For 12 years and and we love this community and. We both work solely in the emergency department and so we have been here through a lot of changes and not so many changes yet and your husband's name is is Paul OK great excellent And John how are you so I've been here it's about 2 and a half years now came here to build to build a new facility which had been an interesting journey back and I grew up in Colorado spent most of my career working in hospitals throughout Colorado both in urban settings and in rural settings and here I am in an absolutely beautiful part of the state right and we'll get to the new facility here in a little bit but 1st let's start with some news any new news about a potential ballot question what can you tell listeners about the Bell question that is is an issue in discussion that we've been having as like many of the other special districts throughout the state we are we've been assessing the potential impact of the of the Gallagher tax limitations which as as as many of the organizations cross state very nervous and as we as we look at the potential impact and the long range impact of any kind of tax reduction due to Gallagher we think that we need to have a ballot initiative. The board of the Boers had several meetings discussing it I think Russia reach a final decision on Friday but it is very likely that we will have a a ballot initiative for for a tax increase to offset the Gallagher actions yeah and Friday is when bout language is due to the county so that it's coming up for everyone and I know that these are hard to scratch and that a lot of our local districts are having we have 25 taxing districts in San Diego County and all of them will be affected by Gallagher our acted subject to Gallagher what can you say about can you offer specifics about this impact I think that I think I think worst case is we're in 2020 we could lose up to $250000.00 in tax revenue. You know because a GALLAGHER That's the beginning of a decline because we will never be able to recover that money. If property values appreciated and and the the state what economy kind of settled down we would have to go back to for the voters to get that 250000 back and it would and if if it if it things continue the way they have been it could be another 2 years there could be another decline and so part of this whole effort is to create mechanisms to avoid those those fluctuations in tax revenue due to the whatever goes on the economy. And you know Kara just so that our listeners know the just like you spoke of the many taxing special districts that we have. We are one that collects a mill levy we passed a mill of the in 2002 when the Telluride Medical Center split from Montrose hospital at that time and the ask to the voters at that time was that this mill levy would be to support 247 emergency services here in our community and our voters approved it at that time we haven't gone back to the voters since 2002 so if we do decide to go for this ballot initiative it will be because of the impact that potentially the Gallagher amendment will have on us as a special district and will impact our ability to provide those 247 services along with a lot of other things that have changed since 2002 that you know certainly make a difference in in how we are able to run our business and continue to maintain those kind of services Yeah so specifically for about language I think that's what you just addressed is it would be specifically for emergency services or what would be the. We're emergency services and and really didn't just general operations maintenance of the building keeping our equipment up to date you know we look at we have C.T. Scanners that probably is becoming close to obsolete and. In we need to be looking to replacing it where in a building that kind of joke is being it's an old building is being held together with duct tape and baling wire and a lot of places you know this you know this last spring we had a huge flood because of the water so you know the water system coming in there and so we need you know we need to keep investing in that building as long as we're practicing medicine there. You know that we were talking about this a little bit before the show but I don't know if this is kind of gone into the discussions maybe that the board has been having around this and just how many questions there could be on the ballot this November does that play a role in the hospital districts decision to go to voters so you you have spent a lot of time discussing that issue between the statewide in the local initiatives . You know there's no question the taxpayers are going to be very nervous about about what they're voting for and you know I think what I think that we need to reform remind people is a lot of the a lot of the mill levy increases people are seeing it as really to protect current tax levels not to see increases so I I think that will be the be I know that will be a big consideration for the voter and we discussed we wait a year. And if we wait a year then in in you know that just you know we know we will definitely see a reduction in tax revenues what what what is the med center already doing more of with less or like you know where you doctor quality you can probably speak to this pretty easily you know we we manage with what we have and we are faced all the time when. With rising costs. And increased amount of patients that we are seeing in higher acuity particularly in the emergency department however our reimbursement is not rising. To correspond to that and you know I think a lot of people have heard in the lay press about the Epi-Pen fiasco and how 10 years ago you could get 2 epi pens for less than 100 dollars and now a consumer has to pay almost $600.00 for those same devices Well that's not the only medication that has affected all of our medicines the costs have gone through the