No decision yet on MPMC management agreement | SkyHiNews.com

No decision yet on MPMC management agreement

KREMMLING — Although the Kremmling Memorial Hospital District board is still expecting to create a management agreement with a larger health system, they've put off making an official decision for another month. Talks of a management agreement followed financial troubles that have bogged down the district soon after its Middle Park Medical Center facility opened in Granby in January 2012. It means a larger health system, most likely Centura Health, will assume leadership and direction of the district through its own chief executive officer. The district's board of directors would still retain authority, however. Although the board was expected to sign off on the management agreement during its regular meeting last week, district officials are still waiting for direction from its bondholders before proceeding. Two board members met with bondholders on March 10 and went over revenue, cash cycles, system upgrades and the Centura relationship. They also discussed a forthcoming report by the bondholders' consultants which will give the formal "seal of approval" on the management agreement. Those bondholders own the municipal debt the district used to construct the Granby medical facility, debt with liquidity covenants the district has had trouble fulfilling. Last Novemeber, the hospital district went into an "event of default" when it missed its base rental payment and had to draw funds out of its reserve. Earlier this month, the Sky-Hi also found the district wasn't meeting its "cash on hand" obligations. "As you are aware, health care is a difficult industry to navigate and more and more hospitals are finding it increasingly difficult to meet all the requirements and demands that are being placed on them," the district's CEO, Cole White, said in an email. "Affiliations, partnerships, joint ventures and management agreements are being used to help improve operations, reduce costs, improve compliance, advance clinical outcomes, and improve overall performance." White said the board expects to finalize an agreement with Centura Health sometime this month, either at its regular monthly board meeting, scheduled for 6 p.m. on April 23, or at a special meeting. According to White, the management agreement contract means Centura will employ the CEO and possibly the CFO. The CEO will be required to report to both the hospital district board as well as Centura. Leia Larsen can be reached at 970-887-3334 ext. 19603.

Hospital district enters into agreement with Centura Health

KREMMLING — The board members of the Kremmling Memorial Hospital District have unanimously agreed to a hospital management agreement with Colorado's largest health network. The hospital district, which does business as Middle Park Medical Center, operates health facilities in Kremmling, Granby and Walden. While the district board will still retain governance over the strategic direction of the hospitals, Centura will provide management and leadership under the direction of a Centura-employed chief executive officer. The district's current CEO, Cole White, said the agreement brings other benefits as well. "It's about being part of a bigger system," White said. "Would you rather be in the ocean with a rowboat or an ocean liner? Both serve the same function, to keep you afloat, but the ocean liner has a lot more to offer than the rowboat." At the time of publication, the district did not provide a copy of the adopted agreement, citing legal issues involving proprietary information. But White and Board President Bernie Murphy noted agreement benefits include better access to education and resources for physicians, improved access to clinical services, more leverage to negotiate with insurance companies and collaboration on keeping health care local whenever possible. Centura will also provide useful assistance in navigating the nuanced changes brought by the Affordable Care Act. "They're the big guys, and we're the little fish," Murphy said. "The way everything is changing in health care, we need help." The resolution, adopted at a special meeting last Friday, May 2, creates Centura Health's first-ever hospital management agreement. The faith-based non-profit network has 15 hospitals, six senior living communities and employs around 6,000 physicians in Colorado and Kansas. Part of its 2020 Strategic Plan is to "become (the) region's rural health outreach leader." "We believe in nurturing the communities that we serve," said Bob Wallace, rural health service line director for Centura, during Friday's meeting. "Just because you live in a rural community doesn't mean you should have second-class health care." The agreement, however, hasn't been without controversy. It comes on the heels of financial troubles that have been shaking the district since shortly after the Granby facility opened its doors. District administrators couldn't meet monthly base rental payments for the facility in 2013 and 2014. Last winter, they dipped into reserve funds to make the bond payment. This spring, they put a freeze on non-essential expenditures. The district has also faced troubled waters in terms of transparency. Earlier this spring, it received the lowest score in a Sky-Hi transparency audit of government and districts in the county. White followed up with a letter to the editor promising better transparency in the future. But last Friday's special meeting raised some eyebrows. The district board held its regular meeting the Tuesday before, on April 29. During the public comment period, district residents asked if there were any updates on the Centura agreement, which has been in the works since last fall. According to members of the public who attended the meeting, board members told the public there was nothing to report. They also did not mention the special meeting planned for Friday. According to Public Relations Director Michelle Balleck, the district posted notices of the meeting 72 hours in advance at the library, post office and the district's administrative offices in accordance with Sunshine laws. "The board did not address the special meeting at Tuesday's regular meeting as the board was unsure if the special meeting would be necessary at that time," she said. While most members of the public spoke in favor of partnering with Centura Health, they took issue with the perceived secrecy of the meeting to adopt the management agreement. Around 25 members of the public showed up to voice their concerns, which took up the bulk of the one-hour Friday meeting. "I feel like we're being duped, we're not being told the truth, and there's something to be hidden," said one district resident, during the Friday meeting. For their part, board members acknowledged they had made a mistake. "I guess you could say we dropped the ball as far as telling folks that we were having a meeting Friday night," Murphy said. The management agreement will go into effect on June 1. To cover the costs of the agreement, the hospital district will pay Centura $40,000 for the first year, $60,000 for the second year, $80,000 for the third, then $100,000 for the fourth year. The district board will still control the Centura-employed CEO's salary and benefits. They can terminate the contract at any time with 120 days notice. White said he expects both sides to officially sign off on the agreement this week. While White and board members called the lack of notification a "slip-up," they said the dialogue at Friday's meeting was productive overall, and the management agreement will result in a positive relationship with Centura, the hospital district and locals. "I think it's going to mean really good health care for the community," Murphy said. "That's why we did it." Leia Larsen can be reached at 970-887-3334 ext. 19603

