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By PEGGY McCRACKEN
Staff Writer
Reeves County Hospital can expect at least a six-month wait for a family
practitioner who delivers babies, two recruiting firm representatives
told the board Tuesday.
Bill Lentz of Harris, Kovacs and Alderman of Dallas said the average
placement is three to four months, and the district can expect another
90 days for the doctor to begin his practice after signing a contract.
Lentz said his firm also provides locum tenens physicians to fill
temporary vacancies. Because RCH already has a locum tenens provided by
H-K-A, they would reduce their $2,000 retainer to $950 to initiate a
search, he said.
The placement fee is $10,000, and the average search cost is $19,000 to
$22,000, he said. "We are not cheap. We do not give money back if they
don't get a doctor.
They seek to recruit only those physicians trained in the United States
or Canada, he said. Last year, the firm placed 29 Canadian doctors, who
are seeking to move because of Canada's government health care system.
Mark Blakeney of Jackson and Coker said his firm is the oldest and
largest in the nation - and about half the physicians they recruit are
foreign trained.
Currently they have an agreement with Methodist Hospital in Lubbock to
recruit physicians for over 30 hospitals in rural areas, such as Pecos,
who have a working relationship with the larger hospital.
No fee is charged to initiate the search, and the district pays only
$500 per month, with a total fee of $17,000 for a successful placement.
Without the Methodist Hospital affiliation, a search would typically
cost $23,000 to $26,000, he said.
Because they do a background check and in-depth interview to match
physicians to communities, doctors have a record of staying longer.
Since 1988-89, 80 to 85 percent of the doctors recruited are still in
practice in that location, he said.
Their investigation usually weeds out those doctors who are not well
trained or who have a poor track record, he said.
Family practitioners who want to move to rural West Texas are 45-55
years of age, "Maybe in Houston or Dallas and ready to slow down,"
Blakeney said. "Others have practiced in rural areas and want to
continue that."
Both men said that the district would have to guarantee a family
practitioner who delivers babies at least $140,000 to $150,000 income
the first year. If his or her practice in succeeding years does not
generate that much revenue, they are likely to leave, said Lintz.
Administrator Bruce Birchell said he is working with contingency firms
to recruit physicians, and has invited a Spanish-speaking prospect who
is interested to visit Pecos July 21-22. The earliest date he could
begin practice would be July 1995, he said.
"Didn't we decide to put those (1995 prospects) on hold at the last
board meeting?" asked Marcella Lovett.
"We felt, since he expressed such high interest in Pecos, it would be
worthwhile to have him pay a visit," Birchell said. "We are looking at
February or March, anyway."
The hospital will have to pay about $1,500 in expenses for the visit.
Birchell said he had contacted several physicians recommended by
contingency firms, but none of the others were interested. Contingency
firms represent the physician, and they do not offer background checks
nor arrange interviews, he said.
He said he believes he should follow through on those recommended, but
"We need to make a switch to a retained search firm."
Michele Cser obtained her registration as a physician assistant Tuesday
and went to work in the physician center, Birchell said. Dr. Orville
Cerna is interested in using her in a rural health center, and a second
may be opened in the hospital's emergency room.
The board approved purchase of an air conditioner for the laboratory,
which has already been installed. Board chairman Raul Garcia said he
approved the emergency purchase because test equipment in the lab is
heat sensitive.
Also approved for purchase was a floor buffer and gas card analyzer for
anesthesia. No action was taken on bylaw changes nor on radiologist Dr.
Alexander Kovac's contract, following a discussion with him and the
medical staff in executive session.
Steve McCormick, finance officer for the city of Pecos, asked the board
to approve an actuarial study for the ambulance service so ambulance
personnel can be covered by the firemen's retirement program.
The study would give the entities costs on funding the plension plan.
The city and hospital district equally share the cost of ambulance
service.
McCormick said ambulance personnel are now paid on a contract basis, but
Internal Revenue Service regulations may require that they be considered
employees. In that event, the entities may have to pay a penalty, plus
Social Security tax retroactively.
If they are on the payroll as part-time employees and covered by the
firemen's pension plan, they would not be required to pay Social
Security tax, he said. Ambulance attendants are on call for 24 hours a
shift at $2 per hour. He estimated the cost to fund the plan at $3,000
to $4,500 per year for the hospital and city, who would each pay half.
