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Riley told the board of directors in their regular meeting Tuesday that
the contract should be ready for their approval in the next meeting.
Dr. Ma has agreed to take a refresher course in obstetrics and to
deliver babies once he sets up his practice in October.
In the meantime, Dr. Gajic is still interested in Pecos, but would
require a J-1 work visa. Riley said she has learned that getting such a
visa is a complicated process.
Jeannette Alligood said that Dr. Gajic wants a guaranteed salary of
$400,000 per year for three years if that is legal.
"Based on my knowledge of J-1 visas, there is no guarantee they will
stay once they are hired and the visa status changes," she said. "In the
past we had a lot of difficulty meeting two guarantees and establishing
two doctors simultaneously. It stretches our resources."
To continue negotiations with Dr. Gajic could create legal problems for
the hospital, she said. "I think we should just do one doctor at a time."
Chairman Raul Garcia said he doesn't believe retention of a doctor under
the J-1 visa program would be a bigger problem than any other.
"I don't think it would be a bigger problem, but a lot of money,"
Alligood said.
"You only pay them as you need to pay them," Garcia said.
Alligood said that the fact that Gajic doesn't want a payback period
bothers here.
"All the others had payback time equal to the guarantee," she said.
"Gajic is not willing to do that."
Riley said the difference is he would be employed versus having an
income guarantee.
"Whatever collections we would make would go to the hospital," she said.
"The bigger concern is having two new physicians at the same time; also
the J-1 process is going to be pretty cumbersome."
"I'm also sensitive to repercussions from enticing Gajic on for any
length of time," Garcia said.
Riley said that Gajic has several offers and is waiting for Reeves
County to make an offer.
"He is real interested in this opportunity, but it would be quite a
process to get him on board," she said.
Marcella Lovett said that other hospitals have had problems with J-1
visa doctors, and "It's a shady area who we answer to: immigration or
the department of agriculture."
Extra legal fees would also be required to get visa approval, she said.
"Let's get Dr. Ma and see what else we can do. I don't think we can
afford, time wise, money wise and energy wise to take on a J-1 visa
doctor at this point."
Gajic's time is running out to get his visa, Riley said. "He will
probably have to get settled real quick or will be leaving the country."
Garcia said he would late to let Gajic go without a contract with Dr. Ma
in hand.
"I think we should hang on just a little. Look how long it has been we
have worked on a doctor. I don't have that much against J-1s," he said.
Alligood said she would agree "if that's the only thing we can get. But
we have to have the employment issue settled - how we can legally do it."
Riley said she hopes to have information in the next 10 days whether
Gajic could be employed in the Rural Health Center.
Continuing her report to the board, Riley said Congress is looking into
cuts in Medicare and Medicaid, and the hospital needs to look at how to
operate as efficiently as possible.
Mike Hathorn, finance officer, reported that Medicaid has approved his
annual cost report showing reimbursement due RCH of $271,000. He expects
a check Thursday.
He was pleased that the report was approved in six weeks, as opposed to
six months last year, and that the amount was much greater.
"I will settle for a quarter million dollars as against $30,000 any
day," he said.
Riley said she has met with all department heads to discuss management
styles and to orient herself to each department.
Managers were disappointed in the Lubbock Methodist operational audit
report on May 30, she said. "The consensus was that the report did not
reflect the positive verbal comments made by the surveyors and contained
much misinformation."
Al Bondeck of Texas Tech met with staff and individual board members on
June 5 to begin preliminary discussions about establishing a
relationship with the hospital, she said.
A group of hospital representatives met with the Department of Human
Services on June 8 to discuss the improvement of information flow, she
said. They reviewed Medicaid coverage for newborns and other
opportunities.
PECOS, 1995 - Indigent care costs have doubled in the past year because
Reeves County Hospital has added a number of specialists to the staff,
and patients can go directly to them for care, said Carolyn Riley
Tuesday.
