HMS answers questions 061225

By Mary Alice Murphy

At the request of and hosting by Merritt Hamilton Allen, founder and owner of strategic communications firm Vox Optima, the Beat received an invitation to speak with Hidalgo Medical Services Chief Executive Officer Dan Otero DBA (doctor of business administration) and HMS Board Chair Carmen Acosta, a retired Hidalgo County clerk and later probate judge, who said she loved serving the public and making a difference in the communities. Also joining the group was new board member Lorenzo Saenz, a nurse and former Army medic, who teaches kinesiology at Western New Mexico University. He noted he is a graduate of Cobre and said he's happy to be back and able to serve the community he lived in.

Allen thanked the Beat for taking time to hear from the leadership of HMS because "what I found really interesting about this board is they made a decision to focus all of their outreach and public relations on patient care and patient outreach. And that's one reason you haven't heard much, and suddenly we're here with a lot of negative scrutiny, and they decided it's time to start having a conversation."

The HMS Board of Directors consists of 11 members, and according to the bylaws at least 51 percent .of the board must be made up of patients. Acosta said that has been a big plus because "we experience what the patients are experiencing and we are the advocates for the voice that isn't in the conference room. Five board members have been with us for five years, and I've been here the longest at 20 years. People think that's a long time, but I met some from Las Cruces who have been board members for 33 years and 25 years."

"I feel that each and every board member is there because they're there to serve the community," Acosta said. "HMS has made a big impact in our communities and serves the communities. We review patient surveys, employee surveys, check ins, safety reports, so we can keep well informed, because our main goal is to be sure that we're providing quality health care and that the needs of our community are being managed."

She noted that the board members are unpaid volunteers and are nominated by community members and board members.

Otero pointed out the most recent patient satisfaction survey HMS had completed. "On the second page, we have our patient satisfaction monthly trends, which showed over the last year, we continue to improve patient experience scores. The Net Promoter Score is a measure on the question that says, how likely are you to refer a friend or family member to HMS for services. In health care across the country, if you score 35 you're doing really well in health care. That's just the comparative. As you can see, we've continually improved that over the years and are hovering now around 70%, which, as you can see in the the definition at the bottom of that graph, is in the excellent range, and that means most people will refer their friends or family. On the next page is our patient satisfaction score and the net promoter score for the year per division. Our primary services are primary care, dental and behavioral health. So you can see that those net promoter scores are 71,78 and 56 respectively, with the associated patient satisfaction scores. The next pages are the questions that our patients are asked, and how they rate us on those questions, and that's everything from arrival, how easy was it to get an appointment at HMS, their most recent visit, their experience with their provider. So we can see these are individual questions that can really give you a drill down."

To a question on how they decide what questions to ask, Otero replied: "So we are with AAAHC (Accreditation Association for Ambulatory Health Care), which is an accreditation company that we choose to use to be a patient-centered medical home. And when you become a patient-centered medical home, you're required to survey your patients, and you're required to ask specific questions to ensure that you're creating a medical home. A medical home by definition, means that when you come here, we're going to make sure you get holistic care, either within HMS or with the appropriate referrals. So those questions are pretty standard. They're not required, but one of the required questions is related to your ability to navigate that last part.So what some of the required questions include is your ability to integrate, get integrative care, and that your healthcare system helps you navigate the healthcare system. So it's not hard to get an appointment and figure out how to get health care correct, whether that's a referral internally to a behavioral health provider, or if that's a referral to cardiology services. And that's why we have the partnership with the hospital and other providers in Las Cruces and in Tucson.Then the third to last and second to last pages have graphs that show that same data and how we've been trending up in recent years. And then on the back, we offer all our patients the ability if they want to talk to us, either to bring a concern forward, or if they want to share a positive comment with us, the survey gives them that option to say they want a call back."