Hospital district still afflicted with financial ills

GRANBY/KREMMLING—As the Kremmling Memorial Hospital District continues to wade through a mire of money troubles, it's looking at major overhauls to get back on track. Rising health care costs and inefficient systems have pushed the hospital district down a rocky road of sliding cash flows and debt payments potholes. The hospital district board, which oversees both the hospital in Kremmling and Middle Park Medical Center in Granby, is considering a major overhaul in management to help smooth things over. Much of its financial trouble came to light soon after the Middle Park Medical Center opened in Granby in January 2012. To finance construction of the facility, the hospital district issued a hospital revenue bond. These types of bonds are tax-free municipal debt, usually backed by the revenue the hospital is able to generate. The hospital district makes payments on the bond twice each year. The official statement describing the details and requirements of the bond is a long, complicated, 223-page document. But it contains a "liquidity covenant" that specifically requires the hospital district keep 50 days of cash on hand for the fiscal year ending in December 2013, and 60 days cash on hand for the fiscal year ending December 2014. Minutes from the hospital district's board of directors meeting, however, note that the district had only 12.5 days cash on hand in November and only seven days cash on hand at the end of December. According to the district's finance director, Brendan Gale, that "seven days cash on hand" did not include the bond reserve. He stated that with the bond reserve, district actually had 24 days cash on hand by the end of December 2013, and by January the figure had improved to 27 days cash on hand. Still, those figures fall short of the bond's requirement. The district's financial troubles have also been recently reflected in their ability to make debt payments. Although the district makes payments on the bond twice a year, the district is required to set aside monthly base rental payments. These payments should accumulate every six months, adding up to an amount sufficient enough to make the semi-annual bond payments. But last December, the district drew upon its reserve fund to make the full $940,000 interest and principal payment, which means these monthly payments likely weren't being met. Gale confirmed the district hasn't been able to make monthly payments in 2013 or 2014. The bond official statement also gives the district just six months to replenish the nearly $1 million it took from its reserve fund to make the bond payment. "We have not yet replenished the reserve fund," Gale said. "We are working to do this as soon as possible with guidance from the bond trustee." In light of the district's financial turmoil, meeting minutes on Feb. 26 noted hospital staff worried about layoffs. On March 4, Middle Park Medical Center, the business side of the hospital district, issued a press release responding to concerns over the hospital's financial constraints. It noted the district is reevaluating its business strategies. The district's board of directors will be meeting with the bond holders this month "to tour MPMC's facilities and assure (them) that we are able to comply with the bond covenants," the press release said. To cut costs, district administrators have implemented a spending freeze on non-essential expenditures. According to the press release, the district is now considering a management agreement with a larger health system as well. Centura Health will likely be the one providing direction. The district already signed an affiliation agreement with Centura Health in August 2011 to help expand its health care system. Under a management agreement, Centura Health would provide management and leadership under the direction of its own chief executive officer, who would be employed and appointed by Centura Health and approved by the Kremmling Memorial Hospital District's board of directors. The board of directors would still retain authority over the district. What this new management agreement would mean for current CEO Cole White or other management staff remains unclear. "The terms of the contract are being negotiated," Gale said. "Details of contract negotiation cannot be disclosed." According to the press release, the board of directors expect to sign the management agreement at their March 26 meeting. Other future cost-saving measures could include staff adjustments, moratorium on staff overtime, service line revisions and a service price increase. A statement from White noted that the financial challenges facing the hospital district are not unique. "Rural hospitals throughout the nation are facing looming challenges," White said. "Health care has been on an unsustainable track … reduced reimbursement rates and demands for proof of performance mean that we have to improve our efficiency and operation effectiveness every year just to stand our ground." Leia Larsen can be reached at 970-887-3334 ext. 19603.