Riley, hospital executive director, told the board that the indigent
care policy allows patients to see the physician of their choice. She is
recommending a policy change to require they first see a primary care
physician, or "gatekeeper."
Costs are higher when a patient sees a specialist, she said. "The
greater degree of specialization, the greater the number of tests and
the more expensive it is."
The disease should be treated at the most primary level possible, she
said. For example, a person with chest pain may go to a family
practitioner and find he is suffering from indigestion, rather than a
heart attack.
Under Riley's proposed plan, a patient who goes directly to a
cardiologist for chest pains would be sent to the primary care
physician. If he did require the services of a specialist, the
gatekeeper would give him a voucher.
Board chairman Raul Garcia questioned why the patient is now able to go
directly to a specialist.
"The present policy was established in 1989, and we had only four
doctors and maybe two specialists on staff, so it was not a problem,"
said Nancy Ontiveros.
However, in the past six months, the hospital has established numerous
specialisty clinics, and it has increased costs, she said.
"The original policy was well founded, but what's happened, we
automatically brought these people in. That's when we should have taken
a look at it," Garcia said.
"Now I see why our indigent care has doubled in the past year, and we
have yet to talk bout this. We have looked at everything else," he said.
Riley said that all other hospiutals have a gatekeeper to screen
indigent care patients.
"They have made changes in the past six months because of the same thing
we are seeing now," Ontiveros said.
"If this was going on, somebody should have noticed," said Chel Flores.
Ontiveros said the information has been presented to the board several
times. Former administrator Bruce Birchell sent it in memo form to the
board, she said.
Jeannette Alligood said that Birchell told the board about the problem
in January.
Flores asked about the cost of prescriptions purchased by indigents at
"the high priced pharmacy instead of low price pharmacy."
Ontiveros said the initial policy was to take bids.
"The next time they all decided to bid the same price so they could all
get a piece of the pie, so we use all three pharmacies," Ontiveros said.
"That's price fixing," said finance officer Mike Hathorn.
"That went before our board, and they allowed them to do that,"
Ontiveros said. "They came and gave a presentation to our board and
recommended it in 1991."
Flores said the high-priced pharmacy has filled more prescriptions than
the other two. "I was wondering if the patient had been told not to go
to this pharmacy."
"We can't do that," Ontiveros said. "So long as the board sets the
policy that all three pharmacies are to be used, we have to go by it."
Riley said the hospital needs to take "real, live competitive bids" or
look at an in-house pharmacy.
"We have done studies and found that, of the three providers, one was
getting 67 percent of the business," Garcia said. "Obviously there's
ways to get around this. Share and share alike was not being done. I am
going to recommend to the board that we take bids."
He suggested board members take a "real good look" at a chart prepared
by Riley to compare Pecos to Alpine, Fort Stockton and Monahans in
indigent care services and discuss changing the policy at the next
meeting.
All others contract with one pharmacy for prescriptions, use a
gatekeeper to screen patients and require vouchers for a speciality
visit.
Reeves is one of only three counties in Texas that use judgment appeals
of indigent cases, Riley said. Alpine, Fort Stockton and Monahans all
use policy appeals.
A statistical report for the first five months of the year show that of
43 newborn discharges, 40 were eligible for Medicaid.
Riley reported that she, Alligood and Iris Rives attended a meeting in
Midland Wednesday to hear a presentation by the state on indigent care
funds.
"If the federal government approves a waiver, Reeves County hospital
will be required to participte in a program whereby our indigent care
funds will be submitted with Medicaid funds to the federal government
for matching dollars," she said.
However, the program would begin with tertiary care centers in June
1996, and "I anticipate that it will be a long time before we see this
program in Pecos," Riley said.
The board awarded the bid for hospital professional and general
liability insurance to the Texas Hospital Insurance Exchange.
Premiums for $1 million per incident - with $5,000 deductible - and $3
million aggregate on professional personnel will cost $44,197.
General liability of $3 million will cost an additional $5,825.
Bills totaling $401,532 were approved for payment as monies become
available. Hathorn reported that $67,322 in invoices over 60 days old
have been paid.
