Lisa Young: I'm here at Delta Health today, speaking with CEO Jonathan Cohee. Let's start off with some of your background. Tell us a little bit about yourself.
Jonathan Cohee: Thank you very much for having me. I was born and raised in northern Michigan. Started out in Hogan Lake, Michigan. I spent most of my youth in northern Michigan. Ended up going to college in a little town in Iowa, Lamoni, Iowa. Played baseball, football out there and then went back and spent a good part of my early adult life in Michigan.
In Northern Michigan, I worked in the woods with my dad. That's how I grew up. Started my health care career out as a nurse's aide. Became really interested in kind of how the health care system worked. I fell in love with therapy and worked in a nursing home, saw how the therapist worked and that sparked my interest, became an occupational therapist, and just kind of grew my my health care career from there.
Young: And yeah, really getting kind of started on the ground level and moving all the way up now as CEO of Delta Health. How long have you been the CEO here?
Cohee: I just started July 7th was my first my first day here as CEO. I started with Delta in November of 2023 as their chief operating officer.
Young: One of the things we want to talk about is the status of the hospital's finances. You know, going back a number of years, I've covered the hospital for almost five years now and there have been some pretty stormy times financially. But I think there's some good news here. So I'd like for you to share where things are at as far as the finances since you came on board.
Cohee: Yeah, thank you. I think the hospital first of all, this hospital has always shined when it comes to their clinical performance. They really track that closely. I think some of this struggle, as most most health care systems, has really been in the financial piece of it. When they brought me out as the chief operating officer, I really started to look at daily what was it that we were doing, work with the department heads and get them involved in looking at their daily metrics and seeing how they could improve our performance.
I'm really interested in creating access and making sure we're trying to be as efficient as possible. When we focused on access, when we focused on making sure that we're looking at what we're doing on a daily basis, then you started to see improvements and everybody has been 100% on board and if you look at the financial health of the hospital, everybody really measures that by days cash on hand and our days cash on hand will fluctuate between 22 and 26 days, cash on hand.
But how I like to show the performance is in February of this year is actually February 22nd Change Health Care had a cyberattack and they they're the ones that are kind of our warehouse for all of our billing. That cyberattack, it really slowed down our billings from February to the beginning of May. Change, took care of about a third of the health care systems throughout the nation. And it was a struggle. It was a struggle for everybody.
But if you look at health through the organization, how did we make it through that? We didn't have to reach out to anybody to give us money to shore up operations at all. We were able to maintain, maintain solvent, pay our bills continuing to operate and we're continuing to do the same today.
We've been able to keep all of our facilities maintained and continue to grow, add new, new equipment and new service lines. But we'll get to we'll get to that.
We're financially were set in a really good place. Just one little benchmark that will show you after all of that, in August, we had a $920,000 bond payment that came due and every year we would kind of struggle when that came up. And this year we're able to pay for that with cash. So it it just kind of shows where we are today versus where we were a year ago.
Young: So if we were on a grading system, you know, the old school from F to an A when you came in, what grading would you give the hospital at that time?
Cohee: Well, that's tough from a clinical standpoint, I'd say, I'd definitely say they were B-plus, borderline B-plus, A-minus. You can always improve and I'm a pretty hard grader.
I'd say from an operations standpoint, I think the team has gone a really long way. So nobody get after me for this. But we're probably about a D-minus just from a straight operation standpoint. And I'd say right now, if you look at our trajectory in and where we are, we're probably at about a C with great upward trajectory, but still a tremendous amount of work to do, but have made a lot of great progress and a lot of that progress.
Young: You know, one of the big questions that I have is how Delta Health handles delinquent accounts, because that's a big part that can take a big chunk out of out of the hospital's revenue. How is that actually handled?
Cohee: I think what we've tried to do is we've tried to shore up the front end and how we collect information. So we brought on a new patient access manager and that patient access manager really worked with the admissions team right from the get- go to make sure we had clean demographics. It seems like it would be easy, a no brainer, but the cleaner our information is to at the get go, the better we're able to collect.
