Health care “minimum standards” proposal voted down
Budd: Experience outweighs “book learning”
by Annie O’Brien

At their December 13 meeting, the Rural Health Care Board (RHCB) rejected a motion to adopt minimum certification criteria for all incoming and current health care providers in Sublette County’s Rural Health Care District (RHCD). A group of Sublette County medical personnel presented the qualifications, namely Board certification, they believed District doctors should possess.

The American Board of Medical Specialties issues certification after doctors complete residency training and take an exam for a particular medical field. All doctors, nurse practitioners and physician assistants currently employed by the RHCD are Board certified in their areas of expertise Leslie Rozier, a family nurse practitioner at the Pinedale clinic and member of the health care providers’ committee, explained the group’s recommendations. The group wanted to require all RHCD doctors to maintain Board certification in their field of expertise. Rozier explained the committee based its recommendations on several factors. Currently in New York State under the Medicaid Obstetrical and Maternal Services (MOMS) program, Medicaid will only pay for treatment by a Board certified obstetrician or family practitioner. Similar requirements may affect programs in Wyoming, Rozier said. However, doctors do not need to be Board certified to practice in Wyoming.

Rozier said, “In the future, it [Board certification] will all be connected to reimbursement by Medicaid and likely Medicaid as well.”

The providers’ group also based its proposal on a St. John’s Hospital policy that only grants admitting privileges to Board certified physicians, nurse practitioners and physician assistants. Rozier and Dr. Judy Boyle have admitting privileges at St. John’s.

Financial considerations also influenced the group’s decision. Rozier said the Board must pay ten percent more in liability coverage for doctors and mid-level providers, such as nurse practitioner or physician assistants who have contracted with a non-Board certified physician, then it would for Board certified providers.

RHCB member Dave Racich, who acted as a liaison between the providers’ group and the Board, argued for adopting the minimum standards recommendation. He said the requirements would send a message to potential RHCD doctors that Sublette County “has set a bar high.” Racich acknowledged the District would need to remain flexible despite the minimum standards’ requisites.

But RHCB Chairman Bill Budd spoke against the motion. He said roughly half the doctors in Wyoming lacked Board certification. Demanding all future District doctors to possess certification would inhibit the Board’s ability to staff its clinics. “I see no reason to tie the hands of the Board and say we’re not going to talk to anyone who’s not Board certified when half the doctors in the state are not Board certified,” Budd said.

After speaking with Carole Shotwell, the Executive Secretary for the Wyoming Board of Medicine, Budd said experience practicing medicine in a small town in Wyoming should carry as much, if not more weight than “book learning.” He objected to establishing a rule that would force the Board to disqualify more than half the state’s available workforce in the field from working in the RHCD.

In an attempt to find a compromise, Walt Bousman suggested the District compel all doctors to become certified within six months of being hired. The Board could still hire uncertified physicians. Racich proposed “grandfathering,” or exempting older, uncertified doctors from the minimum standards requirement.

Rozier insisted the certification mandate was not an attempt to deny David Burnett, owner of the private Wyoming Range Medical practice, and a family practitioner who lacks Board certification, RHCD access privileges. The requirements were simply intended to bring high quality doctors to the county’s clinics. In an interview conducted later she said that Board certification was a basic standard of care in 2006.

“Board certification is like your car having its emissions inspection,” Rozier said. When the motion went to vote, Budd ber of the Board. Each member of the Board, in alphabetical order, voiced their vote individually. Bousman and Racich supported adopting the minimum standards requirement. Garry Eiden, Budd and Jud Faler voted against it. Faler said he opposed the motion only because he did not want to establish hiring policies before Kip Boone, who will likely become the RHCD’s Clinic Administrator in January, could review them.

During the public comment portion of the meeting, retired nurse Cindy Van, voiced her disapproval of the motion’s defeat. She commended Racich and Bousman for supporting the providers’ recommendations. Staffing District clinics with qualified doctors is just as important as providing stateof-the-art facilities, Van said.