MPMC, Centura officials sign agreement

KREMMLING – On May 8, Middle Park Medical Center and Centura Health announced they officially signed and finalized their management agreement, effective June 1, 2014. The management agreement leverages the strengths of both organizations to provide residents of Grand, Jackson and northern Summit Counties with improved access to clinical and operational services, education and resources to meet the increasing need to provide convenient, integrated, high-value care, while keeping health care local. MANAGEMENT AGREEMENT SPECIFICS • The Kremmling Memorial Hospital District Board of Directors will continue to fulfill its ongoing role to provide the strategic direction of the hospital. • Centura Health will provide management and leadership expertise under the direction of a Centura Health employed chief executive officer appointed by Centura Health and approved by the Kremmling Memorial Hospital District Board of Directors. • The chief executive officer will run the hospital operations on a day-to-day basis beginning June 1 and work with MPMC on an ongoing basis to identify areas where additional clinical and operational services, education and resources are needed. • MPMC staff will have support and access to colleagues and partners throughout Centura Health with whom they can discuss challenges, explore best practices and obtain feedback to help determine high-value health care solutions.

Middle Park Medical Center CEO Cole White resigns

Middle Park Medical Center Chief Executive Officer Cole White has resigned. The Kremmling Memorial Hospital Board of Directors accepted White's resignation on Thursday, May 29, effective immediately, according to a May 29 press release from Middle Park Medical Center. "It's been an amazing learning experience for me," White said of his time with Middle Park Medical Center. White's resignation had been in a "pseudo-planning stage" since the district entered into talks with Centura Health regarding a management agreement, which will take effect June 1, White said. White's resignation, will allow the board and Centura to choose someone who is the right fit for both organizations, he said. The board has appointed both Middle Park Medical Center's Chief Operating Officer Trampas Hutches and Chief Financial Officer Brendan Gale as interim CEOs. "The Kremmling Memorial Hospital District Board of Directors will now begin the important task of finding an experienced CEO to lead Middle Park Medical Center," said Bernie Murphy, president of the district's board of directors, in prepared statements. "Through our management agreement with Centura Health, we will work collaboratively to identify a candidate. The Board of Directors, providers and staff of Middle Park Medical Center remain committed to delivering convenient, patient-centered, high-value care to the communities we serve." White had served as CEO since March of 2013. Before that, he served as Middle Park Medical Center's chief financial officer for longer than three years. "The Board and I are incredibly thankful for his enthusiasm, passion and commitment throughout his years of service at Middle Park Medical Center," Murphy said in a statement. "We wish Cole the very best in his future endeavors." Three new board members have joined the hospital district. They are Gary Bumgarner, Amy Mahon and Kelly Johnson. Hank Shell can be reached at 970-887-3334 ext. 19610.

