Asking and answering

A civil and amicable meeting was held Wednesday at the Platte Valley Community Center to further discuss the future of healthcare in the Platte Valley and surrounding areas.

The Healthcare Sustainability Project Subcommittee (HSPS) once again had Health Management Services (HMS) president Karl Rude on hand to both take and answer questions along with United States Department of Agriculture (USDA) Community Programs Director Lorraine Werner who spoke on USDA funding for a possible Critical Access Hospital.

The meeting began with HSPS board member and Saratoga Councilman Will Faust opening the meeting by giving an overview of the agenda and telling the assembled that the bulk of the meeting time would be allotted to audience questions and concerns.

Faust then added that the HSPS, in conjunction with the Corbett Medical Foundation, had engaged BKD, an accounting firm from Missouri, to look at sustainable healthcare research.

Faust also had those in attendance make sure they had filled out their emails on a form being passed around the room so that HSPS could contact those people with upcoming meeting information.

New and Expected staff

Karl Rude introduced himself as the runner of the Platte Valley Clinic, Saratoga Care Center and Laramie Peak Therapies which are current healthcare providers in town.

Rude introduced the six staff members who were in attendance at the meeting and thanked them for their hard work in getting the facilities back on their feet.

Rude stated he had been working to recruit midlevel providers and permanent medical doctor staff to the facility. He added that Emma Bjore, aging and geriatric specialist, had been added to the staff on a once-a-month basis at the clinic. He noted that Bjore would also be the medical director of the nursing home. Rude said that Bjore was currently going through credentialing procedures to get started at the clinic but that she had begun her duties at the care center.

On further staffing, Rude reported that another nurse practitioner, Ruby Ayers, was lined up to join the staff from Missouri and that he had been in talks with a retired regional medical doctor who had agreed to begin discussions with HMS.

Another angle being pursued by HMS was having discussions with a Christian ministry recruitment company that looks at bringing Christian doctors to medically underserved areas.

Credentialing

On the process of credentialing, Rude said, "I know there's a lot of complexities as to how the healthcare model works. We talked about some of those complexities in the previous meeting. One of the things I talked about was this credentialing process that happens though us getting our NPI (National Provider Identifier) number through CMS (Centers for Medicare/Medicaid Services) and how that's a huge hurdle for us to do."

Rude then announced, "We have accomplished that. And we have done so in record time. I've not seen anyone do it faster than we just did. Very impressed with the staff who has worked so diligently to accomplish that. So, we will be up and running as a full-service provider and will soon be able to bill as a healthcare provider. The free clinic days will shortly be going away but bring your insurance in and we will be able to continue to provide the service you know we can provide."

A Pass

Rude also announced that the administrator of the nursing home and clinic business manager, Mark Pesognelli, had just passed the grueling administrators exam and encouraged those who know Mr. Pesognelli to congratulate him.

Critical Access Hospital

Rude then launched into the plans and research being done on the possibility of creating a Critical Access Hospital (CAH) in Saratoga. "The first phase to that process," Rude explained, "is really just an exploration phase of 'is it even appropriate for us to do this?'" Rude continued, "I genuinely believe in it. I wouldn't even be asking for us to spend the money to engage the companies to do this if I didn't believe the outcome would be a 'yes' answer. But that doesn't mean that we don't need to be responsible-ask those questions, thoroughly vet those answers and come back with documented proof from outside experts that say, 'this is a valuable thing.'"

To that end, Rude announced, "We have engaged a company called BKD. They are an accounting firm from Kansas City, Missouri. They have a very, very strong reputation for being capable of completing this. They have a healthcare division that is involved in these projected financials. They have qualified financials, examined financials that forecast into the future and have been successful in securing USDA funding in past opportunities.

Rude continued, "Its not a company I have worked with before, but their resumé was strong and the references I went to were very positive and the people I could shake information from at the USDA gave me the wink and the nod and said these guys were really something."

Describing some of the research process Rude said, "You will see them come through town and ask questions and they will be a part of some of these forums-maybe even as early as February. Understand that those things are coming and what they are trying to do is ask the question of: 'Does the town need it? Does the town want it?, and can we make it happen successfully?'" Rude went on, "If the answers to that are 'yes' then we turn down the line to Miss Werner (USDA rep) and say 'can we have some money please?'"

Rude then turned the discussion over to Lorraine Werner.

USDA Input

USDA Community Programs Director Lorraine Werner introduced herself and said the USDA "has been around since Abraham Lincoln was president," and continued "What we do is we are the only federal agency that can build a small town from the underground up. So we do business loans, we do grants for community facilities, we do housing and we do infrastructure including water and solid waste and wastewater."

Werner explained that the most important thing to her agency was community support for a project and the second most important element was sustainability. Werner then stated, "If you want it and you are willing to support it and we can make it sustainable for the long haul, I'm going to fund it."

Werner then explained the funding models saying the funding came from "direct funds and through guaranteed funds. We go through national lenders that will help us make this project happen. I will monitor the project from the very beginning with BKD's study, feasibility, opinion on how it's going to work all the way through the end. As a matter of fact, after the project is built, whatever project it is, I will ask for quarterly financials, and I will be out here visiting to make sure everything works. That will go on for at least two years to make sure that it is sustainable and the project does not fall into hard times-or if something comes up I am there with my little box of tools to help fix whatever it might be so it we carry on and we have a successful project."

