Bed Sharing, Health Care Priorities

In her March 4th Op/Ed, Commissioner Maggie Hart-Stebbins makes the classic mistake of mixing apples and oranges. Commissioner Stebbins would have you focus on UNMH as a level one trauma center, while conveniently forgetting the fact that UNMH’s proposed $146 million 96 bed solution to ER overcrowding doesn’t provide a single direct bed for level one trauma care.
The theory behind UNMH’s plan is that building a new 96 bed facility will free up beds in their UNMexisting facility by moving elective care patients to the new one. Elective care patients are precisely the patients the Lovelace bed sharing agreement proposes to serve. These patients would not be “traded like baseball cards” but would simply be scheduled for care at Lovelace rather than UNMH. If it’s true the UNMH plan to build $146 million elective care hospital would reduce wait times in UNMH’s level one ER, so too would an elective care bed sharing agreement with another institution.
At the February 26th County Commission meeting I lead a discussion regarding the future role of Bernalillo County in health care. At the meeting were representatives from Presbyterian, Lovelace, UNMH, and Casa de Salud. There were a couple of issues upon which all of the parties seemed to agree. First, no one knows exactly how the Affordable Care Act (Obamacare) will affect health care delivery and second, ACA (Obamacare) is a delivery system based on preventive care through clinics not acute care hospitals.
UNMH is focusing all of their efforts on building a new hospital while dragging their feet on building a new and needed North Valley clinic. Given the changes in health care delivery, the existing need for clinics, and the uncertainty regarding the role of hospitals in the era of ACA, wouldn’t it make more sense to focus on clinics and enter in to common sense bed sharing agreements with other providers? Those agreements would provide immediate relief, allow time to evaluate the effects of ACA, and save $146 million taxpayer dollars.
In addition to bed availability, there’s also the broader issue of how ninety million of Bernalillo County taxpayer dollars are being used, how they are being accounted for, and the ability for the elected officials who are responsible for those dollars to make sure that they are used efficiently and effectively.
Currently, there’s no mechanism in place for the County Commission to set objectives for the use of county tax dollars. Yes, UNMH provides a quarterly report to the Commission, but has failed to present the UNMH Budget to the Commission prior to each budget year as contractually required. Further, even if UNMH were in full compliance with their reporting obligations, the Commission is specifically excluded from directing how the $90 million under its authority is being used and what the priorities for those funds are.
UNMH plays a vital role in Central New Mexico’s health care delivery but they are not the only provider and they’re not perfect. As Commissioners we are tasked with looking at more than what’s good for UNMH, but also what’s good for the entire health care system in Bernalillo County – which also includes two major hospitals, large medical groups, and community clinics. The fact that the top priority of UNMH is to begin the first phase of a $1.5 billion mega-hospital at a time when the country is shifting from a hospital model to a clinic based health care delivery system, calls into question their overall priorities. The fact that UNMH is insistent on excluding elected Commissioners from the decision making process calls into question their fitness to set those priorities.
These issues serve to underscore the need to create a committee consisting of all of the major providers, community clinics, and taxpayers to provide the Commission with the guidance and expertise necessary to navigate these changing times. As a member of the County Commission I am committed to finding the best answers to these questions and to providing the best possible care to Bernalillo County residents from both public and private institutions.

This post was published by the Albuquerque Journal under the title “UNMH Priorities Are All Mixed Up.” (Read it here)