Dr. Kai-wood Ma signed the contract offered by the hospital, but made
three changes to it, Riley said.
Jeannette Alligood said she would agree to allow travel expenses for the
doctor's wife and children in the $7,000 moving expenses; but would balk
at allowing him 36 months to repay the $143,500 in income guarantees and
advances.
But she said the third request that the $5,000 stipend for living
expenses be included in the promissory note be negotiated.
Garcia did not allow a motion to that effect, "because we are still in
the negotiating stage," but directed Riley to so inform Dr. Ma.
Alligood said she would object to the 36-month payback over 24 months.
"It takes away from the incentive to stay and fulfill his obligation,"
she said. "If he leaves in six months, we would have to immediately
recruit another doctor and wouldn't have the funds available. That's the
only reason that re-payment terms are in, is if he doesn't fulfill his
obligation."
Riley said that if she had written the contract she would not even have
put in the 24-hour repayment period.
"Generally repayment commences immediately after the income guarantee,"
she said. "But if that's a deal breaker, I would let it ride."
Hathorn said he has been busy with other matters and didn't have time to
make a financial report.
The computer system has been slow, and he called in the software vendors
to check it out.
"It was at 98 percent capacity," he said. "They eliminated some records
we didn't need and got it down to 85 percent."
They proposed an upgrade that would increase the memory at a cost of
$22,000.
"I have heard nothing but bad mouth about this system," Alligood said.
"Maybe we want to look at another system. If we don't like the software,
why update a bad system?"
Hathorn said the upgrade would be to the hardware, and "You can get a
lot of software to run on an IBM."
The addition of records from the Rural Health Clinic has pushed the
already overloaded system to the brink of crashing, he said.
Dr. Joel Adams was approved for emergency room privileges, and the board
accepted with no regrets the resignation of Dr. Orson Anderson from the
staff.
Riley said the Eunice Anderson trial is scheduled for July 13. The
hospital sued Anderson for breach of contract after she left without
fulfilling her obligation as a pediatrician.
All local pharmacies have been dispensing prescriptions for indigents in
a "share and share alike" agreement forged with the board previously.
Chel Flores raised the question in a recent meeting about the pharmacy
charging the highest prices getting the largest share of the business.
Administrator Carolyn Riley told the board that selecting one pharmacy
through competitive bidding should cut indigent care medication costs.
Another cost-cutting measure approved by the board is to require
indigent patients to see a local physician, who may either treat the
disease or refer the patient to a specialist.
Present policy allows indigents to access specialists directly, and the
hospital is required to pay the bills. Specialists usually order more
tests.
"In the last two years our specialty clinics have grown by leaps and
bounds," Riley said. "They are being walked into by indigent care
patients without a gatekeeper. We are proposing putting in gatekeepers -
our four active medical staff members and Michele Cser (phyician's
assistant)."
When the patient visits a local physician and is referred to a
specialist, he will take the physician's order to Nancy Ontiveros, the
hospital's social services director. If the patient meets indigent care
guidelines, he will be given a voucher for specialty services. The
specialist must present that voucher for reimbursement from the hospital.
Applicants who are turned down for indigent care may appeal to a
committee set up by the board. Currently, the committee is authorized to
approve the application even if the patient does not qualify under state
guidelines.
Riley said that Reeves County is only one of three in the state that
uses that type of appeal, and she recommended a change to policy appeals
only. That is, if the patient does not qualify under state guidelines,
the committee must turn down the appeal.
Jeannette Alligood and Marcella Lovett supported the policy appeals
method, but chairman Raul Garcia, Jesse Prieto and Chel Flores voted to
keep the judgment appeals method.
"I would recommend we continue with judgment appeals," Garcia said. "I
would hate to burden one person with policy appeals...I feel like three
people, as it is being done now, can do as good a job. There's going to
be human judgment, regardless of how we do it."
The board approved guidelines for the committee, which include
establishing the health status as "extremely serious," "severe,"
"moderate" or "non-systemic."