Werner added, "We are not going to build anything the community doesn't want -that won't be sustainable."

Community Support

Faust then asked Werner to paint a picture about what community support meant for her.

Werner explained that the "best community support is cash-let's face it-If the community can raise some cash to help pay for this, that's excellent." she then continued, "the second best community support is what the community will offer to the project as far as letter writing or saying that they want it or why they want it. Not just that they want it, but why? What makes it important to you?" Giving examples, Werner went on, "I've heard already a couple of things like; 'The roads close enough in the wintertime enough times that it is scary when you have a medical emergency,' or 'we have many of our businesses relying on tourism and ranching and other things that are high accident prone, and it would be nice to have local, good medical facilities right here.' I also know that because of the airport situation and some of the infrastructure that you already have, that you can fly out emergency people on planes rather than trying to fight the winds in helicopters like so many communities in Wyoming do."

Werner said that if donors would be willing to donate a wing or something-that would be great. She also said that was not the final determiner saying, "If the community could not get that kind of support, it's okay, we're not gonna count that," adding "BKD is gonna forecast if we have Medicaid and Medicare and private pays and these many people are served and this is what's gonna happen-they are going to forecast that out five years."

"I'm gonna look at it, their expertise is going to look at it. If you can't come up with a lot internally, it's okay. We are still going to see what is sustainable. We're not gonna build the Taj Mahal and hope you guys can pay for it down the road. We are going to build modest and cost-size and design to meet your needs right now."

Werner concluded saying "If you want it, we are going to make it happen."

Rude added to those thoughts saying, "So if you represent an organization, or an individual as yourself, or an educational classroom, or your own business-whatever those things are-where you say, "this really is an advantage to my ability to recruit people to town, to support my staff, to support my growing family'-it's an interest I was concerned about when I moved to town and it would be great for me to be able to have it here." Rude continued, "We individually have healthcare needs in my family and these are the things it would be a blessing for."

Competition?

Audience member Nancy Jansa asked if Rawlins was working on a CAH and if there would be competition for funds. Werner replied, "Rawlins has a hospital now. They have not come to me." Werner explained that the BKD study would take into account where people go for healthcare now and what the competition is-and that those factors would be considered when deciding what is best for the community.

Rude added that, "the funds that disperse also come out of a rolling basis. So it's not like there's 'X' amount every year and we're all chomping at each other to get it. If there is valid reasons for those funds to disperse here, they will disperse here. If there are equally valid reasons for those funds to disperse anywhere else in the state-including our neighbors-then they will disperse them there."

In a nod to Memorial Hospital, Rude said, "To the core of the mission of my company, we exist to provide professional healthcare in support of rural communities. I don't think Rawlins is anything but a rural community as well. We are not trying to do anything in this project that's designed to injure what they are doing. We want to see them be successful while we also want to be successful." Rude continued that while he had heard individual complaints, they were just that-individual complaints. The complaint he wanted to address is that many people say it is just too far from point of injury to treatment.

Past Successes

Audience member Kate Sherrod asked Werner if she had worked on similar situations that had resulted in building a CAH. Werner replied that she had and pointed to the Hot Springs County CAH, Crook County and the Big Horn Regional. The CCMSD website is http://www.crookcountymedical.org/ You can find information on the Mountain Lodge Assisted Living in Douglas at http://mtlodgeassisted.com/

Site Picked?

When the Saratoga Sun asked if there had been a site picked for the CAH, Rude responded, "No. Let's be logical, we have some of the best airfield in the entirety of Wyoming. We'd be fools to go too far away from that. We already have a core of medicine and people used to that-keeping in that space makes sense.

The Sun then asked if the town donating land would count as support, Werner replied, "Absolutely."

Data Offered

Carbon County Community Prevention Specialist who works with the Department of Health, Sally Patton, stood to offer any data she had on drug, alcohol, tobacco use/abuse along with sexually transmitted disease and mental health information for the board to use. Rude thanked Patton and said that he was not trying to keep any information gained during the research phase a secret and offered any of that data back to Patton if it would be of use. Rude also offered any of the information garnered to anyone else it might be helpful to-specifically including the ambulance service.

Missing Equipment

Audience member Don Sherrod asked if any of the equipment found missing from the clinic during the changeover had been recovered. Several board members chuckled and replied, "No."

New Contact Information

Rude then mentioned that there were new contact numbers for the Platte Valley Clinic along with a new website. The new phone number is 307-326-3169 , the new fax number is 307-326-3259 and the new website is [email protected] or plattevalleyclinic.com.

Rude reminded attendees that if they were still getting calls from the Platte Valley Medical Clinic, that was not the current clinic. He then stressed that the clinic's name was now Platte Valley Clinic.

Record Receipts

K. Sherrod asked if the clinic had received any requested medical records. Rude said yes, he had seen some of them trickling in on CDs. He added that a patient could not open the records and recommended those patients bring those CDs to the office so they could be added to the clinic's Athena system.