roof I remember when a vial of epinephrine costs $0.60 and now it costs us $25.00 to get that same vial you know in those costs they we also see them providing $2047.00 emergency care year round in a community that has a really high seasonality is of is a big challenge you know we have to have all of the up to date equipment all of the medications to treat all different types of ailments whether it be related to trauma or medical problems and some of which are outrageously expensive but that we have to have here in this town because we're so far away from the next closest hospital we can't delay a treating people you know until they get to Montrose or to St Mary's So we take that burden on financially and in 2002 I think the taxpayers definitely took that into account because they wanted to have they valued that 247 emergency care and unfortunately at this point the cost to provide that care have gone. Up Yet our reimbursement hasn't matched that you do you are well did that ballot measure passed by a wide margin do your member you know I wasn't here in 2002 so I don't know that I could speak to that yeah it'll be really interesting to see how everything plays out and we'll know more a by the end of the day Friday about just how many valid questions there will be but while we're talking about you know changes in the industry and changes in in health care maybe you could talk a little bit about some of the challenges or trends that are surfacing that the public might not be aware of but are tapping resources. There was a lot of them were do I start. We're seeing a lot of as between the between Medicaid and Medicare and the expectations of the governmental payers and the commercial payers they really want to see us be better managing the patients that we take care of so we're making a large investment as well as well as a lot of other clinics across the country in terms of our whole care major program so yeah so you know trying to trying to get patients to be much much more proactive in terms of maintaining their health and well as a result you know we've invested lots of money in terms of information technology something better track patients and and how they're mazing their health and what's happening with their their biometric measures we have 2 people whose major function is to to reach out to the patients make sure that they're there they're getting the health care they need that they're getting their lab procedures or taking their medications these are these are all expenses that. Historically clinics didn't have and in the the I think that the philosophy is at some point there's going to be a payoff to the insurance companies and to the payers and to the consumer that they're going to be healthier and the consulate here is going to read the reduce but it's a it's a long term investment and it's. Again it's very resource intensive Yeah you know I was reading about trends in in health care and that are demanding the A to. Pension of health systems across the country and one of them was you know this is a big one strategies about health care missed now encompass behavioral and mental health absolutely talk about how the med center addresses so that's good that's a big piece we have and we I think Telluride medical centers by whether it's going on the forefront to a lot of the Western Slope plan clinics we actually have a behavioral health counselor in the medical center who's available throughout the day for to what we call warm handoffs if a patient is seeing a physician and the physician senses that there's some personal things going on in the patient's life they may be impacting their health the counselor can actually come and visit with that patient and have it have a dialogue about what's going on and where appropriate get that patient connected to the right mental health professional. That we have one person in the clinic right now she is very busy we're actually trying to recruit a 2nd one right now as well. And I you know it was at a meeting this afternoon with the battles the Rules Committee had overlap and you know the you know that there catchphrases mental health matters and that's really true then in else care is that if we don't if we if we can't figure out how to manage the the mental and emotional health of our patients it's going to be really hard to manage their health as well yeah you know that's interesting because I was looking at some of their statistics because they are going for they have about question around mental health and supporting that and services in and preventative care but they were talking about how people who go into the med center maybe they're there for whatever other reason but are given a sheet of paper to fill out right in the US like there's it's been pretty significant but there's quite a few incidences where people need mental health care just through that identified through that sheet of paper so every patient whether they present to the primary care to the emergency department and it doesn't matter if you're there for an ankle sprain it will. Or for a sore throat we are asking patients these series of questions just to make sure that everything is OK with them at home OK with them in you know their. Personal relationships and things like that in that way we can hopefully identify somebody who maybe it risk but doesn't want to reach out unless somebody asked that question. And unfortunately you know although mental health is and behavioral health is a huge part of a person's overall physical health it is one of the more. Under recognized certainly it is not reimbursed for and so although we value this and we think it's important for our clinic to focus on these issues we are footing that bill so to speak. We're getting through all of the challenges and obstacles before we move into the what's new at the med center but you know while we're added