Only the first three would be considered for futher assistance.
Appellants must have no resources available, have exhausted all other
personal or public resources for help; the cost of medically required
service is prohibitive relative to the resources available and denial
could result in a potentially serious complication.
Health permitting, the client must be present at his or her appeals
hearing.
The hospital will not provide organ transplants nor experimental
medications or treatments to indigent care patients.
Riley said that the policy is not new; "It defines what we are already
doing."
By going to policy appeals, the committee would be bound by state
regulations basing indigent qualifications on income levels, number in
household and other resources available, Riley said.
"It is a fairly objective method," she said. "Either they meet the
criteria or they don't."
"Under the judgment appeal, we say we `We know you are over the limits
of income, but due to extenuating circumstances, we wll make an
exception and reimburse for your health care,'" she said.
Policy appeals would control costs, Riley said.
But Flores disagreed. "I don't think it would change much. We go by the
guidelines, no matter how hard it is," he said. "I have felt that `these
poor people need all the help they can get,' but you look at the
guidelines and say you can't."
"I am not denying people need help," Lovett said. "I served on that
committee also. They come to the committee because they don't fall
strictly within the guidelines."
"The way the discussion has been going on, it sounds like we have been
giving away the money," Flores said. "It is very stressful not being
able to help people in need."
Alligood said she has also served on the committee, and she feels
adhering strictly to the policy would take away the stress of making a
subjective judgment. However, her motion to go to policy appeals failed
3-2.
In other action, the board approved the termination of Alexander Kovac,
M.D. as director of radiology. Kovac exercised his option to terminate
the contract with 30-day notice that he is moving to Big Spring.
Visiting radiologist Dr. John Young of Alpine was approved for
consulting and clinical privileges at the request of the medical staff.
Riley said that another radiologist has shown an interest in moving to
Pecos, and he will tour the town and hospital to determine if it would
be suitable.
Riley said that Dr. Eunice Anderson, who left Pecos with one year to go
on her three-year contract, has filed for bankruptcy. The hospital had
filed suit to recover $104,062 paid to her in income guarantees, office
rent and equipment and other support.
That trial was set for July 13 in 143rd District Court. However, Riley
said that no trial will be held, and the hospital must file its claim
with the bankruptcy court.
Dr. Kaiwood-Ma has contracted with the hospital to open a family
practice here as of October 1, and he and his wife will be here August
11 to look for a house. Riley said that he may not be able to obtain his
Texas license and complete obstetricrical training by the October 1 date.
Dr. Edward Sigh has asked for medical stff privileges, Riley said.
Research of state regulations reveals that the medical staff bylaws
wouuld need to be modified to accommodate chiropractors, she said.
William G. Reilly, M.D., an orthopedist from Hobbs, N.M. will begin
holding a monthly clinic in Pecos, with the board's approval of staff
privileges. He works well with Dr. Zeek, who has an established clinic
here, Riley said.
Also approved was Raymond Collier, M.D., for emergency room staff.
Riley said that five hospitals have indicated interest in working with
RCH in a networking relationship.
"There are several facilities in the area who have a common working
relationship through Blue Cross HMO," she said. "Some are talking about
networking with them."
Bills totaling $416,473.33 were approved for payment "as monies become
available."
Finance officer Mike Hathorn said he has paid all the bills that were
over 60 days old, and the present balance is about $194,000.
Riley presented the annual progress report of Quorum Health Resources
Inc., the firm operating the hospital under contract with the hospital
district. Board members said they wanted to study it before giving
approval.
HOSPITAL 2
1995
Baby doctor OKs hospital pact
By PEGGY McCRACKEN
Staff Writer
PECOS, 1995 - Dr. Kai-wood Ma has agreed to terms of a contract with
Reeves County Hospital, and a copy for his signature is in the mail,
said Carolyn Riley, interim administrator.
Riley told the board of directors in their regular meeting Tuesday that
the contract should be ready for their approval in the next meeting.
