Moab Regional Hospital representatives asked the Grand County Council on Jan. 21 to support their opposition to awarding a state-level grant and loan to the San Juan Health Services District for a clinic planned in Spanish Valley.
MRH officials alleged that the proposed facility would be in direct competition with the nonprofit hospital, duplicating hospital services and driving up patient costs. Councilmembers were reluctant to take a strong position in opposition to the project, however.
Two providers in the Valley
The issue turned out to be the main item of discussion, though it was not listed on the agenda, and was instead raised during the “citizens to be heard” portion of the meeting.
“We’re here to ask you to do an unusual thing, which is to support our challenge to a proposed CIB funding of a clinic in San Juan County about a mile from the border in Spanish Valley,” said Doug Fix, the vice chair of the board of Moab Valley Healthcare, Inc, which owns and operates the hospital.
Fix was accompanied by hospital CEO Jen Sadoff.
The San Juan Health Services District is in the application process for a grant and loan package from the Community Impact Board to fund a clinic in the San Juan County part of Spanish Valley. The grant portion would be $1 million and the loan would be over $4 million, subsidized at a 1% interest rate.
The Utah Permanent Community Impact Fund, known as the CIB, is part of the Utah Department of Workforce Services and provides loans and grants for necessities to counties, cities and towns that cannot collect taxes on federal lands, which includes Grand County and San Juan County. The CIB is funded by oil and gas lease revenue from public lands.
The proposed clinic site is less than one mile from the Grand/San Juan County border and only eight miles from MRH.
“There was clearly no regional planning involved in any of this,” said Fix, addressing the council. “You weren’t contacted, the Canyonlands Health Care Service District wasn’t contacted, nor were we contacted, and frankly if you read their application to the CIB, you would never know there was a hospital in Moab or any health care services.”
Fix and Sadoff claimed that no true “regional study” had been done to assess the need for a new clinic, though the San Juan Health Services District’s application claimed to have conducted one.
“We would certainly be considered in the region,” said Sadoff. “It doesn’t say, ‘has county planning occurred,’ it says, ‘has regional planning.’ And it hasn’t.”
Fix implied that the narrative was skewed to present the clinic as the only provider in the area, which could be crucial to the proposed clinic qualifying for the federal Rural Health Clinic program, opening up loan and grant opportunities.
Sadoff said she did travel to meet with the administrator of the San Juan Health Services District to discuss the matter, once the application was made public.
“What they said was that the citizens of northern Spanish Valley had been paying taxes and not receiving services and they felt compelled to provide services for those citizens,” she reported.
That explanation clearly did not ring true to Sadoff.
According to census data, the San Juan County portion of Spanish Valley is estimated to have around 500 residents.
Sadoff pointed out that a similarly sized population in San Juan County—residents of the area between Bluff and Mexican Hat—also do not have their own clinic, and are further than eight miles from a health facility, but there are no plans for a clinic in that area.
“This really isn’t about just serving those people,” Sadoff said.
Profit margins come into play
Sadoff attributed the clinic plans to a different motive: siphoning off patients from MRH.
“This is about seeing a valley of about 9,500 people from which to draw from,” she said, “and Monticello is a small town.”
Patients from all San Juan County clinics are referred to the San Juan Hospital in Monticello.
Sadoff noted that the services the new clinic would offer—laboratory, radiology, and specialty services – “basically feed hospitals,” and can serve as sources of revenue. She said that greater regional competition is likely to drive prices for these services higher.
Sadoff explained that a large part of the cost of lab and radiology services is the machines themselves and the salaries of the professionals trained to operate them. If the pool of people using those services is divided among more facilities, she pointed out, the cost per user will rise.
“If somebody wants to come in and compete with us, go ahead,” Sadoff said “But don’t do it with subsidized money; don’t get free money to come in and create competition with a community nonprofit that is providing these services already.”
Sadoff emphasized MRH’s efforts to provide high-quality, comprehensive services to the area including community needs that are not profitable to the hospital.
MRH recently conducted a community health needs assessment: the number-one need identified was for addiction medical services and behavioral health services, and the second priority was to reduce long wait times for primary care.
Sadoff summarized the steps the hospital has taken and is planning to address those items. MRH hired a full-time psychiatrist last year and is in the process of hiring a child psychiatrist. To address wait times, nurses are screening calls to appropriately prioritize appointments, and the hospital is recruiting another family practice physician.
She also highlighted the financial aid available to patients at MRH, and the financial navigators on staff to help patients find aid for which they are eligible. Anyone without insurance gets an automatic 39% discount on services, and there is a sliding financial aid scale based on income and family size, regardless of whether a patient is insured.
Sadoff was clearly frustrated by the lack of communication and potential complications from the proposed clinic.
She noted that she conducted a zipcode study on patient services provided by MRH and she found that San Juan County residents were regularly using the hospital.
“Last year we gave away 1.3 million [dollars] in uncompensated care to those residents,” she said.
Council members lukewarm on issue
Sadoff and Fix requested that the county council send a letter to the CIB board asking them to deny the application, or, if not deny, at least require a thorough regional needs assessment before approving the funding. The proposal has been tentatively approved but is awaiting final approval at a meeting of the CIB on Feb. 6.
Council members were not supportive of such a strong approach, on guard about potentially stepping on other government officials’ toes.
“I think we need to be really careful about getting in another county’s business,” said Councilmember Greg Halliday. “Our representative on the CIB lives down there, and he’s one of their county commissioners. So I think we need to be real careful about how we address this.”
San Juan County Commissioner Bruce Adams serves on the CIB board as a representative of the Southeastern Association of Governments.
Councilmember Curtis Wells agreed with Halliday.
“I would prefer to talk to CIB board members,” Wells said. “I think asking for a regional assessment is a good approach but I think a letter is just not the right tool to use for this issue.”
County Clerk/Auditor Chris Baird weighed in with a similar opinion.
“This is a very sensitive issue and you would do a lot better to talk personally with the CIB board members,” he advised. “I’m just afraid that if you send a letter you could end up with the worst of all outcomes, which is that you’ll have no effect on the process and jeopardize this entire community’s ability to get grants from the CIB and low-interest loans.”
Council Chairperson Mary McGann spoke strongly in support of drafting a letter asking for a regional study.
“I would like to formally say that we aren’t for or against a clinic per se, but we are in favor of regional planning and a needs assessment,” she said. “I think sending that in a formal fashion would be beneficial because, if they’re spending that kind of money, that needs to be done.”
The council agreed that they would contact CIB board members and ask for a delay in approving the application, rather than sending a formal letter.
The proposal for the Spanish Valley clinic has been tentatively approved by the CIB but could be approved at their next meeting, scheduled for Feb. 6 in Salt Lake City. The agenda for that meeting has not yet been publicly posted.
The Grand County Council meets on the first and third Tuesday of each month at 4 p.m. in the Council Chambers (125 E. Center St., Moab). Meetings are also live-streamed online on the Grand County Youtube page.