another one of the trends that I thought was unless we continue to improve the customer experience customers will go elsewhere for care maybe that ties into I mean really there's not that many opportunities here for the but but still the customer care part of the customer experience the medicine is pretty limited right now in what it can offer right even in the waiting area there's not a lot of privacy and you you know talk about the restraints that you're under Yeah we are you know the billing really is at physical capacity. You know. They talk about the fact that they you know they brought in architects 2 or 3 years ago to look at the building said to be doing what you're doing in this building right now you should be in a $20000.00 square foot building we're in we're in a $10000.00 square foot building and only about 7500 square feet is for clinical. Pace So it's very tight and it you know and I I mean the example of how tough it is for us is we need a better space for taking care of our or behavioral health patients and if we were you know or the clinicians were seeing them down the basement which is not an ideal place to be seeing a patient anyway and it probably was not it was not acceptable to code so we you know if you've been to the medical center we have we have I call these very attractive one and a half steel shipping containers that are now. A meeting room a behavioral health counseling room and that by putting that structure on them on the campus we can create a room just for behavioral health patients to be for if they if they're going through which we had experience it's a it's a much more private a much more comfortable room and that and what that and we can use it for group therapy and it's actually since we have obtained it its uses have grown Yeah it got started I think what it started out for now it's used for a little bit of everything yeah child birth classes are right. Yeah I think there's an opportunity for a lot more community education particularly given go back to our But the focus on us trying to create a healthier patient population if we can offer health education classes you know the shipping container is a great you know this is a great place and it is the wellness and I said I thought it was an end Yeah but it is and it's a you know you cross it you look across the world the shipping containers are becoming are being used for a lot of different things yeah so how long are those in place until you. Have a new facility or you have to go back to council Yeah we have that we have temporary use for permit more so in theory I think we have 6 years. That we can use it so what are your numbers like at the med center these days are you see. Thing an increase in patients what are the demographics like any changes or trends that people might be interested in knowing in terms of who's using the. Room. In the emergency department are our total numbers have have kind of been pretty steady We certainly have noticed a little bit of an older demographic in the past few years. Just people moving to take on lots of visitors our summer has become much more robust you know it used to be that almost you know half of our annual business would occur during the 4 months of ski season and that's still pretty much on target but now our summer has become much more busy and summer as everybody knows is extends from off season die off season where you know we used to have almost 8 weeks on either end that that has definitely dwindled and a lot of our visitors to town you know for good or bad need our services when they when they come our primary care most certainly has. Seen an increase in numbers and I think a lot of people are trying to focus on preventative medicine and they are trying to head off problems because before they end up in the emergency department and so I think we've seen a little bit of a shift plus our primary care has been able to increase their capacity to see patients and so I think that's why we've seen a little shift in the numbers unfortunately were as John said I mean we are really at the max of where we can put everybody in every hour of the day so there's only so much more room that we have to go up in numbers. In the last 2 years. We've. 2 new providers Dr Mahoney and then only the cause is a physician's assistant and typically when you bring in a new provider into a community there's a 2 to 3 your ramp up before their They're busy and both of them. Is which is really what does that say yeah it also speaks to them they're both excellent practitioners and people have really taken to them Dr Mahoney has brought some you know new services to town that we haven't had in the past particularly involving women's health and she is an osteopathic physician so she also our affairs that modality of care for you know different ailments and both of them are just their rays of sunshine in my world and they they're so lovely and the patients love them but you know in a normal community for them to get to the same stature is prat that have been there for years usually takes several years and they have kicked right into gear and you know you know they're booked out just like the rest of them yeah what last Tuesday Amy Peters hosted a show with the superintendents and they were talked a lot about teacher recruitment retention recruitment and retention What's that like in the health care world with nurses and physicians and you know of course I think Telluride makes it a little bit easier because if you come to tell you right we're also where else would you want to be yeah so I mean I would tend to really has been pretty good I you know we've had a little bit of turnover in the nursing. In the 2 and a half years I've been here there's weakest ability the providers. And. You know I think we're OK in that role I think my concern tends to be some of the support staff you know who's going