Stepping up to the table
The five candidates for City of Dillon Mayor fielded questions and offered rebuttal statements during the KDBM-KBEV and Dillon Tribune Candidates’ Forum Thursday evening. The event, staged at the Camp Fortunate Interpretive Center, aired over both AM and FM by the radio station. Sitting, left to right, are Paul Pilgrim, Michael Lee Klakken, Lynn B. Giles, Thomas W. Straugh, and Martin R. Malesich. For more on the city election, please turn to page A-5. J.P. Plutt photo
Hannah considers health care reform effects on new hospital
By J.P. Plutt
Dillon Tribune staff
Health care reform is the hot topic of the month as politicians in some states are holding town hall meetings on the issue with their constituents and the conflict between sides has been the fodder of nightly news programs. The potential ramifications of any action worries all sides while there is agreement with one basic idea – something has to be done about the burgeoning costs of health care.
In Dillon, the conversation is not heated but meted out in carefully constructed thoughts. Barrett Hospital & HealthCare CEO Steve Hannah has a healthy respect for the issue and with every development in the story line, must consider the potential impact to the new hospital project.
“For critical access hospitals, it looks so far like we’ll be to the side of the direct impacts that are being considered, primarily on the health care delivery side of the reform,” said Hannah. “In other words, when we talk about readmission rates there are some things that could impact us indirectly with our tertiary referral partners, but we aren’t directly impacted, at least so far to my understanding, by these initiatives.”
Barrett Hospital enjoys a swing bed program with hospitals in Butte, Bozeman and Missoula, the tertiary hospitals. Hannah thinks that if a patient is referred to one of these tertiary hospitals and then comes back to Dillon for something like rehabilitation, there is the potential with some of the language in the debate that Barrett could see a financial impact. “But otherwise, we haven’t seen any direct initiatives that will impact a critical access-type hospital.”
Hannah is realistic that there could be possible future stumbling blocks as health care reform is implemented. “Our future is not 100 percent guaranteed to be the same as it is today, that’s for sure,” he explained. “I guess where we draw some comfort is that we’ve survived the last four years. When our old hospital was built, that was pre-DRG (a type of reimbursement payment system). That was a huge shift in how health care organizations were compensated and paid. So we’re confident that we can survive whatever changes may come in the next four years, but it is going to be the result of a lot of work. We don’t sit here and think nothing will change over the next four decades, certainly it will.”
One change Hannah is aware of that will impact Barrett Hospital down the road is an aging demographic. The numbers indicate that the population in the Dillon area aged over 55 is going to grow by 55 percent over the course of the next decade, indicating to Hannah that there will be a growing demand for health care services.
Hannah pointed out that the tort reform issue isn’t as big in Montana as in other parts of the country thanks in part to a state legislature that has imposed limits on the litigation side.
The CEO has been engaged on the health care reform issue on the political side at least since April when he and other rural hospital representatives traveled to Washington, D.C. “We met with (Montana Sen. Max) Baucus and his staff as well as (Rep. Denny) Rehberg and (Sen. Jon) Tester,” said Hannah. “We believe that there should be a bi-partisan approach but it is starting to lose support at the congressional level.”
In terms of direction, Hannah feels reform should focus on fixing the programs already in existence – Medicare, Medicaid, the V.A. and Indian Health Services – before another system is created.
“There are pros for creating that additional public plan, but I think there is a lot that can be done to improve the ones we already have,” Hannah stated. “Clearly there are some significant inefficiencies in the system. From the hospital’s perspective we have this very complex billing process that we have to go through and every program is different. We’d like to see more focus on reducing the administrative complexity for the different governmental programs and private insurance.”
Hannah thinks the complexity of billing procedures create problems for patients and institutions. At Barrett Hospital, the staff needs from an operational standpoint of deciphering the billing and collection process could be streamlined and a savings realized in a more simplified system.
Hannah feels one area neglected in the current discussions is that of access to care givers. “It doesn’t seem to have much feet in the broader area but we’re running out of primary care docs in this country,” explained Hannah. “There just aren’t enough of them. If we add folks to the pool of insured by creating these coverage-for-all solutions, we don’t have enough docs nation-wide to accept those patients.”
Hannah doesn’t see the problem as one Dillon needs to address, but in the overall scheme of a giant shift in health care coverage, the lack of primary care physicians seems to be a component that is not factored into the discussion.
Hannah feels insurance should cover pre-existing conditions, be portable and not tied to employment and on the other side feels there should be an emphasis on personal accountability in terms of lifestyle habits, diet and exercise.
“Here in Dillon we are so fortunate to have a solid, stable health care delivery system,” concluded the CEO. “We’re going to do our best to make sure that stays in place. Yes, we are nervous about health care reform and what impact it may have on our ability to reinvest in our infrastructure but our board ad management are confident that this is the right thing to do and if we wait there isn’t going to be a better time later.”
District #10 scrambles
to make ends meet
By J.P. Plutt
Dillon Tribune staff
School District #10, Dillon's elementary system, faced a tough financial outlook last spring when a Building Reserve Levy request of $2 million failed by a slim 15 votes. Building maintenance needs looked to create havoc with the budget for this school year. Some deft moves over the summer kept the district afloat but a Facilities Assessment Report by the independent firm CTA Architects Engineers gives a gloomy outlook.
"Bottom line, the facilities analysis says we can't continue down the same road we're going down because our buildings are falling further and further behind in maintenance and the price continues to escalate as that happens," said Superintendent Glen Johnson.
Coming out of the school election last spring, the district needed to address an order from the State Fire Marshal to either install a sprinkler system in the Mary Innes School or close the doors. The Mary Innes houses administration and kindergarten classes as well as rental space to Head Start.
The cost to the district to have Fire Central Sprinklers of Billings install the system to bring the building up to code came in at $82,000. The district received $78,000 in deferred maintenance monies from the AAR Fund – economic stimulus funds. The balance came out of the general fund.
The boiler at the Dillon Middle School needed to be replaced and once into the project, an asbestos problem was discovered. The project came in at $90,000. The district applied for and received a Quick Start Energy Grant of just over $72,000 through the Department of Commerce. Thus, rather than a $90,000 blow to the budget, the project cost the district $18,000.
A floor repair project at the Dillon Middle School gym that occurred when water pipes under the floor broke and then thawed was covered by an insurance payment.
As the district breathed a sigh of relief after making it through the summer covering projects that absolutely had to be acted upon before this school year began, the Facility Assessment Report came in. According to the report both the roof at Parkview Elementary and the Dillon Middle School need to replaced and insulation added at an estimated cost of $548,000 each, the Parkview heating plant is on its last legs, and the east wing of Parkview Elementary is suffering structural damage as a result of a settling problem because of unstable ground under that part of the building.
"Fortunately the grant went through, fortunately we got money from the state for deferred maintenance that we didn't know we'd get when we put the bond up, but these are one-time-only monies," said Johnson. "We were able to get these little projects done that had to be done, but we still have no money to fix the windows, fix the doors, bring the buildings up to ADA compliance, bring them up to code safety-wise.
"Because of the grants and things, things aren't as bleak as they seemed to be when the levy failed. I"d just like to reiterate that we made it through by the skin of our teeth, but still our buildings continue to need help and we need money to do that."
Credit to Johnson and the Board of Trustees, no programs were eliminated this year though some were scaled back for minimal savings.
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