A portion of the standing-room-only crowd is pictured at the beginning of the annual Melissa Memorial Hospital Forum as CEO Trampas Hutches, pictured at left, begins his presentation on a 2017 recap of the hospital, existing and new medical staff, transitional plan and strategic focus for 2018. Crowd input immediately addressed concerns and questions around the sudden departure of Dr. Aaron Wilson. — Johnson Publications
Crowd demands answers surrounding departing doctor
Melissa Memorial Hospital CEO Trampas Hutches highlighted key details in his annual public forum presentation regarding the state of MMH and its strategic plans as he opened the meeting in the clinic waiting room Wednesday, April 4.
It soon became quite apparent that the crowd of more than 80 was largely there to address their displeasure in the sudden departure of Dr. Aaron Wilson and their support for his medical care.
In his opening, Hutches thanked Wilson for his five years of dedication to MMH and the area’s patients. He said that in January, Wilson gave notice of nonrenewal at the end of his five-year contract that was set to expire in July.
Hutches said that in moving forward, the hospital district made arrangements to start the transition sooner.
Numerous calls of alarm came from the crowd surrounding this information.
Wilson was in the clinic seeing patients the week prior to last week’s forum, then was suddenly no longer employed by the hospital district. Patients were concerned about their follow-up questions with no transition from Wilson’s care.
Sheryl Farnsworth said his NPI number is no longer available to cover Medicare billing. This National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services.
Hutches said after the meeting, “At this time, MMH anticipates that its coverage arrangements will not require any reference to Dr. Wilson’s NPI number in claims submitted for physician services provided after March 29, 2018.”
However, he added Medicare does permit the use of a departed physician’s NPI with a Q6 modifier for purposes of billing the services of a locum tenens physician. This billing method is available for a 60-day period, based on how many days a locum tenens would be needed.
It is possible these Medicare-prescribed billing procedures will be utilized for services of a locum tenens physician if the need arises. If that should be the case, Hutches assured that claims for any locum’s services will include the appropriate modifier and all other information that Medicare requires for the submission of claims in this situation.
“Was there effort to retain him?” was a question asked several times. “Yes,” responded Hutches.
Several referenced an alleged letter that they said Wilson had received from Hutches that banned him from the hospital premises.
“People are here because they want answers,” said Kathleen Kropp, in a call for more information from Hutches.
Citing that Wilson deserves a certain amount of confidentiality, Hutches explained that discussion of such details would cross over legal personnel boundaries.
He did note that Wilson is allowed on the hospital premises as a nonemployee, but not under working terms.
Hank Hassler asked if providers are forced to see a certain number of patients in a certain amount of time.
Hutches said it’s not a matter of force. One of the biggest complaints in the clinic is getting timely appointments, or appointments when patients need them. There were so many different appointment slots, it made it difficult to fit a full day of visits into the slots.
They used to have a 10-minute appointment for one thing and 45 minutes for another. Now, they base all appointments on 30 minutes across the board to standardize and simplify the schedule, added Hutches.
Hassler addressed the number of MDs in the clinic, suggesting there should be more.
Hutches explained that rural health clinic designation by Medicare requires each full-time physician to see a minimum of 4,200 visits per year for maximum reimbursement. He added that 2,080 hours is considered full time (FTE). In 2017, three eligible physicians worked 0.89 FTE or 1,851 hours in the clinic and saw 2,087 visits. The minimum visits based on 0.89 FTE calculates to 3,738 minimum visits needed for full reimbursement.
Therefore, Family Practice of Holyoke will not receive approximately $140,000 in Medicare reimbursement due to this rural health clinic regulation.
Hutches pointed out that MMH recognizes the community’s desire to have two physicians in the clinic and staffs it with at least two physicians. He said the balance they look for in the clinic is two physicians and three or four nurse practitioners.
LaVonne Dalton asked if a plan is in place. “We all hope this doesn’t happen again,” said Dalton, adding, “It’s difficult to start with a brand-new doctor.” When beginning stages of unhappiness are seen in a provider, can there be a way to address it before it escalates out of hand?
Hutches acknowledged merit in a plan to come together as a community/hospital. He also agreed that it’s easier to retain providers than to recruit and noted that Wilson’s leaving has affected the whole staff.
In support of the hospital, Deb Woodhead spoke up to say that she had just spent several hours in the emergency room. “There are still quality providers here,” she emphasized.
“You should have done more to keep him (Wilson),” Sue Jarrett shot at Hutches after reading a heartfelt letter from the wife of a recently deceased man who had been in Wilson’s care.
“Dr. Wilson and Katie don’t want to leave Holyoke,” said Jeremiah Krieger. He cited this as a tremendous loss for the community. “I wish you’d do whatever you could to get him to stay here.”
Hutches named the seven members of the administrative team in response to a question from Judy Beavers, asking, “Who is the administration?” She said many have been told that the reason people are unhappy is the administration. Others pointed their finger specifically at the CEO.
“We deserve the best,” said Naomi Newman, adding, “We want to trust you. We want to be secure.”
Wynona Baker-Brown added that along with customer service comes trust.