He showed a summary of April data. "We had 14 requests for calls, and we succeeded in contacting the patient for 9 of them and we left messages for five. And you can see that there were six compliments that they wanted to call us back and say, 'You guys are doing great work,' for example. Two calls were concerns about turnover, and then two with the word kiosk, for example, but it just gives an overview. We watch that every month. This data goes to one of our five board committees. We have a QI (quality improvement) committee that has four board members on it, and we go into great detail looking at this data, discussing ways to improve upon our performance, whether it's quality performance, patient satisfaction, corporate compliance, or just general regulatory compliance. I'm talking a lot about our regulatory agencies. We are regulated. Everything we do is is regulated by the Center for Medicare and Medicaid Services at the federal level. Federally qualified health centers are also regulated by HRSA, which is the health resource service administration and division of the U.S. HHS, Health and Human Services."

He said HRSA comes in every three years and they spend three days going through policies, making sure that privileging and credentialing procedures are in order. "There's 21 chapters in our regulatory book for HRSA alone, and I'm talking detailed stuff. You touched a minute ago on the board. The board has to be not only 51% patient users of the system, they have to demographically represent the communities we serve. I think we have four females, different ages and professions. We have nurses, government experts. We have an attorney, state police officers, three nurses, and now we have a border patrol agent on our board, financial analyst and two bankers. We have a nominating committee.We do a gap analysis. We have three nurses, one is a behavioral health nurse, two are medical. If what we really need is an attorney, we go out there to find an attorney. It's hard to find people, because people work. It takes time to be on the board. I like to add that patient surveys are anonymous, unless they choose to give a call in number. Not everybody fills out a survey."

Allen said: "This really struck me, you know, in the numbers, because I went to the town hall and no one knows who sponsored the event, and the facilitator wasn't allowed to say. There were a few dozen people who were unhappy, yeah, but HMS sees hundreds of people in a single month. Health care is different, totally different from when I was a child. I've been associated with health care since the '90s, and it has become more regulated. We are at the single most challenging time in the history of health care. Yeah, and I think HMS is committed. I don't just think, but I know HMS is committed to navigating those difficulties to get positive outcomes for our community and for our patients. Whoever thought back them that we would be talking to a counselor over the telephone?"

To the question asking if any of those present were kin to each other, Otero replied: "Don't quote me on this, but I think it's chapter 19 in government standards of HRSA, you can't have any relations. with board members. You cannot be in any kind of familial relationship with employees or other board members. Additionally, our board members have to sign an agreement. They have to train annually and attest to any conflict of interest
and relationship. That's the stuff HRSA looks at when they come in—'show us your annual board training, show us your annual board conflict of interest attestation.' And that just alludes to the annual training. At every single meeting for the overall board, and then the subcommittees as well there are always educational pieces on the operational aspects of HMS."

Saenz said his final care work experience was at a Naval Hospital, and they had just moved to a capitated budget, where they got so much money per patient population, and that was interesting. But at the time, though, it was mostly just the Navy to the Navy, here's money, and so it wasn't terribly sophisticated. You get money from different sources, and each one of them has their own different audit requirement.

To the question on different sources of funding for HMS, Otero said he started at HMS in 2016, "and we were a $19.2 million organization. Now we're $35 million organizations due to the amount of expanded services that we have grown from 19 to 35, and we've not only impacted access to services, over the last nearly a decade, we've been a major contributor to the economics of healthcare in the community. When I got on board, we were just under 200 employees, and we were up to 260 pre-pandemic. We're down to about 220 now. But our funding comes from, really three sources. It's called the HRSA 330 grantee, which is a grant for the federally qualified health center status, which we have to renew and apply for every three years. Very competitive, because there's only limited funding out there. So that's the main source. And then for grant funds, a little over $3 million that is a small percentage of our overall budget, but that funding means that we will never turn anybody away for their ability to pay. The purpose of that funding is to support the operations of people that are uninsured or underinsured. So we don't turn anybody away for their inability to pay. We are allowed to charge what's called a nominal fee. So if somebody doesn't have insurance, HRSA wants us to have the patient be invested in their health care. And so for a medical visit, if they don't have insurance, it's a $20 nominal fee. If they don't have the $20, we take care of them. We also have other grants. So for example, we were awarded two federal grants this last year, and they are two-year grants for $1 million each, and they're both specific to enhance behavioral health services for half a million each in each year. We also received $1.4 million from state funding. So we're always getting grants to bring in money to the community to enhance the services delivered. So that's just this last year, and those grants are underway and being implemented. The rest is what we call patient revenue. We contract with all payers, including commercial and we have contracts with our Medicare, Medicaid, MCOs for the Medicaid population. Of course, we have contracts with the federal government for the Medicare population. We have contracts for Medicare Advantage. So we have 26 different payers that we have contracts with. One of the payers is called multi-plan, and they take some of the smaller payers and they bundle them. So it's really more than 26 so those are our three funding sources, federal funds for a 330 grant, other federal funds for grants awarded to us, state funding and then patient revenue. Now we have a big percentage of our population that's uninsured too. Federal funds have not kept up with the inflation. We're really way behind what we should be getting for what we're providing."

