Finances, survey discussed at healthcare sustainability meeting

The Healthcare Sustainability Project Subcommittee (HSPS) held an open meeting at 5:30 p.m. Wednesday, April 17 to give updates on their healthcare survey results, touch on the financial feasibility study and listen to comments and discussion from the audience.

Survey Update

Will Faust began the meeting saying the subcommitee had received 441 survey responses, which impressed the subcommittee. Faust reminded the audience that there were surveys in self addressed envelopes at several areas around the Valley. Faust also thanked fellow subcommittee member Sonja Collamer for inputting the approximately 70 paper copies which had been returned.

Faust declined to talk about specific results from the survey HSPS had received to this point since the survey will remain open until Friday, April 27.

501(c)(3)

Faust said that the HSPS had been looking into becoming non-profit 501(c)(3) oversight organization.

Faust continued that he, subcommittee member George Haigh and Corbett Medical Foundation member Dulce Schalk had been in contacts with lawyers to investigate turning the HSPS into a 501(c)(3) in order to oversee the Critical Access Hospital (CAH) if that indeed becomes a reality.

Faust continued that this was important so that the community, as represented by the board, would own the facility including fixtures and furniture.

BKD Update

HSPS member Haigh then said that he had been communicating with BKD, the accounting firm hired to do the financial sustainability study. Haigh said that BKD had been impressed with the support they had seen from the community.

Haigh reported that, during the first part of the survey, BKD had found that the throughput of patients in the area was enough to support a CAH. While those results were in, Haigh said he had not received "the juicy stuff" yet and that Phase 2 would be more informative. He also said that HSPS had given the go ahead for BKD to begin the second phase. Haigh later stated the second phase will deal with the financial modeling of all components as well as the assessments of key assumptions within the financial forecast. Also, in Phase 2, BKD will be looking at financial statements for the last three years in comparable facilities to what HSPS is trying to do. Haigh then said Phase 3 would be the full examination report, but that that phase was still several months away.

First Plans

The meeting was then turned over to Health Management Service President Karl Rude, who had some good news to share with the audience.

Rude said that, after talking with the members of the Office of Certification and Survey and the Wyoming Medicaid Offices, both of which are under the Wyoming State Department of Health, that approval had been given for the planned hospital to have 20 to 22 extended term care beds for use similar to the function that the Saratoga Care Center provides now.

The other features of the new CAH would be an emergency room, laboratory services, a radiology department for imaging, a clinic, a physical and occupational therapy area. Rude continued by saying there would be spaces available for visiting specialists to provide diabetes care, phrenology or whatever suportable needs arose. Also in the plans are a dietary and kitchen/cafeteria area.

Profitable Discussion

To open the discussion period, Rude said that the Saratoga Care Center had lost a considerable amount of money and had only begun to turn a profit for the first time in running the care center since it had shut down under previous management.

Audience member Karen Ouzts asked why a discussion of Rude's profits had any place in making a determination of what the community does as far as a hospital.

Rude responded that as a business, he needed to make a profit or at some point just decide to quit losing money in an area. That decision would mean shutting down the Saratoga Care Center.

Collamer added that the community had asked Rude to come manage the nursing home and even, recently, the clinic.

Audience member Mike Foley, husband of Susan Foley, cut to the heart of the matter saying, "I think where the misunderstanding is: I keep hearing people say 'well, we can't even sustain a clinic, how can we sustain a hospital?'" Foley continued, "There is a complete misunderstanding of how the two entities are run. So yes, we can't sustain the clinic, which is why we are going to the hospital, because the hospital is subsidized by the federal government--and that makes it able for a management company to come in and make a profit and stay, rather than pull out the clinic and then we have nothing."

