Sites and sounds at healthcare meeting
Healthcare sustainability meeting begins with slides of possible sites for Critical Access Hospital, turns to discussion including several different topics
June 19, 2019
The Platte Valley Healthcare Sustainability Project Subcommittee (HSPS) held another open meeting at the Platte Valley Community Center (PVCC) on June 12 wherein HSPS Chairman Will Faust announced that the group had become a board and was no longer a subcommittee of the Corbett Medical Foundation. Faust explained the new board would be called the Platte Valley Healthcare Project (PVHP) and had approved organizational documents to be submitted to the Secretary of State the week of June 17. This submission will be followed by filing for a nonprofit 501(c)(3) status soon.
Shortly thereafter the group presented slides depicting five of the locations the group had been looking at for a Critical Access Hospital (CAH) site. The five sites pictured were titled: The Inn Area (just above the Saratoga Resort and Spa golf course off of Veterans St.), The Kathy Glode Park Area (where Kathy Glode Park currently is), The Library Area (South of West Elm and west of 5th St.), The Nursing Home Area (between River and Veterans streets and behind the current Saratoga Care Center) and the Whistle Pig Area (between the Forest Service office and the Whistle Pig Saloon on Hwy. 130).
During the slide presentation, rough and early estimates to develop each parcel were given with prices conservatively gauged between $237,350 and $1,059,220.
These costs were given as high ballpark figures based on land acquisition, utility placing or re-placing and various other factors. Pros and cons for each location were given, which included how each fit into the community and ambulance routes through surrounding areas.
Other possible locations were asked about during the meeting including Build Rite's property immediately to the north of town. Faust said that had been looked at, but because of sewer running through the location and it also possibly being in the North Platte River's flood plain, that site had been taken off the table quickly.
Land offered as a donation was also talked about and the board said that would be considered as site selection moved along.
Audience member and former Memorial Hospital of Carbon County (MHCC) board member Henry Hewitt said placing of Saratoga's CAH would be of concern to MHCC if siting mileage dictated that patients be transported to the Saratoga facility instead of MHCC.
There was also back and forth between Hewitt and the board about numbers being used in accounting firm BKD's feasibility study which includes Hanna and Medicine Bow. It was explained that the numbers being used were based on historical numbers of patients coming to the Saratoga clinic in the past.
Hewitt continued to ask why the towns of Medicine Bow and Hanna were being considered as prospective clients and asked how that could logically be considered in financial considerations.
Hewitt kept asking different variations of both that question and ambulance routing while interrupting those trying to answer the questions while claiming that he was being interrupted.
County Commissioner Sue Jones stood to say, "Historically Hanna, Elk Mountain and Medicine Bow people used this clinic (Saratoga) for years and years, therefore those numbers should logically be included in those (forecast numbers)." On the service area, Jones added, "It (CAH) is going to serve this area, also SCWEMS serves this end of the county ... Rawlins hospital ambulance does not go much further past Walcott junction. Hanna, Elk Mountain-SCWEMS covers that area and Highway 30 from Walcott, this end, we all know is covered by SCWEMS in Saratoga and Encampment. That is also an issue that I know these people are considering is incorporating SCWEMS into this somehow so that they are not so fractured as they have been. They have done a wonderful job keeping it together for many, many years but it is like all the other aspects of healthcare in this county. And I, for one, wish that someday Memorial Hospital of Carbon County and this one work together so that we have first rate healthcare in this county. It is possible if we get our attitudes right and we all get hooked up to the same wagon and move forward instead of this drawing lines in the sand."
After the applause died down, Hewitt said that Jones, as county commissioner, had damaged MHCC and Jones took a moment to address that remark saying that she wished MHCC had taken control of both the financial side and medical side of that business.
Local resident Amy Martin then read a prepared statement with questions about the decreasing growth rate of towns in the Valley, recruiting a full-time doctor for the CAH, services to be provided at the clinic, length of stay and transfer requirements, transparency in past negotiations with the town of Saratoga and past agreement terminations between Health Management Services (HMS) and other municipalities citing several newspaper articles from those towns.