They handed to this interviewer the most recent 990 (required reporting for non-profit organizations) and the audit summary for the most recent fiscal year, but the most significant thing is the audit, with federal funding, with state funding, with local funding, the audit report shows zero deficiencies and zero findings."

To a question about out of what pot of money, Allen was being paid, she replied it was patient revenue, "so that's why I'm on a clock that's winding down."

Otero noted that it's heavily regulated how you can use federal funds. Most of the federal funds go directly to provider and support staff salaries.

This interviewer said the topic of funding kind of leads into a discussion about the senior centers.

Allen said it's a complex funding formula, and "we were talking through it yesterday, and I finally had the aha moment that, like no one, like no one is getting enough funding."

Otero gave some history on Senior Services. "First and foremost, we just want to point out that in 2007, Hidalgo County came to HMS way before I was here to request support and assistance to run the senior services in Lordsburg. And that was 2007, and I've talked about HRSA, right? In the HRSA requirements, they require us to provide primary care, dental, behavioral health and other services that the community may not have. It's an important point, because every three years, we do a community needs assessment. If that community needs assessment says there's a lack in substance abuse services and nobody's providing them in the community, HRSA wants us to demonstrate that we're trying to get those services started. There may not be funds for it. So, it is part of why we grew here in Grant County and also with behavioral health, because there's such a need over the years. So that's a preference, and I'm saying that because senior service is not under the umbrella of ambulatory healthcare. It's a separate business line that we have chosen to do over the years in support of our seniors. So having said that, in 2017, Grant County Manager Webb came to us and asked us, if, because you have such experience in Hidalgo County, would you be willing to do that in Grant County? And we had lengthy discussions at the board meetings. We acknowledged that this is not necessarily under the present umbrella for the services of FQHC but because of our commitment of the community health center. We like to call ourselves community health centers more than FQHCs, because we're community-focused. It's like the Jump into Summer that we did this last weekend. We do community events and sponsorships all over the community because we want to give back. We give to sports teams so that those kids can succeed. HMS has contributed to different groups of schools. I don't know if you know this. We have a student internship for Animas, high school students coming in to be healthcare providers. They just went and met the board and told us what their goals are in healthcare, and they watched us have a meeting."

Otero said: "They asked to continue through the summer. One of the students we gave a $500 scholarship to nursing school. So we're very community focused. Now back to the senior centers, how they're funded. So senior centers is a federal program, with Title Three federal funding as the primary funding source. Then the state legislature will put in money. The third funding source that's required under contract with the Non-Metro Area Agency on Aging is we have to go out and raise the additional funding that's needed. They call that contribution requests. So we're talking about the Senior Center funding. Federal and state are the main source. But it's never enough. Of course, as a matter of fact, the AAA won't even let us submit a budget that is an actual budget. They want us to say here's how much money we're giving you to build that budget first. If you have a gap between what AAA is going to give you and state and federal funds, your job is to also now go out and get contributions from local municipalities, fundraising, whatever you can do. And we have to send those letters to the counties, the cities, and they have to decide through their budgeting process, as you know, from listening to the meetings, this is how much we can or cannot contribute. So after those contributions come in from the five different areas, Silver City, Hidalgo, Grant County, Santa Clara, and Mimbres, there's a gap in the last three years. So HMS has been putting in that extra contributor to that to make the the program whole, if that makes sense."

