Burnett addresses health care board

by Bill Boender

The Sublette County Rural Health Care Board met in special session Tuesday, June 29, at the Marbleton Fire Hall with physicians' contracts as the only item on the agenda. All board members were present. Dr. Judy Boyle and Dr. David Burnett were also present with Elizabeth Greenwood representing them as their attorney.

The meeting was called to order at 7:30 p.m. and the board immediately went into executive session until 8:20. Burnett questioned the purpose of the executive session when physicians' contracts were the only agenda item; Chairman Walt Bousman told him that it was a personnel issue. Burnett also questioned why the two proposals for compensation were not delivered to the physicians until noon Tuesday, giving them only a few hours to review them after three months of negotiation.

The board then outlined the two proposals that offered an increase in annual compensation from $240,000 to $360,000, differing only in the handling of funding of continuing medical education in the amount of $15,000 and temporary medical staffing in the amount of $21,000. Proposal one required no accounting for expenses in these areas while proposal two required vouchers and documentation for any expenses in these areas, with annual maximums and no carryover from the first year to the second year.

After discussion, Board Member Garry Eiden moved to offer proposal one, seconded by Board Member Bill Barney. Board members Jerry Jensen, Bousman and Mary Lynn Worl all spoke in favor of proposal two and there was no vote on the motion, with Barney withdrawing his second. Burnett then announced that he would not accept proposal two and read the following statement:

"In response to a letter from Ed Wood, the board's attorney, I sent a letter to the board dated March 30, 2004, for an increase in the contract amount.

"In that letter I listed several justifications for increase in the cost of providing services under the contract. Among those listed were: inflation, personnel, group and malpractice insurance and Locum coverage.

"The current contract is a contract for services and as such the value of that contract is partially dependent on the cost of providing those services.

"With respect to the cost of services I submitted to various members of the health care board my financial records for the years 2000, 2001, 2002 and 2003. Those records demonstrated an increased gross income of 19 percent over the four-year span. However, the adjusted gross income revealed a 9.7 percent loss when averaged over the last three years. The analysis by one board member who crunched my numbers with his program suggested that the $10,000 increase would be sufficient for 'perhaps one year' but probably not beyond that. I reminded that particular board member why I had originally requested greater than $10,000 increase per month.

"Other value of the contract is derived from what the market deems the service to be worth. Physician coverage for emergency services in this area average from $85 to $145/hour and this does not include a nurse on call as well.

"At any rate, the current value of $27.40/hour is significantly lower than the market value in this area. Because the current market will be quite competitive in terms of recruitment, it will place even more pressure in the area of retention.

"An article in the Casper Star Tribune recently reported that Gillette was spending $2,500,000 on the recruitment of 11 physicians for next year. The president of the Sweetwater County Medical Society has indicated that Rock Springs will be recruiting five family practitioners for the next year at a starting salary of $200,000 a year, a one in five or six call schedule, paid benefits, malpractice etc. In the Casper Star Tribune on June 23, 2004, Senator Charles Scott predicted that there would be a 10 to 25 percent reduction of physicians in Wyoming in the next year. This will place, as I stated above, more pressure on incentives for retention of existing physicians. These include, but are not limited to, CME, malpractice, salary, time off, pension, health insurance and lower ratio of on call time.

"I believe I have made more than a reasonable request to the board considering what I have just outlined. I certainly don't see it as out of line with the other money the board has allocated for the recent budget.

"For instance, each EMS service will be receiving greater than $340,000 for budget operations and the board appears to be committed to an administrative budget of greater than $348,000. In light of this, I think that a contract for $360,000 per clinic seems more than equitable, especially in light of the $4.5-million capital reserve the board is projecting.

"I think I have improved the quality, extent and availability of health care in this county in the past 15 years and I would like to continue to do so for another 15 years.

"I am hereby giving notice to the board that this proposal is totally unacceptable and I will have to consider terminating this agreement as I can no longer financially afford the cost of providing these services."

At this point, Barney asked if some annual accounting of costs for CME and Locum might be acceptable rather than requiring receipts and vouchers. The physicians and their attorney requested a 10-minute recess to discuss that and returned with a tentative acceptance based on arriving at mutually satisfactory wording in a meeting between attorneys Wood and Greenwood.

Barney moved and Eiden seconded to accept this proposal and the vote passed with only Worl voting nay. The parties will set another special meeting to approve and sign the final contracts within the week.