Centura Health, Kremmling hospital district agree to affiliate for Grand County health care

GRANBY – The Kremmling Memorial Hospital District has brokered a deal with Centura Health to purchase the St. Anthony Granby Medical Center for $2.6 million. Effective Jan. 1, 2012, Centura Health will transfer operations and assets of the long-standing medical center to the Kremmling district “with no interruption of service,” according to statements released on Wednesday from both Kremmling Memorial Hospital District and Centura. The date of the transfer coincides with the grand opening of the new Middle Park Medical Center in Granby, presently under construction. Details about the St. Anthony Granby Medical Center building, following the transfer of ownership in 2012, “are still evolving,” the release states. “The addition of the St. Anthony Granby Medical Center building and health care services extends Kremmling Memorial Hospital District’s outreach in Grand County by providing high-quality, cost-effective health care to patients,” said Bill Widener, CEO of the district’s Middle Park Medical Center, in Kremmling. “The purchase is a great addition to our existing services and further demonstrates our commitment to measured growth and meeting the needs of patients.” With the transfer of ownership, about 33 full-time and part-time associates will be affected, the release states. Both organizations “are working together to facilitate employment opportunities at the new Middle Park Medical Center, as well as existing Centura Health entities.” Centura is not completely out of the picture. The pending transaction is viewed as a “collaboration” between the two parties. “Because Centura Health collaborates with its affiliates,” the release states, “and neither organization is interested in reducing health care value or further fragmenting the care delivery process, the consolidation of health care efforts in Granby is necessary.” The organizations also have signed an affiliation and services agreement to continue collaboration where needed to “expand the scope of health care services and enhance the health care status of the residents in Grand County,” the release states. In effect, Centura will be affiliating with Middle Park Medical Center in Kremmling and Granby to support its offerings of cardiac, stroke, spine, oncology and trauma care at both facilities, and to promote the sharing of best practices amongst clinical professionals through education, development and overall talent management. The Middle Park Medical Center facilities – operated by KMHD – will become members of Centura’s Colorado Health Neighborhoods. “We diligently undertook a comprehensive and thorough evaluation of the opportunities available to enhance the value of health services for the residents of Grand County,” said Gary Campbell, president and CEO of Centura Health. “By taking advantage of our organizations’ shared strengths and opportunities while enhancing the quality and scope of services available to residents across the region, we think this is a ‘win-win-win’ for the community, Kremmling Memorial Hospital District and Centura Health.” With various details still in the works, the last six months have resulted in the “epitome of decision-making that will guide health care in Grand County” for years to come, said Eric Murray, spokesperson for the Kremmling district. Centura Health’s integrated statewide network includes 13 hospitals, seven senior living communities, medical clinics, affiliated partner hospitals, Flight for Life Colorado, and home care and hospice services. The Kremmling Memorial Hospital District has been serving the patients of Grand and Summit counties for the last 78 years, with its 25-bed critical access hospital and clinics.

