Summary of Health Care Workshop
by Mary Lankford, Sublette County Clerk
January 9, 2017
Below is a report from the Health Care Workshop that was conducted by Mark Cross, CPA on Saturday, January 7, 2017 with the Board of County Commissioners, Rural Health Care District, and the Sublette Center.
Facilitator summary of the Strategic Planning Workshop hosted by the Sublette County Commissioners held at the court house this Saturday, January 07, 2017.
Commissioner Andy Nelson opened the meeting with all commissioners present and members of The Healthcare Board and Sublette Center Board and community members were present as well and the Facilitator, Mark Cross. Upon opening the meeting was turned over to the Facilitator.
A series of questions from the Healthcare Board Chair were presented and each question was answered by the Facilitator. Opportunity to respond to the presented questions and answers given occurred. With no further questions the meeting proceeded on to the questions surrounding the progress and challenges to the local facilities becoming a Critical Access Hospital (CAH) was started.
The first issues brought to the forefront were Commissioner concerns regarding several areas the first being operational issues of the Health Care Facilities, second being construction and remodel processes and procedures and what is the status of the CAH application.
The Facilitator presented the areas of concern. The Commissionerís questions were toward operational issues and concerns about performance of the Health Care Board and the management of the Clinics in Marbleton and Pinedale. The issues and concerns would be on going and asked by the commissioners and public. The Healthcare Board has the responsibilities to bring in to line with industry standards of facilities of similar sizes.
The Healthcare Board would begin the process of reporting to the commissionerís current year to date financial statements and prior two fiscal years of financials that were audited or reviewed by an independent accounting firm. The information requested would be provided Monday, January 9, 2017.
The process of correcting the variances with industrial standards will take time with the need to be under the CAH model. The CAH model would improve revenues and would allow apples to apples comparison of revenues and operational cost. It was discussed that previous yearís oil and gas revenues made up the shortfalls from prior year(s) operations. Alternative reimbursement methods were not considered in prior yearís due to the abundance of revenues that came from the oil and gas revenues. With the decline of this source the CAH model of reimbursement provides relief in this area.
A discussion and presentation by the Facilitator was given regarding who and where the final decision and responsibility of the construction and remodel would lie. The buildings are owned by the County of Sublette therefore the responsibility for the buildings ultimately falls back to the county (the citizens of the county are the owners of the buildings and the commissioners are the citizenís representative to act in good faith in the running of the county and protecting the county assets).
It is the responsibility of the Commissionerís to approve all Request For Proposals (RFP) on any county building(s) or land. The Commissioners will consider at their next board meeting steps needed to be taken for the RFP process given requested information from the Healthcare Board is received early so a proper review can be made. Consideration for a traditional RFP and a Design to Construct RFP will be part of the discussion.
A funds request by the Healthcare Board for the construction project for both Marbleton Clinic and Pinedale Clinic was also brought up during the session. The funds request to convert both buildings to the CAH model is $2.5 million from the county of Sublette. The additional funds needed come from reserves of the Healthcare Board, the towns of Big Piney and Pinedale for a total of $6.5 million.
Discussion was had regarding the withholding of any approval of the RFP process until operational costs were brought in to align with industrial standards, effectively stalling progress of the CAH model. The facilitator addressed this concern. The operational revenues currently do not and will not cover operational costs because of the current reimbursement model the Marbleton and Pinedale clinics are both subject to. Under the CAH model revenues begin to improve once the CAH model is in place. The costs must be managed but the revenue must also be improved for the health care delivery system of Sublette County to survive and return services that have been reduced. The RFP must move forward to know construction cost and to continue the progress towards obtaining the CAH model.
Further discussion of the CAH model would occur at the next commissioners meeting once requested financial information and questions regarding construction were provided to the commissioners by the administrative staff of the Healthcare Board.