The board approved the study, contingent upon the city council's
approval.
Physician recruitment, capital expenditures, bylaws amendment and an
actuarial study of the ambulance service are among items to be discussed
by the Reeves County Hospital board of directors at 6 p.m. today.
Jackson & Coker and HKA will make a presentation on physician
recruitment to open the meeting, and an executive session to consider a
physician contract is the last agenda item.
Several physicians are considering a move to Pecos, administrator Bruce
Birchell told the board in its last meeting.
A bylaw amendment concerning the joint conference/long-range planning
committee will be considered, as will purchase of an air conditioner for
the laboratory, a floor buffer for housekeeping and a gas card analyzer
for anesthesia.
Dr. James Cam will give the medical staff report, and Birchell will
report for the administration.
By PEGGY McCRACKEN
Staff Writer
While holding tightly to the purse strings, directors for the Reeves
County Hospital District on Tuesday voted to seek a $150,000 line of
credit at a local bank to ensure payroll and other operating expenses
are met as revenues continue to fall.
The board added a provision in the resolution that no capital
expenditures would be made without prior board approval, a deviation
from board policy that allows the administrator to make purchases under
$5,000.
"You can order eight things under $5,000 and run up a heck of a bill,
nickle and dimeing you to death," said Marcella Lovett.
Any use of the line of credit, even for payroll, must be approved by the
administrator or comptroller and one of two board members: chairman Raul
Garcia or past chairman Jeannette Alligood.
"If we are going to beg to secure $150,000 for operation of the
hospital, obviously we are worried about something," Garcia said. "Yet
we have this capital equipment budget we just revised. There is
thousands and thousands of dollars worth of equipment here. I'd hate to
think this money could be nickle and dimed away."
Administrator Bruce Birchell said that restriction would make it more
difficult to buy smaller items, noting that he reports every month on
what has been purchased.
"But that would be after the fact," said Lovett. "If we were told
beforehand why it needs to be purchased, we might be more understanding."
Alligood said that borrowing is an extra-ordinary step, "but we are
faced with extra-ordinary circumstances. I think this is a very sound
resolution and policy for the board to follow under these particular
circumstances."
Birchell said it may not be necessary to borrow any money, but it will
be available if needed. The $75,000 payroll is the hardest to meet,
because it requires cash, while accounts receivable can wait.
Up to $300,000 of hospital accounts receivable will be put up as
collateral, Birchell said. "You can't put up taxes for next year."
Comptroller Mike Hathorn said he is trying to get Medicaid payments
quicker than the normal six months; that $77,000 in reimbursement from
the Texas Department of Health for bad debts are due, and a $45,000
grant from the Meadows Foundation is possible.
"Those are things we can keep in mind that will be coming in, probably
before the end of the year, but it may get worse before it gets better,"
Hathorn said.
Another $12,000 in leftover bond funds may be available for operations
if it can legally be transferred, he said. And restrictions have been
removed from a donation that has a balance of $1,400, he said.
Accounts payable this period totaled $252,000, Hathorn said, which is
less than usual. But $141,000 of that is from one to three months past
due.
"Right now, money is tight. The total has dropped, but aging has gotten
a bit worse," he said.
Birchell said he has made arrangements for one man who owes the hospital
to do yard work to pay his bill, and others may do the same in the
future.
Alligood questioned the legality of such an arrangement without paying
income and Social Security taxes.
Birchell said he had checked with "labor" sources who said it is legal,
but he did not check with the IRS.
Nadine Smith said the district's insurance company said that volunteer
workers would be covered by workers' compensation if they were injured.
"This is not voluntary," Alligood said. "They are working for money.
This goes against everything I know about employment laws. I would like
to check with the IRS and Social Security people...essentially, they are
working in exchange for what they owe us...If you receive something in
lieu of money, like stock, that's taxable and you have to pay it."
Garcia instructed Birchell to tell the board in advance of any such
plans in the future.
Birchell reported that Dr. Jack Turner, an OB-GYN specialist, is working
in the hospital's Physician Center and already has several obstetric
patients.
"We are doing all we can to get Dr. (Joseph) Darpolar licensed," he
said. He is expected to arrive in late summer or early fall.
Dr. Herbert Garfield rejected the board's contract offer, and Birchell
recommended it be with drawn so he can negotiate with five other
physicians who are interested in moving to Pecos.