So we had a combination of two things the revenue cycle system and how we start the process was broke. So we've fixed that, which is created less problems with denials, just demographic denials on the back end. And the just creating that new revenue cycle team has helped has helped that process. So again, we're far from being perfect in that, but that's gone a long way to help correct some of that.
Young: Does the hospital have to eat that cost or is there help? If you have delinquent accounts, you just can't collect on those account who actually kind of eats the cost of that
Cohee: It's the hospital system... So if you don't get the demographics correct one you'll get two denials and some can be just flat out straight denials that you won't be able to recoup and go back and do any kind of appeal to be able to get that refunded with correct information.
It really does come back on on the hospital. So we've had challenges the state of Colorado with the the COVID, the COVID for Medicaid, all of the determination for Medicaid, all of that dropped all at one time. So you had over 770,000 people in the state lost their Medicaid eligibility. And then there wasn't really a plan in the state to get everybody back up and going and so we've had to do that individually here. So you see across the state an increase in charitable care and self-pay.
So we really have to work each individual hospital has to work closely to try to make sure we get people the help that they need to make sure, one, they're Medicaid eligible. If they're no longer Medicaid eligible, what programs can we get them on so they don't have that issue so they can afford health care.
Young: Let's talk about some of the recent changes at the hospital.
Cohee: Yeah. So we've really tried to increase our access by increasing efficiency and just putting an emphasis on that, but then also expanding our service lines.
So outpatient physical therapy was an issue. We had issues getting people in, your wait time was anywhere from 7 to 9 weeks. So we expanded services in a couple of clinics by just creating more space. But then we also created a rehab at home program and the Rehab Home program allows us to do PT and OT and speech services in the home and build that as an outpatient service. And it just allows us to continue to increase, really that's just a matter of getting people, therapists in the in the system to be able to continue to expand. That was one, we are increasing our primary care footprint.
Dr. Terry Wade is retiring at the end of October. So we're going to be taking over that that service. So we'll have primary care services in that area and Cedaredge for the first time. We just purchased Dr. Knutson's orthopedic practice here in Delta. That was official August 12th. So just trying to expand our service line.
We've also brought on some new equipment. We have a Scout System which allows us to place it's kind of like a little tag that we can place in breast tissue that allows our surgeons to more easily locate the area that they have to remove. And so it's a pretty technologically advanced system that we've been able to put in, also purchased the (HoLEP) Holmium laser.
So from then, I'm not a physician, so people will get this. But what it allows us to do is it's a laser, it's a high powered laser system. So our gentlemen within the county and outwards that have issues where they have to have their prostate removed. It allows them to get that removed. In the old procedure, in some of the systems that they have, that prostate would regrow. So they have to have another surgery over the course of the next several years. This this gets rid of that. We actually had people from Mesa County coming for that because it's one of the first here in the Western Slope to use the laser.
And then we have a Spyglass. The Spyglass is another piece of equipment really just allows us to remove gallstones from the common bile duct. Seems pretty easy, but what happens right now is if somebody comes in, they have a gallstone, travels to the common bile duct. We have to send those patients right now to Grand Junction. With this equipment, we won't have to.
So our main objective right now is just to continue to expand our services, do what we do well here, keep that service here and where we can make sure that we're partnering wisely with surrounding hospitals to be able to meet the demands here, but then also have a great place for our patients to go in the event we can't.
Young: I don't know if that also aligns with accomplishments, but did you have something that would be different than what we just talked about.
Cohee: All of those services and expanding those services and getting the access really proud of that the operational efficiencies that we've gained. But really prepping for the the continued move to value based care from a pay performance, the fee for service system that we have now.
With our primary care clinics will will tell you that we put a lot of things in place so we can take care of some of the social determinants of of health, the issues that don't happen within the four walls of like a primary care clinic to make sure people have the nutrition that they have. They can get to the pharmacy, they have travel to be able to get to their appointments. So we have systems in place on the back end right now to manage our chronically critically ill patients within our county.
