Back and forth at HSPS meeting

The largest turnout yet was seen at a Healthcare Sustainability Project Subcommittee (HSPS) meeting held Wednesday, May 8 at the Platte Valley Community Center to hear about a proposed Critical Access Hospital (CAH) and ask questions of the presenters.

After introductions of the subcommittee and speakers present, the approximately 65 people present watched a video describing the present and possible future situation of healthcare in the Platte Valley. That video is available on www.plattevalleyhealthcare.org.

BKD Update

Subcommittee member Will Faust then provided an update on the BKD (financial consultants) Phase 1 financial feasibility study. Faust said the results were available on the website, but that, in a nutshell, the results of Phase 1 of the study were favorable for the construction of a CAH and a contract between the Corbett Medical Foundation and BKD had been completed to begin Phase 2. Phase 2 of the study is expected to take between four and six weeks.

Survey Results

Faust then presented the results of the Healthcare Survey which indicated a high degree of local interest in the topics of lack of sustainable healthcare, access to childcare/after school programs, increasing information about available services, having a full-time doctor, local healthcare providers, cost of care, nearness to a medical facility and a range of responses on where and how people have used healthcare.

Comments made on the survey seemed to be of the "staff the clinic before we even start to think of the hospital," and "the community cannot staff and support the clinic we have now, much less a multimillion dollar hospital" variety.

The HSPS has explained, as chronicled in previous articles in the Saratoga Sun, that using the CAH model allows more funding to be available for staffing and expanded services.

Other comments were in the vein of either a praise or condemnation of the people involved in local healthcare.

The survey results and comments are available on the www.plattevalleyhealthcare.org website.

Questions

and Discussion

Audience member Steve Nicholls asked if the CAH model requires a medical doctor and what happens if we cannot get one for some reason.

Health Management Services (HMS) President Karl Rude explained, "It requires 24 hour access to providers, so mid levels or doctor-the preference being doctors. What it makes available is the funding necessary to recruit them to effective wages. So, the difficulty we have had thus far is not necessarily been having contact with doctors, but as we get to that wage negotiation side of things, what I have got to offer is about 60 cents on the dollar to what they are used to making."

Niccolls then asked if the CAH Medicare program allowed Saratoga to get up to a competitive wage. Rude replied that yes, those government programs allow that additional funding.

Kim Hytrek, former home healthcare business owner, asked about duplication of services and how sustainable the CAH model was.

Rude replied that those questions were exactly what the study being done by BKD was looking into as far as what services could be sustained profitably and added that the difference between a CAH and a competitive model is that Medicare would pay significantly greater than what would be available in a competitive business model.

Rude continued with the hypothetical operational costs, "Say it costs $10 million dollars year for us to exist. To pay for all the things we do as a facility costs us $10 million dollars a year. They look at us and see that 70 percent of our patients are Medicare patients. They will pay us 99 percent of $7 million in the following year. So that is that anchor point of sustainability. Not that we are dependent on revenues to compete with other businesses, but that the government is paying us what we spend to service those customers."

Audience member Henry Hewitt, representing himself as a former board member for Memorial Hospital of Carbon County, pointed out that the 99 percent reimbursement only applied to Medicare patients and that there would also be a percentage of people who could not pay mixed in with those whose insurance would pay adding that a hospital cost for services would be higher than a clinical cost.

Rude allowed that statement was possible saying "Hospital based services are always more expensive than clinic services ... but clinic services in our clinic will still match the clinic service expectation."

Pam Meyers then asked why we could not go back to having a great doctor in town and work on making our county hospital a good one.

Saratoga Care Center Administrator Mark Pesognelli replied that time was an important factor in treating critical situations to positive results and that having a CAH would help bring our tax monies back to the area.

Competing with

Rawlins?

HSPS board member Teense Willford added, "There is a misconception- the word 'hospital,' you think of a huge facility. We have to use the word 'hospital' to qualify for federal funds. It will be 22 beds, like for a nursing home, and 4 beds for critical care. Don't get the misconception we are building a huge hospital. And we're not competing with Rawlins hospital at all."

Hewitt interjected, "That's not true."

Faust added, "I'd say we are (competing) in certain aspects. There are a certain number of emergency cases, especially, that are going to pass right through here or we are going to be the closer place for some people. I think the question here is: 'is that better for the people in the Valley?'"

Former Memorial Hospital of Carbon County board member Hewitt then stood up and made several statements including "The days of ... people that want to be in business for themselves and own their own medical clinic are done. They come out of medical school and know better."

Hewitt stated that the problem hiring doctors was not the money, but the workload a doctor faced in a small community saying no doctor wanted to "sign a contract to die, and that's what happens to 'em when they go into a little town, and they're the only doctor in town, and they just work 'em to death."