Otero confirmed that it was patient revenue that was used to fill the financial gap. "Any good business is not going to run a business that's going to lose money, it just can't. And then you look at where things have gone with food costs, so it was a big driver. So was salary cost going up just at HMS now. Please know that I don't have that actual data in front of me, but health care costs since the pandemic, for each amount has gone up between 35% and 38%. Everybody knows the cost of fuel is going up. When you're taking home delivered meals to a senior with food costs going up, plus demand for meals has gone up because thee are more seniors in need, it adds up. And we know New Mexico is one of these few states in the US that's going to have the largest percentage of seniors. And then we were also required to get rid of our waiting list. One time, we had a waiting list between 30 to 35 seniors that were just waiting for us to have the capacity to meet the demand, and we were told that we had to stop doing waiting lists. So we did. We went out and enrolled every senior that was out there waiting. We also enhanced our enrollment process. We streamlined that so that our seniors, if sometimes we'll get a call they don't want to enroll, but they need one meal because they don't have anything, and we step in and take care of them. So it's been our satisfaction rate for seniors, and I put that in a report I had to do that day when I presented the county 4.6 to 4.7 out of five in satisfaction with quality service. We also asked our employees in the senior centers, and they rated extremely high. I don't remember the exact number on serving seniors and job satisfaction."

"We have requested contributions from our local governmental agencies," Otero said he knew the county was rather shocked at his request to cover the $200,000 shortfall. "We do understand the difficulties that government is facing because healthcare is facing those same issues in revenue and it has to be spread out amongst the entire population, so we understand those deficiencies. We've worked hard with our board of directors, with lots of discussion about the support of the seniors, and never once did we ever say we would abandon our seniors. We met with the county commissioners, we met with Santa Clara, we met with the mayor and the town manager of Silver City, and I showed them the budgets, the actual cost versus revenue, so that they could have data in front of them. We met with our legislators. We showed the data to them. We talked to New Mexico AAA, New Mexico Non-Metro AAA, so we've had all these conversations, and because we're unable to get commitments, we're really left with no choice. So that's why we let the Non-Metro AAA, know that we are giving 60-day notice, to give them time to find the agencies that are going to take over the senior services, and we will cooperate and collaborate the same way that we did when we took them on to make sure that our employees, who are amazing individuals serving seniors, and make sure that they're taken care of for all three services, which include congregate meals in the senior center, a critical component of social aspects of care, home-delivered meals for homebound qualifying homebound seniors, and, of course, transportation. The letter I sent the county talks about when we started our request for funding, May 14, 2020. We met with them in June 2020, before the council and the full board. Met with the council and some commissioners, yes, and in my notes, I did speak about the shortfalls and working together so we could get the seniors what they well deserved. And you know, like any organization, we work there, and we work together. And also salaries is half retention and recruiting, because you can't hire someone, and then if the wage is not a living wage, and we have to treat also our employees so they can at least be able to afford food themselves. They work very hard. I participated in an audit that the AAA did. I was surprised how complex and how much is required for those employees to log, maintain, and what they are accountable for. And so, you know, we know what they go through, and we know what's required in any operation. They are all complex in their own way. And AAA also has requirements that need to be met. And we did meet these requirements, and we worked hard to keep it going. It's just hard to to keep going with something we can't sustain.You know, there's compliance and then there's quality and palatability."

Otero explained that the AAA will identify which contractor who's going to be the new providers. "So just hypothetically, let's say that Grant County decides to run the three centers or four centers, and then they will contract directly with the county. And this is a hypothetical example. It could be anybody They will contract with them, and then we will begin meeting and transitioning services within 60 days. August 9 is the plan date to where the employees and the seniors can say we officially now are getting our service. We contract with Grant County for two senior centers , Gila and Mimbres. We contract directly with the town of Silver City for the Senior Center, and we contract directly with the village of Santa Clara for the Santa Clara one. It could be a private vendor. Some entity is going to contract with NM AAA. I want to state we have contracted with the county and municipalities for the facility only. We want to make sure that this transition is smooth."