to the front desk staff you know unfortunately those those positions the compensation levels are quite quite as good as. They don't meet like anyone talk. Just so. But you know to be able sustain a lifestyle in Telluride that it's just it's a you run into the same problems and in terms of housing it right I bet everyone else has Yeah they have some real employees that you were talking for reasons or that's OK It's at the end I always say this program should be at 8 o'clock in the morning everyone would be right at it. Well a reminder to listeners that you can call in any time 7 to 84333 we're here talking about the med center and a few other. Components of that but I guess you know what a lot of people probably want to know is what's the update on the new facility where does the site search stand at this point so the World's Longest Journey the ongoing saga of the new med center facility you know there's a don't book in my it that I inherited in my office that has talks about the medical center moving out to society turn in 190100000 This clearly is a concept as you know going on for a very long time it really has been a long journey you know we continue to. To pursue pursue options there in the you know Fort Unfortunately there's not a whole lot of options available and so we've had a look we've had a lot of conversations with Sam a gala Corp in terms of the property they own a society turn and you know they they're very interested in us being part of their development but there's a lot there's a whole lot of moving parts to go with that September 12th they actually had there's going to be a planning commission workshop where they're going to be discussing the S A V.C. Property a society turn to see how how it fits into Sam a go get Valley Santa guild County master plan and part of that the discussion is as N.B.C. Will talk about that they see there's a role for say for Telluride Medical Center to be on that $25.00 acres so that you know that's the again that's the beginning of a whole nother long journey because until you know that the county and Santa develop Corp can come to an agreement in terms of how that land is developed and we really can we really can't make a deal say hey we're Bible lands and so it you know. A pessimist says it's going to take if you're to get through that kind of that county planning process which is it's an interesting way to put it yeah. It's a long process but you know again it it's it's obviously is very interested in us being part of their project so that's that's the encouraging part of it is you know if you 2 years ago or so it's be on the ground and it's not going to be 2 years before we're there so yeah our goal has not changed are we still have an intense need to have a new facility we just need to find the place to put it it must be frustrating for for you I mean for both of you obviously but Dr colic I remember we were talking about this when you last came on this program it was this topic we're saying maybe 3 years ago I was yeah and that was during the site selection process and then it seemed as though. It had found a home in Mountain Village and does it feel like it's one step forward 2 steps back I mean it's certainly it is definitely been a frustrating process you know try and stay optimistic the whole time and we we just do our job and I know at the end of every ski season we'll have a collective sigh that because that that is really when we are taxed on a daily basis as far as our patient volume and our lack of space. And I know we're still you know even if if this new deal happens to go through I know we're still years away so we need to make and make it work every day at the med center currently but I think we really need to have our eye on the prize that a new medical center could allow us to do everything we're doing right now in a much more appropriate space and allow us to do a few more things that I think our community could really benefit from. Yeah well you know I said you know the presentation of the housing study a couple of weeks ago and he's the discussion of the the amount of population growth we expect to see in this area in the next 151520 years. That's a large amount large population and whether it's health care or other services to the town the town of the county really needs to build the infrastructure to support those populations if they want to come live here. The you know they were talking about like with the jail it possibly expanding the administrative parts of it like the facility of the of the sheriff's office isn't something to Norwood has the Med Center the hospital district had any discussions about like an annex for administrative offices is there currently we've already here I think yeah OK it's true there are some functions that we have we have off site in. Actually get most of our billing function is you know we actually outsource that somebody we have all those resources that we don't have to How's the building I just I just moved back into the clinic which has really made a big difference a lot don't get as many steps through the day as I used to but you know it's. That I have said the organization are really impacted by at least having some leadership in the same building. And the funding remind me for a new facility. Does what was that going to be I can't even remember if there was going to be about Question for that well yeah. I think I know what I was interviewing for the job they were talking about a general obligation bond I think we have at least in recent conversations we don't think that's a realistic expectation so we would have to be getting debt financing there the U.S. Department of Agriculture actually is very interested in through their community community development program to actually loan us the money which is and they have a very low and good low interest loans whatever we do in terms of debt