Health Care panel speakers are, from left, Lillian Montoya, Brenda Romero, Dr. Eric Ketcham and Dr. Madhavi Garimella. Photo by Angie Bratton
Brandi Weiss reads a question for panel members, from, left, Lillian Montoya, Brenda Romero, Dr. Eric Ketcham and Dr. Madhavi Garimella. Photo by Maire O’Neill/losalamosreporter.com
Scene from SALA Event Center as the theater fills up with health care forum attendees. Photo by Maire O’Neill./losalamosreporter.com
BY MAIRE O’NEILL
maire@losalamosreporter.com
The topic “Health Care in Northern New Mexico: Changing Landscape,” drew a large crowd Feb. 24 to the SALA Event Center where they heard from a panel of four speakers who filled in many blanks on the challenges and successes of health care in the area. The event was sponsored by the League of Women Voters of Los Alamos, the Los Alamos Community Foundation and Anchorum Health Foundation.
Speakers on the panel were:
Lillian Montoya, senior vice president of CHRISTUS St. Vincent New Mexico and president/CEO of Christus St. Vincent Health System;
Dr. Eric Ketcham emergency room physician for Presbyterian Healthcare Systems and director for addiction medicine at Presbyterian Espanola Hospital;
Brenda Romero, RN, MSN CEO of Presbyterian Española Hospital with more than 40 years at the hospital and 30 years as a nurse; and
Dr. Madhavi Garimella of Medical Associates of Northern New Mexico, who is board certified in internal medicine, endocrinology, diabetes and metabolism, with 20 years in the community.
Brandi Weiss, Program Manager and Anchorum Fellow at Los Alamos Community Foundation read the questions for the panel members, starting with, ” What challenges may arise for you or your institution in the next one to five years for delivering health care?
Lillian Montoya said for most hospitals the pressures are probably very similar to those that people think about each day as they try to navigate the health care world.
“Everything from workforce challenges, which are very real for us in terms of recruitment and retention – certainly the financial pressures that we experience every day from shifting reimbursement and payment arrangements that are challenging, national decisions around who can qualify for Medicaid and who doesn’t, who can receive care and who doesn’t. We’re having to make these decisions every day about how we can deliver the services that matter to a community in that shifting environment – and it’s incredibly challenging,: she said.
Montoya said hospitals are having to encounter and experience more integration around AI, cyber security and privacy challenges.
“How do we navigate that so that you feel safe in getting care? Perhaps at the very top of your list would be access and every hospital, because of those financial pressure and the regulatory environment is every day having to make tough decisions about what services can we reasonably deliver in the community that meet the access needs. What can we reasonably grow and what can we sustain. Coming out of the pandemic, we had some very unique challenges in that moment and I would say today that the challenges are different but they’re equally challenging to navigate,” she said. “We have to continue to work as partnering health organizations to figure out how we take care of a whole community. I would say that is one of our biggest lessons through that pandemic experience.”
Dr. Garimella, speaking on behalf of the MANNM clinic said specifically for Los Alamos it is very difficult to recruit physicians.
“Our clinic for example has been trying to recruit physicians for at least a couple of years, and unfortunately we have people who want to come but then they look at the housing processes in Los Alamos and then they decide that they cannot come and so we have that problem. It’s difficult to recruit staff because staff can’t live in Los Alamos and most of the people live off the hill so day to day operations become hard sometimes if there’s a snowstorm or other things like that,” Dr. Garimella said.
She noted that Los Alamos has the same issues in terms of Medicaid and that the 2.8 percent reduction in Medicare reimbursement last year is very hard to sustain.
“Los Alamos has an aging population and most of the people are on Medicare and we do want to keep our doors open. We do want to be able to take care of out patients but the reimbursement rates are going down and the cost if business is going up and it becomes hard,” she said. “Because of all these problems it’s hard to retain people. I worry about my patients. For example, when Visiting Nurses closed down, we don’t have people who can do in-home physical therapy and my patients who need hospice care. We have my patients who need equipment and there’s no place in Los Alamos to meet these needs – even diabetic shoes – people have to go off the hill to get things,” Dr. Garimella said.
She said on a day-to-day basis it becomes really hard because, “We want to do our best for our patients.”
“Everybody in Los Alamos deserves the best care but it’s hard if they have to go somewhere else for their imaging study, somewhere else for their equipment, somewhere else for their physical therapy. I think those are the daily frustrations that make it hard because we want to do a lot of things but we are restricted by pre-authorizations and facilities. Those are things I hope will get better in the next five years,” Dr. Garimella said.
The panel also discussed what they do to provide services for the under-served population.
Brenda Romero said Presbyterian works with patients who don’t have a peer source to find a peer source.
“We provide food for our patients. We have programs that when the patient comes to the hospital we assess their social needs. The doctor can write a prescription for food and every Wednesday we pass out food in the lobby for those patients that receive the prescriptions,” she said. “With Dr. Tyler Taylor’s help and maybe the help of others in this room, we’re going to be able to provide cell phones for patients in the Renewal Clinic who don’t have a cell phone so that we can communicate with them in between the times when they’re coming to the Renewal Clinic to see how they’re doing and to see if we need to move up their appointment.”