On a question about providers, Saenz, as a provider said. "As I said earlier, healthcare in general, it's become its most complex it's ever been. When we look at it within the state of New Mexico, we're looking at over 800 providers having left the state, and, of course, the hardest hit areas are rural areas."

Otero said HMS has contracted for six new providers, maybe seven, the number keeps going up every day.These are things that are being worked on. "We obviously see what the issue is. And you know, HMS has taken steps to ensure that that quality level of service and health care afforded to our community."

To a question about whether they would be staff or locum tenens, Otero replied that HMS does not hire locum tenens, "because that's a heavily regulated short term engagement between a health care system and a locums company. We contract with contract providers. It can be very misleading if you say you hire locums, because CMS says a locum tenens can come in for only three months while the providers on maternity leave, for example. So we try to contract long term. So let me just explain who the news ones are. We have the five medical providers. Two of those are contract providers. The others are employees. We want to contract with these contract providers, longer term, six months to a year. And then we have two more that are in behavioral health, a new chief behavioral health officer, starting soon, a director of crisis services, and an MD in internal medicine. We also have Doctor Stinar, who's a triple boarded physician in pulmonary, internal medicine, just about everything. And then we have a director of crisis services that's coming on board. She's a clinician that will be practicing as well. She's a psychiatric nurse practitioner for Tu Casa. The combination of services we offer at Tu Casa, you can access at any of our locations, pretty much. Yeah, there's some specialty that crosses over there sometimes. And then we were one of three organizations in the state of New Mexico to start the New Mexico psychology internship Consortium. There were no training facilities in New Mexico for psychologists to come to finish their training. So Indian Health Services in Shiprock, Hidalgo Medical Services and the state hospital in Las Vegas came together with the HMS board of approval."

Otero continued: "I'm sharing now there's a serious shortage of physicians, nurse practitioners, dentists, hygienists, psychologists. So part of the HMS board vision was to develop these educational models and partnerships so that we can continue to build the healthcare workforce that's in dire need of support. So we, after about three years as a consortium, the American Psychological Association, the APA, has accredited us as a teaching entity now in all our facilities. We have two new interns starting on August 1 that will also be coming in and providing psychology services to our local community. We have the only neuropsychologist in the region. They would have to wait to see a neuropsychologist without her. It has been a year for us to do psychological testing. So not only do we have that access being provided to Grant and Hidalgo counties and the surrounding area, we also received a grant through the rural healthcare delivery fund act that came out of the governor's office this year to ensure success of that program for our area."

"We have a school of medicine that's rated high, and they're still leaving the state. And, like you said, because of the malpractice costs. On the non-physician providers, I think I remember reading this, we don't have enough slots in our schools in New Mexico to meet the need in our own state. That's projected to be, just looking at registered nurses, we're projected to be somewhere between 500 to 1000 short. And when we look at advanced practice, registered nurses, we're short there, too. There's absolutely not enough slots in the schools to cover the need that we see for providers. And then when we look at like physician alternatives, like CMPs, etc, I think it gets even tougher."

Saenz agreed: "It does absolutely so. I keep saying and I keep going back to it, but we are at a point in time where healthcare has never been as as difficult. It's never been as complex as it is right now. I take that to heart, because, as a professor of nursing from Western New Mexico University in the School of Nursing and kinesiology, for educating, training, and some instances, placing these students in a now very tenuous position in healthcare. And so, you know, that's the motivation for being on the board. You've got to try and make the system more amenable to those new students and new graduates."

Otero went back to staffing. "We just had a great nurse practitioner accept our offer, and we're working through the contract that will be starting in early July as well, coming out of Dallas, and then the two interns. So it was a total of seven new providers."

To a question, Otero replied that the HMS Financial Officer is Gretchen Cannon, who has served in not-for-profit, community health center finance ,"for about 25 years, if I remember correctly, She was an auditor for HRSA before she joined us, and just incredibly strong ethics and integrity, and that's what this leadership and board are built on."

The big question in the room was "Why did all these providers all of a sudden go poof—Dr Arizaga and Isaac Saucedo and Dr. Stephens and Dr. Etheridge and who else left?"

