Jacob Cintron is truly a product of El Paso.
Cintron grew up in Central El Paso in one of the poorest neighborhoods in the nation, earned three degrees from the University of Texas at El Paso and is now the top executive at one of the city’s busiest hospitals.
He was born at Providence Memorial Hospital in El Paso. He worked his way through college, changing light bulbs and painting at the county hospital. For the past six years, he has been CEO of Del Sol Medical Center.
The hospital, located on the Eastside, is one of two in El Paso owned by Nashville-based HCA Healthcare, the largest for-profit hospital chain in the country with 165 hospitals. The company also operates Las Palmas Medical Center in West El Paso.
Cintron, 58, and his two siblings were raised by their mother near Thomason Hospital, now University Medical Center.
“I had a strong grandmother and strong mother. Regardless of how little we had, they taught me a strong work ethic,” Cintron says.
He started working at Thomason when he was a junior in high school and stayed there for 17 years. It was more than a job, he says; it was like family. Coworkers there taught him to drive and executives later encouraged him to go to college.
Cintron has since earned a bachelor’s degree in industrial engineering, a master’s degree in accountancy and an MBA from the University of Texas at El Paso.
His plan was to go into engineering, but he loved working at Thomason and decided instead to stay in the health care industry, eventually becoming associate administrator at Del Sol.
Cintron held executive positions at three major health care systems in Chicago, San Antonio and San Diego, before returning to El Paso to become CEO of Del Sol in 2007.
The Tenet-owned Sierra Providence Health Network, which operates four hospitals in El Paso, had just opened a competing hospital in Far East El Paso.
Cintron says his first job was to reengage with the doctors at Del Sol and reevaluate the services the hospital was providing.
The hospital has been growing, and Cintron says it now has the highest market share in El Paso. It has won a number of awards and is now a Level 2 trauma center, which means it can handle any type of trauma patient and multiple patients at one time.
The hospital has 347 beds and employs nearly 1,300 people, including about 400 physicians and 589 nurses.
Cintron is on the boards of the United Way of El Paso, Greater El Paso Chamber of Commerce and Emergence Health Network, as well as UTEP’s Advisory and Centennial Campaign boards.
He also chairs the board that operates the local Health Information Exchange – an electronic medical record-sharing network. The exchange is in its infancy but, when finished, will be a way for local health care providers to exchange health information electronically.
Cintron and his wife have a daughter who is 7, and four sons ages 15, 22, 24 and 31.
He sat down with El Paso Inc. and talked about the business of health care, recruiting doctors, the new health care law and HCA’s plans for El Paso.
Q: Where is the hospital focusing its investment now?
We want to continue to grow our regional presence. A lot of the Southern New Mexico hospitals may, for example, be in smaller cities and may need help enhancing their services.
The second area is making sure we continue to maintain a strong alignment with our physicians and our patients in El Paso. And as a consumer, the things you are going to look at are not just cost. It is going to be the accessibility, the convenience, the kind of care you receive.
Q: Many hospital chains nationwide, and El Paso is no exception, are investing in stand-alone emergency departments, urgent care centers and health clinics. Why has Las Palmas and Del Sol mostly stayed out of the fray so far?
A couple of reasons. You have to be very cautious about where you open these centers and exactly how you do it. So, for example, some health care systems have opened up urgent care centers that compete with physician-owned urgent care centers but charge more because they are hospital-based. So families go there thinking it’s an urgent care center like any other, and they find themselves with a large bill.
When you’re doing urgent care centers you also have to keep in mind where you are placing them and how that relates to existing urgent care centers that your physician partners may also have. Typically, you want a patient to go to their primary-care physician. Urgent care centers are popular after hours when doctors offices are closed, or are helpful if you need something immediate but it doesn’t require an ER visit.
Q: Why do you think there is all this investment in the health care market in El Paso now? Besides these stand-alone emergency departments and urgent care clinics that have popped up around the city, Sierra Providence Health Network recently announced it is investing $120 million into its hospitals and University Medical Center is investing $152 million. And then there is El Paso Children’s Hospital, which isn’t even two years old.
Some of it is just the need to maintain medical facilities here, but then you also have investment in new technologies. So, for example, we invested in a high-tech system that uses magnets to guide a probe to the part of your heart that has a murmur to be able to take care of it – the only one in El Paso. We are currently investing in a hybrid operating room that will include a cath lab.
One reason we might be seeing investment is people are looking at health care reform and the prospect of more people getting some kind of insurance coverage. It’s well known that El Paso has a large percentage of uninsured.
With the size of our population along with Juárez and Southern New Mexico and the area’s large Hispanic demographic, it’s not only a great hub for providing care but also for research. So I think El Paso is going to be a very strong attraction to a number of different organizations.
Q: How many use the emergency room at Del Sol?
At our emergency department here at Del Sol, we’ll probably see about 70,000 to 75,000 people this year. But we also have a fast track at our emergency room that operates like an urgent care center.
We are looking at urgent care centers and freestanding Emergency Departments and are evaluating possible locations and quantities. As you know our community growth is going to be Far East, Eastside and the Lower Valley areas.
Q: How seriously?
Q: Can we expect any announcements soon?
I can’t tell you. When we’re allowed to say, we’ll let you know. We’re very close. Very, very close.
HCA invested $7.6 billion in capital statewide, $29.5 billion nationwide, in 2012. They are investing in a number of cities in the state of Texas.
Q: You mentioned about 70,000 people will use the emergency room this year. Can you put that in context?
It’s been stable. That’s about how much we average every year. There is more and more of a push to go to a lower-cost model. For example, if you come to the ER because you have sniffles, when you look at what the ER service provides as a Level 1 or Level 2 trauma center and all the resources there, that is a lot of dollars for sniffles. Really the goal is getting the patient in the right level of care for the need they have.