Government Funding

Explaining why a CAH would be sustainable Rude said, "The reason a hospital would be fundamentally different is because of the term 'Critical Access Hospital.' Critical Access Hospital well, ultimately, is a business. It is a federal program from Medicare and Medicare has decided-and the federal government has decided-that healthcare is so important in rural communities that they will lose money hand over fist to make sure that rural communities have healthcare. The same way that the forestry department thinks it's important to have firemen to stop wildfires-the same way the federal government thinks it's important to have military to run our national defense. It is a top priority of Medicare as it engages rural environments, that you would have access to healthcare in this community. In so doing, the federal government is willing to pour money into these type of projects to do things like have a hospital in Saratoga. The reason we are moving in that direction is because without accessing this Critical Access Hospital program, at some point we'll have nothing."

Faust said he had been approached by several conservative persons who asked why Saratoga should take a government handout. Faust said he thought about that comment and decided to answer with the following: "We all just paid our taxes. Our taxes didn't go up or down because we could potentially have a hospital in town. What we are doing is what so many other small communities in America have figured out on how to provide healthcare and we are tapping into those dollars-if we aren't using them, somebody else will be."

Full Time Doctor?

Faust said that one of the themes noted in collecting the healthcare survey was the need for a full time physician. When asked if that would be possible with the clinic as it currently stands, Rude explained, "The price to get a full time physician is staggering and we had this conversation all over as we toured local hospitals.--Starting price on a new physician is about $330,000 a year to bring a physician to a community. I don't know that we will be able to offset that at the clinic. We will be able to offset that at a Critical Access Hospital because of the way that funding model works from the government program perspective. But to get a full time medical doctor in town and not ask me to go out of business or the community to just shove cash into the operation to pay for a physician to be here, it will not be possible under the circumstances we have seen or the physicians we have approached to have a full time physician until we can have a Critical Access Hospital."

Ambulance Help

When asked if an ambulance addition would be part of the CAH, Rude replied that, while a physical addition was not currently part of the vision that, "All of the ambulance service and its costs annually could be put on the cost report that is the document that the federal government uses to assign payment to us to stay open."

The upshot seemed to be that if the ambulance program was willing to join with the CAH that they would be reimbursed up to 70 percent of their costs throughout the year.

Rising Bills?

The question was asked if patient costs would rise with the creation of a CAH. Rude replied that prices would remain based on an area-based fair market assessment.

Editor's note: A Saratoga Sun employee was recently billed $376 for a new patient visit/physical including a $50 glycosylated hemoglobin test. Blue Cross paid $100 of that, leaving the patient with a $276 bill for the visit.

USDA Funding

When asked about the role of the United States Department of Agriculture (USDA) in funding the CAH, Rude replied, "The USDA will step in to help us fund the building of the project. They will hold a considerable amount of debt as we make loan payments against that debt for a very long period of time at a very ideal interest rate so that we can have this stuff happen." Rude continued, "They will ask of us annual audits to make sure we are being reasonable and responsible, they will engage us from time to time to have conversations with us about how we are performing according to their projections and expectations."

"In Network"

One audience member asked if CAH providers would be "in network" doctors, saying that she had heard of doctors "out of network" who charge a higher rate.

The reply to the question is that HMS has been working to be credentialed with every conceivable insurance company so that the healthcare provider would be recognized by their insurance company.

Staffing

When asked if how he knew he could fully staff a CAH, Rude replied, "That is based on experience that we have had in small communities as we develop new infrastructure. We work in small communities in many different states. I think people like working in nice places. They like working in places where technology is up to speed, they like working in places that look nice, that smell nice, that are contemporary. As we have built facilities all over the place (including North Dakota and Montana), when you have a nice, new, clean place to service patients and residents, well, when the patient and residents want to be there, then the staff wants to be there."

Platte Valley Clinic Nurse Practitioner Susan Foley stood to say, "I don't think people realize how many people drive right past the clinic to go to a job in Laramie or Rawlins who want to work here and we just don't have the capacity to employ them. I don't think we'll have any trouble staffing."

Networking

Toward the end of the meeting several audience members spiritedly talked about how they could spread the message and get more people involved in the meetings or the discussion in general.

Next meeting(s)

The next meeting of the HSPS will be at 5:30 p.m. Thursday, April 25 at the Grand Encampment Opera House. There is another meeting scheduled for 5:30 p.m. May 8 at the PVCC.