Hewitt said he had been concerned with healthcare in the county all his life and had worked to make the Rawlins hospital, which is now a CAH, financially solvent saying that the CAH there had a $12 million reserve when he left.

Hewitt said that his concern was that if this gets done (the Saratoga CAH) it could hurt the Rawlins hospital.

Hewitt concluded his remarks saying, "I believe the Community Access Hospital project will fail."

Audience member Mike Foley replied to Hewitt saying, "First off, I'd like to point out that, no disrespect intended, but what happens in Rawlins, does not affect healthcare in the Valley here. What we are talking about is an ER visit and an ambulance ride. A matter of five minutes as opposed to a matter of 40 minutes assuming the roads are open. Now, that concerns me. I could care less if that affects the bottom line of Rawlins. What matters to me is the life of my loved one."

Number two, I think you may have a misconception on the actual Critical Access hospital as it's formed here. The Critical Access Hospital mandates no more than 25 beds. We're talking five bed hospital with the nursing home enveloped into it for those other 20 beds, so there's your income. The revenue streams are there. As far as a doctor goes, my best friend is willing to come here for the agreed upon dollars that they are talking now-he is jumping at it. And it is a matter of dollars. It is also a matter of a stable environment-which is what that hospital does."

Foley continued by saying a clinic had to rely on contributions and income where the CAH uses a federal program to guarantee a revenue stream while providing a nice new location for physicians to work in.

Willford added, "The road was closed 70 days last winter on I-80, so you couldn't even get to the Rawlins hospital-that's something else you need to take into consideration."

Nurse Practitioner at the Platte Valley Clinic, Susan Foley, stood to say, "This is not about trying to hurt the Rawlins hospital in any way. I have a great relationship with the doctors that I have worked with there. They have been very supportive. The plain reality is that, geographically, we are isolated. As much as I would love to say 'let's beef up that hospital and make it great,' but if you can't get there-and I had, just a couple of weeks ago during one of those storms, I had somebody sitting in our clinic for five hours trying to get them to a hospital that could meet their need with an issue that could have cost them to lose a limb. To me, that's unacceptable."

Foley went on to say she had worked in both small and large facilities around the region and said, "It is an ugly, ugly environment for healthcare in rural communities. The federal government is doing things to try to help and bolster getting us access, because access is the problem for us. Access to Rawlins, unfortunately, is always going to be 40 minutes away."

Faust added that the subcommittee had looked at CAHs in Montana that were similar distances away from other hospitals and added that some of those were as close as 30 miles apart-and that those had worked.

Program Longevity

Margaret Weber asked what the longevity of the mentioned government repayment program was expected to be. Rude replied that these programs were a staple of healthcare in quite a few flyover states since 1996 and that hospital administrators in these areas would be sure to have a say in a change of legislation, but that operators had to be nimble in negotiating any possible changes.

Current Progress

The panel was asked what was currently being done to improve healthcare at the clinic and Pesognelli replied that, since HMS began their own clinic in the Platte Valley Community Center, they have since taken over the Platte Valley Clinic, added a second provider, added telemedicine capabilities which include nephrology and rheumatology specialists, found a geriatric specialist to come to the care center/clinic once a month and is currently engaged in talks with other physicians.

Pesognelli stressed that he was also a local and very concerned with making the clinic as good as is possible.

Alternatives?

Hewitt, again, urged the board to look at alternatives including adding an emergency room to the clinic to be available when the roads were closed. He continued with concerns about having a CAH without a profitable line, like surgery, and said the clinic really needed to affiliate with a hospital like Ivinson (Laramie) or Memorial (Rawlins) and that those affiliations would help with recruiting doctors. He added that the nursing home should also be saved separately and added that, "My problem is why, if I fall and break a leg or I'm in an automobile accident, why take me to a ER that doesn't have a hospital that can treat me?"

Rude replied, "We'd be able to treat that, and secondarily I can't get Rawlins to call me back. I have been calling for a year-nobody there wants to talk to me. We vetted those ideas. The standalone ED-Critical Access Emergency Departments-has not yet been funded through Medicare. We have been exploring that-it has been part of the studies-to talk about whether we can put that stuff through. We have vetted idea after idea after idea-I'd like to welcome you to your first meeting-but we looked at things extensively."

Audience member Randy Raymer asked Hewitt that, since Hanna had a clinic that was affiliated with Memorial Hospital-and that since that affiliation was supposed to help bring a doctor to Saratoga full time-how often did the Hanna clinic have a doctor there?

Hewitt replied, "At the most a couple of days a month. " He then added, "We could run a bus out there to get the people cheaper than we could have a doctor there."