Dr. Ma has agreed to take a refresher course in obstetrics and to
deliver babies once he sets up his practice in October.
In the meantime, Dr. Gajic is still interested in Pecos, but would
require a J-1 work visa. Riley said she has learned that getting such a
visa is a complicated process.
Jeannette Alligood said that Dr. Gajic wants a guaranteed salary of
$400,000 per year for three years if that is legal.
"Based on my knowledge of J-1 visas, there is no guarantee they will
stay once they are hired and the visa status changes," she said. "In the
past we had a lot of difficulty meeting two guarantees and establishing
two doctors simultaneously. It stretches our resources."
To continue negotiations with Dr. Gajic could create legal problems for
the hospital, she said. "I think we should just do one doctor at a time."
Chairman Raul Garcia said he doesn't believe retention of a doctor under
the J-1 visa program would be a bigger problem than any other.
"I don't think it would be a bigger problem, but a lot of money,"
Alligood said.
"You only pay them as you need to pay them," Garcia said.
Alligood said that the fact that Gajic doesn't want a payback period
bothers here.
"All the others had payback time equal to the guarantee," she said.
"Gajic is not willing to do that."
Riley said the difference is he would be employed versus having an
income guarantee.
"Whatever collections we would make would go to the hospital," she said.
"The bigger concern is having two new physicians at the same time; also
the J-1 process is going to be pretty cumbersome."
"I'm also sensitive to repercussions from enticing Gajic on for any
length of time," Garcia said.
Riley said that Gajic has several offers and is waiting for Reeves
County to make an offer.
"He is real interested in this opportunity, but it would be quite a
process to get him on board," she said.
Marcella Lovett said that other hospitals have had problems with J-1
visa doctors, and "It's a shady area who we answer to: immigration or
the department of agriculture."
Extra legal fees would also be required to get visa approval, she said.
"Let's get Dr. Ma and see what else we can do. I don't think we can
afford, time wise, money wise and energy wise to take on a J-1 visa
doctor at this point."
Gajic's time is running out to get his visa, Riley said. "He will
probably have to get settled real quick or will be leaving the country."
Garcia said he would late to let Gajic go without a contract with Dr. Ma
in hand.
"I think we should hang on just a little. Look how long it has been we
have worked on a doctor. I don't have that much against J-1s," he said.
Alligood said she would agree "if that's the only thing we can get. But
we have to have the employment issue settled - how we can legally do it."
Riley said she hopes to have information in the next 10 days whether
Gajic could be employed in the Rural Health Center.
Continuing her report to the board, Riley said Congress is looking into
cuts in Medicare and Medicaid, and the hospital needs to look at how to
operate as efficiently as possible.
Mike Hathorn, finance officer, reported that Medicaid has approved his
annual cost report showing reimbursement due RCH of $271,000. He expects
a check Thursday.
He was pleased that the report was approved in six weeks, as opposed to
six months last year, and that the amount was much greater.
"I will settle for a quarter million dollars as against $30,000 any
day," he said.
Riley said she has met with all department heads to discuss management
styles and to orient herself to each department.
Managers were disappointed in the Lubbock Methodist operational audit
report on May 30, she said. "The consensus was that the report did not
reflect the positive verbal comments made by the surveyors and contained
much misinformation."
Al Bondeck of Texas Tech met with staff and individual board members on
June 5 to begin preliminary discussions about establishing a
relationship with the hospital, she said.
A group of hospital representatives met with the Department of Human
Services on June 8 to discuss the improvement of information flow, she
said. They reviewed Medicaid coverage for newborns and other
opportunities.
Specialists up indigent care costs
By PEGGY McCRACKEN
Staff Writer
PECOS, 1995 - Indigent care costs have doubled in the past year because
Reeves County Hospital has added a number of specialists to the staff,
and patients can go directly to them for care, said Carolyn Riley
Tuesday.
Riley, hospital executive director, told the board that the indigent
care policy allows patients to see the physician of their choice. She is
recommending a policy change to require they first see a primary care
physician, or "gatekeeper."
