Moving forward despite risks

At a meeting Wednesday night at the Platte Valley Community Center, about 35 people showed up with questions about the Platte Valley Clinic and its future.

The Healthcare Sustainability Project Subcommittee (HSPS), which is now a subcommittee of the Corbett Medical Foundation (CMF), answered those questions after giving an overview of current operations at both the clinic and the Saratoga Care Center.

Board member Will Faust opened the meeting by introducing the other members on the panel. Joining Faust at the head table were; Leslie McLinskey, Teense Willford, Sonja Collamer, George Haigh, Karl Rude, Mark Pesognelli and Mike Glode. Subcommittee member Ron Hawkins was not present for the meeting.

Faust moved into the meeting by presenting the mission statement for HSPS which is to "support and make recommendations to the Corbett Medical Foundation during the medical clinic administration transition period and to explore options to ensure long-term sustainable healthcare in the Platte River Valley." After the mission statement, Faust noted that the people selected for the subcommittee were specifically chosen for their different background and varying locations in the Valley so that a variety of voices could be heard.

Faust turned the meeting over to CMF president Mike Glode for comments. Glode introduced board members present and updated the assembled on what CMF was doing. Glode said that Health Maintenance Services (HMS) had been selected to run the clinic early on and had negotiated their transition subsidy. Glode continued by saying that, until HMS can be certified to do Medicare/Medicaid billing, CMF will be covering the expenses for the clinic. Glode also made a point of saying that CMF had also subsidized the outgoing Dr. Kaiser up until he left the clinic and added that CMF had added into the new lease that HMS is required to bring in a full time physician.

The meeting was then given over to president of HMS, Karl Rude. Rude began by giving a little background on HMS operations, saying that the company already was running the Saratoga Care Center along with various other rural health care services in Montana, North Dakota and Wyoming.

Rude said he had been late to the meeting because he was having a last-minute conversation to close a commitment from a new medical provider. He then introduced FNP Susan Foley, who is currently the health care provider at the clinic along with her husband, Mike, who has been helping the clinic with technological infrastructure issues.

Rude said that he had been transferring staff from the care center to positions at the clinic and that meant he had had to hire new positions at the care center.

Credentialing And

Sustainability

Rude continued, stating that the clinic is a fully functioning clinic as defined by the state of Wyoming. Rude added that, though the clinic did not have CMS (Center for Medicare/Medicaid Services) credentialing yet, that did not mean that the clinic is not a licensed, insured healthcare provider.

Rude said that the clinic was working through an arduous process that can take between 30-120 days and that they were at about day 32 already.

The CMF has decided to take up the slack until the clinic can be credentialed and are paying employees salaries until such time as credentialing occurs.

Rude assured the crowd that there will be little or no breach of continuity of care capability through this transition time.

Rude continued, "As we get our credentialing in place there are numerous procedures that we'll have to go through to then get more credentialing-other pay sources that we can get money going-these things take quite a bit of time. All of that is about making the business model sustainable-none of that is about making the healthcare we provide anything more professional than it already is, we are operating up to the expectations of the state of Wyoming for clinic providership."

NEW DOCS

Rude added that HMS was still in the process of working to find a full time physician and that he had been working through his connections and offered to listen to any leads the public may have.

Rude then announced that he had reached an agreement with Dr. Emma Bjore, who currently works out of Laramie's Ivinson Hospital. Bjore is a geriatric specialist who has agreed to be the medical director of the nursing home, Rude said Bjore would also be seeing patients at the clinic on Fridays and Saturdays. and that Bjore was one of only three Gerontologists in the state of Wyoming.

Rude concluded saying that HMS, "is putting together a very comprehensive suite of very professional providers. We have very professional providers with Susan already in town here. We have a few more that are joining us shortly."

The meeting was then turned over to questions from the audience.

MEDICAL NETWORKING

Rude was then asked by an audience member about relationships with other existing medical facilities.

The answer Rude gave was, "Healthcare, as an organization, always marches to the individual voice of the patient. All of the laws are geared towards patient preference. So anywhere that any patient that comes into the clinic, would want to be directed to receive further ongoing medical care we can facilitate the transition of medical records, expertise and conversations that follow that patient."

Rude continued, "If you come to a point where you have a medical concern based on x, y, z diagnosis, our providers will know there's a couple of people in the region that are best at that. If you are talking with Susan about that, she can say 'you need a pulmonary specialist, I know there's somebody good here, I know there's somebody good here, I know there's somebody good there.' and if you choose any of those we will be glad to get those medical records to them on time for your next appointment."