"That's a good idea," said Alligood. "He doesn't appear really
interested. I would hate to make an offer to another physician with him
still pending." Her motion to withdraw the contract offer was approved.
Board members agreed to pursue contracts with physicians who could come
this year, rather than obligating the hospital to wait until 1995 for
one candidate to complete his residency requirements.
The board rejected a $1,000 offer for tax sale commercial property at
1222-24 S. Cedar Street and delayed action on a similar offer for a
residence 411 E. "D" St.; and approved emergency room privileges for Dr.
Berta Lutherer.
By PEGGY McCRACKEN
Staff Writer
Bruce Birchell will continue as administrator for Reeves County
Hospital, district directors decided Tuesday.
Interim administrator for the past several months, Birchell was one of
three candidates for the position. The management company, Quorum Health
Resources, provides an administrator and finance officer, but both must
be approved by the board. All five directors were present, and the vote
was unanimous.
The hospital has made some progress in collections, but operating
revenues were below budget projections last year, and increased expenses
brought the operating loss to $1.5 million.
Property and sales tax revenues of $1.8 million, interest income of
$14,311 and a loss of $63,950 in area ambulance service left a net gain
of $178,895 for the year, said Dan Painter, auditor, in a report
presented by his assistant, Crissy Martinez.
Painter said that the inability to collect patient account receivables
continues to cause cash flow problems.
"The growth of accounts receivable is compounded by the growth of
expenses," he said.
Patient accounts receivable at the end of 1993 was $1.8 million, with
$907,670 not expected to be collected. That leaves $931,404 to be
collected, Painter said.
Meanwhile, payroll expense was $2.4 million, up from $1.8 million in
1992. Additional nurses were retained to cover for regular nurses in
obstetrics training, accounting for some of the $566,126 increase. Total
expenses were $6.2 million, up $1 million from 1992.
While revenues increased with the growth of the medical staff, Birchell
warned that revenues will fall below projections for the last half of
this year, due to the departure of Dr. Kanayo Ubesie. Expenses will be
greater, because the district is paying $8,000 per week for a
locum tenens doctor to fill in while a replacement for Dr.
Ricardo Tan is recruited.
Texas licensing requirements have delayed the arrival of Dr. Darpolar
for that office for at least three weeks, Birchell said.
Birchell said a physician's assistent is here, awaiting licensing. She
is processing an application for a rural health clinic for Dr. Orville
Cerna, and a second one will probably be set up for Dr. Garfield if he
agrees to the modified contract approved by the board.
A rural health clinic allows the doctor and hospital to receive
government subsidy for some patients. One physician's assistant can
serve two clinics, Birchell said.
Physician contracts should be included in the board's minutes, Painter
said in his audit. Confusion arose over several contracts that had been
negotiated by at least three different administrators, and copies of the
contracts were not in the minutes.
With that in mind, board chairman Raul Garcia asked the secretary to
revise minutes of the previous meeting to include the names of board
members authorized to sign checks and changes made in board policy.
Three amendments were made to the personnel policy: All employees must
provide for safety and well being of families by following applicable
standards of care and courtesy; keep facial hair trimmed; and to
authorize department heads to send employees home when the patient
census is low.
Time off will be on an equitable basis, with each employee to lose no
more than eight hours per week. An employee may voluntarily take time
off when the census is low without jeopardizing his status.
Jack Rogers, director of nursing, said the policy will apply to all
hospital employees, including registered nurses.
"It would affect everyone, including housekeeping," said board member
Jeannette Alligood.
The board approved amendments to the capital budget that will decrease
purchases by $58,000. Items already purchased or on order include
scales, telemetry system ($74,180), computer and memory board, porgable
X-ray unit ($34,860), electrocautery unit, drug infusion pump,
ultrasound upgrade ($84,818), pulse oximeter, ice machine, credit card
machine and incinerator.
Estimated cost of Priority 1 items to be ordered is $71,663. Priority 2
items would cost $35,596, and Priority 3 items are estimated at $20,750,
for a total of $128,009.
Birchell said he will bring a proposal to the next meeting to open a
line of credit at a local bank to finance any purchases the district
does not have money to pay for.
Alligood suggested holding off on some purchases until the new doctors
have established their practices and revenue is up, rather than
borrowing money.