Randy Raymer later added, "I attended a council meeting last night where a councilman actually said it as simply as can be said. Councilman Wilcoxson looked as his fellow council members and said, 'Everybody wants a good doctor. That model is dead. It is gone. It has left the building. It is not coming back.' So there isn't any more Dr. Lunt, Dr. Noton, Dr. Bartholomew who will come back to this community ever again no matter how much money we have or what we throw at it. There has to be a complete change and a completely different look at this whole situation-or we are not going to have a clinic. We will be down in Hanna where Henry (Hewitt) said they'll send the bus down."

More People in the

Valley

Nancy Jansa then pointed out that the area was due for an influx of population including 250 people coming to work at Brush Creek.

Faust added that the board had been working on census data that was about as long in the tooth as is possible, but that it would be interesting to see what the upcoming census would bring.

Ownership

Wendy Barkhurst asked who was going to own the CAH and if HMS had a stake in building the facility.

Faust replied that the 501(c)(3) would own the facility saying, "There's a couple of reasons for that. One, if it's town owned-which town? We got three towns in the Valley. If HMS owns it, how is that any different than the gun they have to our head right now? It is all of ours, it needs to be a board that is representative of the Valley."

Barkurst then asked who would be on the hook for the multimillion dollar USDA loan.

Rude explained that the 501(c)(3) board would be in charge of the money aspect, but that the USDA would oversee repayment of the non recourse loan. He added that if the operating management company failed to make the CAH work, the USDA can call on other operators until it works. Rude said, "We've (HMS) been one of those operators they can call when things fail. In fact, as a company, that's pretty much what we do. Things blow up and we get a phone call from some state and they say, 'You want to come here?' That's how I ended up in Saratoga."

Rude further explained, "This process has been defined so clearly by USDA because of that. It's their money that they put out to us."

Barkurst also asked if there was a contract with HMS to be guaranteed the management position of the CAH.

Faust replied, "Absolutely not."

Barkhurst then inquired what, if any, stake HMS had in building a CAH.

Rude replied, "Right now, it's my outlook to see this endgame, if it's sustainable, come to fruition. If it isn't, and this is where Will says we have a gun to our heads ... if there is no future other than what I have got here, I have some very heavy decisions to make."

Another audience member, Rocky Fiedor, clarified the point asking, "Even though he (Rude) is in the process of assisting put this together he has no guarantees he could be dismissed from that position the day after it (CAH) opens."

Faust and Willford chorused, "That is correct."

Faust continued, "The 501(c)(3) would own the hospital. The rank and file employees will work for the 501(c)(3). That includes part of your billing department, your doctors, your mid-levels, all the way down to maintenance staff. But we won't, in our community, have skilled CEOs of hospitals. It is just not a skillset that we have. Now, if that person moved into our community, the 501(c)(3) could conceivably hire that person. But we don't have them right now."

Living Decision

Rheyanna Powell pointed out that as a mother of three it was important to have emergency care closer than 40 minutes away and continued saying that she had been in conversations with people who did not want to live in Saratoga due to the clack of critical care and added that people also leave here for that same reason.

Nursing Home Beds

Sandy Streeter asked what the current occupied bed count was at the nursing home. After Pesognelli said the number was at 27 Streeter asked if the 21-22 beds envisioned for long-term care could be expanded.

Rude said that currently the local residents numbered around 21 but that Pesognelli currently sought outside patients for the nursing home which would not be sought after in the CAH.

A Facebook observer asked what would happen when more senior care beds were needed once those 22 beds were filled.

Rude said, "That's hard stop. There's 25 beds allowed in a Critical Access Hospital ... Those (additional) residents would be referred to nursing homes outside of town."

Rude continued that, "Utilizing home health so that we could keep people in their homes more than coming into the facilities, that should cover some needs."

Timeline

Another Facebook observer asked what the timeline for completion of a CAH was.

Faust replied that the BKD study needed to be completed first and that Phase 2 would take four to six weeks and Phase 3 would take an additional three to four weeks. After that, a fundraising campaign would be engaged to come up with the 20 percent the USDA construction loan did not cover.

Rude added, "The goal is as fast as is responsible."

Rude then said his hope was have the CAH project completed by the end of 2021.

Siting

Rude then presented a slide show highlighting six locations the HSPS was looking at around Saratoga on which the CAH could be built. Those six were listed as: 1.) The Church and Current Medical area; 2.) Kathy Glode Park; 3.) South River and Pine Streets; 4.) The Hot Springs Location; 5.) The Airport Business Park; and 6.) The Library Area Lot.

Rude did say there were a few other sites being looked at but that those were dependent on dealing with the private property owners.

Strengths and weaknesses of each location were discussed including whether utilities needed to be added or moved, cost of land, access and other considerations.

The Saratoga Sun will go more into depth on site selection as soon as more information becomes available.

Next Meeting

The next HSPS meeting is scheduled for 5:30 p.m. on Wednesday, June 12 at the Platte Valley Community Center.