After Karl Rude, HMS president, asked where Martin would like him to begin and Martin replied, "Anywhere," Rude began to answer the question about previous negotiations with the town. When Faust went to clarify a point about who had been invited to discuss management of the clinic. Hewitt again interrupted the speaker-to which several people objected.
PVHP member Teense Willford interjected, "Henry, would you like us to just abandon the whole project?"
Hewitt replied that the only way this thing could work would be in conjunction with MHCC.
Eventually, Faust continued that, in March 2018, both he, as former councilman, and Mike Glode, with the Corbett Medical Foundation (CMF), had met with three different regional providers including MHCC. The reason Faust gave that HMS was eventually selected was that HMS provided a vision to not only keep the nursing home, but to expand medical services in the Valley. Faust explained that some negotiations had been conducted in private at that time because those discussions were between private businesses; HMS and previous clinic owner Bryan Kaiser.
Rude then took the question about previous operations in Malta, saying that when HMS had arrived in Malta, MT that nursing home had already been insolvent for some time. Rude said HMS had turned that around to a positive asset value, restructured the debt, reassigned how the USDA was going to help fund the facility and worked a creative solution to pivot the facility's mission from a skilled nursing facility to an assisted living facility.
Rude continued that the board which oversaw the pivot was then replaced and the new board decided to go back to a skilled nursing facility, which Rude said ultimately is still losing six figures a year. After that, the board dismissed HMS.
Martin then reiterated her question about sustaining healthcare when the area's population has declined. Rude said that though the population had decreased, the percentage of those 65 and older had grown and that that group was the one that needed healthcare the most. It was his hope that having new high-tech healthcare in the area would interest people in coming to these towns. Rude also pointed out that there was a proven statistic that shows CAHs have a 1.4 to 1 ratio for creating jobs.
CMF board member Laura Bucholz pointed out that the census does not take into account the increase in seasonal employees that come to the area yearly.
Faust added that, unfortunately, the census was about as long in the tooth as it can get, with the newest census data coming next year. Faust then said he had seen more new homes built in Saratoga in the last six years than had been in the previous 11.
Sustainability Still in Question
Another audience member asked about the sustainability of the proposed CAH. Faust replied, "For you to take our word for it right now and say, 'You know what? This is going to be sustainable.' I can't tell you that right now. I've said it from the beginning, I'm a believer in this critical access concept-but it is yet to be proven to me. That's why we're paying BKD, one of the leaders in the accounting of this type of analysis, and it's why we're going to them and saying, 'We don't want to put fluff in this to make it work. We need an honest answer.'" Faust continued, "We don't have a foregone conclusion here."
Faust then invited those curious to come to the July 17th meeting to see what the real numbers are as presented by BKD at that meeting.
Encampment Mayor Greg Salisbury pointed out that, "I think one of the things that everybody is missing is the economic values of what healthcare can bring to the Valley." Salisbury continued that the ambulance and helicopter were a big help but that having healthcare, locally would help with the sale of property and job creation.
Salisbury added that, "SCWEMS is a great thing. It's not working real well and I don't know if it's really gonna last. If we don't combine these kinds of things, you're going to lose that too."
Saratoga resident Steve Niccols asked what a possible "plan B" might be if a CAH proved not to be sustainable. PVHP board member Sonia Collamer replied, "At this point, we have been trying to keep our eye on the ball and move towards this Critical Access Hospital. Of course, if the figures come back, like Will (Faust) said, we're not going sit there to face the negative figures and put everybody at risk. Then we will have to have a plan B." Collamer went on that since, HMS had a contract with the clinic until 2023 and that business also had a lease on the nursing home facility there would be time to develop a different sustainable course should the CAH model not fit the Valley.
Doctor and 96 Hour Requirement
Martin then asked if there would be a doctor 24/7 or if there would just be telemedicine. Rude explained that there would be doctors, but that the community would not be able to support a doctor on a 24 hour basis. He added that there would be doctors that would be recruited to live in the Valley along with mid-levels to make the project go forward.