again because of Tabor Yeah we're going to have to we're going to come in and have a. Yeah and most certainly you know a good portion of our project once we have a piece of land you know we would certainly look to philanthropic donors which luckily we have a very generous community that has always supported us and supported our role in this town so you know we certainly would be looking to that is as part of the route to pay for this right it's just getting to that for getting through that 1st major step of finding the site really is the biggest part of it yeah what are there any are valid questions on a state level that will affect health care in Colorado this year at all do you. Know I'm also curious too about the doctor colic or maybe you could speak to this about the opioid epidemic and if we've seen any effects of that here is that you know I get that question all the time and what what our current situation is regarding the you know most certainly the opioid epidemic is is a problem everywhere we are we are fairly lucky that aren't. Numbers do not compare to other communities as far as we don't have quite the number of patients who are addicted or who overdose on opiates that being said we are very cognizant of it and we have. Opioid policies in our emergency department we try and use alternative medications when we can and that's actually been a statewide initiative and it's actually a really interesting. You know part of medicine to delve into into looking at different ways to treat pain. But it certainly is a challenge it's we are lucky that it is not as big of a challenge is say in you know Mesa County or in Denver you know it cetera but you know it definitely is on our radar and where do patients go if they have you know on a day like what are the where do you refer patients Center for Mental Health there are so that that's a that's a big challenge you know a lot of patients that suffer with all types of substance abuse whether it be opiates or alcohol or whatever a lot of times that does go hand in hand with mental health or behavioral health issues and so it usually is a multi-pronged approach to try in and see what's at the root of all of it you know a lot of people self medicate with opiates or alcohol because they have underlying depression or you know other types of mental illness I will say are the Center for Mental Health has been really helpful in coordinating with us our primary care in our behavioral health specialists we we really work closely with all the providers in every patient is different and everybody scenario is different so you really have to. Really give it an individual approach to treatment unfortunately we don't have any you know detox facilities or rehab facilities that are close by and we really don't have a huge number in the state. But we aren't unusual I mean particularly for our remote rural location but we are looking at different solutions and the Center for Mental Health has definitely been you know hopeful and working with us you know what other progs of the of services do you have to partner with other organizations on like I was just thinking about like hospice for example to them you have a hospice program I can't remember the update on that there's a kind of a county policy of care program OK And is that run through the Med Center this is. A private corporation isn't sure and a medical director of she's got she's acting down a role Dr Grandy most certainly does and we you know people are choosing to. Live out their time in a beautiful place like this if this is where they love and most certainly palliative care has become another Pronk of of health care that you know we've had to absorb certainly looking forward when we have a new facility you know a lot of our extra services are limited right now because we don't have space to put new staff we don't have space to do anything we we actually don't have the space to do what we need to do today so we allot of these extra things. With air quotes I. You know we put off until put it on the list of what we can do with the new facility hinges on. What do you have any new programs that you'd like to highlight or anything new at the Met. Center that you think the public should know about any new services or you mention staff already that to Dr Mahoney and Dr Cohen Elaine Collins but you know we'd love to have a lot more specialties here and there and again the space has been an issue now we've just been recently approached by a designer Tristen Montrose who'd like to be doing every specialty clinics up here and we are so we're now initiating conversations with them to see how we can make that work in the medical center. But again with. So many specials coming to be say Have I really like to have specially clinics up your Kirti all Zita plastic surgery. And we just don't have rooms here We're lucky we've got 2 or 3 P.T. Groups that have a presence at our facility. We've got the the midwife who sees patients in the medical center and she comes what like twice a week or something like that if she comes twice a month twice a month Yep Yep So I mean we have an ultrasound tech I mean we we definitely cobble it all together we we have space for you know one person every other day and so we tend to try and maneuver our visiting specialist you know fit into all those spaces that is you know that's one of the things that if our board of periods to move forward with the mill of the question you know having If that passes that would enable us to continue providing all those services if we don't get that Mileva the. Increase then we are going to be faced with when we are hit with a potentially $250000.00. You know deficit from our current tax levy that we're going to have to cut some services and unfortunately you know those could be one of the thing. Things that would be on the chopping block and I mean I hate to talk