Col. Michael Amaral

 

So far, the Army has spent close to $200 million overhauling health care at Fort Bliss. But more than $1 billion is still to come.

Col. Michael Amaral will oversee much of that spending in his job as William Beaumont Army Medical Center’s new chief of staff.

Amaral uses the word “challenge” frequently. The greatest of them all, he says, is recruiting physicians, and he has personal experience as to why.

The Army convinced him to take the Beaumont job by telling him he could come here in 30 days, or retire in six months.

“My first reaction was to ask if there was any flexibility on that retirement offer,” he says, brutally honest.

But Amaral visited El Paso and fell in love with the city. He has only been here five months, but says he may just stay and retire here, at a later date.

But convincing others has been a challenge, he says, and recruitment is slow.

About El Paso and Fort Bliss, he says: “I had all these preconceived notions, and it’s turned out that I’ve been wrong about everything.”

Amaral grew up in Massachusetts, and the large Red Sox banner in his office leaves no doubt where his baseball allegiance lies.

He graduated from Norwich University in Vermont, with a bachelor’s degree in biology, and earned a master’s in health administration from Baylor University.

Most recently, he worked in the TRICARE regional office in Rosslyn, Va., and also worked with the Army’s substance abuse program.

Amaral, who wouldn’t give his age but talked a lot about retirement, spoke with El Paso Inc. in his office at William Beaumont Army Medical Center. He kept one eye on his Harley-Davidson motorcycle parked just outside his office window.

He talked about recruiting docs, Fort Bliss’s baby boom, who shouldn’t come to the ER, and how the Army plans to spend $1 billion.


Q: There’s a baby boom at Fort Bliss?

Yes, and that is an intentional thing. We’ve been planning this out for a while, but we didn’t expect it to really hit until April. Troops are coming back from theater, and soldiers do what soldiers do when they’ve been apart from their family members for a year.

We just opened a Level 2 Neonatal Intensive Care Unit that’s fully staffed. We brought on an excellent neonatologist and neonatal nurse practitioner. Before we had to refer a large number of our expectant moms Downtown (to civilian hospitals) because they had some level of risk in their pregnancy.

We had great success with our network partner down there, referring about 30 patients a month, but we’ve decreased that to 3 or 4 a month. You are not going to get better care anywhere in town than you can get here at Beaumont, and we are trying to market that to the expectant moms.

Q: How many births?

We have had 53 births so far this month, so we are on target to have about 120 births this month. Ultimately, we think we have capacity for about 160 births per month.

Q: How much of an increase is that?

February was the first month in a while that we broke 100, and that was a short month. Normally, we were staying in the high 80s or low 90s range. So, in essence, we think we can almost double our capacity.

Q: How many visit the Beaumont ER room?

Approximately 185 people daily. We get anywhere between 12 percent and 18 percent of the city’s trauma cases.

Q: How many ER visits are for non-emergency issues?

About 40 percent of the people who show up at the ER here could have been seen by their primary care manager.

Q: Wow. What problems does that cause and how has Beaumont responded?

First of all, the patient is not getting the continuity of care they get by seeing their primary care manager.

There is not a good system right now, especially if they go Downtown, to communicate that episode of care to the patient’s primary care manager.

We are trying to improve that by getting patients an appointment with their primary care manager as a follow up to that ER visit.

Another challenge is the cost. A ballpark figure of what an emergency visit costs, and this is from my previous job in Virginia not Beaumont figures, was $900 per visit.

Those patients could go to an urgent care clinic in Downtown for about $90 a visit and get the same treatment.

We also have what we call a quick care clinic now. You’ll hear in civilian hospitals about “fast tracking” patients.

They come in, they get triaged, they don’t need emergency care, and so they send them to a primary care capability to get their treatment. We developed that here.

But if our beneficiaries go Downtown to the ER and are “fast tracked,” the billing still comes in at the point of entry to the hospital, even though they are just getting primary care treatment.

We are trying to work with our beneficiaries, but there isn’t much we can do because there is no incentive for them not to go Downtown.

Q: After a decade of war, I imagine the Army has gotten really good at treating trauma.

We rely very heavily on our trauma treatment in the ER to help train doctors for what they may experience over in theater. Conversely, the things they experience over in theater, where you are in a much more raw environment, is training them better for when they come back here.

