A Rude awakening

On Aug. 7 it was announced that Health Management Services (HMS), LLC. would be taking over management of the Platte Valley Medical Clinic. This came on the heels of the announcement that the Town of Saratoga would neither renew nor renegotiate their lease with Dr. Bryan Kaiser, who took over as provider following the departure of Dr. Dean Bartholomew.

HMS, a company based in Billings, MT., has managed the Saratoga Care Center for three years following a crisis that threatened to close the facility.

A tentative date of Oct. 1 has been set for the transition, according to HMS President Karl Rude, by both HMS and Kaiser. The Saratoga Sun spoke with both Rude and Mark Pesognelli, administrator of Saratoga Care Center, on Aug. 6, the night before the official announcement was made.

“We have a tentative start date on Oct. 1. Dr. Kaiser wanted me to use ‘tentative,’ so on or ‘about’ and he said if we were ready to go earlier that’s good and he said we’d have some leeway if it needed to go longer,” said Rude.

Is There a Doctor

in the Room?

With Kaiser’s lease not being renewed and HMS coming in to take over management of the clinic, many have wondered if that means the recently arrived doctor will be leaving no sooner than he arrived in the Valley. According to Rude, he is open to the idea of Kaiser continuing to see patients who have come to rely on the doctor in his short time here.

“We’re exploring what that transition will be like,” said Rude. “It’ll be based on him and us as we discuss further and watch that go. He is open to the idea. I think the biggest thing is patient continuity and making sure the community feels like there’s not a gap in service. To that end, if it can work that way that would be fine by me.”

Another announcement made during the Saratoga Town Council meeting, and one that has raised more concerns and questions, was that the clinic would not have a full time doctor on day one of HMS taking over management of the facility. This has left people to wonder if the Valley would have a full time doctor at all under HMS.

“The ideal is full time doc (doctor), that’s the ideal. What we’re looking for is a blend, though, that suggests something that’s a sustainable operation. I want to make sure that what we build as a business model works,” Rude said. “If a provider, doctor provider, is available to cover the time and if the patient load can justify the expense of a doctor to cover the time and we can break even and make profit, then I’m absolutely good with that.”

Rude added that his intention is to have a conservative start and build relationships with entities in town that could support the clinic as it moves forward.

“I don’t want to start at a point where I’m dependent on other sources of revenue to support a business model that I built to be unsustainable. I want my expenses to be smaller than my revenues because that’s just how you build sustained businesses. Everybody else in the world has to do it that way and I think healthcare should, too,” said Rude.

Access to Healthcare

Yet another announcement, among the multiple that were made on Tuesday night, was of the founding of a steering committee that would work towards the funding and construction of a Critical Access Hospital (CAH). According to Rude, this is part of a plan by HMS to increase medical access to residents of the Valley.

“The goal that we have in mind is more healthcare services than the community has seen in the past,” Rude said. “We’ll be talking about new buildings, we’ll be talking about new services. We’re exploring possibilities of emergency departments, we’re exploring possibilities of a hospital, we’re exploring possibilities of better imagery, better laboratory services. That group will ultimately be the ones that guide HMS as HMS advises that group.”

According to http://www.ruralhealthinfo.org, the CAH is a designation that is given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS) and was created by Congress during the Balanced Budget Act of 1997. The intention of the CAH designation is to not only reduce the financial vulnerability of rural hospitals, but also “improve access to healthcare by keeping essential services in rural communities.”

“Historically, we’ve run hospitals for 35 years so we ran them before critical access hospitals existed. We were at the table discussing why critical access hospitals needed to exist when Montana created the model that piloted the federal model and then we’ve run them since,” said Rude.

HMS currently runs two CAH designated facilities. Crook County Medical Services District, one of the facilities, has three clinics based in Sundance, Moorcroft and Hulett. The other facility, which HMS most recently took over management of, is Niobrara Community Hospital in Lusk. Rude stated that, in both cases, HMS had been asked by the facilities to step in and fix them “financially and culturally.”

Since the announcement last Tuesday, it has been expressed by some members of the community that the construction of a critical access hospital seems to be a lofty goal. For one thing, how would HMS go about finding funding for such an endeavor?

“What I’m looking at in the community here is USDA Rural Development funding. There’s some grant funding available in smaller quantities to do exploration and feasibility studies because there’s a lot of intermediary steps,” said Rude. “You can’t throw the plywood together and make a lemonade stand. You got to have a government study that supports it, you got to have third party review, you got to have approvals.”

Healthcare and

Technology

Yet another concern expressed by residents of the Valley is what they see as a loss of experience with what has been seen as, essentially, the dismissal of Kaiser. While Rude stated that he would be open to Kaiser providing continuity for the clinic and he would ideally like to provide a full time doctor, the president of HMS also stated that this is where he believes technology can help as well by providing access to specialists.

“Telemed. That opens up a world of possibilities, too,” said Pesognelli.

So, what is telemed?

“It’s a Skype conversation with your doctor that’s enhanced by having all of the ability to process, technologically, your diagnostic info across a satellite. If you think about most of your interactions with a doctor, the nurse comes in and checks heart rate, blood pressure, temperature, all of those kind of things. The doc walks in and talks to you about all of the things that the nurse measured, maybe looks down your throat. You don’t need to sit in the same room as somebody to have a conversation,” Rude said.

Rude went on to add he believes the advancement of technology has reduced the need for attempting to recruit and retain specialists in rural areas.

“What we’re finding is, rather than bringing specialists at great expense to try and stay a long time in the community, what we’re actually doing is creating that technological interface that spans time and distance to cover those needs. There’s a lot of spaces where you can do stuff like that,” said Rude. “If you have access to their pool of technology, your community has access because of the technology.”

Apparent Transparency

Following the decision announced by the Town of Saratoga not to renew the lease with Kaiser, the concern of transparency was brought up in regards to the decision that had been made. This left many wondering how transparent HMS would be moving forward with their management of the clinic and their pursuit of a CAH.

“They should expect no disruption. For what we’re trying to plan, we’re running the operation the way it is. The access to therapies, the quality of care that we give, the facility and it’s operating condition that we have. They can expect no change from the status quo,” Rude said. “As we go forward, they can look to what it is that we’re doing alongside this new group of community members to see what the future will hold. Be it improvements in the building that we’re in, a new building that we want to move into, increased access to all the different services that will be a part of the plan.”

Rude added that Valley residents should expect “full transparency” as HMS moves forward. This includes, according to the HMS president, town hall forums for feedback, open meetings and discussion of the formative finances “as it’s appropriate to release those things.”

“I think it’s going to give the community opportunities they’ve never had before. It’s always great to be able to afford that kind of increase in service level to the community. Having lived here for 10 years, I love this town. I’m committed to it, I’m not going anywhere,” said Pesognelli.

This is a developing story and the Saratoga Sun will continue to keep you updated. The Sun encourages questions, concerns and comments in the form of a letter to the editor.