The board voted to keep malpractice coverage at $1 million per
occurrence and $3 million total, at an increased premium of $12,000.
Total premium for one year is $69,000.
Birchell said that the coverage could be reduced because, under Texas
law, hospitals don't have to pay out more than $100,000 per occurence on
one individual.
"If the law was breached, or the need to settle a case for more than
that was apparent, insurance would not be there to pay it," he said.
Marcella Lovett asked Andy Epps, Quorum representative, if their
management contract calls for the higher coverage.
Epps said it does, but that could possibly be changed. However, he said
that a Kingsville hospital recently had to pay out $750,000 over and
above their insurance coverage.
"The reason we put those limits, it is a very los-side limit," he said.
"Things get that high routinely. It is a reasonable limit for you."
Alligood asked if attorneys normally sue for tha maximum amount of
insurance.
"At one time I would have said yes, but now they are going in excess of
the limits," Epps said.
Lovett said that an insurance officials is advising the medical and
dental profession not to get too low a limit, but not too high, either
because lawyers will sue to the maximum.
"If he had his way, he would advise everyone to drop all insurances so
malpractice suits would go away and people would go back to
responsibility and acts of God," she said.
Epps said the malpractice coverage includes nurses, who can be sued
individually. "That's the real issue," he said. "State law doesn't limit
it on the people, just on the hospital."
Birchell said the scholarship committee awarded $500 per semester to
Betty Perea, an LVN who is studying to become an RN.
By PEGGY McCRACKEN
Staff Writer
Reeves County Hospital's gross operating revenue increased in 1993, but
so did expenses, auditor Dan Painter told the finance committee Tuesday.
"Cash flow has improved, but collections must remain a top priority,"
Painter said. "Expenses increased and should be watched."
He said that a computer inventory he recommended last year is still not
on line, and work on a detailed plant and equipment ledger is at a
standstill.
Because of frequent changes in administrators, some confusion arose over
physician contracts and how much they were to be subsidized by the
hospital district, Painter said.
All contracts should be included in the board minutes so they can easily
be located, he said.
Despite his recommendation last year that cash handling duties be
divided between two or more people, one clerk still handles all those
functions, Painter said.
Bruce Birchell, administrator, said that is a matter of costs versus
control.
"You have to decide if you need to control costs or control (handling
procedures)," he said.
Painter went through the entire audit with the finance committee, and
will make a brief presentation to the full board in the June 14 meeting.
Birchell gave the committee a list of equipment needed, listed by
priority. He said that, with the hospital and equipment 15 years old,
capital expenditures are one cause of the increase in expenses.
That is expected to continue through 1995 as old equipment is replaced,
but fewer capital expenditures are planned for 1996, he said.
One piece of equipment not on the list has broken down and will have to
be replaced at a cost of about $17,000, he said.
Rather than purchase the colonoscope separately, along with two similar
scopes that were already approved, director of nursing Jack Rogers said
that doctors recommend purchasing a gastro-intestinal video system to do
all the work.
"It will allow the operator to pass a scope through either the mouth or
colon and look into the stomach, lungs and bronchials," Rogers said. "He
can get magnification on a TV screen and record it on video. Dr. Bang
feels it will be better service and safer for patients."
Examinations with the GI viceo system would be shorter and would do a
better job of diagnosing and taking out polyps or burning ulcers in the
stomach, he said.
"The system we have now is limited, because he has to look with one eye
through the scope and can only see a small portion at one time," he said.
Rogers said the videos could be used to educate the staff and new
physicians. The complete system would cost $65,000, he said.
"After what we just heard on our audit, how is this going to burden us
in the cash department?" asked committee chairman Raul Garcia.
Brichell said that cash will be tight for the rest of the year, with the
departure of Dr. Kanayo Ubesie and the arrival of two new doctors.
"I looked at a couple of options to ease the cash crunch," he said. "We
could lease the equipment for a five-year period or get a line of credit
with the bank for a short period."
The three scopes and an X-ray machine already approved would cost about
$74,000, and lease payments for five years would be $1,700 per month, he
said.
But a line of credit would be least expensive, he said.
"My concern is that we have extended ourselves to the point we are going
to have to watch our expenses," Garcia said.
He said the full board would consider the purchases in their next
meeting.
By PEGGY McCRACKEN
Staff Writer
Reeves County Hospital District directors on Tuesday approved changes to
a contract offered to one family doctor hoping to practice in Pecos, but
rejected demands of a second.