Costs are higher when a patient sees a specialist, she said. "The
greater degree of specialization, the greater the number of tests and
the more expensive it is."
The disease should be treated at the most primary level possible, she
said. For example, a person with chest pain may go to a family
practitioner and find he is suffering from indigestion, rather than a
heart attack.
Under Riley's proposed plan, a patient who goes directly to a
cardiologist for chest pains would be sent to the primary care
physician. If he did require the services of a specialist, the
gatekeeper would give him a voucher.
Board chairman Raul Garcia questioned why the patient is now able to go
directly to a specialist.
"The present policy was established in 1989, and we had only four
doctors and maybe two specialists on staff, so it was not a problem,"
said Nancy Ontiveros.
However, in the past six months, the hospital has established numerous
specialisty clinics, and it has increased costs, she said.
"The original policy was well founded, but what's happened, we
automatically brought these people in. That's when we should have taken
a look at it," Garcia said.
"Now I see why our indigent care has doubled in the past year, and we
have yet to talk bout this. We have looked at everything else," he said.
Riley said that all other hospiutals have a gatekeeper to screen
indigent care patients.
"They have made changes in the past six months because of the same thing
we are seeing now," Ontiveros said.
"If this was going on, somebody should have noticed," said Chel Flores.
Ontiveros said the information has been presented to the board several
times. Former administrator Bruce Birchell sent it in memo form to the
board, she said.
Jeannette Alligood said that Birchell told the board about the problem
in January.
Flores asked about the cost of prescriptions purchased by indigents at
"the high priced pharmacy instead of low price pharmacy."
Ontiveros said the initial policy was to take bids.
"The next time they all decided to bid the same price so they could all
get a piece of the pie, so we use all three pharmacies," Ontiveros said.
"That's price fixing," said finance officer Mike Hathorn.
"That went before our board, and they allowed them to do that,"
Ontiveros said. "They came and gave a presentation to our board and
recommended it in 1991."
Flores said the high-priced pharmacy has filled more prescriptions than
the other two. "I was wondering if the patient had been told not to go
to this pharmacy."
"We can't do that," Ontiveros said. "So long as the board sets the
policy that all three pharmacies are to be used, we have to go by it."
Riley said the hospital needs to take "real, live competitive bids" or
look at an in-house pharmacy.
"We have done studies and found that, of the three providers, one was
getting 67 percent of the business," Garcia said. "Obviously there's
ways to get around this. Share and share alike was not being done. I am
going to recommend to the board that we take bids."
He suggested board members take a "real good look" at a chart prepared
by Riley to compare Pecos to Alpine, Fort Stockton and Monahans in
indigent care services and discuss changing the policy at the next
meeting.
All others contract with one pharmacy for prescriptions, use a
gatekeeper to screen patients and require vouchers for a speciality
visit.
Reeves is one of only three counties in Texas that use judgment appeals
of indigent cases, Riley said. Alpine, Fort Stockton and Monahans all
use policy appeals.
A statistical report for the first five months of the year show that of
43 newborn discharges, 40 were eligible for Medicaid.
Riley reported that she, Alligood and Iris Rives attended a meeting in
Midland Wednesday to hear a presentation by the state on indigent care
funds.
"If the federal government approves a waiver, Reeves County hospital
will be required to participte in a program whereby our indigent care
funds will be submitted with Medicaid funds to the federal government
for matching dollars," she said.
However, the program would begin with tertiary care centers in June
1996, and "I anticipate that it will be a long time before we see this
program in Pecos," Riley said.
The board awarded the bid for hospital professional and general
liability insurance to the Texas Hospital Insurance Exchange.
Premiums for $1 million per incident - with $5,000 deductible - and $3
million aggregate on professional personnel will cost $44,197.
General liability of $3 million will cost an additional $5,825.
Bills totaling $401,532 were approved for payment as monies become
available. Hathorn reported that $67,322 in invoices over 60 days old
have been paid.
