Minimum standards shot down

by Janet Montgomery

In a three-to-two vote, minimum standard requirements for new-hire physicians was struck down last Wednesday night at the Sublette County Rural Health Care District board meeting.

Before making a motion, board member Dave Racich said, “They (local health care providers) would like to see the doctors who are employed by the district meet certain standards.”

He asked the board members to consider the standards listed on a hand out.

“I would like to see those adopted,” Racich said. “At least it lets physicians know, at least who will be potentially be coming here, that this district has set a bar high that we want them to attain those skills.”

While Racich said there were good aspects to the standards, he also conceded “there are times that maybe ... perhaps that we might have to assess physicians that ... might not meet these.”

However, Racich said he thought that is what the local health care professionals in their judgment would need to look at and assess the potential hires with.

“They have to work with them, we just have to pay it,” Racich said, and made a motion to adopt the standards.

Board member Walt Bousman seconded the motion.

While board member Jud Faler said he agreed with the standards and wanted to see more, he asked that the standards be postponed for a three-week period to allow for possible input from the potential administrator.

Family nurse practitioner Leslie Rozier, who also submitted the standards to the board, said all the health care professionals employed by the district are currently certified in their respective fields of expertise.

She also said there is legislative language coming ahead, which the state of New York already applies, where reimbursement where Medicaid services require that you be a board certified physician.

“To practice in the State of Wyoming, you do not have to be board certified,” she said, “although, physician’s assistants have to be certified as do nurse practitioners in this state to practice and to be reimbursed by Medicaid.”

Staff members or professionals with admitting privileges for St. John’s Medical Center in Jackson have to be board certified, she said, adding that both Rozier and Dr. Judith Boyle were on staff at St. John’s.

Rozier also told the board it would be paying 10 percent more for liability insurance coverage of non-board certified physicians.

“They do not randomly approve liability coverage for non-board certified physicians,” she said. “It has to be a one-on-one evaluation.”

Rozier also offered contact names for further information.

In talking about standards of care, Rozier said all the family practices in Wyoming are required to be board certified within six months of completion of family practice residencies.

“That’s just some more information as to why we feel strongly as a professional staff as to anyone who is hired, be able to meet the minimum requirements,” she said. “The concerns are, and we all have to step to the plate for this, is it will all be, in the future, all connected reimbursement with Medicaid and most likely Medicare as well.”

“I’m going to speak against the motion as I see no reason that we should be adopting these kind of rules,” Board Chairman Bill Budd said.

Budd said he had learned that the certification was not a requirement for licensing in the state, and that it is estimated that half the doctors in the state are certified.

“I have no problem with what Ms. Rozier said or what Dave said if that’s what they want to do,” he said. “But I see no reason why we should tie the hands of the board and say we’re not going to talk to anybody who doesn’t have board certification when half the doctors in the state are not board certified.”

Budd said he was told that there was no comparison between certification and experience, saying “you can’t compare book learning with actual experience.”

“Basically, the decision is probably going to be made by the professionals in this county ... and if they choose to on their own to make that a requirement ... that they be board certified ... that’s entirely up to you, and you have a right to do that,” Budd said. “But as far as establishing that as a rule that everybody has to follow, I’m opposed to it and I’m opposed to the motion.”

Bousman offered up that the certification could be made a requirement to get upon hiring.

However, certification has to be completed following a residency program.

Racich offered that he had no problem amending the minimum requirements.

“This sets a standard that I think we would all like to see qualified individuals come and practice medicine in Sublette County,” he said, whether board certified or physicians who have been grandfathered in for years of experience and nominated by physicians already here.

“This just sets a bar and lets the people in this county know we are looking for the best,” he said.

If the policies were adopted now, and the new administrator wants to do something different, they could be changed.

“This just gives him an indication that this is where some of the board would like to go,” Racich said.

Rozier asked to clarify that the proposed minimum standards were not about certification for those already in Sublette County

“This is what we want to bring into this county for new individuals,” she said.

In a roll call of a vote on the matter, Racich and Bousman were outvoted by nays from Garry Eiden, Sr., Faler and Budd. Although Faler offered an explanation for his vote asking the board re-visit the requirements with some changes made.