Kremmling hospital, Centura form partnership

KREMMLING – The Kremmling Memorial Hospital District signed an agreement with Centura Health last week, an indication that Colorado’s largest conglomeration of hospitals and health care services is steering toward a possible partnership with the hospital district on its new medical campus in Granby. Representatives of Centura Health attended the hospital district’s July 22 meeting to show support for an agreement between the two healthcare providers. Centura Health CEO Gary Campbell and Kremmling Memorial Hospital District CEO Bill Widener signed a memorandum of understanding, viewed as a first step toward collaboration. The document was a culmination of several years of discussions between the two providers, according to Kremmling Hospital District Board President Kent Whitmer. “This news of a possible affiliation with Centura might surprise some people, but it’s been a notion for years now,” he said. “We can benefit each other and the community by working together and not against each other. We are talking and working towards some sort of affiliation. We don’t know what that may look like, but we are working towards it.” Campbell, who oversees 13,000 employees and the 6,000 doctors of Centura, outlined his company’s “2020” strategic plan at the meeting. Centura Health, which operates the Granby Medical Center, is one of the state’s largest private employers, operating 12 hospitals, seven senior living communities and home care and hospice services. Released in April of 2009, the plan is based on principles of building “systems of care,” of creating a health model that services “health” care, not just “sick” care, and builds on the company’s foundation, he said. The plan promotes “physicians, hospitals and communities working together,” according to Campbell, and changes the “scope of competition” to ultimately benefit patients. “Centura’s strategic plan is a tangible indicator that their intentions are to develop with us,” Widener said. 6320 Corporation formed To further move forward on the project of building a $20 million, 40,000-45,000 square-foot medical center on 10 acres of land in Granby donated by Granby Ranch in 2009, the Kremmling hospital board adopted bylaws and selected members for a 6320 Corporation that will serve to secure debt to build the building. The members officially appointed July 22 are: Granby Mayor Jynnifer Pierro; Manager of Cliffview Assisted Living Center Jeff Pexton; Widener; KMHD CFO Cole White; and KMHD Chief Nurse Carmen Covington. According to CFO White, the 6320 Corporation will serve to engage new debt for the Middle Park Medical Center where a taxing entity such as the district cannot. “It is the 6320 Corp that is assuming all the risk,” he said. “Of course there is risk tied to the fact that as a hospital district, we are entering into a long-term lease with the 6320 corp, the entity that is essentially building the building.” But the Kremmling hospital district is not putting up any collateral (such as land, facilities or cash flow) to build the building in Granby, he said. The building is close to being financed by selling federally subsidized Build America Bonds. White characterized the overall risk to the existing Kremmling Memorial Hospital and the district “minimal.” “People who purchase bonds and invest into these types of capital projects have no interest in running small hospitals,” he said, “and so there is always a small amount of leeway and flexibility. But I would like to think that the probability of that happening is very small. The odds of us defaulting on those bonds are even smaller.” “One of the main reasons for focusing on going to the east end is to preserve what we have here in Kremmling,” Whitmer said in response to concerns from constituents about whether the Kremmling Memorial Hospital can still survive after the Granby facility is built. “From what we have been told by our consultants over the past five years, this is the most viable track to preserving what we have here and to make it something really special.”