Dr. Kai-wood Ma signed the contract offered by the hospital, but made
three changes to it, Riley said.
Jeannette Alligood said she would agree to allow travel expenses for the
doctor's wife and children in the $7,000 moving expenses; but would balk
at allowing him 36 months to repay the $143,500 in income guarantees and
advances.
But she said the third request that the $5,000 stipend for living
expenses be included in the promissory note be negotiated.
Garcia did not allow a motion to that effect, "because we are still in
the negotiating stage," but directed Riley to so inform Dr. Ma.
Alligood said she would object to the 36-month payback over 24 months.
"It takes away from the incentive to stay and fulfill his obligation,"
she said. "If he leaves in six months, we would have to immediately
recruit another doctor and wouldn't have the funds available. That's the
only reason that re-payment terms are in, is if he doesn't fulfill his
obligation."
Riley said that if she had written the contract she would not even have
put in the 24-hour repayment period.
"Generally repayment commences immediately after the income guarantee,"
she said. "But if that's a deal breaker, I would let it ride."
Hathorn said he has been busy with other matters and didn't have time to
make a financial report.
The computer system has been slow, and he called in the software vendors
to check it out.
"It was at 98 percent capacity," he said. "They eliminated some records
we didn't need and got it down to 85 percent."
They proposed an upgrade that would increase the memory at a cost of
$22,000.
"I have heard nothing but bad mouth about this system," Alligood said.
"Maybe we want to look at another system. If we don't like the software,
why update a bad system?"
Hathorn said the upgrade would be to the hardware, and "You can get a
lot of software to run on an IBM."
The addition of records from the Rural Health Clinic has pushed the
already overloaded system to the brink of crashing, he said.
Dr. Joel Adams was approved for emergency room privileges, and the board
accepted with no regrets the resignation of Dr. Orson Anderson from the
staff.
Riley said the Eunice Anderson trial is scheduled for July 13. The
hospital sued Anderson for breach of contract after she left without
fulfilling her obligation as a pediatrician.
Pharmacists to bid on indigent referrals
By PEGGY McCRACKEN
Staff Writer
PECOS, 1995 - Pharmacists who want to provide prescriptions for indigent
patients of Reeves County Hospital must submit bids, the board of
directors decided in the regular meeting Tuesday.
All local pharmacies have been dispensing prescriptions for indigents in
a "share and share alike" agreement forged with the board previously.
Chel Flores raised the question in a recent meeting about the pharmacy
charging the highest prices getting the largest share of the business.
Administrator Carolyn Riley told the board that selecting one pharmacy
through competitive bidding should cut indigent care medication costs.
Another cost-cutting measure approved by the board is to require
indigent patients to see a local physician, who may either treat the
disease or refer the patient to a specialist.
Present policy allows indigents to access specialists directly, and the
hospital is required to pay the bills. Specialists usually order more
tests.
"In the last two years our specialty clinics have grown by leaps and
bounds," Riley said. "They are being walked into by indigent care
patients without a gatekeeper. We are proposing putting in gatekeepers -
our four active medical staff members and Michele Cser (phyician's
assistant)."
When the patient visits a local physician and is referred to a
specialist, he will take the physician's order to Nancy Ontiveros, the
hospital's social services director. If the patient meets indigent care
guidelines, he will be given a voucher for specialty services. The
specialist must present that voucher for reimbursement from the hospital.
Applicants who are turned down for indigent care may appeal to a
committee set up by the board. Currently, the committee is authorized to
approve the application even if the patient does not qualify under state
guidelines.
Riley said that Reeves County is only one of three in the state that
uses that type of appeal, and she recommended a change to policy appeals
only. That is, if the patient does not qualify under state guidelines,
the committee must turn down the appeal.
Jeannette Alligood and Marcella Lovett supported the policy appeals
method, but chairman Raul Garcia, Jesse Prieto and Chel Flores voted to
keep the judgment appeals method.
