From the pages of
Sublette Examiner
Volume 2, Number 7 - May 16, 2002
brought to you online by Pinedale Online

Fee is not a subsidy, but contract for services

by Cat Urbigkit

Fee is not a subsidy, but contract for services

Dr. David Burnettís contract with the Sublette County Rural Health Care District (RHCD) board to operate the Marbleton/Big Piney Clinic provides Burnett with $18,500 per month in return for his providing 24-hour-per-day, seven-days-per-week emergency care.

That pens out to $25 per hour for the medical coverage. For comparison, the RHCD is paying $17 per hour for two emergency medical technicians for daytime, weekday coverage.

Last week, Burnett proposed that the board up the contract amount another $2,000 per month, prompting criticism from RHCD board member Walt Bousman, who called the contract amount a subsidy and said as the population of the county increases, the subsidy amount should decrease.

Burnett and his clinic co-workers, Dr. Darcy Turner and PA-C Rich Anderson, agreed to an interview to discuss the issue in more detail.

"Several years ago, when this controversy over contract amounts became heated, the board decided that the contract for operation of the clinics would be on a basis of a contract for services," Burnett explained.

"At that time, the board determined that the needs of the operating physician for the clinics were not determined in the contract Ė that the contract itself was just for emergency services."

Burnett said the $18,500 per month is not a subsidy, but is the cost of supplying the services required in the contract.

"So itís really a moot point to discuss physicianís income or any other concerns dealing with proprietary information from the clinics, when the board has made that determination," Burnett said.

"My request to the board for an increase in the contract amount was based solely on the fact that the cost of providing those services has increased," Burnett said. "If the board chooses not to agree to that amount, then so be it."

One issue that appears to get confused in the debate is the public contract for round the clock emergency services versus the contracting physicianís private practice. The physicianís private practice and its financial information are not public business, but the 24-hour emergency care availability at the contracting clinic is indeed public business.

Burnett said that the board used to require financial reporting from the contracting physicians, but when the board abandoned the concept of a subsidy, it abandoned the financial reporting requirement as well.

"So actually, the financial operations of this clinic is a non-issue," Burnett said.

Since none of the RHCD board members have any particular medical business operational expertise, the Examiner asked Burnett what the board should be looking at in considering what the contract fee should be. He answered: "They should be looking at the cost of providing medical care, locally, regionally and nationally, to try to come up with some determination whether they are being gouged or overpaying or whatever ... My contention is youíre not going to be able to find any other facility in the state or this country that youíre going to be able to contract for emergency coverage at that rate."

Burnett continued, "If I want to find an individual to come in and supply relief coverage for this clinic Ė whether itís a PA, RN, nurse practitioner or a physician Ė I canít find one to do that for probably twice that amount."

Turner confirmed that when he worked the hospital emergency room in Thermopolis, he was paid between $35 and $40 per hour "whether I saw somebody or nobody."

"The highest percentage of our non-payment for services comes with emergency services," Burnett said. "It sometimes costs us money to treat these patients.

"If someone comes in in an emergency and canít pay, we just eat it," Burnett said.

He said it is difficult for the board to make equal comparisons when there isnít any other area comparable to the Sublette County situation, either in the contract amount or other terms: "but can they find sufficiently trained, qualified individuals, in sufficient numbers, to share the call schedule thatís required?"

"If I were making as much money as Walt Bousman thinks that I am making ... then my priority would be to hire another physician to reduce the workload of the physicians here," Burnett said.

He explained that medical residents in training are by law limited in the amount of on-call time they can handle, with it being no more frequent that every fourth night. Burnett said for the majority of the years he has practiced in Sublette County, medical professionals here have taken call every night or every other night. Only in the last few years the amount of on-call time has been reduced to every third night.

"That practice, plus that we practice without a hospital, makes recruitment and retention not only difficult, but highly unlikely," Burnett said.

When asked if a patient came to the clinic in an emergency, could they turn that person away because of inability to pay, all three (Burnett, Turner and Anderson) resoundingly answered, "No."

"Our care and treatment of the patientís needs ... is not circumvented because they do not have the ability to pay," Burnett said. "They get the same care, whether we get paid or not.

Anderson explained that the cost of providing care continues to rise, including medical supply costs, lab services and professional fees.

Burnett agreed, stating, "As long as the costs continue to rise, the cost of supplying the services will continue to rise as well."

Turner pointed out that as the population increases, so must the amount of clinic personnel to handle the increased medical need for that population.

Burnett said the county is fortunate to have a group of dedicated health care providers at both clinics working to fill the calls and the needs of patients here, while numerous other counties across the nation are dealing with health care provider shortages.

"My major concern is thatís not jeopardized for the future," Burnett said. "I will fulfill my contract obligation whether the board approves the increase or not."

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