Rude also stated, "Patients have the right to direct their care wherever they want to go. If you choose to continue to see local providers or you want to go see other providers we will always facilitate the transition of your care and your records to those locations at no charge to you."

Previous Care

Center owner

Rude was then asked if he had any relationship with the previous owner of the Saratoga Care Center. While reticent to make that connection, Rude did say that he had a five-year lease on the building which is still owned by the previous operator.

Credentialing and Billing

Audience member Kate Sherrod asked what the timeline was for credentialing asking, "Do you have a timeline for when you are going to credentialed for Medicare/Medicaid and private insurers at all? Because the foundations pockets are not bottomless and they are sustained by community donations. So we are going to be paying you two times basically."

Rude was quick to say, "No. I don't get paid at all."

Sherrod further queried, "The Foundation doesn't get billed until this is worked out?"

The reply was, "Nope. The Corbett Foundation is paying the salaries of all the employees in place all the other operating expenses are me."

Sherrod continued, "I'm talking I come on in for an appointment and I get a treatment or a prescription or whatever. I still have to pay you or my insurance company does."

Rude explained, "Your insurance company won't pay and I'm not asking you to pay. You'll pay a copay up front, whatever the copay is according to your insurance plan and then the rest of that will be forgiven."

Rude then continued, "I don't have a deadline on that and mostly because CMS won't give it to us."

Rude also described some of the difficulties HMS had encountered in getting the CMS credentialing but said he quickest he had seen was 30 days and the longest was 120 days.

At that point Faust interjected that, "This is something that in the early stages with HMS that we were fully aware of. It's something that every new clinic has to go through and so in those talks with the foundation and HMS happened very early on knowing that this is the case."

Name Change

Sherrod noted that the name of the clinic had changed from the Plate Valley Medical Clinic to Platte Valley Clinic and asked why this was so.

Rude said that he was starting a new clinic and he could not retain a name already used.

Sherrod noted that she had had problems in the past listing unknown providers on insurance forms.

Rude replied, "That's why I'm not billing for services. Because right now if you came in and we reported this to your insurance and I sent you a bill for the services, they would say 'who the heck is this?'"

Personnel changes

Sherrod said she has seen some of the nursing home staff moving to the clinic and wanted to know if some of them would be coming back to the nursing home.

Rude said he was not looking to bring them back and had already staffed some of those care center positions.

Rude then introduced Sandy Mink as the new director of nursing and Stephanie Ponich who is the new assistant director of nursing at the Saratoga Care Center and said he was very excited to have them.

Further

Credentialing

Rude was then asked if private insurance credentialing was the same as CMS credentialing. Rude replied "It's a second process. Medicare and Medicaid will pay us once we are credentialed. Once we have that other providers will recognize us as a pay-worthy facility." Rude then used the example of Blue Cross/Blue Shield. Rude said after CMS certification, Blue Cross/Blue Shield would ask for details about providers. Once the insurer has that information there is a typical 90-day process before a new clinic is recognized as pay-worthy. Rude said that process would be the same for every insurer and that those details would be required for each medical provider in place and for every new medical provider.

Records, Transfers,

Deletions

Asked about medical record keeping, Rude said the clinic would be using the Athena medical record program which is the same program that was used by the previous clinic. Because this is the case, the new clinic should have access to some limited access to the previous patient records.

Rude was then asked about the cost of medical record transfers with the questioner noting that Dr. Kaiser was requiring $20 a person to transfer records. Rude said a patient could stop by the clinic to fill out a short record request form and they could get the records transferred for free.

Rude went into the record keeping systems that had been used in the past including paper and electronic records. He went on to say that,"there was an electronic health record called Amazing Charts that was held on the network server," and continued, "that network server was wiped of all of its contents prior to me taking over the building." Rude said he hoped there was a backup somewhere and that he was working to get that backup.

Rude did say that if you request a medical record from any provider that you have a medical record with in the last 10 years we will be able to go get that-and we will do that free of charge.

Faust joined the conversation saying that he had filled out the form for his family's records to be transferred in about one minute but said the most common question he had run into was the timeframe or time limit on having those records transferred.

Rude said the outside limit was 30 days and after that time a complaint would have to be made to the Wyoming Board of Medicine.

Rude encouraged anyone concerned with their records to stop by the clinic.

REPAYMENTS

Faust asked if the clinic could back charge for Medicare/Medicaid once the clinic was credentialed. Rude answered "yes" and said that there were a couple of different government providers that once you got credentialing you could bill for those services provided during the credentialing review period. Rude added that those amounts would be donated back to the CMF up to the amount that the foundation had donated in recognition of the commitment CMF has made.