Q: How does HCA Healthcare view the El Paso market? Is this a strong market for the company?
Remember, HCA is the largest private hospital system in the nation – about 165 hospitals nationwide, 43 hospitals in Texas. What I like about HCA is they know their markets well. They’ve always been supportive of El Paso. They’ve always made the investments in El Paso related to capital growth, physician recruitment and have supported various programs for the El Paso market.
Q: How many physicians has the hospital recruited in recent years?
I would say, in the last maybe 10 years, 70 to 100. All of the hospitals in town do a physician needs assessment every two years that determines what specialties are needed in the area and it is no secret that El Paso has a physician shortfall.
The challenge then is how do you attract people to the city who may have not grown up here? Some might argue we’re not an Austin, we’re not a Denver, but here’s what’s amazing. If you get them down here, they choose to stay here because we’re not an Austin, and not a Denver. They look at the weather, the closeness to ski resorts, the beauty of the mountains, the culture.
I’ll tell you, one of the biggest sources of physician recruitment is word of mouth. We recruited one physician who has brought us about five or six from the East Coast because he loves it here.
Another is Texas Tech and the school of medicine – physicians who complete their residency and fall in love with the city and decide to stay.
You’ll find that physicians don’t get into this for the money; they get into it for the cause. It’s a calling.
Q: What did the hospital’s most recent physician needs assessment find? In what areas are you focused on recruiting?
There is always a need for certain specialties, but we also have a need on the primary care side – your internal medicine, your family medicine physicians. So, for example, our needs assessment for the primary service area says the region is short about 120 to 130 doctors.
What does that mean? It means that our doctors are very busy. When we recruit doctors we tell them the biggest challenge you’re going to have is deciding when to limit the size of your practice so your quality of life is maintained.
The other thing about El Paso is my grandmother kept her doctor until she died. My mother kept that same doctor until he died. Word of mouth and physician loyalty in this culture is very strong.
Q: What is the greatest challenge for hospitals right now?
One challenge is the Affordable Care Act and its rollout specifically. It is a potential benefit for the community here in El Paso. There are a lot of moving parts though, so people are just waiting to see how things settle out.
The website problems are going to get worked out, but the key then is making sure that eligible El Pasoans are getting signed up for these new health care offerings.
The United Way of El Paso County obtained a grant to hire “navigators” to help people sign up for health insurance. That was supported by Sierra Providence, Las Palmas Del Sol and UMC. If anything, we need to look at how we can boost that support a little more to get more people to sign up.
Q: More people signing up means more insured people and more insured people means more paying patients.
Well, not only that, though. Keep in mind that private hospitals in the state of Texas provide more uncompensated care than public hospitals.
Q: How much does Del Sol provide?
We averaged from January through November about $190 million in charity bad debt and uninsured discounts – an average of about $17 million a month. HCA, in the state of Texas, averaged about $3.89 billion total.
Here’s the idea I want to correct. Yes, it’s great that we can get more people insured. Yes, it’s great that there may be some reimbursement where there may be none today.
The reality is I have never seen a doctor, I have never seen a nurse, that would say, “Well, because they don’t have insurance, we really don’t want to provide care.”
Q: It’s no secret that the U.S. spends a lot on health care. Why are the prices so high for even some basic procedures?
You have to look at a number of things. Look at the cost of a physician going to medical school and the kinds of loans he or she has to pay back.
Look at the risk of litigation. Fortunately, Texas has tort reform. But how many doctors practice defensive medicine simply because of the fear of getting sued?
The regulatory requirements can be high. The cost of technology. I mean, you can spend, if you take into account construction, anywhere from $3 million to $4 million on a cath lab.
You also have to look at what the hospitals really collect. I was talking to Congressman Beto O’Rourke about it yesterday, because he had talked to a VA patient that had a high bill from one of the centers. But regardless of what that bill says, it really comes down to what the payer has agreed to pay. We might get paid 15 or 20 cents on the dollar.
For example, you hear the horror stories about overpriced aspirin or a box of tissue. You don’t get charged for that. There is normally a set fee that is negotiated. The insurers have negotiated rates that are fairly constant hospital to hospital.
Doctors are under a lot of pressure from reduced reimbursement rates. It means they either have to see more patients or they have to quit seeing a certain type of patient, so they don’t lose money.
What you’re seeing with health care reform is that reimbursements are being reduced to all the providers whether it be research organizations, pharmaceuticals, manufactures, hospitals, physicians. We are all having to adjust to a lower reimbursement model.
Q: Blue Cross Blue Shield of Texas and HCA have been at odds over reimbursement levels. Their contract expires Dec. 31. If that happens, people with Blue Cross would have to pay much higher out-of-network fees at Del Sol and Las Palmas hospitals here. What is the latest on the negotiations?
The contract with Blue Cross and Blue Shield was renewed on Thursday, ensuring that Blue Cross members will continue to have access to high quality care at our hospitals here. Negotiations like this are not unusual. We were simply asking to be reimbursed at the rate Blue Cross Blue Shield already reimburses others. They are a good partner.
Q: A union now represents registered nurses at Del Sol and Las Palmas. They are some of the first nurses in Texas to vote for union representation, although some other El Paso hospitals have followed. What are your thoughts on that?
We work well with our employees and didn’t feel there was a need for unions. But our employees voted, and we respect the process.
We still have great relations with our employees and their liaisons. Without them we wouldn’t be who we are. They are the cultural fabric of our facility, and we are proud of that and always will be.
Email El Paso Inc. reporter Robert Gray at firstname.lastname@example.org or call (915) 534-4422 ext. 105.