Kremmling Hospital District hopes to improve on 2013 financial woes

A financial audit of the Kremmling Memorial Hospital District released last month paints a bleak portrait of the entity's finances in 2013, though an executive with the district pointed to improving numbers in 2014 as a sign that the district isn't headed toward insolvency. The audit, from accounting firm Dingus, Zarecor & Associates PLLC, found that the district's operating margin had fallen from -7.1 percent in 2012 to -11.1 percent in 2013. The district's current ratio, a liquidity ratio that can indicate an entity's ability to pay off short-term debt, also fell from 1.8 in 2012 to 1.2 in 2013, according to the audit. By the end of 2013, the district's liabilities exceeded its assets by more than $2.4 million. "The District has suffered recurring losses from operations that raise substantial doubt about its ability to continue as a going concern," states a letter from the auditor to the district board. The district, which does business as Middle Park Medical Center, has been under increased financial pressure since the construction of its new facility, MPMC-Granby, in 2012. The district financed the new facility with a hospital revenue bond. In December 2013, the district dipped into reserve funds to make its semi-annual bond payment, violating bond covenants and defaulting on the bond. The bondholders have agreed not to call the bond before January 2015, according to the audit, and the district made its June payment on time. Minutes from the district board of directors Aug. 14 meeting state that "drastic changes are needed to assure financial viability for the facility," though CFO Brendan Gale disputed that assertion. "I would have preferred that the comment be made simply stating that 'improvements need to be made,'" Gale wrote in an email in response to inquiries about the district's finances. Gale did not say whether there was a possibility that the district could relieve itself of MPMC-Granby in the future. He said the Granby operation is "an important part of the future of KMHD, and a vital part of health care in Grand County." Financial challenges The district has made a number of changes to combat financial ills since 2013, Gale said. One major change has been the initiation of a management contract between Middle Park Medical Center and Centura Health. The agreement, effective June 1 for a period of four years, dictates that Centura will appoint a chief executive officer, to be approved by the district board. The district announced this month that David Ross would fill in the new CEO position. In return, the district pays Centura the compensation, benefits and expenses of the CEO as well as a management fee. The fee is $23,334 in the first year and increases to $60,000 in the second year, $80,000 in the third year and $100,000 in the final year. The district also made a staffing reduction in March 2014, and has worked to make staffing more efficient, Gale said. Staff productivity has increased steadily since 2011. In 2013, the net patient service revenue per full-time employee, a measure of staff productivity, exceeded that of 2012 by more than $10,000 and 2011 by more than $30,000, according to the audit. Other areas of focus include claims and billing, improving market share and increasing specialty care, which Gale said is an area of opportunity for the district. Financial uptick Some of the changes the district made seem to be paying off, according to financial statements released in May 2014. Net revenue in May 2014 exceeded the same month last year by more than $200,000, and year-to-date net revenue was up more than $500,000. Year-to-date operating expenses in May 2014 dropped slightly from 2013. As of May 2014, the district had also closed the gap between its total liabilities and assets, though liabilities still exceeded assets by more than $900,000. Though finances seem to be on the uptick, Gale said additional improvement is needed. In May 2014, the district's days in accounts receivable, or the time it takes to collect payments, stood at 84 days, well above its target of less than 58 days. Looking forward to the district's December 2014 bond payment, Gale said the district would have enough cash on hand to make the payment, and would even be able to transfer the funds to the bond trustee in September. Reform benefits Though not quite the financial boon some may have hoped it would be, the expansion of Medicaid associated with the Affordable Care Act, also known as Obamacare, has benefited the district. "The Patient Financial Services and Social Services departments are encouraging patients who may be eligible for Medicaid to apply," Gale said. "The result has been that KMHD receives some reimbursement for services provided to those patients which, though minimal, is better than no reimbursement and possibly having to write off those account balances." Since October 2013, the number of Medicaid-approved individuals has more than doubled in Grand County, according to numbers from the county Department of Social Services. Between October 2013 and August 2014, enrollment increased from 988 to 1,957. The amount of revenue KMHD receives from Medicaid has increased in turn. In May 2014, revenue from Medicaid was $324,352, up from $105,982 in May 2013. Hank Shell can be reached at 970-887-3334 ext. 19610.

Middle Park Medical Center selects new medical records system

Middle Park Medical Center will pursue a new electronic medical records system with Centura Health, its managing health care system. MPMC's board of directors chose Centura's Epic system at its Oct. 29 meeting after leadership made the recommendation. Previously touted as the best option for MPMC, joining Centura's system will give MPMC staff improved interoperability with many Front Range facilities that patients frequent, said MPMC Chief Operating Officer and Chief Information Officer Trampas Hutches. "Obviously, it made more sense to go with Centura," Hutches said. Though a cost hasn't been agreed upon, Hutches said the final cost would be around $1.3 million, down from the previous estimate of $2.1 million. Centura hasn't yet brought its own 16 hospitals onto Epic, but plans to do so in three waves, the first being in May 2016. MPMC will be the first manage affiliate hospital to implement Centura's software and will do so in its own separate wave in September 2016, Hutches said. Staff has expressed frustration with Healthland, MPMC's current EMR software system, which they say functions poorly. The system hasn't been updated since 2008. In many instances, doctors said they had resorted to scanning and faxing medical records to other facilities for lack of an adequate EMR system. The new software will also improve MPMC's billing system, which has been a recurring issue in its financial reports. MPMC executives had considered a number of other options including cloud-based EMR systems and Epic software with health care systems other than Centura. MPMC leadership grappled with finding a system that was both optimal and could be implemented quickly. Epic currently has around 53 percent of the market share nationally, and joining the system will mean MPMC can share records easily with any hospital in the world, Hutches previously told the Sky-Hi News. Though Centura's Epic software was the optimal choice, the timeframe of implementation was a concern for MPMC leadership. Centura officials had expressed doubts as to whether MPMC would be able to go live in one of the system's first waves, saying they didn't want to subject MPMC to the troubleshooting that comes with implementing new software. But MPMC staff made a successful presentation to Centura leadership in September, Hutches said. "Our physicians were there to voice their concerns and those kinds of things and that really impressed them so they moved it up quite a bit," Hutches said. MPMC must complete negotiation contracts with Centura before it can implement the software, Hutches said. Implementation should take six months after it starts. MPMC has also hired an Epic specialist to assist with implementation. "I think it's just a big win for us to be able to come down to an organization that big and be able to convince them that we're really state of the art with out infrastructure, and we're able to take this type of a project on," Hutches said.