Dr. Joseph Darpolor accepted the contract offered to him, with two
changes. He asked for and received medical insurance for his family and
clarification of office expense that the hospital will reimburse.
He will take over the physician center set up by the hospital in Dr.
Ricardo Tan's office at Fifth and Oleander Streets. Dr. Kanayo Ubesie's
will transfer his records to that office, which will be staffed by a
locum tenens doctor until Darpolor arrives.
The board was not so agreeable with requests made by Dr. Herbert
Garfield, who wants $2,250 per week stipend while in obstetrics training
required by the hospital; to defer obstetrics training until he has
established his practice; and to find a house before he makes a
commitment to sign the contract.
Marcella Lovett said the board had offered $1,500 per week while
Garfield goes to school for four weeks. "You can live awfully good for
that," she said, noting that the hospital would pay his living expenses
during that time, and schooling is free.
Hospital administrator Bruce Birchell said that if the board chose not
to accept Dr. Garfield's request, another doctor has agreed to come on
student visa status.
"Other than that, we would have to start recruiting again," Birchell
said.
Jeannette Alligood said she is concerned that Dr. Garfield doesn't want
to start school right away.
"That's one of the most important issues. If he starts his practice,
when is he going to find time to go to school? There's not going to be a
good time."
With Ubesie leaving, the practice of obstretics (delivering babies) is
one of the major concerns in recruiting doctors.
"We could wind up with him being here long term and not going to school,
and it won't give the service we were trying to accomplish," Alligood
said. "We need someone quickly, but this does not move quickly."
Jesus Prieto said that the more the board offers, the more Garfield
wants.
"It gives me grave concern about what would happen once he gets here,"
Alligood said. "We are a long way from each other - what he would find
acceptable and what we offered to pay."
Lovett said that what the board offered is "generous to start with."
Dr. James Cam, chief of the medical staff, said it sounds to him like
Dr. Garfield is trying to test the water a few months to see how things
are before going to school.
"That money offer - if he works as an emergency room phyusician, he will
be making $7,000 per month. He's asking for the amount he would make as
an ER physician while he's being trained for obstetrics," he said.
"I would hate for him to get out here and test the waters," Alligood
said, proposing to leave the contract offer as is and "see if he comes
back with a counter offer."
Birchell said the board can extend an offer to someone else in the
meantime and take the first one to agree to contract terms.
He said that Dr. Khalid Ali, a surgeon from Egypt who has practiced two
years in England and one in the United States, is trained in obstetrics
and could come to Pecos in early January, 1995.
"He is ready to sign right now," Birchell said. "I am asking for
direction. With a J-1 (student) visa, you have to offer them a two-year
employment contract."
The J-1 visa program is administered by the U.S. Department of
Agriculture to allow foreign doctors to study and practice in the United
States.
Alligood asked for more information on the program so the board will
know exactly what it is responsible for.
Birchell said he would bring all the information on the program and a
proposed contract for Dr. Ali to the next board meeting.
The board met in closed session to discuss physician contracts, but took
no action in open session.
Chairman Raul Garcia appointed four committees, including a finance
committee and social security-retirement committee that Lovett and
Alligood opposed.
Alligood said the social security-retirement committee is inactive
because it was established to solve problems the district had when the
Internal Revenue Service returned employees' social security payments
when the district was formed.
"I think that was resolved by the committee at the time, and we opted to
go with a retirement sysstem rather than going back into social
security," Garcia said. We de-activated this committee. If we ever think
there's something for it to do, we can put it to work. Let's leave it in
place."
Birchell said the by-laws would have to be changed to make the executive
and finance committee legal, because it called for the board chairman,
vice chairman and secretary to be on the committee.
Lovett said that Garcia petitioned the board last year to allow the
entire board to do the work of that committee.
"What's your feeling now?" she asked Garcia.
"To put three people on this committee," Garcia said.
"I feel it might be more fair if the president, vice president and one
more board member be on the committee," Lovett said.
But Birchell said that would violate the Texas Open Meetings Act because
three members of a five-member board would constitute a quorum.
"We looked at these prior to tonight, and we thought this would be the
best way to do it," Garcia said.
Birchell said he had talked with the hospital's attorney, Scott Johnson,
about having a quorum on the committee, and he suggested they post
notice of meetings as an executive session (closed to the public).