Otero countered with: "That's a span of time, right? That's the first thing I want to open with. It wasn't just like all in one moment. And there's always, always reasons behind every resignation or termination. But we don't talk about personnel issues. We just can't legally. But they all have their individual reasons for sure."

This interviewer said: "At that town hall, some said it was because of your micro management and not leaving them the autonomy to practice."

Allen jumped in: "I was there, and the issue was not due to management, it was just how doctors have to practice period. I mean, you could have put that complaint in any healthcare system in America, and those providers would have had the same complaint. That's my opinion."

Otero said: "No no, That's spot on and and you have to define clinician autonomy. It's different for every one of them. Just today, the American Medical Association released their top five or six priorities, One of the priorities that the physicians are advocating for is that no more can administration in any healthcare system dictate how many patients they see a day. That's what they're hoping for. But when you're in business, you have to serve the population effectively. Number one, which means access. First, you have to have access so that when a patient needs to be seen, they can be seen by a qualified clinician. And then there has to be a collaborative partnership between the employer, whether it's the hospital or it's HMS, or it's a clinic or Memorial in Las Cruces or it's Presbyterian Hospital in Albuquerque, you have to have an agreement on what that business model for access and appropriate productivity is to lead to paying for their salaries and their support staff. But yeah, the AMA is saying, 'We don't want administration participating in that metric, but it has to, if you're going to be an employee provider. But there has to be an agreement on and it happens up front on what the access metrics are going to be. Does that help?"

Saenz chimed in: "I've heard providers who don't work for HMS complain about HMS. I used to work at a Navy teaching hospital, and the complaint sounded very similar. Then again, I just thought it was so interesting that this group— you know, it's pretty clear that this thing was organized by providers, but they wouldn't allow their facilitator to say who hired her. I personally figured who did it was that list that signed the letter of no confidence. Once it went out, and whether that's the case or not, that was just my suspicion."

Otero addressed another issue. "HMS, again, with the support of the board of directors, back in 2013 started a residency program, as you're aware, and graduated 13 residents until 2022. when the program had to be closed due to lack of physicians and physician faculty. We took care of those final two or three residents that were in the program. We made sure that they were able to finish their programs at another location. We immediately continued conversations with our partners around the state and their state legislators. And you've heard about this because I know they've reported at the meetings where HMS, Gila Regional Medical Center and UNM now have created a collaborative, and we're working to reopen the family residency program with all three agencies. They're going to house it in Gila Regional Medical Center, but the sponsoring institution over the program will be University of New Mexico, and the program will be housed at Gila Regional Medical Center, because we can get improved funding to be able to support the program. HMS will be a rotation site. It's a very common, not real common in New Mexico, but it is a common model, but that's just one aspect of what we did. We partnered with a partner in relationships."

To the question of when could the community see that happen?

Otero replied that it takes years. Now that UNM is involved, they have to get all the ACGME (Accreditation Council for Graduate Medical Education), all the affiliation agreements before anyone can start recruiting for residents. "There are not enough resident slots for all the physicians that are graduating medical school. They have to go to a residency to become board certified, so they're really struggling with that. But the residency program is only one small part. We partner with WNMU. We take their social worker students. They rotate through here. We have contracts with the Arizona School of Dentistry and Oral Health, where they train dentists. We get two to four dentists that rotate up here with us. We get money for that. This is what we're doing to support health care development, health care professional development. We have nurse practitioners rotating through. We're getting ready to have the first WNMU nurse practitioner student rotate through soon. We do administrative internships. We have rotation contracts with New Mexico State University and I already mentioned the high school partnerships that we have."

Allen said: "One thing that I really took to at that town hall was the patient who said they moved here in 2019 and enrolled in HMS. Everything was great, and then suddenly, about a year and a half later, everything went downhill. And I thought, you mean the pandemic. I mean that's when, and that's when we lost so many providers."