Middle Park Medical Center OK’d for federal loan

Middle Park Medical Center has secured a $24 million loan from the U.S. Department of Agriculture and averted the possibility of receivership. The Kremmling Memorial Hospital District Board of Directors officially accepted of the loan at its Sept. 24 meeting. The department will use the loan to pay off the $22.4 million left on the certificates of participation issued to finance MPMC's Granby facility. "This is a huge step forward for MPMC, our staff and ultimately, the quality of care for all of our patients," said MPMC CEO David Ross in a press release. "This removes the distraction of receivership and lets us focus on making Middle Park Medical Center the premier critical access hospital in Colorado." The loan, issued through the department's Community Facilities Direct Loan Program, has an interest rate of 3.6 percent, much lower than the 7.1 percent that MPMC pays on its current certificates. The organization will save about $481,000 per year with the new loan, said Charles Ervin with Dougherty Mortgage LLC. MPMC hired Ervin to help process the loan. MPMC will pay about $1.2 million per year on the new loan, which is amortized over 35 years. The approval marks the end of a tumultuous financial period for MPMC, in which the organization defaulted multiple times on debt incurred to build its $20 million facility in Granby. MPMC failed to make a November 2013 payment on the debt, causing the trustee to dip into its reserve funds and triggering an event of default. MPMC triggered an additional event of default when it failed to replenish the reserve funds. U.S. National Bank Association, trustee for the bondholders, filed a motion in March seeking receivership of MPMC's assets. In that motion, the trustee made additional claims of default. After news of the loan approval broke, the motion was withdrawn. During negotiations earlier this year, board members expressed frustration with what they said was the bondholder's unwillingness to cooperate. During the Sept. 24 meeting, Ervin pointed to the paucity of covenants attached to the new loan as evidence of the department being a less overbearing lender. MPMC CEO David Ross agreed. "I think USDA is a more friendly, personable and collaborative partner than our existing bondholders," Ross said. Jeremy Anderson with USDA said the department was willing to negotiate with MPMC regarding any restrictions on the loan. The USDA would also like MPMC to consider it as a lender for future projects, Anderson said. "I can tell you that we are really interested in making sure everything goes well for the guys for the next couple of years because we've seen the feasibility analysis, we've seen the appraisals, we know you have future needs," Anderson said. "We don't want you to be in a position where future needs are hard to address. We'll probably be able to be there before other lenders are willing to get in there." If MPMC chooses to incur additional significant debt in the future, USDA would like to be involved in those discussions but wouldn't be restrictive, Anderson said. Possible future projects could include improving or replacing MPMC's Kremmling facility, Ross said. MPMC hopes to officially close on the loan on Dec. 1. In the coming months, Ross said MPMC will focus on expanding its specialty clinic services including orthopedic surgery and ophthalmology. The organization will also work on community outreach. "We just want to get out in the community more and be a healthcare system that the Grand County community is proud of, and that includes improving our billing," Ross said. MPMC pursuing Centura medical records system MPMC is currently working with Centura to find an agreeable price and timeframe for joining Centura's Epic electronic medical records system, Ross said. Centura is transitioning to the system next year, and Ross said MPMC hopes to be part of the first wave of facilities to implement the system. "We appreciate our relationship with Centura, and we want to be more clinically integrated with them," Ross said. MPMC staff has expressed frustration with the organization's current EMR system, which they say is dysfunctional. MPMC is a considering other options including a cloud-based system, but Centura's system is the ideal choice, Ross said. Ross said he hopes to get a final recommendation to the board at its Oct. 29 meeting and have a new system in place by the end of 2016.