I’ll tell you, some of the cases that our docs have brought back from the edge – I’m getting goose bumps just talking about it. Seriously, these doctors are just phenomenal at what they do.

Q: With the massive growth in the soldier population here, has recruitment and maintaining optimal staffing-to-patient ratios been challenging?

Yes, recruitment is difficult. Generally, El Paso is underserved medically, and now that I have been here, I don’t know why people don’t want to come to El Paso.

I’ll tell you, I came to El Paso based on a “report to El Paso in 30 days or retire within six months,” and my first reaction was to ask if there was any flexibility on that retirement offer. It has never been on my top 10 list to come to Fort Bliss.

And trust me, I’m definitely learning I’m not the only one, now that I am trying to recruit. But the thing is I had all these preconceived notions and it’s turned out that I’ve been wrong about everything.

First and foremost, I thought that El Paso equals Juárez and there is no difference. I flew down here to interview, and shortly after I got here, they announced El Paso being the safest city in the country again, which put those worries to rest.

I love this community. I live up in the Northeast and I love the area up there. I’m dead serious. I asked the chamber of commerce here recently if there was anything I could do to help them advertise how great El Paso is – give me a 15-second spot and we’ll put it out on national TV or something.

This is the best assignment I have ever had, and I’m not just saying it because you are recording this.

Q: You’re converted, but what are the staffing needs now and how are you attracting physicians here?

I haven’t cracked the code yet on recruiting. What I am trying to do is get our providers to go to national conferences to talk about El Paso – the low cost of living, the low crime rate and the ultra-modern hospital that will open in 2016.

Q: What are Beaumont’s staffing needs?

Our greatest need is for behavioral health providers – psychiatrists, physiologists, social workers – because the U.S. Army Medical Department and the Defense Department have expanded those programs based on what we have coming out of the 10 years of war. There is a great need for those services, but recruitment is a challenge. For example, there was a position that both we and Fort Carson advertised – the exact same position just in different locations. We received two applicants and Fort Carson received 20 something.

Again, I am convinced it is the perception of the area. Fort Carson is also high-plains desert, but it is not a border town.

Q: Beaumont referred $57 million in care to the community last fiscal year. How much of that was related to behavioral health?

A good portion of it is.

We have a limited capacity here, especially in inpatient behavioral health, so we have to refer a lot of our soldiers to University Behavioral Health of El Paso and Peak Behavioral Health Services.

Every day we get a report on how many folks we have down there. There are a lot of these kids coming back from theater who have a lot of serious problems.

Q: Do you hope to expand behavioral health care at Beaumont?

We’ve got the capacity to do more. We expanded our psychiatric ward a couple months ago to 28 beds; the problem is we can’t staff them, going back to the recruitment issue.

We could effectively almost double our capacity in-house, which we prefer to do.

The civilian organizations provide great care, but it is a lot easier for commanders to come up here and visit their soldiers and a lot easier to stay in touch with what’s going.

Q: As construction starts, how much of the $1 billion needed to build the new Beaumont medical center is in hand, and how is the project going to be funded moving forward?

That one I’ll have to get you, but it is on year-to-year funding. In FY 2013, in the proposed budget, we did take a slight decrease in what our projected funding path was.

It doesn’t mean it is going to necessarily impact the project though, long term.

If that continues though, there is the potential of it getting pushed back.

Q: The July 2016 opening?

Yup.

Q: How concerned are you the date is going to get pushed back given the budget issues in Washington?

I’m looking at the $16-trillion deficit, and that makes me slightly concerned. I am not concerned about the new medical center getting built – it’s going to get built – it’s just a matter of the opening being pushed back 12 or 18 months.

Q: How many beds will the new hospital have?

It will have 135 inpatient beds.

Q: The current facility has 144 beds. With all the growth here, that seems counterintuitive.

Our average occupancy right now is about 85 patients a day. We’re very efficient at using our inpatient space. We’re not going to admit you for the sake of admitting you. The decision was made based on the population projection in El Paso and other planning figures that 135 inpatient beds was sufficient for our population.

Q: What are some of the unique features of the new Beaumont?

It is going to incorporate “smart room” technology, which uses radio frequency tags. My ID badge, for example, will have a radio frequency tag and each room will have a radio frequency reader.

