Health District discusses budget cuts

by Jonathan Van Dyke

Local medical care officials met with the Rural Health Care District (RCHD) to go over budget cuts for next year and discuss ways to overcome the district’s estimated budget deficit during a special budget meeting on April 1.

“The mandate of the previous (health care) board was to get sustainable, 24/7 health care, and I think we’ve done that,” said Dr. Tom Jones, medical director for the Big Piney/Marbleton Medical Clinic. “I understand that we have to have sustainable, affordable health care, and we’d like to help participate in that.”

Officials from each department, including billing, maintenance, Emergency Medical Services (EMS), nursing and laboratories, submitted fiscal year 2009/2010 budgets with the goal of each entity reducing its budget by 10 to 20 percent.

“I’m looking at what we asked for and what came back,” said Dave Racich, RCHD treasurer. “Everybody hit where we were asking. Now it’s just a matter of how much more we have to come up with to make ends meet.”

While preliminary budget numbers would not be released, CFO/CEO Lorraine Gatzke estimated that with these new possible cuts, the RCHD would be operating at a $1.2 to $2.6 million deficit going into next year.

The board does have some significant investment and reserve funds, but members preferred not to dip into those unless things turned truly dire. More scheduled budget workshops are anticipated with each department before the final numbers are crunched this July.

“I want to be financially responsible for you guys, you the taxpayers,” Racich said. “I feel we should be responsible with your money, end of story.”

Much of the early and late conversation centered on EMS. Director Wil Gay commented that he just cut down his staff by three emergency medical technicians (EMTs), which will save $186,000 and decided to put new ambulances on the backburner as well, which should save more than $200,000 — much to the disappointment of his team.

“I would like you to remember there are crews and patients that depend on those ambulances,” EMT Kris Bacheller said. “We’ve been stranded more than once or twice in Jackson and Idaho Falls in ambulances that have mechanical problems. It is an incredibly frustrating situation. Take that into consideration when you look at those budgets. It would be appreciated.”

The RCHD board also discussed the Sand Draw ambulance barn, and what could be done to alleviate costs with it, including possibly asking the energy industry for help. The building has already been paid for.

“If you close Sand Draw, you’re telling everybody out there, that for $12,000 (utilities) you’re going to have to wait 45 minutes to an hour for an ambulance,” Gay said.

The EMS also has a near $100,000 reserve fund with the County Commission it could draw upon to help with future costs.

Later in the meeting, it was even suggested that the County Commission fund EMS — but to have the RCHD run it. The EMS numbers for next year come in at just under $4 million in the preliminary budget.

“Obviously, this county needs it,” Gatzke said. “If we weren’t funding EMS, we’d be fine financially.”

Several times throughout the meeting, RCHD members implored the public to lobby for County Commission help, especially regarding the $18 million cost of the two new clinics.

“We are still considerably short of where we need to be,” Racich said. “Given what the commission, what they still want, there’s still that thought out there that we need to pay back for these clinics. If that happens, something is going to have to give.

“You the people, maybe we can convince the commission that’s not a justifiable way to run our health care in this county.”

A lot of the deficit pain comes from the new heightened levels of health care being provided in the county, especially now that both new clinics are operating, officials said.

“I would like to think that the county commissioners would support us in our endeavor to maintain one of the most excellent medical care systems that I have ever seen,” said Kris Roork, a physician assistant who has worked for the county since 1992. “We went from horse and buggy to rocket science.”

She also suggested that commission funds could at least be helpful until a future vote to raise the RCHD’s mill levy by an additional two mils. The district currently runs on two mills. A mill is .0001 of a dollar assessed on property taxes. For example, raising the mill levy to four would increase one’s property taxes by $19 on $100,000 of assessed value.

The board can’t call for a vote on mill levy increase, “which we feel we can operate under,” Chairman Bill Budd said, until at least May of 2010. Actual money flowing from a mill levy increase might not come until 2011 or as late as 2012.

“It costs a lot of money to operate them (the clinics),” Budd added. “We’re not in the same place that we were 15 or 20 years ago in this county or anywhere else.”

Another possible avenue for budget help, which could be enacted next year, is for the county to receive a Rural Health Clinic designation. By reaching certain operating benchmarks the district would be reimbursed by Medicare for costs.

“I think it’s imperative that we get that Rural Health Clinic designation,” said Cindy Van, board member. “I think that, next year, that will make a significant impact.”

While the occasional hyperbole was thrown out in meetings past about cutbacks in service, board members reiterated their commitment to making the budget work.

“That’s not anticipated at this time, it’s certainly not anything we’d want to do,” Budd said. “This is not an emergency meeting from our perspective.”

Instead, the RCHD will look forward to meeting with each department to continue work on next year’s budget, with an eye to getting all its accounting in order for a meeting with the County Commission.

“I think we have to have a defensible budget to the public and the county commissioners,” Van said.

If the county commission is unable or unwilling to help the financial situation, then the board will be facing tough decisions on more cuts, dipping into reserve funds or finding some other alternative.

“If they say run it on what you have, then you’re going to be looking at some drastic measures from our part,” Budd said.

The room of medical employees echoed the hope to maintain the quality of health care in Sublette County.

“We’re very happy to be here,” said Dr. James Quirk, medical director for the Pinedale Medical Clinic. “It’s a pleasure and a honor to take care of the people of Sublette County. We’re very proud of the progress we’ve made in the last two years. We’re especially proud of the emergency services we provide. We’d hate to see patient care suffer, or change.

“And recognizing the realities of our situation, it is our sincere hope that we can continue to offer the fantastic patient care that we feel we are [providing].”