time of the first attempt, the district would have relied on property taxes. State Rep. Ellen Roberts sponsored a bill this year that allows the districts to get funding from sales taxes too.
“We feel that the recommendations we came up with will provide you with long term sustainable care,” Webb said at the Ignacio forum.
She started off with demographic information. The county populattion in 2006 was just over 49,000. It is projected to reach 54,837 in 2010, and 68,615 in 2020. Growth of older residents is higher than the over-all growth rate, and they use health care services more than the general population.
Thirty percent of county residents live on less than 200 percent of the federal poverty level, compared with 24.2 percent statewide. Nineteen percent of county residents don’t have health insurance, compared to 16 percent statewide.
Aside from the uninsured, the local issue has been the difficulty of people on Medicare or Medicaid to get a doctor who will see them if they are a new patient. Practices can only afford to carry a limited number of those patients, and most of them are maxxed out locally.
Audience member Wendy Rice said school-based clinics should be part of the primary care solution.
Eileen Wasserbach said anti-tax sentiment was an issue with Ignacio area residents in the first health district effort.
Webb said she thinks voters will respond better to a mix of property and sales taxes. “I am firmly convinced that this is needed,” she said. “The community now appears to be well aware that there’s a crisis situation, that it affects each and every one of us.”
The end of the Valley Wide clinic also should make a health district easier to support, she said.
Southern Ute activist Sage Remington complained that the Primary Health Care Community Coalititon doesn’t include any tribal meembers; and none of the tribal employees they or RSI have worked with are actual tribal members.
He said the coalition should send a letter to the Tribal Council soliciting tribal member input. “This is a very important issue,” Remington said. “There’s a chasm that exists, especially in mental health services. There’s a lot of violence in this community, and there’s a reason for it. A long time ago we had ceremonies and traditions to address these issues.” Now there is a cultural vacuum, he said.
Susan Franzheim said the current effort needs to include people involved in other previous and sometimes competing efforts to address the lack of primary care, not just the previous health care district effort. She also objected to what she considers a Durango-centric resort community focus in the RSI study. Most of the county is not a resort community, she said.
“Much, much more work needs to be done on this,” she said.
At the presentation later Monday in Bayfield, retired doctor Brooks Taylor asked if the coalition is addressing the block of people who voted against the tax district last time.
Coalition member Bern Heath of Southwest Colorado Mental Health said they were not only communicating with the deal breakers but that many of them are now participating on the Citizen's Health Advisory Council to help work for a solution. "This effort requires all of us working together," he said. "We will certainly hang separately."
Lydine Hannual asked why the coalition is using only data gathered from La Plata County, because residents from Pagosa Springs, Aztec and other outlying towns use La Plata County physicians.
Webb said they used the bare minimum to show the need. Coalition member Richard Risk said they wanted to avid criticism that they were padding the numbers by using a larger study area, and that the tax district would be subsidizing non-residents. Those were issues last time around.
Another audience member said her personal doctor now works in Farmington. "How about recruiting those physicians that left when Valley Wide closed?" she asked.
Webb answered that there was no economic base to employ them. Valley Wide was losing money, couldn't collect it from federal or local sources (because of Durango’s “resort” designation), so reduced its staff trying to save the operation. The departing physicians didn’t start their own private practices here because the largest customer demand is from money losing patients.
"There was no promise for this subsidy," Webb said. "The physician may like the area but can't make a living here. They need this base to be employed."
Kathy Kronwall of Forest Lakes said her nurse practitioner in Farmington told her it takes two meetings a week to learn how to fill out Medicare forms.
Webb said sharing common services like billing is one of the coalitions' recommendations.
There is help right now for persons who need care. San Juan Basin Health Senior Outreach Nurse Tracy Davis reported SJBH and La Plata County Senior Services have received a $250,000 grant that provides three years of services to people age 60 and older.
An outreach nurse visits the person and evaluates the needs, then assists with connecting that person with the appropriate care facility. Phone 749-4007 for these services.
Coalition members encouraged people needing a physician right now to phone the stop gap clinic at 764-1790.. According to Risk, there is one physician, two nurse practitioners and a mental health counselor on staff.
RSI is supposed to review comments from Monday’s forums and come up with final recommendations in October.
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