Otero said healthcare called it the great resignation."And it was happening in other industries. But the great resignation was real, and we felt it. Our consumers felt it, and our providers, who used to have a number, for example, of 20 patients a day, they said, we're not doing that anymore. We're tired. We just went through two really brutal years, and it's called burnout. It's called work life balance. Many providers are like, I won't work full time anymore; I'm just going to work part time. And we flexed those schedules, and we offer that flexibility. But the pandemic had a major impact on health care, and I don't know a health care system that has recovered fully in the post pandemic world."

Allen said: "And that's the honest honesty of the truth. My niece was hospitalized in March, and she went to Presbyterian, which is one of the nearest, nicest hospitals in Albuquerque. She had to wait 48 hours for a room, and that's for an ER room. So she was on a gurney in the waiting area for 48 hours."

Acosta said a board member went to UNM recently. "How many days did she sit in the gurney? Like three or four days."

Allen said her niece almost died. "You know the workforce has changed so much. It's amazing how accountability is not a priority. I think it's it's a multi-factorial issue."

Otero concurred and said:" There are multiple issues at work here that are all contributing to the same end. But there is a silver lining here, and this is what I hope you take away. What is the attrition rate for those of our providers that are local? Was it what percentage again? So for our local employed providers, our turnover rate is 6% That beats anything in the nation."

This interviewer noted that one of the HMS patients was just irate about the phone system, because he was poor, and he just had a local phone, and he said HMS was long distance, "I can't even call for for an appointment anymore."

Otero said: "I'm glad you brought that up. During the pandemic, our call volume increased by 30%. People wanted to be tested and vaccinated, etcetera. Our phone system at that time actually failed. We ran out of phone lines, so that's when we began to acquire the necessary resources to buy a brand new state of the art phone system, and we also established and opened a call center. I can show you the data where our abandonment rate is less than 5% although it got really high there for a while. An abandonment rate means that the call wasn't picked up in a certain amount of time. I can't remember the metric, if it's 10 minutes or whatever, but we do very, very well in the call center now, extremely well."

He confirmed it was a local call center, but with a number that sounds like an 800 number something like 575-800-1HMS. "When you are scheduling 72,000 visits a year, it's going to be hard. That's our visits number, with 14,000 unduplicated patients, 72,000 visits a year across 12 locations."

This interviewer asked what was perhaps an unanswerable question: "Do you expect cuts in federal funding with DOGE and all?

"We're preparing for it is the best way to say that, because it is so unknown, strictly on the Medicaid front, but potentially other restrictions," Otero replied. "We monitor that very carefully, and we're preparing for that in case."

Another question that somebody had asked the interviewer. "Does HMS treat illegal aliens?"

Otero said: "We treat every human being that walks through the door, regardless of their ability to pay or their nationality status. We're required by federal law, some of the laws from 2010 to the Affordable Care Act, which you're familiar with, as well as the the national laws and federal laws around civil rights prohibit us to turn anybody away. Whether that will change, we don't know."

The interviewer said a friend who digs into numbers noted that HMS has spent more than half a million dollars on marketing and advisory services.

Otero said: "Our marketing is in house number one. We used to partner with a marketing firm called SkyWest Media, which we stopped a couple of years ago, and we have our own internal advertising media development person, but we do it all in house, and we try to share our advertising among local areas."

The interviewer went back to TuCasa. "Obviously, we need those services here. So what's going to happen with with Dr Arizaga? Is this new person gonna be the chief behavioral health officer?"