Hutches referenced the new MMH mission statement, printed on the wall behind him, “The Melissa Memorial Hospital family delivers compassionate care nurturing trust with those we serve.” The need for renewed trust was evident.
Fielding a number of other specific comments on individual experiences with lack of recent appointment availability and questions about services, Hutches responded.
“Regardless of who’s working here, you can choose to jump on board or you can go down the street to the competition,” he said. However, he pointed out that if people go down the street, it becomes difficult to have health care in this community.
Seeking to improve communications/relations and trust, Hutches said he would like to have a few from the community on a Patient & Family Advisory Council. He received immediate volunteer offers. Those interested are encouraged to contact him.
Dr. Moore asks for chance
Standing by idly as questions, accusations and suggestions were presented and responded to, Dr. Rebecca Moore stepped to the front to speak, in a move that settled the tone and set a direction for moving forward.
Moore, an internal medicine doctor who has spent the last 20 years as a hospitalist, just started with MMH this month.
“I care very much for people in rural communities,” she said in acknowledging her decision to move to Holyoke. “I will do everything I can for you. I already like Holyoke,” she added.
“I had my choices of places to go, but I came here because of this man,” Moore said as she pointed to Hutches. “He tries so hard to give you what you need.”
“The nurse practitioners here, the staff — I’m so blessed,” Moore added. She said she wanted to work in a place where she would not feel rushed. She cited her days of primary care in Denver when 6-minute appointments were asked of her.
“I promise you, I won’t let you down.”
Referencing the bulk of the evening’s conversation, Moore added, “We can’t talk about the details, but it must have been severe. Please don’t blame this man (Hutches), as he has a huge heart.”
She said the new clinic manager has been working on cleaning up things to get consistent, timely care for patients. “That’s what we’re shooting toward.”
“I’m just begging you to give me a chance. My goal is to be the best I can be with you,” Moore added.
Asked about her experience in pediatrics, Moore acknowledged that she’s in adult medicine.
Hutches said Dr. Daniela Vargas-Boyer, a bilingual family practice physician, will start July 31 and that Jessica Skomp, FNP, is an amazing family nurse practitioner.
To acknowledge the immediate need, by Monday morning, April 9, Hutches announced that Dr. Erin Ward-Hekamatpour will begin seeing patients Thursday, April 26. She will be working in the clinic only Monday through Thursday from 9 a.m.-5 p.m. for several months to complement Moore’s services and ensure patients of all ages are seen.
Aside from the situation pertaining to Wilson, Hassler ended the meeting by noting that some very good things have been done at the local hospital. He referenced specifically the pharmacy and emergency medical services.
Staff, state of district, strategic focus addressed at forum
Wednesday evening’s annual hospital forum opened with information on the state of the East Phillips County Hospital District.
Hutches announced new medical staff members, including Moore, internal medicine, Coumadin clinic and hospitalist, who started this month; Vargas-Boyer, a bilingual family practice physician, who will start July 31; and Derek Doorn, FNP, a family practice nurse practitioner, who will start April 23.
Existing medical staff includes Dr. Kevin Cuccinelli, Dr. Derek Wright and Dr. Kajsa Harris, all in family practice, ER and hospital; Dr. Dennis Jelden, trauma, hospital and resident preceptor; Jessica Skomp, FNP, Kathy Meyer, FNP, and Deaun Carpenter, FNP, all in family practice, ER and hospital; and Lane Looka, FNP, ER certified NP, family practice, ER and hospital. Hutches said the hospital is recruiting for another FNP.
The 2017 recap highlighted the following points:
—Higher volumes than 2016 with high points in EMS, surgery and pharmacy; and flat growth in lab, specialty clinic and inpatient units.
—Gross income at $21.4 million in 2017, up from $17.2 million in 2016 and $14.7 million in 2015, with 2018 projected at $27.8 million.
—Quality remains high. Recognized as a top 3 critical access hospital by the Colorado Rural Health Center in October for patient satisfaction, high-quality outcomes and Medicare beneficiary quality improvement program.
—Additions of optical services, pharmacy, knee and hip replacements, and $46,000 given in community support in marketing to 69 different organizations.
—Engagement survey results showed an 87 percent employee satisfaction rate statistically.
—Opportunities for improvement noted in clinic hours, same-day appointments for acute illness and timely clinic follow-up on results.
Strategic focus for 2018 in employee investment includes leadership development, culture training, financial training and retention.
Tactics to be used are the Joe Tye culture of ownership model, manager training, financial training and employee on-boarding.
The new mission statement, “The MMH family delivers compassionate care nurturing trust with those we serve,” was cited as a better fit for the organization.
Values were also recently defined in the areas of integrity, service, ownership, passion, collaboration and courage.
In the area of community service, Hutches highlighted day care assistance and an MMH master community plan.
In terms of growth, areas targeted in the strategic plan include mental health services, dental service, chemotherapy, outreach lab services, accountable care organization, increase in primary care with alignment of obstetrics services with Sterling Regional MedCenter, increase of swing bed and inpatient utilization, and implementation of community paramedicine program.