"Wouldn't that also have to stand up to the open meetings act?" asked
Alligood.
Birchell said that it would, but that Johnson would give him the legal
wording to do so.
Alligood asked if finance committee meetings are open to the public, so
that anyone interested could attend.
"Probably not," Birchell said.
"I would think they could be," Lovett said.
Alligood made a motion to change the by-laws to place the chairman and
vice chairman of the board and the chief of staff on the committee, with
the administrator and comptroller as ex-officio members.
Prieto seconded the motion, and the vote was unanimous.
Garcia sought to stop the scholarship committee from taking action on an
application until the board revises the policy.
"I wasn't thinking of revising it at this point," said Alligood, who is
the board's representative on the committee with Birchell, director of
nurses Jack Rogers and Iris Rives.
"We don't know what's in it," Garcia said. "At least the chairman
doesn't know. I'm sure 60 percent of the board doesn't know what's in
those rules."
"You were here," Lovett said. Delay would be detrimental to the
applicant, who plans to continue her nurses training at Odessa College
this summer while working at the hospital for 40 hours each weekend, she
said.
"This would benefit the community. I admire people working like she is."
Prieto said he had no problem with the committee's action, and Chel
Flores agreed. "I think we should go on with what we have without
holding up anything more," he said.
"Are you familiar with the criteria on who gets assistance?" asked
Garcia.
Flores said the board had agreed to provide scholarships to those with
the most financial problems and who are more eager to go to school and
to come back and work for Reeves County at least two years.
"I don't think we can re-visit everything and rehash it," Alligood said.
"The action that was taken was considered. Let's get this girl some help
if she meets the criteria."
"I am automatically a member of that committee anyway, so we will take a
look at it," Garcia said. "That will be a time to look and revise until
we are blue in the face."
In other business, the board approved medical staff privileges for two
emergency room physicians, Steven Cox, MD and Eusebio Barrientos, MD;
approved sale of property at 510 S. Hickory and 515 S. Elm Street taken
in a judgment for back taxes, tabling for further study an offer of
$1,000 for commercial property at 1222-1224 S. Cedar Street;
Adopted bank resolutions authorizing Raul Garcia, Jesus Prieto, Iris
Rives and John M. Hathorn to sign checks, with two signatures required;
and approved bills to be paid as money is available.
By PEGGY McCRACKEN
Staff Writer
Reeves County Hospital District directors decided Tuesday to proceed
with plans to build an incinerator for medical waste, rejecting
alternate plans to sterilize waste and send it to the landfill or to
have a disposal firm pick it up monthly.
Monthly pickup would require a separate, air conditioned building to
store the waste, because it would have an offensive smell, said Bruce
Birchell, administrator.
Sterlilization would also require space the hospital doesn't have at the
moment, and regulations could change that would outlaw it, he said.
Birchell said the staff began dealing with the medical waste issue about
a year ago and began in January to seek a license and permit for an
incinerator.
"The licensing process has been carried forward. The state has done an
inspection, and advertising has been done," he said.
Now he has learned that proposed EPA regulations would eliminate 80
percent of hospital-based incinerators. If so, the hospital probably
could operate it for four years before having to shut it down.
The American Hospital Association is opposing the regulations, and they
could be changed so that small hospitals would have less stringent
standards.
"Then we could continue to use it," he said.
Pickup would cost $200 to $400 per month, and a sterilizer would cost
$23,000.
An incinerator would cost $29,800 installed on the hospital's support
pad. It is guaranteed to meet all emission requirements, is economical
to own and operate, McRae Combustion Systems claims.
The board also approved a contract with Parikh Rakesh, M.D., a family
practitioner who has agreed to be trained in obstetrics; approved
emergency room privileges for Calvin Casipit, M.D., Karen Pennington,
M.D., Steven Kastle, D.O., and Walter Long, M.D.; anesthesia privileges
for Hall Keyes, C.R.N.A., and additional privileges for Joseph Darpolor,
M.D.
Birchell said he has contracted with a therapist to provide physical
therapy to swing bed patients, but has been unable to find another for
in-house therapy.
Jerry Giardina, nurse anesthetist, said his wife is training in the
Philippines and will be available in 10 months, he said. She would have
to pass a test in the United States and work under a proctor "that we
can't provide," he said.