Otero said: "We've hired a chief behavioral health officer, which is primarily an administrative role to oversee behavioral health programs. But Tu Casa was a vision that a group of citizens here locally had. And when I started in 2016, Dr Neil Bowen told me, like on my third day, 'hey, we were just awarded the bid to provide services at a new facility that's going to be built,' and this is where I learned that the county and with some of the grants that are out there, we're going to build a facility to treat substance abuse, was kind of basically how it was described to me. In essence, we were awarded the bid in 2015. I started in 2016. My job was to make sure that we successfully opened that facility after it was built. At that time, there were no state regulations, yet they were using the term crisis triage center, which is a social detox facility, but they were no rules promulgated, and a health care system can't provide services until the rules are promulgated, and then we can align with those rules. Those rules fall under what's called a New Mexico ...New Mexico. It's the regulations for healthcare. I apologize, I'm drawing a blank on the acronym, but all the healthcare rules are in there. So they promulgated the rules. But before they even promulgated the rules for the crisis triage center, we worked with the county and opened up outpatient access to behavioral health services so that we wouldn't have an empty facility like Dona Ana did for many, many years when they were trying to open the crisis care center. So we've been providing outpatient services and been filling a significant gap in access to the healthcare services and substance misuse. I call it misuse now. The services include MAT, medication-assisted treatment, and having our medical providers get patients started. Those that have the need, we're prescribing them Suboxone, and they come in for therapy in a 24-hour system. We opened in November, I believe it was of 2020, which, if you remember that we're right in the middle of a pandemic, and the first year we lost that first month, we lost $74,000, the second month, we lost $72,000. I made a commitment to the Board of Directors. If the business model that's been put together by the state doesn't work, we'll have to close it. So after two months, we unwound that and contacted all our local stakeholders and state stakeholders, and we had to close it. Then the state came back and said, 'We have to figure out a better way to open up crisis triage centers in rural New Mexico.' Dr Bowen served on that committee for a year. They changed the regulations to allow for more telehealth, so less administrative costs to run the facility. Senate Bill 10 passed at the legislature around that time, saying that we can accept involuntary admissions. First, the regulation only allowed for voluntary admissions, which is a good thing, but they said if you're going to do involuntary admissions, you have to follow the inpatient affiliate regulation, which required a seclusion room and a recreation area outside. We worked with the legislature and the governor, got funding to pay for the architect, and then worked to pay for the architect and to pay for the construction of those renovations so we could reopen. "

Otero noted there was aa lot more detail behind that. "Between the transition regulation, writing a new regulation, public input, approval of those regulations, then we had to go back and find out if the reimbursement rates that they gave us for the initial regulations needed to be changed, very complex stuff. That's the stuff, unfortunately that the community is not hearing, and if they did, it's really hard to understand. We also had a work group between the county CHI and HMS, and we were working with our legislators to make all that work, that continuum of care, which included crisis triage center, a 14-day crisis stabilization unit, and long term vision was a local inpatient facility. So we've been working with that group for several months, and that kind of came to a close recently, probably six months ago. When we heard that that project was going to be paused at the direction and good recommendation of Board of Directors, our board requested a meeting with the Grant County Commission, and we have not been able to get that meeting to happen. We've been trying to meet with the county commissioners to explain the complexities of services and potential transition of services. I know a couple of them have been rather outspoken about two Casa in the meetings."

Otero continued: "I'll just say this, it's not that we haven't given 120% to get it reopened. There's been barriers. As a matter of fact, if somebody were to ask for the public records on the Tu Casa Advisory Board, there is detail after detail of the every month meetings, talking about meetings with the state. We hold them in this room right here and how we going to get this regulation done. So there's,a whole storyline behind that very issue."

When told the County Commission was trying to dissolve the advisory board, Otero agreed, and said: "Yeah, I think they did at a couple of months ago. HMS always had Dr. Arizaga attend county board meetings, reporting onTu Casa and t she was open to questions."

He said he felt everybody at this table was agreeing on that it's tremendously important to have behavioral health services.

Acosta switched topics. "When's the last time you've heard of house calls? HMS does it if the patient meets the criteria. We do house calls. I'm so proud of our employees. They are HMS, not the buildings. They are the ones that take care of patients and advocate for them. Our employees show compassion and respect for everyone that walks through that door, and they have stuck with us because they believe in our mission and they believe in our leadership, and so does the board."

She expanded on the house call issue. "We have community health workers, who assist in social security applications, disability insurance, Medicaid, Medicare, sliding fees, reduction rates and medication, even if they don't know how to insert a car seat and get a car seat."

Acosta also talked about the Family Support Division that does some of the things like car seat training and enrollment in programs. Their role is to get people enrolled in insurance, Medicaid. They assist them with that. "We have a very complex system, with lots of wonderful services provided."

Otero told the Beat: "You were absolutely lied to on this story, on our side of this. So thank you for coming."

Allen concluded: "If we don't have a conversation, we never, ever get anywhere."