that way but really I think the you know our listeners need to understand how how much of the tightrope we are walking at the medical center to be able to provide everything that we are I mean that's a good point like what would be the 1st to go you know I hate to even later speculate on the their lander you got about the librarian she refused to answer it seems like I'm not even going there you know if it's so hard to think you don't want to scare people you don't want to put nodded out any kind of but however you know if if it if the Gallagher affected us and we continued to have you know downward income I'm sure it wouldn't affect emergency services and I would I would hate I know that there was a time in our not so recent history that you know people had to drive all the way to Montrose to you know get some specialty care. I mean I would hate to see that happen and you know I think we would do everything that we could to avoid it in our discussions and granted this is not been approved but in the discussions I have overheard you know the talk of the amount would be you know an increase of $10.00 on $100000.00 piece of property and that is not set in stone Please don't anybody quote me on that but the discussions that I've been a part of it is a very reasonable amount that will allow us to sustain our current level of services and really and plan for the future you know John kind of touched on this. Briefly but you know I walk into the emergency department every day and I look at that C.T. Scanner and I just kind of smile at it because I hope that it keeps working because it has been in place for 9 years and the average lifespan of the of a C.T. Scanner is 4 to 7 so it has out lived its life span and it is a vital piece of equipment that we have in the medical center if it goes down it would be catastrophic and we would have to replace it or people would have to could you imagine if your child is in ski and gets a concussion and you have to drive them all the way either in an ambulance or your car to Montrose to get a CAT scan I can't even imagine but you know having that mil levy increase would allow us to have some security that we could do the necessary things to keep practicing the way we are let's take this call real quick Kyra live on Cotto. You know I know for years. The public was being kind of room for the pro property because they needed. The new space they needed a quantity of it and that that that in Town of the largest base and then she unlike previous records from you know 889 years ago ever they thought about OK well we need to think about future services like you were just didn't know and when to be nice. And we had. After surgery and Botox and well we knew she teething. Possibly surgeries or you know knee surgeries shoulder surgeries and things that are being done over and Montrose junction Durango and I guess the question I have is how much space you think you need and then also about the priorities of you know there's some of the new trial writers there was rather do there to talk to in plastic surgery here but we also need that emergency. Physical type stuff because you know about biking skiing injuries things relate to that and what it is things like. Plastic surgeries do they just take a lot more the budget if you designate a portion of the new building for that as opposed to more Amergin C.P.P. Type stuff. You know in terms of what is that a fair Medicaid how do we take care of just regular locals. And in terms of space and services and then how to pay for it out of certain insurance. Sort of equations and you know I think money makers you know bang for the buck like well that's a good point percent of the bunch of this but we can pay for the services that we're going to cut you can kind of get into that a little bit. OK I think we people have a better grasp but thank you. John you want your so yeah you covered a lot of target area that with that question so we you know as we as a feasibility studies of the population Elsie's of have. Progressed over the years we really think $30000.00 square 830000 square foot building would really be adequate for really it addressing the needs of the community I would say that the the projections that I have taken a look at it really is looking at the population base within it within the hospital district and say McGill County they really have not built in OK we're going to have a whole bunch of people you know flying into Telluride to get there to get their cosmetic surgery taken care of. So I you know there's no question that those kinds of of patients would would certainly help with the profitability of the organization but that's that is that has not been the driving force in terms of the program plating of the facility. When I talk in situ when we talk about the model the hospital I know sometimes I talk to folks and they they have a vision of what's in Montrose in terms of a hospital and that but that is far from the path of work we're taking and there's you know there's a model that we're seeing across the country is called a micro hospital which is really an outpatient facility like we have now with with much more up patient capacity much more diagnostic capability. In primarily outpatient surgery and so short. In we envision that at some point you know this this build this possible become a critical access hospital in under Medicaid regulations the average length of stay for a critical access hospital can exceed 72 hours so there are you know there's some there clearly are some regulatory. Guidelines that have that kind of limit our focus to to kind of the simpler thing you know I earlier on I talked to people who thought we were we want to build a heart surgery center here and I. You know that's that's far from from a thing we ever saw I will say that early in my career I had a chance to do some consulting and Bill Valley