Romero said there’s a lot Presbyterian is doing to help patients, even if it’s trying to help them by finding somebody to donate money for their medicine.
“If they can’t afford the medication, there are churches in Espanola that provide money for that work, working through ourselves, our employees or the community to help them get what they need,” Romero said.
Romero, discussed the challenge to provide the care needed for a population that is getting older.
“At Presbyterian Espanola. we are a smaller acute care facility and so we stabilize patients but we can’t provide all the care that the patient needs at our facility. We transfer them to Lillian and her team at CHRISTUS St. Vincent. We support each other each day in trying to decide who needs to go there and if she’s full, who could come to our hospital. If we’re lacking equipment or supplies, we borrow or lend from each other, including Los Alamos Medical Center,” Romero said.
“All hospitals help each other – trying to figure out what’s best for the patients, how we can navigate the pressures related to the finances. You all know that when a new year comes and there are changes to the health care plans that we’re all signed up for and what it covered last year might not be covered this year, and it might not be covered as well, and you need a prior authorization for something you didn’t need it for. It’s frustrating not only for you and the community, but also for us,” she said.
She noted that the really good thing is that the hospitals have employees who work really had to help patients navigate health care and what they need.
“Having conversations with the health plans or coaching you on what to do next or when to go or what to say to make that happen,” Romero said, adding that being a not for profit facility allows them to provide the care anyway and then figure it out later.
Lillian Montoya said as a non-profit, CHRISTUS St. Vincent sets aside resources to fill the gap.
“This last year alone, we invested about $40 million in care for patients who either don’t have insurance or don’t have adequate insurance, plus an additional $20 million for a safety net for non-profits in the community to help CRISTUS meet the needs of the community – people that we can’t always get to,” Montoya said. “Those are people who are outside the walls of the hospital unless they are coming in for treatment. For them we have the Connect Program to help connect people with community resources after they receive medical care so they don’t have to return to the emergency room.”
She said a lot of people are connected to housing, help getting their medication, or transportation, which is a significant problem in Northern New Mexico.
“With our aging population, you’d be surprised at the number of people that are in this program and they’re in one of the biggest demographics – living in isolation – not having family of friends to get them to an appointment or help them pick up groceries, take care of food insecurity or fill prescriptions. This is a program we have had in place for about11 years and it has made a profound difference in the lives of people who are no longer constantly having to return to the emergency room for their system support, if you will,” Montoya said.
She said spiritual care is also provided for all the denominations in the community for those who practice their faith and those who do not, “so that they can see them and hear them and be available to them they’re going through cancer or any type of experience”.
“We’re also bring our chaplaincy service into our ambulatory clinics because we know that sometimes its not when you come to a hospital that you want to be connected to your faith, it’s when you go into a clinic appointment and you want to talk to somebody about the challenges you’re facing, so we layer all that into the care we provide to the community. Then of course, in our partnership with Anchorum St.Vincent’s, the donor advice fund and other programs in the community outside the walls of the hospital,” Montoya said.
She noted that most people don’t have an inpatient experience or an emergency department experience, but they do have a clinic experience of a housing challenge.
“We do want to be a part of that situation, and that’s where we lean on the experts in the community – their resources and talent, to help fill that need,” Montoya said.
Dr. Ketcham noted that the recently-expanded Renewal Clinic at Presbyterian Espanola Hospital is definitely serving the under-served population.
“Although we’ve been providing services and addiction medicine for seven years and inpatient addiction consultation as well, it’s the decision to use kind of a prime real estate chunk of the hospital and dedicate that to our substance disorder population that has been an investment both in labor and time and gathering those resources, and fundraising and grants development, etc.”, Ketcham said. “We really feel we can treat these very vulnerable patients. Not only are we serving the patient population, but treating patients with substance abuse disorder is really treating the entire family. When you have a patient that has an opioid use disorder or an alcohol use disorder – using cocaine or methamphetamine – it really tears a big hole in your family. It leaves kind of a wake of destruction.”
Dr. Ketcham said when talking to the families, they are so grateful that they have gotten their family member back from being lost in “this wilderness that is so consuming”.
Dr. Ketcham noted that he works as an emergency physician but that his primary work is actually as an addiction special and growing the addiction service line.
“It’s all about trying to meet a tremendous, un-met need that’s been un-met for a long time. This is a patient population that overall tends to have what we call a “poor payer mix”. In other words, primarily Medicaid patients and a lot of folks who are uninsured. This requires an investment in the hospital to be able to provide those services so we are very dependent on making sure that Medicaid continues to get funded and that we don’t get that kind of funding pulled,” he said.
Dr. Ketcham also noted that the Renewal Clinic is extremely vulnerable to changes in government funding such as human services grants that have allowed funding for the bricks and mortar part of the clinic’s expansion as well as recruiting physicians. He said if those types of programs go away, it directly impacts the ability to care for the most vulnerable patients.
The panel also discussed other issues raised by the audience including telemedicine, physician burnout and adolescent psychiatry, all of which can be heard on the League of Women Voters video of the event at
Editor’s note: It appears that Los Alamos Medical Center was not invited to participate in the event, according to organizers. Several readers have asked if there was input from LAMC on the issues discussed.