The potential of that technology is that, when I walk in a room, the TV will show the patient who is walking into the room. It is also going to unlock the privileges for the doctor to access the patient’s electronic medical records.

It even has the capability to track hand washing. Hospital-acquired infections are always a concern, and the biggest challenge in preventing those is people washing their hands. Patients will also be able to order their meals through the interactive TV.

Q: What about the medical center’s energy use?

Gen. Dana Pittard, commander of Fort Bliss, is a big advocate of renewable energy here on post. As part of the design of this project, we looked at two specific elements.

The first was a water reclamation program. We wanted to set up a water treatment plant to convert any of the water coming from the hospital to gray water. A lot of people say, with the technology we were looking at using, that it was potable water.

But that is uncomfortable for people, so we were looking at the possibility of selling the water to the golf course next door for their sprinkler system.

But when they did the economic assessment, it was determined it wasn’t economically feasible or really needed for this area. They don’t have a shortage of gray water, but potable water probably would have been a different story.

Q: And that just grosses people out.

Yeah, it’s perception, “I’m drinking water that came out of a hospital.” But the other really cool piece that we are looking at is the possibility of using geothermal energy sources.

We want to drill down and see if there is a sufficient source of geothermal energy. It would be a huge energy savings for us, but it doesn’t just help the hospital.

There is not really the venture capital, somebody willing to spend the money to drill down and see if anything is there; but if we prove that there is a viable geothermal source down below El Paso, that expands it out to the entire city to start tapping into that renewable energy.

Q: Geothermal was picked over solar?

That’s correct. I asked the same question: “There are 300 plus days of sunshine here. Why not solar?”

The reason was, again, the economics of it. Solar technology today is very expensive. It was estimated that it would take about 42 years to get any return on investment, and that was just an awful long payback. The deal breaker is that energy is so inexpensive in this area. They are doing solar at Fort Irwin, Calif., because energy is so expensive there. I want to say their pay-off period was like 12 years.

Q: People have been talking about geothermal energy here for years. Is there anything concrete now?

Yes, there is a contract out for them to do the exploration for geothermal. There is going to be a well drilled to see if we have the source. If we have the source, we will use it.

Q: I commute past the intersection of Spur 601 and Loop 375 most every day on the Far Eastside. I see new ramps and massive tracts of flattened land there. What am I seeing?

What you are seeing is essentially the footprint of the new Beaumont. The water tower is built, and what they’ve started doing now is laying all the pipes. They’ve also leveled the surface and started to build some of the preliminary roads.

Q: What are the chances of El Paso getting a stand-alone VA hospital?

You’re asking me to break out my Magic 8 Ball and shake it up and read it? We would love for them to find the funding at the federal level to build a VA clinic adjacent to the new Beaumont. We have identified a footprint.

If they get the funding, I understand it will be plug-and-play, with all the utilities ready to go. Right now, though, that area will just be a fitness trail and some walking trails.

Q: Where will veterans in El Paso go to get their care?

The VA clinic next door here will remain functional until they get another building. Essentially, the biggest change if the new clinic isn’t funded would be the VA’s beneficiaries would have to be transported from the clinic here over to the new hospital to get their care over there.

We will still be partners and fully support them. It just won’t be as convenient for them to get services.

Q: Some are concerned that the level of service at Beaumont might not be maintained, as you get ready to close the doors and transition to the new facility.

I was at Walter Reed when there was a perception that they weren’t maintaining the facility because they knew it was going to close. That will not happen here.

This facility will be fully maintained, fully funded for maintenance, until the day I turn the key on that lock. There will be no degradation of services, and there will be no degradation of care. But when it comes to providing new services, as you get closer to closing the doors on a hospital, you need to make some decisions on what you are willing to invest in – the proposal to get a da Vinci device for example.

If we can’t do this until, say, next year and it is going to require a $2.5-million infrastructure upgrade to support it, we will have to make a business decision whether we wait another couple of years and have it in the new facility or we retrofit it here.

Q: Might you retire here?

Yes, El Paso is now on my list.


 

E-mail El Paso Inc. reporter Robert Gray at rsgray@elpasoinc.com or call (915) 534-4422 ext. 105.

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