Presbyterian Healthcare Services and its affiliated companies have 13,000 employees, nine hospitals, approximately 1,000 health care providers in 50 specialties, and a health insurance plan that covers 650,000 New Mexicans. With about $5 billion in combined annual revenues, it is the state’s largest private employer – or at least is neck and neck with Walmart for that distinction.
But it’s highly unlikely the man in charge of making sure those numbers add up, President and CEO Dale Maxwell, would be in the job today if he hadn’t gotten kicked out of PE class on the first day of his senior year in high school and ended up in a class with a teacher who still holds a special place in his heart.
“Math was my strong suit, and I always thought I wanted to be an engineer. My dad was an accountant, so I didn’t want to be one. Then I got kicked out of PE, and the teacher who took me into her classroom was Mary Louise VanBuskirk” – affectionately known as “Mrs. B” to a generation of Silver High School students. She died in 2019, and her obituary talked about how she taught students not just accounting but also the “debits and credits of life.”
“She was an amazing teacher, and I fell in love with accounting,” Maxwell said. “I went to New Mexico State University, enrolled in the business school and got my degree.”
It set him on a path to run New Mexico’s biggest company.
Maxwell, 55, took the reins as Presbyterian CEO in 2017, moving up from chief financial officer when CEO Jim Hinton left to run a hospital/health care system in Texas. It was always going to be a big job, and then it got a lot more complicated when the COVID-19 pandemic hit in March.
Preparing for a surge of COVID-19 patients, medical providers around New Mexico were ordered to severely limit “non-emergent” procedures from mid-March until June.
“We took a big financial hit,” Maxwell said. “Everyone did. Our revenues dropped by 45% overnight. The cost of supplies went up 5 to 10 times. The supply chain completely broke down.”
But he thinks Gov. Michelle Lujan Grisham made the right call.
“It was a tough, fast decision but looking back I really think stopping elective procedures was absolutely the right thing to do. Health care across the nation needed a pause to understand the virus, to make sure we had enough Personal Protective Equipment for the workforce and to try to manage for the volume of patients that potentially could have come into health care.”
New Mexico’s problem was complicated by the relatively low number of hospital beds and ICUs.
“We have a low supply so when the models started coming out and we saw the rate of spread and hospitalizations it was easy to see we could be overwhelmed. Thankfully we never were.”
Visiting Presbyterian’s main administrative campus adjacent to Albuquerque’s Balloon Fiesta Park for this interview – socially distanced and then some at a big conference room table – was reminiscent of a science fiction movie where everybody is just gone.
Typically home base for about 2,200 Presbyterian employees, perhaps 50 now come into the office. On this day, the only people we ran across were two people who were logging folks in and taking temperatures. Some of those logging in had stopped by to gather office stuff to take home.
Maxwell doesn’t envision many employees back on campus until the end of March 2021 – then adds that he thinks that may be too optimistic.
“Our workforce is doing well from home and in some cases (claims processing and billing for example) is actually more productive,” he said. “So there are a few areas of the organization we might never bring back.”
“So yeah, it’s a lonely building. I come in most every day. The parking lot is empty and I miss seeing people’s faces.
“But it’s a little bit of normalcy to get up and drive in to the office. Then once you get here you’re reminded of the atmosphere we are in. It’s kind of surreal.”
Maxwell has a unique perspective on this once-in-a-lifetime pandemic.
“I look at this pandemic as a gift to health care. Historically this has been an industry where the patients meet health care on our ground. Where I hope this pandemic takes us, and what we’ve seen in the last six months, is now health care systems are having to meet the patient where the patient wants to receive care.”
“Historically, you would have to call up and make an appointment and show up at a clinic to see your physician. Today, when appropriate, we can take care of you over your phone. By e-mail. By video.”
Maxwell knows providers can’t do it all by phone.
“There has to be a balance. In certain cases, a video visit is not going to meet the needs of the patient and it’s not going to give physicians the information they need. We are going to have to find that balance.”
Maxwell ticks off examples of how he says Presbyterian is coming up with new ways to meet patients’ needs.
⋄ Hospital at home. “You get admitted to your house instead of the hospital and we take care of you with home health nurses and physicians.”
⋄ The emergency department navigation program that coincides with the new PresNow facilities. “We can connect individuals to primary care physicians who will take care of them for a lifetime while an emergency room visit just takes care of that particular episode.”
⋄ Complete Care, a program to manage elderly patients on Medicare. “It’s taking care of that population in their home and giving them dignity.”
Maxwell won’t say why he got kicked out of PE except that maybe he was “having a little too much fun.”
“We moved to Silver City from Bisbee, Arizona, when I was in the fourth grade. It’s small, and I loved growing up there. Maybe the downside is everyone knows your mom and dad and in certain situations you would be grounded before you even got home. But it was a place where the community watched out for one another.”
His mom was a nurse.
Dale played football, basketball and baseball at Silver High – back when players wore jerseys to school on game day.