Platte Valley Clinic Nurse Practitioner Susan Foley asked Rude to further explain the planned bed layout and how that related to Martin's earlier 96-hour transportation question. Rude replied that of the 25 planned beds 20 to 21 of those beds would be long-term care beds which would function much like the current nursing home. As such, those beds would be exempt from the acute care 96-hour transfer regulations. Rude then added that the remaining four to five acute care beds would be subject to a 96 hour and then transfer rule, but that requirement was not a hard stop requirement, but an average of time spent over the year. Some beds would not be full for the 96 hours so that others could go a little longer if needed.
Turning Away the
Another questioner asked how it was going to work if the older population was increasing but the number of rooms available for long-term care was being reduced. Rude said that currently the nursing home is licensed for 43 beds and has a 27 to 28 census. Rude said as of now the care center was recruiting outside of the Valley's geographic service area to keep the care center financially stable because that facility needs a 27 resident load. Rude continued that 21 beds should take care of the geographic service area demand. Rude added that, with changing federal rules and financing, there may be a need to expand into different areas in the future, but that he would be adding a home healthcare line soon which should help with that dilemma.
Supporting a Doctor Now?
A question was asked concerning how many patients were being seen at the daily basis at the clinic.
Nurse practitioners Susan Foley and Ruby Ayers consulted and said the clinic was seeing around 40 patients a day.
The questioner then followed up asking how many patients a day a doctor could see. The answer was around 30.
The question was then posed that if there were that many patients, how come the clinic could not afford a doctor?
Rude replied, "I could lay both these women off (indicating Foley and Ayers) and recruit a physician to town and you would have a physician. So the allocation is two employees who can cover each other's time, who are competent providers, who are loyal to the community, that want to be here and have been great friends of our company since they have become a part of it. I am not going to cut them loose so that I can have one physician that is going to burn out."
After that reply, Kristen Barkhurst stood to make a comment on the past state of healthcare in the Valley including the past doctors. Barkurst said she had left the Valley for a while to pursue a medical degree and work with people in a family practice as well as a hospital setting. Then she continued, "I understand and I care what everyone is saying about wanting a doctor on staff ... I have worked with some of the most amazing family nurse practitioners-and these gals that we have in this office right now are right there with the best of the best."
I just encourage people-do your research on our nurse practitioners, they are amazing. We can do the telehealth thing to get our doctor services and specialty services if need be, but our nurse practitioners are the ones that are going to pull this thing through until a final decision is made."
Henry Hewitt asked if there was a possibility that MHCC could run the clinic and the CMF could run the nursing home. Rude replied that the CMF was not allowed to contribute to operating a private business like the Saratoga Care Center and added that not many people were inclined to contribute to a for-profit business.
Rude did say that these questions and others were being considered in the event that a CAH turned out not to be feasible.
Hewitt reiterated that great strides had been made at MHCC financially to build up some reserves but those may be jeopardized by a Saratoga CAH.
CAH Model Working
The Saratoga Sun then asked Hewitt if there had been financial reserves at the hospital before MHCC became a CAH. PVHP board member Karran Bedwell replied, "No."
A follow up question was then asked, "So, a CAH model works then?" Hewitt replied, "Yeah, but it's a long path in how they build up their reserves."
Then Hewitt later added, "The hospital in Rawlins would not survive if it was not a CAH."
Colton Miller asked if other companies like HMS were asked their opinion on this project.
Faust said that there were very few companies like HMS that did this kind of thing, but that the subcommittee had reached out to regional providers to get help.
Faust did add that the subcommittee had reached out to medical legal specialist, Lance Ramsey, who said that there was almost no one who was doing what HMS was doing.
Susan Foley commented that she had worked in several CAHs that were affiliated with larger national medical chains and that she had found that it was really important for a community to keep local control because, when that is lost, it loses the ability to respond to the needs of the community. Foley gave the example of school physicals saying, "We do a lot of them on our own time. We don't take extra time off. We are not bound by, 'If I work until 7 o'clock tonight to do school physicals, then I get to come in at 10 o'clock tomorrow and we get to cut clinic hours short.' We don't do that."
Results of Phase II of the financial feasibility study are expected to be released by representatives of accounting firm BKD at the next healthcare sustainability meeting which will be held at 5:30 p.m. on Wednesday, July 17 at the Platte Valley Community Center.