Notes from Sublette County Rural Health Care Board meeting
by Dawn Ballou, Pinedale Online!
January 20, 2017
The Sublette County Rural Health Care Board held their regular meeting on Wednesday, January 18th in the Commissioners meeting room in the Sublette County Courthouse. Prior to their regular meeting, the board held a workshop for staff to update the Board on 2017 revenue impacts and an overview on their mitigation plan.
Staff members told the Board they are facing multiple factors affecting their overall budget operations. Reductions in revenue, increased costs of operations and goods, losses due to unreimbursed medical care services, the need to replace outdated equipment, increasing reporting requirements and more all add into a mix that is making it increasingly difficult to cover all their operational costs to provide health care services in Sublette County.
The Board received the bad news that the Big Piney Town Council had made the decision the night before to rescind their $500,000 commitment that had been made a year ago toward the Critical Access Hospital (CAH). The Town Council still supports the concept of the CAH, but the decision was purely financial for the needs of their budget. There was also some confusion as to whether the $1 million committed by the Town of Pinedale for the CAH would be a direct contribution or considered a loan to the RHCD.
The Commissionerís meeting room was filled to standing room only with people sitting in the aisles and gathered outside the door in the hall for the subsequent board meeting. During the public comment session concerns were heard about after hours Emergency Room services at the Marbleton/Big Piney Clinic and ambulance service response time to south Sublette County calls. Much of the staffing shortage issues go back to the funding challenges, which the District believes would be greatly helped by getting the CAH designation. The RHCD continues to meet with the Sublette County Commissioners to try to move things forward to resolve issues over fiscal management and coordination of facility operations with the CAH.
A number of members of the public came to hear discussion on a new topic that was added to the agenda at the beginning of the meeting. There was considerable public concern centered around a meeting Rural Health Care staff had with staff of the Sublette Center the day before on Tuesday, January 17th to discuss their future interactions and relationship. In that meeting, Sublette Center staff said they were told that the Rural Health Care District had made a decision they were limiting their doctors to seeing only 25 patients at the Sublette Center and the decision was to go into effect in 30 days. This caused great concern with the Sublette Center staff. They wanted the opportunity to ask the RHC board for clarification on what was said and make sure the Board was aware of what those decisions would do to the future viability of the Sublette Center.
Lara Hayward, CNA Manager at the Sublette Center, told the RHCD Board "the news we received yesterday was devastating to us." She said she asked for clarification three times about it at the meeting. "At 25 we donít function," she said. She asked if it was a Board decision to do this?
Laura Clark, Chairman of the RHCD Board, said the Board didnít decide this and none of the RHCD board members were at that meeting. It was an internal staff matter that normally wouldnít rise to the level of the Board. She assured everyone present that it would never be the intention of the board to put the Sublette Center in a position of closing their doors.
Dawn Walker, Sublette Center BSN Administrator, told the Board, "What youíre asking us to do is to recruit a physician." In the Centerís discussions with outside doctors, there have been concerns about what level of RHCD services they would have access to. Would their orders stand for lab and X-Ray, could they take their patients to the ER, would unassigned patients be transported to out of area hospitals? Walker said they needed something in writing from the RHCD defining these things in order to recruit a doctor. She said they needed 36 patients to break even at the Center, currently they are at 33.
Malenda Hoelscher, Rural Healthcare District Health Care Administrator, explained the January 17 meeting was part of their usual new year reset where they meet with others on their collaboration. It was an administrative operational meeting between the two staffs and doctors where many topics were discussed including changes in the number of MDs in the District and being able to cover Dr. Burnettís impending retirement. She said it was mentioned there was a potential moving forward that the District may have to cap the number of patients that the doctors see at the Sublette Center. "We are so held with the indecision of the CAH. It was a professional courtesy that this could be a situation we are facing." She said no decisions were made at that meeting. The RHCD will continue to provide as has been their practice.
The picture of the immediate RHCD doctor caseload pressure seemed to be alleviated a bit when Dr. Burnett said he would continue to care for his current Sublette Center patients. He explained that he is basically retired and the future success of the retirement center shouldnít rest on his ability to see patients.
After much additional discussion, there appeared to be a consensus that the RHCD and Sublette Center staffs would be able to continue having discussions to work out their respective needs and concerns. The 25 patient limit and 30 day timeline appears to have been more of a miscommunication than an edict. There appear to be other options that can be explored to alleviate the RHCD Doctor case load concern without impacting Sublette Center patient health care. The RHCD leadership said they would expedite discussions about the future, figure out what services other doctors might have access to, and explore the possibility of jointly recruiting another doctor, all of which seemed to be satisfactory to the Sublette Center staff.