Really proud of that because with our footprint in the services that we are able to provide, when we move fully, when we ,when the health care system in the US moves fully to value based care, Delta County is is ready for that with that footprint. And I'm really proud that everybody is continuing to be comfortably uncomfortable in work with me to help move towards that.
Young: As a CEO of Delta Health, when you look to the future, what is it that you're looking towards? You talked a little bit about the value based (health care), but beyond that, what are some other goals or vision casting that you have for Delta Health in, say, the next 3 to 5 years?
Cohee: It's really meeting the community members in Delta County where the community members live. So making sure that we're mindful of people in Paonia and in Crawford in all over in Delta County to be able to provide them the services at the time they need it where they need it. Value based care is moving more and more of those services at home.
More and more of those services to the primary care and the specialty care clinics. So you really shouldn't treat the ED (Emergency Department) as your primary care. And so that's really where we need to move. So you'll see rehab at home, continue to expand. You'll see infusion services at home, continue to expand, wound care at home and primary care moving towards that, that model.
More telehealth services and just making sure that we're partnering with the different entities within the community to help meet those meet those needs. So you start to see here and feel more of those services here. We need to expand our urgent care model here within Delta. We have a lot of work to do.
We just opened up our Urgent Care again here in Delta, but we really need to go. We have a long way to go to meet the needs of the people here in Delta.
Young: You may have mentioned this before, but you have a partnership with Intermountain Health. Tell me a little bit about that partnership and why that is also important to Delta Health and helping folks here in the area.
Cohee: Yeah. Any time we have a patient that we can't meet their needs, whether it's a cardiac need, neurology need, any of those primary services that we don't have here. We have to make sure, whether it's Intermountain or Community Hospital, we're doing a really good job and being a good partner in making sure that when we transfer patients from here, we have a good collaborative agreement in place. So our physicians are talking to their physicians, we're operating off of their protocols. So when they arrive at Intermountain Health, when they arrive at Community Hospital, there's great collaboration and our patients are able to get what they need and we're able to start their life saving services here, get them prepared and ready to be transported. So we have good outcomes for our patients here.
Our teams in the E.D. have done a tremendous job this summer. I think it was early, early spring. We got our Copper Certification. They'll correct me, I'm sure. But what that allows us to do is all of our pediatric traumas that come in here, our clinical E.D. team, has worked so hard to make sure that they're prepared and they're ready to be able to get our pediatric patients in Delta County exactly what they need to be able to be transferred.
And so I'm proud of that is one of I think there was four Copper Certifications throughout the state of Colorado, and we're one of those four and they just recently had their certification again as a level four trauma system. They passed their certification with flying colors. So I'm just really proud of that. But working hard at making sure that we're able to get our patients what they have in need here, but collaborate with a community hospital or an Intermountain Health for those services that we can't provide.
Young: Thank you for the conversation today. Is there anything else that you would like to add?
Cohee: Integrated Health they provided a great behavioral health service here and that service cease to exist very quickly. So everybody in the community rallied around Rocky Mountain Health, deserve some credit for for making a lot of that happen and allowing us to pivot rather quickly. But we added to service.
We expanded our services in the clinic. So we have behavioral health counseling available in all our primary care clinics. We expanded by two people in every clinic. So anybody that's identified in our system that needs behavioral health counseling, we're able to get them counseling that they need.
Another big service. We added we added peers to our emergency department. And what these peers do is they recognize when patients come in and they have a behavioral health episode and have behavioral health needs, we're able to collaborate with those in the area that picked up some of those behavioral health services and get them the service they need when they need it. So they don't stay here within this system and they're able to go, whether it's a crisis response that they need, whether they need an inpatient treatment, whether they need addiction services or whether it's just counseling.
I'm really proud of the team and what they did to pivot to really meet the need.