When asked if that could be done with private insurance Rude said "No. Private insurance will not do that."

PRESCRIPTION

REFILLS

Another question asked was about whether another clinic visit would be required to refill current prescriptions that had run out. Rude referred that question to FNP Susan Foley who said, "because of the number of people and only one provider being available, call your pharmacy and tell them you need refills. As long as it has not been over a year when they needed the prescription, I will do 3 months. That should give us time to get at least another provider on board and then we can start seeing people for their regular annual exams, check their blood work-all the kind of stuff we need to do to really be able to manage your medications well. But I will give you a three month stretch."

HEIRARCHY

Rude was then asked about the chain of command at the clinic and who people would have to answer to.

Rude responded saying, "The Platte Valley Clinic is a privately-owned business enterprise by myself and my wife. So at the end of the day I, as the president of Health Management Services, am the ultimate vote on what occurs at the clinic." Rude went on to add, "The business end management of the clinic is going to be done under Mark Pesognelli. Mark is working to make sure the billing office is attacked, that the patient experience is good, that our receptionists are on point, that our contracts are managed-anything do do with business in fact." Rude quipped, "Mark is not much of a doctor." adding, "So medical care goes to the medical providers. The highest education level medical provider typically becomes the medical chief-of-staff."

In terms of heirarchy, a medical doctor would be at the top with a FNP (Family Nurse Practitioner) who can provide independent care is next with a PA (Physician's Assistant), who requires doctor's oversight, being next and so on down the nursing staff.

TELEHEALTH

Another audience member asked if the clinic would be willing or able to incorporate telehealth for those with specialty needs.

Rude responded immediately, "Yes." adding, "Modern healthcare is provided to its best with telehealth. That is urban, rural, anywhere. The specialists that you need and you want are typically available through telehealth and we will make that happen."

Rude elaborated that, "Today we received a contract from a company called Nighthawk out of Florida. Nighthawk is a specialty radiology firm that also does telehealth. Our radiology readings are going to be done through Nighthawk. That's a kind of a beginning to that. We are also looking at GlobalMed which is one the VA uses. It is a very comprehensive program that has an access to a huge network of specialists. We have contact with the Wyoming Hospital Association and a few of the CEOs in different hospitals that are trying to build their own network of experts that would be at least Wyoming local networks." Rude concluded, "We will have those in place. We want you to get the specialty care through that. We are going to be a top med clinic for special instances."

When asked if a patient could continue to see a specialist they currently have, wherever they may be, Rude replied, "Let me know who they are and I will make sure they are on the top of the list."

HOME HEALTHCARE

When asked if there was a future possibility for home health care. Rude smiled and said, "Yes. Soon." then elaborated, "Home health will be something that's available to any of the facilities at HMS ... there was a lot of concern and consideration at one point and time talking about assisted living. I don't know how viable that is. I think home health is the better end of the spectrum to focus on."

CRITICAL ACCESS

HOSPITAL

Rude said he was really excited about the possibility for Critical Access Hospital which is currently envisioned as having an emergency room staffed 24/7 and a fully-equipped laboratory with lab and imaging equipment. The facility is also envisioned as having a few beds so longer term care could be taken care of locally.

Rude said CMS and the United States Department of Agriculture (USDA) would cooperate to fund a rural hospital and said that HMS had taken actionable steps towards that goal. Rude then pointed to several similarly funded projects HMS had taken on around the region.

Moving forward

despite risks

When asked if possible changes in federal healthcare legislation made him anxious, Rude said that yes, everything in his life-school notes, house payments, kids that I am raising-is reliant on the "knuckleheads" in Congress.

Though constantly aware of the perils involved Rude said, "Hail can come and yet they plant fields. Plague can come and yet they raise cattle. Financial crisis can come and yet we invest. It could go terribly wrong because somebody makes a change on us. But we have to move forward despite the risk."

Part of moving forward is not a blind acceptance that this is the only thing we are going to build. We have outside companies that will help us evaluate us. It is not just 'trust Karl,' it is 'trust the group of people that are here as a board,' it is 'trust Karl as a healthcare provider,' and 'trust these outside third party companies that we have engaged to write the plan and bring it to a conclusion.'"

Rude also gave several other possible hospital/emergency room models that may be possible and the Saratoga Sun will report on these in more detail as those decisions are made.

UPCOMING MEETING

The next open meeting of the HSPS will be 5:30 p.m., Wednesday, Dec. 12 at Platte Valley Community Center.