As far as records requested by the clinic itself Rude said he had not seen those yet.

Questions for

the Audience

Rude asked what audience members felt was needed as far as services that were needed.

A doctor was the first, and obvious, answer.

Physical therapy additions and women's health options were requested.

An emergency room was listed as needed by a visiting audience member who happened to be a Registered Nurse who had worked at a CAH in the past. The questioner agreed fully with Rude who said CAHs, "keep minor healthcare issues and they take major healthcare issues and make those possible solutions."

D. Sherrod asked if there was a disaster plan just in case there was a major incident at the airport or elsewhere. Rude said that there would be a plan but referred most of that question to Carbon County Emergency Coordinator and Saratoga Mayor Elect, John Zeiger, who was in attendance.

Home health care was also suggested. Rude grinned and said, "I am so close to being able to say something about that."

Telemedicine was also discussed and Rude said this type of technology would be very helpful in building the type of new services the Valley could use.

Psychiatric was also listed as a possible need. In that vein, Family Nurse Practitioner Susan Foley said there was a seasoned psychologist who was currently working on her Wyoming license and that she was looking to set up a practice in town. Foley continued that this person could prescribe medication and could help at the clinic doing medication management and working on mental health issues as well as providing counseling.

Hemodialysis was mentioned and Rude said that required a specialty hemodialysis center. Rude also said that he had had conversations with higher ups at the Department of Health who said that this happened in the other states but did not happen in Wyoming. He did say that technology was helping with the size of the machines required and that having it here would require some changes in legislation, but that he favored having hemodialysis here.

Rude said that any other recommendations could be made publicly or personally to him or any other board member-and that those suggestions would be taken into account.

Other recommendations included the ability to take care of chronic disease management, pulmonology, getting internists and oncologists.

Doc Types

A consensus seemed to be reached on needing a friendly face who was concerned with the overall well being of the patient and would come to know patients personally.

Rude said, "We focused a lot on those conversations with physicians that are already here regionally. It is nothing for me to go to a national firm, grab a headhunter, figure out what the check is worth and write a check and drag someone here. I don't have good capture rates on stuff like that. I want somebody that wants to be part of this fabulous community."

Rude again mentioned the missionary physician outreach and K. Sherrod asked if there would be any hesitancy to prescribe something like birth control.

Rude said he had not seen anything in their literature that would indicate that and added that in a letter he had received it was said, "These people come through a program that is a medicine program. The profession of medicine is and how that is practiced is not necessarily based on their prerogative of their faith." Rude then added, "Again, if we are finding where people are practicing their faith, not their medical practice, I don't think that is a responsible practice in medicine ... You get to choose your healthcare, not me."

Rude did give the website of inhisimage.org for the missionary service and said the organization was based out of Tulsa, Okla.

Rude added that patient guided healthcare was his focus and board member Sonya Collamer said that she felt what the Valley needed was a doctor with a caring personality who listens.

North County

After it was asked why there was no one of the meeting from the Encampment side of the Valley, several audience members from there stood up. Rude then asked if there was anyone from Hanna or elk Mountain present. When no one responded, Rude said he would like the people of Hanna and Elk Mountain to consider attending future meetings and hoped folks from that side of the county would also think about the future hospital as theirs. It was noted that while these communities had clinics of their own, it might be possible to network with them for telehealth or other services.

Ivinson Support

When discussing women's health care (obstetrics in particular) and the miles several audience and board members had traveled during pregnancies, the talk turned to how supportive Ivinson Memorial Hospital in Laramie was and still is in HSPS's endeavors.

Rude said "Ivinson has, as of yet, been very supportive of what we are doing. Dr. Bjore is an Ivinson hospital doctor and they have given her the latitude to come over and to do this. We have seen other referrals to physicians that necessarily haven't panned out yet, but we have a lot of support in Laramie and they believe in the access to healthcare we are trying to create."

Faust added, "Ivinson was engaged at the very first days of things." Faust said the board had had discussions with Doug Foss, Ivinson CEO, and the hospital's CFO and continued, "the offer has stood, whatever support you need from a specialist, information, sharing non-profit documents, how all the legal work they have had done ..." Faust added that Ivinson's leadership had been very easy to work with.

Turnaways

Foley then stood and thanked residents for their support and the several "thank yous" she had received for continuing to provide local care. She did say that, until a full staff could be arrived at, it was an unfortunate truth that there had been some patients turned away from the clinic. When Werener asked if the clinic could keep records of any turnaways because this was data that should be included in determining community needs for a CAH, Foley said that they had been keeping those records all along and that those would be available.

Foley then added, where possible, patients should try to schedule visits a week ahead of time-at least until some new staff arrives in March. She also said that if requested records had not been received, the clinic did have the forms needed to file a complaint with the medical board. Those forms will need to be notarized and it was noted that a notary was available at the Saratoga Care Center and town hall.

Next Meeting

Having covered a wide range of healthcare topics and having received kudos for the cooperative nature of the meeting from Carbon County Commissioner Sue Jones, the next HSPS meeting was announced for 5:30 p.m. Wednesday, Jan. 16 in the Platte Valley Community Center.