RHCD approves budget, accepts Dr. Wallace resignation

PINEDALE – At Wednesday’s regular meeting of the Sublette County Rural Health Care District (RHCD), the board looked at the fiscal year 2018 budget, Dr. Buck Wallace’s resignation and clarified previous questions with a freestanding emergency department (FED) brought up at a special meeting held on Monday, July 10.

To start the meeting, the board needed to approve the 2017-18 budget following a budget hearing that saw no comment.

The overall budget for the 2017-18 year will be $9,704,758, which will have the RHCD operating in the red in the amount of $2.7 million. According to director of finance Lorraine Gatzke, the $2.7 million will be taken from the WyoStar account to the general fund, if needed. She says they still have $7,910,456 in the district’s WyoStar reserve accounts and $1,631,700 in long-term investments.

“Right now, we are sitting OK,” Gatzke said.

During new business, the board first excused the absence of vice chair Scott Scherbel before moving on to address a resignation letter from Dr. Buck Wallace, who has been on sabbatical since Sept. 1, 2016. Wallace’s resignation is effective Aug. 31 of this year. Clark thanked Wallace for his service to the district and what he has done for Sublette County.

Following an executive session for legal discussion, the board resumed its public meeting by entering into old business. First on the agenda was to share information regarding an FED and if it is a viable solution for the local district moving forward.

Clark said she spoke with Wyoming Hospital Association Vice President Neil Hilton to find out what kind of reimbursement such a facility could bring to the RHCD.

“The problem with the FED right now in Wyoming is nobody does it,” she said. “There’s no benchmark; there’s not even any regulations right now.”

Through a conference call with Wyoming Hospital Association President Eric Boley a few months ago, Clark discovered FEDs were not even recognized by Centers for Medicare and Medicaid Services (CMS) at that time, she said.

“Because of that, (Boley) said private insurance probably does not recognize it most of the time, either,” she noted. “Again, we don’t have one in Wyoming so we don’t have a benchmark.”

She went on to add that there is a licensure required by June 30, 2019, which would mean both clinics would need between $500,000 and $600,000 worth of work to meet hospital standards by that date.

Before moving on to additional business, Clark read a quite from Boley, which stated: “I don’t see any advantage to going the (FED) route, because it doesn’t change reimbursement structure. Unless you receive cost-based reimbursement, a (FED) doesn’t change what you are already doing. I believe that for Sublette County to have a sustainable business model, the cost-based reimbursement that a CAH would afford you is the only way I could see you being able to continue providing the services your community has – has come to know and expect.”

The board then moved on to a second informational item on the agenda, pertaining to a recent meeting that took place regarding public relations and marketing. Board member Kathy Anderson stated she, Taliesin Consulting small business consultant Susan Barney, Kimberly Emerson of K&K Marketing and PR, practice manager Amanda Key and RHCD administrator Malenda Hoelscher met to look at Barney’s Phase 1 report that looked at public concerns and objections folks in the southern portion of the county had with the CAH.

The group broke Barney’s report down into three categories in regard to what needs to be achieved as a goal. The three categories she stated included defining where the money has gone and been spent on, along with education about CAHs and communications.

Anderson said there could be arguments made for leaving the past behind, along with explaining – in an easy-to-understand way – to concerned locals as to where the money went.

Barney was present at the meeting and was ready to get authorization to begin work on Phase 2, which would take existing data and put it into an easy-to-read format for people to look at how $102 million in mill levy money was spent in the course of 15 years.

“Do we want to concentrate part of our focus on answering the questions about what our predecessors have done with the money?” Anderson asked. “Do we want to do that adjunctive to what K&K is doing?”

Since Barney’s Phase 2 work would greatly differ from what K&K is doing for the district, the board felt it would be an asset for the small-business consultant to continue her work for the district with the second phase. Barney said she thought it was important for naysayers to understand that it’s not that the boards in the past were negligent, but decisions were solely on what those previous boards and administrators knew at the time.

“The previous boards and previous administrations didn’t do the type of deep analysis that you guys are paying to have to have done right now,” Barney said. “If they had brought in consultants like you are now, we probably would’ve had a CAH back then and you guys would be making $25 million a year right now.”

Clark was a strong advocate of having Barney continue her work and the benefits it could potentially bring.

“It would give the information to them that they could understand it and digest it,” Clark said of educating those who have concerns with the RHCD’s push for critical access designation. “We need the key players on our side. I think there is a lot of value in this.”

“I like the general concept a lot,” board member Chuck Bacheller added.

Despite receiving the Phase 2 proposal the day of the meeting, the board didn’t want to put off the approval of the proposal until the next monthly meeting. The cost paid to Barney for her continued work was dropped from $2,500 to $1,750 after a discussion of lessening the workload required of Gatzke to dig up all the information Barney would need to complete the phase, in turn, reducing the depth of the summary. The board approved Barney to do a summary of historical data, which was approved 3-1, with Wendy Boman opposed, expressing concern that Neenan may be covering similar territory.

The last item of old business on the agenda pertained to bill paying. According to Anderson, the current system has Gatzke paying bills as they come in. At meetings, Gatzke gives a check register and has the board sign vouchers, which thereby give their blessing on checks that have already gone out. Anderson wanted to bring more oversight to the paying of bills.

“To me, it doesn’t make sense to approve stuff after the fact,” Anderson said. “We’re responsible for the money and accountable for the money.”

Clark didn’t want to fix a system that wasn’t broken and wasn’t in favor of shifting from a governing board to a managing board. She also stated having two to three meetings a month to approve bills would be unrealistic in terms of getting enough board members to attend.

“We have managers in place overseeing and looking at things,” Clark said. “If something looks odd, Lorraine is available.”

Another argument came from clinical services coordinator and director of laboratory services Sharon Rutsch, who said sometimes equipment breaks that needs to be replaced immediately. She believed it wouldn’t be viable to pull the RHCD board together every time they needed to order supplies or equipment.

A suggestion arose from the discussion to do away with the voucher system, which is part of the district’s by-laws.

“Is there any reason other than the by-laws that we sign the vouchers?” Anderson asked.

“No,” Gatzke responded. “We are the only ones that operate the way we do.”

Anderson suggested amending the by-laws to eliminate the board requirement to sign the vouchers, but keep the check register.

Through working with the RHCD legal council, they will amend the by-laws to reflect the desired change for vouchers. The item would then be added to the next regular meeting’s agenda for approval.

The next regular RHCD meeting will be held on Aug. 16 at 6 p.m. at the Big Piney Town Hall, which is a change from the previous meeting location of the Marbleton Town Hall.


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