He is still an athlete.
“I used to run and do triathlons but my body revolted,” he said. “So I just went to cycling. I love endurance mountain bike racing but have had zero opportunity to do those races this year. I miss it because it’s a release for me. You have time to think and you learn a lot about yourself when you push yourself beyond what you think you can do.”
He is married to Paige. His daughter Emily, 25, is finishing up her Ph.D. in physical therapy and stepdaughter Phoebe is a senior in high school.
Maxwell is United Way of Central New Mexico campaign chairman this year – joking that he picked a terrible time to do it in the middle of a pandemic-inspired economic slump.
But he quickly adds, “There is probably not a more important time for the community to marshal those resources.”
Maxwell moved to Albuquerque in 1988 and got a job with an accounting firm.
After he joined Presbyterian, the chief financial officer position opened up. Maxwell wanted to apply but didn’t have the required master’s degree.
“So I went back to school at an older age and got my master’s from Seton Hall. I did night school, online from afar while I was working. My daughter was young and it was tough. I worked a ton then (would) go home, try to have dinner with my family, put Emily to bed and do school work until 1 a.m. Then get up at 5 a.m. and start my day. I did that for two years.”
Eventually the CFO role opened up again. This time, Maxwell got the job.
Maxwell readily concedes that in many ways health care is a mess.
“Part of the problem is the transparency of what things cost. Health care is built around a single billing number. But for the same service Medicare pays us one amount; Medicaid pays a different amount; and in commercial contracts with health plans you have negotiated rates. You bill all of them the same and there are discounts off of that for what they actually pay.”
“A health care system has to calculate what it is actually going to get paid and build its business on what you get paid for and not what you actually bill.”
He says when people talk about “Medicare for All” they are talking about a single cost structure for offering services within that coverage.
Would that eliminate private insurance?
“If you look at other parts of the world that have universal health care you will find they have some sort of supplemental private insurance. Every country rations care in some form or fashion. It’s unrealistic to say everyone can have everything right now.”
COVID-19 cases in New Mexico are way down from their peak. So are COVID hospitalizations. Mortality rates are dropping nationally as new treatments emerge and more young, healthier people contract the virus.
So what lies ahead?
“Right now we are just below 100 percent capacity in our hospitals,” Maxwell said. “We have switched to all private rooms right now given the nature of the virus.”
But “it’s a worry as we try to predict what will happen when respiratory distress season hits; when flu season hits. And if the virus behaves differently in winter months … We’re going to have to dance through the winter months knowing we might have to put in place additional mitigation measures.”
But he is not in favor of shutting down the country.
“You can shut things down and the transmission goes away but as you open up the virus is still there and it’s going to come back. It’s this constant ebb and flow of trying to balance virus and the health of individuals with overall economy.”
“Until we have a vaccine, we’re going to be playing this game.”
He is optimistic about an eventual vaccine’s effectiveness, provided the virus doesn’t mutate.
“With flu they are guessing. If COVID stays somewhat stable maybe we’ll have a higher effective rate. We could have six to seven vaccines. What is their true effectiveness rate? How long does it take to vaccinate the population.”
It’s complex, he said, adding that it could be six months after a vaccine is available to have enough immunity to fully open things up.
New Mexico is a poor state, with around 50% of the population on Medicaid, which pays providers less than commercial insurance. That affects both the number of hospital beds and New Mexico’s chronic physician shortage – something Maxwell doesn’t see “getting any better in the near future.”
“Recruitment to New Mexico is difficult due to low payment environment, high rate of crime and challenges in our education system. We are working more closely with the University of New Mexico Medical School to find ways to retain graduates in state and we need to continue to be creative in how we use nurse practitioners and physician assistants.”
As for more hospital and ICU beds, Maxwell says the focus has been on managed and community health care to prevent unnecessary hospital stays. “We have limited resources and don’t have the luxury of building and maintaining excess capacity.”
That said, Presbyterian has embarked on building a new $230 million hospital tower and parking structure on its campus at Interstate 25 and Central. It will add another 144 private patient rooms.
Presbyterian has grown from a small tuberculosis sanatorium founded by the Rev. Hugh Albert Cooper in 1908; Maxwell says the underlying purpose hasn’t changed.
“It’s to improve the health of the patients and communities we serve.”
“Unfortunately, today’s health care institutions often take care of the patient at that catastrophic event. So as I look to the future, the only way we are going to get at that total cost is if we can go upstream and start to address some of those factors before that event happens.”
And it needs to get easier for patients.
“It’s impossible to navigate the system. We have to simplify it so the consumer doesn’t have to worry about which specialist to see, how to get in and which tests need to be done and how much is it going to cost.
“The way I try to think about it is any patient walking into Presbyterian should be treated like a CEO and be hand-held from start to finish. We’re a long ways away from that.”
Daunting, for sure.
But the way Maxwell looks at the world, “There has never been a barrier in front of me that I didn’t think I could get over. That’s kind of how I think about life.”