Revenue generated by an in-house therapist would be about $66,000 per
year, and the salary would cost that much or more, Birchell said.
"Therapists are hard to find. They demand very high salaries - in about
the same league as physicians that do obstetrics.," he said.
Dr. James Cam said that a therapist is needed. "For out patients alone,
we utilize a lot for stroke and back injury."
Dr. W.J. Bang said an in-house therapist is needed for burn victims who
do not need to be transferred.
The board sold an Ohmeda Ventilator to Pecos County Memorial Hospital on
their bid of $2,000, approved purchase of a a $695 exam table for Texas
Tech OB Clinic and signed a contract with Dan Painter for $12,500 to do
the 1994 audit.
Finance officer Mike Hathorn reported that cash flow and collection of
accounts receivable is an on-going priority, but that collections are
extremely difficult.
Private pay accounted for 26 percent of ageing accounts as of May 31.
They are being turned over to a collection agency earlier, and
collections have improved, he said.
Net patient revenues for September were $9,300 more than last year, but
the operating loss was up by $49,300.
For the year, the loss is $458,700, which is $819,700 more than this
time last year.
Bills approved totaled $422,547. Hathorn said some of those have already
been paid, and accounts payable as of Tuesday was about $366,000 "Much
better than last year."
By PEGGY McCRACKEN
Staff Writer
Reluctantly following the trend for managed health care, Reeves County
Hospital District directors on Tuesday signed an agreement with TakeCare
Administrative Services Corporation, aka Preferred Plan of Texas, to
provide services to member insureds and heard a proposal by Methodist
Hospital on a different type of plan.
With TASC, inpatient hospital services will be paid on a per diem rate,
while outpatient services will be reimbursed at 85 percent of billed
charges.
The contract is similar to one the board approved in the last meeting,
but is more detailed and more restrictive, said Bruce Birchell, hospital
administrator.
Marcella Lovett said she is concerned about excluded services, with the
determination on whether they are necessary for the patient's care to be
made by a TASC doctor.
"Will that be someone sitting in Dallas or Philadelphia who is not
familiar with this area?" she asked.
Birchell said he doesn't know where the doctors making the utilization
review will be located, but the patient is responsible for the bill
whether his insurance company approves the treatment or not.
However, the hospital cannot charge the patient more than the per diem
rate listed in the contract, he said.
Ray Mason of Methodist Hospital in Lubbock described their Health
Maintenance Organization, which is a pre-paid plan that enlists local
physicians as gatekeepers.
High Plains Baptist Hospital in Amaraillo initiated the program eight
years ago to keep out-of-state HMOs from coming in, he said.
"We can no longer hide from managed care. It is here. We have fought it
harder than anybody," he said. "Blue Cross will be coming in the spring
with a managed care product."
Methodist Hospital has joined High Plains and Hendrick Hospital in
Abilene to serve West Texas, and the HMO will eventually go statewide,
Mason said.
Physicians and hospitals are being invited to join the HMO, which
already has state employees signed up and will be marketing to agencies
and companies to enroll their employees.
Covered employees would go to their member primary physician for all
their needs. If he refers them to a specialist, it would have to be one
who is a plan member, Mason said.
"If they bypass the primary physician and go to another city, they don't
get it paid for," he said. "It puts them back to your primary physician
in the local community."
That is the difference in the HMO and PPO, he said. "Others have limited
physician involvement. The HMO has the physician as gatekeeper."
The contract he proposes pays the hospital a per diem rate for
in-patient care that reimburses 91 to 92 percent of normal charges,
Mason said. He proposes to reimburse 80 percent of outpatient charges.
Birchell said he would give board members a copy of the proposal before
they meet to consider it.
Birchell said physicians need to discuss it before the board acts
because it is different.
"If we choose to go with it, it needs physicians pulling together.
That's what makes it effective," he said.
By PEGGY McCRACKEN
Staff Writer
High incentives to attract physicians to a community are driven by the
market and not by greed, Dr. W.J. Bang told Reeves County Hospital
District directors in their Tuesday meeting.
Dr. Bang said he was concerned about comments made in the last board
meeting that new doctors disregard the Hippocratic oath and become money
hungry.
"That's not right," he said. "As a matter of fact, the Hippocratic oath
is the backbone of our philosophy, and we are functioning under that
philosophy."
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