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Published on: 9/30/2008
Last Visited: 5/18/2009
Kean Spellman, CEO
The Taos working class is among the poorest in the nation, with a median family of four income of $29,000, 15% lower than the national average.
As many as 70% of the resident children have healthcare funded by Medicaid.
But Taos' mild climate attracts retirees and vacationers, especially to its luxury ski resorts, creating an inordinate demand for certain services such as orthopedic surgery.
Its real estate market is climbing even in the current housing slump, and the service area is experiencing annual population growth of nearly 4% for over 10 years, said CEO Kean Spellman.
"These factors make for a unique healthcare situation, one that we continue to find new ways to cope with," he said.
After 11 years as Holy Cross' CEO, Spellman is the longest tenured CEO in the state.
He said his perceived longevity has more to do with the high-pressured state of healthcare today, adding that more than a decade of experience with the community has contributed to the hospital's success despite such a challenging location with high poverty levels.
"Far too often, CEOs are expected to turn healthcare systems around in a matter of months, when it takes a year for even the most talented CEO to adjust to a new hospital and its needs," he said.
One of Spellman's recent goals at Holy Cross was increasing revenue by emphasizing fundraising efforts among the more affluent of the area's citizens and improving the hospital's grant writing capabilities.
Thanks partially to these measures and solid program design, Holy Cross's annual net revenue has increased from $20 million to $53 million in 10 years, and its grant revenue has jumped in just two years from zero to more than $1 million, enabling Spellman and his team to address the hospital's biggest challenge: staffing.
During Spellman's tenure, Holy Cross has employed or contracted with 20 physicians and more then 200 other employees, but the hospital continues to need more.
To alleviate the demand for primary care physicians, the hospital increased its hospitalist services to cover seven days a week, which is unheard of for a hospital of its size.
Spellman said that program actually loses money year to year but boosts morale among primary care physicians that are all too scarce, is welcomed by nursing staff, and adds consistency on the floor.
"A little over a year ago, the privately practicing pediatric physicians in Taos announced they couldn't keep their practice open, so we spread the word and petitioned the state and raised $1.1 million to build a state of the art pediatric facility on our campus," Spellman said.
The construction should be finished by the beginning of next summer.
Direct employment of physicians is a growing trend at Holy Cross, one Spellman said the hospital originally had no interest in pursuing.
But when the hospital couldn't find any OB/gyn physicians to move to Taos and open a private practice, even with income guarantees, the hospital offered direct employment and saved its obstetrics program.
Today, Holy Cross employs all three of its OB/gyn physicians, half of its pediatricians, all of its seven hospitalists, and four surgeons.
"Building and managing relationships with employed physicians is our biggest new challenge at the moment," Spellman said.
"We've been relying on consultants for management right now, but we need to hire a full time employee who will live in Taos full time because I see this is a growing need that is not going away."
Looking ahead
Recruiting of physicians and nurses will be a central aspect of Holy Cross's new 20-year master plan, which Spellman said will be finalized in October.
While other hospitals are dealing with huge vacancy rates, Spellman reported that although Holy Cross has had success recruiting nurses, its steady growth continues to increase demand.
The hospital is working with a local university to establish a nursing school on the hospital campus, and funding for this goal was achieved recently to start the new RN program but without the facility.
To allow for better use of clinical space in the main hospital building, the new campus plan includes the construction of a new administrative and wellness building to be completed by the end of the current fiscal year.
The Holy Cross campus will also expand, with the addition of a physical therapy building and an outpatient service and imaging center, in the next few years.
Spellman said he hopes to relocate a successful, local orthopedic practice on campus and to increase synergy.
The strategic and facility plan will also take into account the unique challenges of a small, nonprofit hospital: charity work that is not reimbursed and securing reimbursement for an increasingly uninsured population.
"We've always managed to find a way, but doing so has become increasingly difficult," Spellman said.
"It's tempting to get bogged down in the day-to-day challenges, but we need to stop looking in the rear view mirror and look at the road ahead."
And no group at Holy Cross is better at lifting spirits for the future than its volunteer auxiliary, one of the largest of its kind in the state.
The auxiliary's 100-plus members host treat days for all employees, baking a huge array of cookies and treats on Valentine's Day and helping host a huge Christmas celebration.
Spellman explained that a crucial, early addition to the hospital's master plan was the construction of a gift shop in 2005 for the auxiliary to increase its funds.
Before, the volunteers worked with an annual budget of only $2,800; today, they make that much in a month.
Few hospitals of Holy Cross's size have so large a volunteer corps, but Spellman says they are indispensable.
"Many hospital executives take their auxiliary volunteers and foundation volunteers for granted, but we appreciate how much they do to much to raise the morale of our employees and how positive a force in the community they are as well," he said, explaining that some of their extra funds were recently put toward local nursing scholarships.
The community piece is, for Spellman, the ultimate goal for Holy Cross.
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