"I would recommend we continue with judgment appeals," Garcia said. "I
would hate to burden one person with policy appeals...I feel like three
people, as it is being done now, can do as good a job. There's going to
be human judgment, regardless of how we do it."
The board approved guidelines for the committee, which include
establishing the health status as "extremely serious," "severe,"
"moderate" or "non-systemic."
Only the first three would be considered for futher assistance.
Appellants must have no resources available, have exhausted all other
personal or public resources for help; the cost of medically required
service is prohibitive relative to the resources available and denial
could result in a potentially serious complication.
Health permitting, the client must be present at his or her appeals
hearing.
The hospital will not provide organ transplants nor experimental
medications or treatments to indigent care patients.
Riley said that the policy is not new; "It defines what we are already
doing."
By going to policy appeals, the committee would be bound by state
regulations basing indigent qualifications on income levels, number in
household and other resources available, Riley said.
"It is a fairly objective method," she said. "Either they meet the
criteria or they don't."
"Under the judgment appeal, we say we `We know you are over the limits
of income, but due to extenuating circumstances, we wll make an
exception and reimburse for your health care,'" she said.
Policy appeals would control costs, Riley said.
But Flores disagreed. "I don't think it would change much. We go by the
guidelines, no matter how hard it is," he said. "I have felt that `these
poor people need all the help they can get,' but you look at the
guidelines and say you can't."
"I am not denying people need help," Lovett said. "I served on that
committee also. They come to the committee because they don't fall
strictly within the guidelines."
"The way the discussion has been going on, it sounds like we have been
giving away the money," Flores said. "It is very stressful not being
able to help people in need."
Alligood said she has also served on the committee, and she feels
adhering strictly to the policy would take away the stress of making a
subjective judgment. However, her motion to go to policy appeals failed
3-2.
In other action, the board approved the termination of Alexander Kovac,
M.D. as director of radiology. Kovac exercised his option to terminate
the contract with 30-day notice that he is moving to Big Spring.
Visiting radiologist Dr. John Young of Alpine was approved for
consulting and clinical privileges at the request of the medical staff.
Riley said that another radiologist has shown an interest in moving to
Pecos, and he will tour the town and hospital to determine if it would
be suitable.
Riley said that Dr. Eunice Anderson, who left Pecos with one year to go
on her three-year contract, has filed for bankruptcy. The hospital had
filed suit to recover $104,062 paid to her in income guarantees, office
rent and equipment and other support.
That trial was set for July 13 in 143rd District Court. However, Riley
said that no trial will be held, and the hospital must file its claim
with the bankruptcy court.
Dr. Kaiwood-Ma has contracted with the hospital to open a family
practice here as of October 1, and he and his wife will be here August
11 to look for a house. Riley said that he may not be able to obtain his
Texas license and complete obstetricrical training by the October 1 date.
Dr. Edward Sigh has asked for medical stff privileges, Riley said.
Research of state regulations reveals that the medical staff bylaws
wouuld need to be modified to accommodate chiropractors, she said.
William G. Reilly, M.D., an orthopedist from Hobbs, N.M. will begin
holding a montly clinic in Pecos, with the board's approval of staff
privileges. He works well with Dr. Zeek, who has an established clinic
here, Riley said.
Also approved was Raymond Collier, M.D., for emergency room staff.
Riley said that five hospitals have indicated interest in working with
RCH in a networking relationship.
"There are several facilities in the area who have a common working
relationship through Blue Cross HMO," she said. "Some are talking about
networking with them."
Bills totaling $416,473.33 were approved for payment "as monies become
available."
Finance officer Mike Hathorn said he has paid all the bills that were
over 60 days old, and the present balance is about $194,000.
Riley presented the annual progress report of Quorum Health Resources
Inc., the firm operating the hospital under contract with the hospital
district. Board members said they wanted to study it before giving
approval.
Copyright 1996 Pecos Enterprise
324 S. Cedar, Box 2057, Pecos TX 79772
Phone 915-445-5475, FAX 915-445-4321
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