Medical Center back in the seventy's and nobody ever envisioned to become an international orthopedic surgery center so who knows you mean who knows what would happen here until you're right in 203040 years but in terms of our 10 to 15 year vision 30000 square foot building is going to be for more than adequate to take care of the community and it's in and it's not going to be its financial base is not going to be driven by doing exotic surgeries and fly people in for boutique kinds of procedures OK thanks for answering that was a quite the question there I think that might have been Dave so the hospital district is governed by a board of directors and how many people are on that board so if I board members 5 board members. So Richard Betts was the board chair and they was fans or who was vice chair Robert Pinkert who's recently on the board. Lynn Lynn Blackwood just join the board she's a secretary treasurer and Chris chief and OK And how often do they meet once money like a minimum of a minimum of once a month Yeah I think recently it's been about Weekly what are their current priority directives like well the number the number one priority is to get a site and get progress going on replacing the curve facility. They they clearly the me they hear. They hear their neighbors talk about how tight is the facility and how they like to see more services in it so they're being responsive to the needs of the community 2nd the 2nd one is how do you protect the financial viability of organization which is. It's to the middle of the issues right OK And you said we'll probably know more about that on Friday then yes OK All right great well check in with you then or I'll check in with county clerk Kathleen Neary on all of the potential questions that we may have is there anything else that you 2 would like to talk about that I've missed anything else you think the public needs to know well you know I wasn't sure the one story is a you know we talked a lot about you know our frustrations the insurance companies are paying us for our costs and you know there's lots of expectations that you know we are trying to become far more efficient as an organization and we were blessed the collar health Andijon gave us a grant where they they have provided us a team of analysts to come in and really do a deep dive of our organization look at our finances look at our operations and they will be they why should be coming back with recommendations on how we can be more efficient in how we operate our facility because you know you know you know it's you know we can cry all we ought about not having enough money we but we it's you know we still we have just we have the fiscal responsibility to make sure we're offering the best we possibly can so we're taking this resource and in the in the coming year they will be giving us their results in the exciting thing is the current Health Foundation they've got this capacity capacity expansion program and they actually have some funds available that we can tap into to help us implement the recommendations so that you know it's you know we are looking to other ization to help us become more efficient Yeah in community do they do this across the state for health systems across the state. Selective institutions I know that I know that . The hospital Norte the they have just completed their analysis and are now going for funds but but I think there are there maybe 12 or 13 hospitals that got to have access to these funds and when did you say that the results would come back Well we're hoping that by the time we get in. Sure FAUL budgeting process is one of their preliminary recommendations to help it's actually always good to have a fresh set of yeah particularly when you're you know it ministry to of group we've all kind of grown up here and you tend to make decisions and move forward based on your needs right now and those can most certainly impact other decisions that either will or have been made so to have a group come in and look at everything and say So why are you doing it this way I think is is really an excellent exercise and to really make sure that where we all think that we're doing you know the best job in being very fiscally responsible but it's good to have another set of eyes to come in and take a look at that house perspective you have outside perspective All right anything else that you want to tell Dr colic or now things are just like you know hearing about the emergency department. All right well I really would like to thank you both for coming on tonight I appreciate your time and thanks to our listeners for tuning in we'll be back again next Tuesday with another installment of off the record Thanks Kara. Thanks for listening to the record. Expressed on this show those are bargains join us again next week for another installment and in the meantime drop us online news A.K.O. T.-O. Dot org with feedback and I. We're. Oh. Oh. 2 2 for. Yes of the life will they Brubeck. Just a couple of minutes before the hour of 7 o'clock here on a Tuesday night and tell your I Colorado you are listening to my favorite is a station that's key a deal in to any rat Yeah. OK well since it is pretty much time. To read the daily can win are for Tuesday September 4th 2018 birthdays for today Paul Harvey Tom Watson Mitzi Gaynor Dunn Conover than one bird Lisa Knight Jackie Kenneth flick. Johnson moon he Simone and John Samone when love Joe I I one sky Mike Piazza. In Damian Wayne on it's me after the film festival film festival is playing at the Nugget a cold war is started $815.00 and at the Palm theater Rama also had 15 tickets go on sale 30 minutes prior show time and if you lost anything during the festival it's located at live 7 that's where you can find that stuff or Dimmock all 369-1140. Right now at the at the bean the Telluride gold Kings are pumping out some nice music for current.