RHCD: Contract amount at issue

by Cat Urbigkit

Monday evening's Sublette County Rural Health Care District budget workshop was held at the Daniel Fire Hall, and included routine discussions of budget items.

That is, at least until a board member raised the issue of what amount the physicians' contracts should be. Currently the board pays $18,500 per month to Dr. Judy Boyle of the Pinedale Medical Clinic and the same amount to Dr. David Burnett of the Marbleton/Big Piney Clinic. This amount is deemed the fee for the "contract for services" in which the physicians operate the county's two clinics and guarantee 24-hour, seven-days-a-week medical care.

At a recent meeting, Burnett proposed that the contract amount be increased $2,000 per month. He reported to the board the reasoning behind the request, including the decrease in Medicare compensation and his need to raise his nurses salaries to compete with the district's increase in pay for emergency medical technicians, coupled with increasing malpractice insurance and health-care coverage costs. Burnett's proposal would also allow the addition of a women's health care provider in his clinic.

Board member Walt Bousman said although costs have increased, so have the rates, "so I'm not for it (the contract increase)."

Board Chairman Dave Racich suggested the board begin with a $500-per-month increase as a point for discussion. He noted that last year the board upped the rate $1,500 per month, and prior to that he had estimated that it cost between $27 and $47 per hour to have a physician's assistant (PA) or nurse practitioner for after-hours stand-by. Racich pointed out that welders get between $60 to $80 per hour.

The current contract amount breaks down to about $25 per hour for 24-hour coverage.

"So where are your priorities?" Racich questioned. "It's definitely a bargain."

Board member Bob Dew said he realizes there have been some large increases in the cost of providing medical care in the last year.

"I would like to see a pretty fair monthly increase" in the contract amount, Dew said. He added, "When we increase the payment, we should be expected to get an increase in the qualifications of the people that are covering the after hours."

But Jim Greenwood said: "We've got one clinic with two doctors and one PA. We've got the other clinic (with) one doctor and two PAs. And one clinic's rate increases were more than the other clinic's. I'm trying to justify in my mind how to be fair to both entities."

Burnett questioned why Bousman is opposed to an increase; Bousman responded that "lots of people aren't happy" that the doctors have raised their rates and also want to increase the contract amount.

"Are you talking about Pinedale or Big Piney?" Burnett asked, to which Bousman responded, "Pinedale."

Burnett said he asked for the amount he feels he needs to operate the clinic "and now we're back to basing that on what the situation in Pinedale is."

Greenwood suggested the board members not examine the rates, but base their decisions entirely on the need to provide for 24/7 care.

Burnett asked Bousman about his "being closed-minded" about the issue, and Bousman commented on Burnett's "supposed" cost increases. Racich shut that part of the discussion down when it became clear the discussion could quickly become a lengthy, full-blown debate.

Racich said that in the past, any of the physicians have been willing to share confidential financial information with individual board members if the board members asked for the information. While that information was quite revealing to the board members, Racich said, "What good is that information to us?" since the board can't discuss it anyway.

Dew proposed upping Racich's proposal to an increase of $1,000 per month. Racich said the entire board should decide the issue, and since board member Garry Eiden Sr. wasn't present Monday night, that decision should be made at the board's next meeting. That meeting will be held July 8 at 7:30 p.m. in the Marbleton Fire Hall.

As a follow-up to the meeting, the Examiner spoke with Boyle, since she was not in attendance at the session. Boyle said, "I believe my prices are equitable" for her double-boarded certification and is competitive with other regions.