Healthcare, take III

The Healthcare Sustainability Project (HSP) subcommittee held their third open meeting January 16 at the Platte Valley Community Center to provide updates on the state of healthcare in the Valley and take questions from the audience.

Staff Updates

After subcommittee member Will Faust welcomed everyone to the meeting, Karl Rude of Healthcare Management Services (HMS) reported that there had been success with recruiting another nurse practitioner who had signed a contract that starts March 1. He added that Emma Bjore, a senior and aging specialist and medical doctor, had been making her first visits to the Saratoga Care Center and the Platte Valley Clinic. Rude then announced that W. Michael Comly, a retired physician from Ivinson who currently works at the free clinic in Laramie, would begin to make visits to the clinic starting with two Mondays a month but hinted that more days might be possible. Rude, stated that both physicians had agreed to be available for appointments via telehealth services.

Rude then said that, at this point in time, there is no full time physician who has yet agreed to move to town, but added that HMS has been using several different recruitment agencies to try to bring a physician in. Rude continued that he felt using nurse practitioners and technology would give the community the most access to healthcare for the least cost for the time being and that HMS was looking to be good stewards of monies spent in assuring quality healthcare.

Veteran Interest

HMS administrator Mark Pesogelli reported that representatives from the Veterans Administration (VA) had visited the care center recently and were in the process of putting the facility into their system. While the representatives were at Saratoga Care Center, Pesognelli took them over to the clinic and said the representatives were very interested in providing veterans services at the clinic. As an extension of that visit, talks have begun to see if there is a possibility to use GlobalMed (a telemedicine service used by the VA) to provide veterans services in Saratoga.

Tele-Benefactor

Rude then said a private benefactor to the Corbett Medical Foundation had allowed the Platte Valley Clinic access to new telemedicine technology and said his organization was very grateful for the gift, which allowed the clinic to purchase the telemedicine equipment.

Critical Access

Faust then updated the audience with information that the subcommittee had been working on an engagement letter with BKE (an accounting firm) to perform the first phase of a feasibility study for a Critical Access Hospital (CAH). Faust continued that members of HSP would be touring several newly-constructed CAHs in Montana to get a feel for the operations and check out the facilities. Faust hoped to bring back information gained on the field trip and a BKE representative for the next HSP meeting.

First Time Charges

Rude then went into the current billing situation at the clinic. Rude said this had been going smoothly now that the clinic was accredited, but that because Platte Valley Clinic was listed as a new clinic, new patient bills were being sent to patients. Some administrative fees of $86 each for entering new patient history information has been sent out, but Rude said these would not be charged because he had committed to not charging patient record transfer fees. Rude added that these fees should be paid for by insurance, but that these charges would be passed until March 1. After March 1 new patients will receive these charges.

In order to avoid these charges, a patient who has requested a records transfer should call and see if the clinic has received those. If a customer had not had a request fulfilled, the clinic has the forms required to file a complaint with the Wyoming Board of Medicine. Patients were also advised to stop by and fill out a short patient history form before the March 1 deadline to avoid the “new patient” charges.

The Search Goes On

Audience member Keith Bailey asked if the search for a physician was being hampered by the time of year, graduation or resident cycles or just Saratoga’s location.

Rude replied, “Likely there are cycle issues as far as finishing residencies … some of it is I am trying to be very very cognizant of the money we are spending as we are going into the build of this business model, I want to be very, very conservative about the way we are spending money so that we can have sustainability going into the future. I know that the Corbett Medical Foundation is committed to help with the salaries as it pertains to physician recruitment. We want to make sure we are being good stewards of capitol, so the right professional for the community–I am interested in. It’s not about speed, it’s about appropriate selection.”

A question was then asked if HMS was looking for physicians solely in mountainous regions or nationally. Rude replied he was looking at mainly medical schools with reciprocity through Washington, Alaska and Montana and others because of familiarity of culture. He added that there is another locator they are using that is nationwide, but that neither search had thus far produced a viable candidate. Subcommittee member Teense Willford added, “We want someone who wants to live here and become part of the community.”

Nurse Practitioners & Telemed

Pesognelli revealed the clinic was now seeing around 25 patients a day which was deemed good for a clinic with one nurse practitioner (NP) and two registered nurses. Pesognelli added and that the incoming NP would almost double that capacity. Rude said he felt good that the new NP had visited in January and loved the winter, the remoteness and the town itself .

A audience member asked. “If what I am hearing correctly, you’re saying right now if you need a medical doctor, chances are you’re not going to get it in Saratoga because you have a one in seven chance of the doctor being in when you need the doctor.”

Administrator Pesognelli replied, “ I wouldn’t say that. What I would say is we have nurse practitioners in the building right now. Dr. Comly has committed to us to take the time via telemedicine which will give you the opportunity to see not only the nurse practitioner face-to-face, but also be able to remote in to a doctor. When I say ‘remote in’ to a doctor, I would like to clarify that a little bit. It’s not merely sitting in front of a video screen and waving at a doctor. This particular technology gives you the opportunity to plug in different tools; for example a stethoscope. The doctor would have a nurse right there with you. The nurse would be able to put the stethoscope on you and the doctor would be able to hear across the technology exactly what is going on—just as if the doctor was sitting right there with you.” Pesognelli continued, “They can do EKGs that way, they can do ECGs that way, they can do eye, nose and throat that way. This technology is pretty phenomenal.”

Rude spoke to the question also, saying, “The other thing is, I would like to address the phrase ‘need a doctor.’ Our nurse practitioners can practice almost to the fullest capacity of a medical doctor. They can do so, if need be, by consulting MDs and DOs. The quality of care you are getting from the NP is on par with what you are expecting from a physician. Historically, because of the way the medical profession has worked, we are very used to the idea that only a doc can do this for me. That just absolutely is no longer the case. Training for NPs is, today, better than what MDs were probably getting 20 years ago. The practice that they can have is incredibly comprehensive.”

Mike Foley later added, “Just of note, national surveys now show that nurse practitioners have a higher satisfaction rate than physicians.”

Specialists

Rude said he had had conversations with several specialists he would look to bring to town and said that, while he was hesitant to name names during the negotiation phase, a qualifier Rude held out was that the specialist would also do family practice care along with their speciality. Rude said one candidate was encouraged by the talks he had been a part of.

Flighty Response

When asked if life flight possibilities would be available, audience member Karron Bedwell with the South Central Wyoming Emergency Medical Service (SCWEMS) said that everyone in the SCWEMS coverage area had been covered with Classic Air Medical, a life flight service, with a base in Rawlins. Bedwell said that, while Classic Air membership cards had been sent out, anyone in the coverage area had access to the service and that service was started with a 911 call that met the criteria for airlifting a patient.

Health at Home

When discussion of home health services arose, Rude said, “I am desperately close to being able to make my home health announcement. We get closer and closer every day. Home health will be something that will be available shortly.”

Fair Enough

Among other topics, it was noted that local health fairs are coming and that they are a lower cost way to get information to local healthcare providers. Saratoga will be having their health fair from 6-10 a.m April 24 and 25 at the Platte Valley Community Center and Encampment will hold theirs the same hours April 26 and 27 at the Encampment Opera House.

Next Meeting

The next healthcare sustainability meeting is set for 5:30 p.m. on Wednesday, Feb. 13 at the Platte Valley Community Center. Rude invited anyone with questions or concerns to attend.