Hospital board makes contract talk public

Future discussions over the contract between Crook County Medical Services District (CCMSD) and Health Management Services (HMS) will take place in the public eye, said the Board of Trustees last week. After hearing concerns from numerous members of the community, both at Thursday’s meeting and beforehand, the board pledged to continue negotiations without going into executive session.

This promise was honored immediately, providing an opportunity for board members to air their thoughts regarding HMS’s performance. It also gave HMS, members of staff and audience members the chance to correct a string of apparent misunderstandings.

Community Input

Thursday’s meeting began with public comments, during which several audience members responded to reports of a job posting that appeared to reveal the board’s intent to oust CEO Nathan Hough.

Dave Cromas of Peak Motion Physical Therapy commented that he was troubled to read about the issue in last week’s newspaper and said the situation regarding HMS’s contract, “Ought to be substantially more transparent than it is.”

Cromas noted that Hough appears to have enormous support. He referred to last month’s board meeting, when six members of staff spoke to their satisfaction with the current state of the district, and said this suggests HMS is doing a competent job – “That might be putting it lightly,” he added.

Cromas also shared concern that a trustee was “so distressed” by board’s actions that he resigned and said he was in attendance to beg board members to spend less time discussing this issue in private. “If Nathan is rotten, accuse him, back it up and get rid of him – but make it public,” he said.

Betty Myers agreed “wholeheartedly” with Cromas’s statements and also called for the board to state publically what reasons they have to be dissatisfied with Hough. Over her 37 years as an employee of CCMSD, she said, people always seemed to be disgruntled, but she hadn’t heard “one bad thing” about Hough and HMS until last week’s article came out.

Kristina Davis, Nurse Practitioner, told the board that “this hospital is run better than any hospital I have ever been in”. Andy Miller, President of Sundance State Bank, commented that the district is an important part of the community and the public wants to understand what is going on.

The final person to speak was Trustee Trish Habeck, who made an impassioned speech about her desire to see the situation resolved. Members of the public have been calling her at all hours, she said.

Habeck stated the board needs to keep in mind how much growth has been seen since HMS arrived, and also the desires of the employees. “If I look at the numbers,” she said, “It shows that we are growing.”

She said she doesn’t want to step back in time to when the hospital had no patients and the community was outraged by the loss of its previous management company.

“I really hope, as board members, we can really work together,” she implored in closing.

Truth versus misunderstandings

Over the course of the meeting, it became clear that the board’s dissatisfaction with HMS is based at least in part on a series of misunderstandings.

Chairman Mark Erickson, for example, revealed the board’s biggest concern is that the contract states CCMSD will have a “dedicated, full-time CEO”. However, he said, “We are not getting what we paid for” as Hough now serves for a few hours each week as the CEO of Lusk’s hospital.

Erickson commented that Hough’s divided attention could be the reason certain things have been “hurried”. For example, he expressed dissatisfaction with the ambulance Hough secured via a contract with a Sioux Falls company, which turned out to be much older than the vehicle Hough promised.

Hough challenged this statement, explaining that Erickson was speaking about two different things. Hough’s correction aligns with coverage from this newspaper; having attended both relevant meetings, we reported that Hough explained to the board both before and after the ambulance arrived that it was a short-term “band aid” solution to secure a functioning vehicle while negotiations take place to secure a long-term contract for an ambulance that would be built to the district’s specifications.

Habeck presented the minutes from the meeting at which the short-term contract was approved, commenting that the board did agree to the 2002 model as a “band-aid”.

Trustee Sandy Neiman said the board was never informed about Hough’s role in Lusk or asked for its approval. She and Trustee Connie Lindmier both cited a lack of communication from HMS as the origin of the problems between the management company and the board.

It appeared the communication issues may go both ways, however, when Miller asked from the audience whether HMS has been notified that the board feels there has been a contract breach. “They will be,” said Erickson, handing a document to Karl Rude, HMS President.

Erickson stated several times that he has an issue with Hough performing the CEO role for two districts when the contract with HMS requires he be full-time and dedicated to CCMSD. Cromas asked from the audience whether these terms are defined in the contract.

Dedicated does not mean exclusive, he pointed out, and full-time can be interpreted in more than one way. It’s important to make sure these terms are unmistakable, he said.

Lindmier stated that the board was not informed that that “multiple employees” would be going with Hough to Lusk with no reimbursement for the district. Amber Ondriezek, Director of Nursing, stepped forward to correct this misconception.

While certain members of staff are also employed at Lusk, she said, this is entirely separate to their employment with CCMSD. Speaking as one of those employees, she said, “This county does not pay me a penny to go to Lusk” and said she has worked there for “many years”.

Neiman later brought this up again, claiming that a member of staff told her they had felt forced into working for Lusk. Hough denied categorically having asked any employee to work outside the district and said any who take shifts in Lusk are doing so separately to their employment for CCMSD.

Neiman also complained that comments about the board have been made on Facebook and implied this was Hough’s responsibility, telling him he should have stopped employees from doing so.

“Don’t you think that if you guys actually listened to us as employees, people wouldn’t resort to Facebook?” retorted employee Melaynee Trandahl from the audience.

Neiman responded that the board has asked employees to attend meetings and speak with the board, to which Trandahl stated she has worked for CCMSD for ten years and has never been asked to do so.

Neiman shared her hurt feelings that employees would “downgrade the board so much” with their reactions to the rumors of HMS leaving. The board has done so much for employees, she said, such as better health insurance plans; Trandahl responded that she does not stay for the insurance, but because she loves working for the district and with the team.

Communication

From the audience, Miller commented that it seems miscommunication and lack of clarity in the original contract may be to blame for the current woes and urged the board to look for a solution, “because we’ve got a good thing going here”. Cromas agreed, stating there are multiple paths from this moment towards a destructive outcome and only one or two to a good one; however, he said, it will be possible, “in calm tones to get where we need to be”.

Lindmier stated that part of the problem is that, “As a board, we’ve been out of the loop.” Throughout the discussion, she repeated her desire for better communication.

“We all want what is best and I think we can work through this,” she said, pointing out that it will take everyone involved to make this happen, including the staff.

She further stated that the board has discussed the situation in executive session so there wouldn’t be “a lot of what, if and when”, but that has not worked, so from now on it will be made public. However, she said, the fact that the issue became public may be a blessing as communication is likely to improve now the issues have been aired.

As he has not been included in recent executive sessions, Hough asked the board during the meeting: “What do I need to be doing better?”

“The impression I got is that…you don’t want me here, and I don’t know why,” he said.

The board responded that communication needs to be better, with Erickson adding that the board wants “100% sole focus on CCMSD”. He and Neiman confirmed that board’s distrust of Hough began around a year ago, when the board found out that he was dividing his attention with Lusk.

Neiman claimed that the board had heard “through the grapevine”, rather than from Hough himself. The board agreed that this predicament may have been worsened by the fact that the contract states questions must be directed to Rude, rather than Hough himself.

“We weren’t getting the answers and it just started this slippery slope going down,” said Erickson.

Discussion was held over the need for Hough to act as the point person for all communication, to ensure that such a problem does not occur again.

Hough shared that lack of communication has been an issue both ways. He told the board he has ceased to make rounds of the clinics because “the assumption is that I must be at Lusk”.

The CEO defended his work, commenting that he only spends a few hours a week in Lusk and that he has not once been unavailable when needed by CCMSD staff or board members; this was supported by Trandahl, who further commented that information-sharing with Lusk has helped the district grow.

Future Negotiations

The board is preparing its thoughts regarding what needs to be included in a potential future contract with HMS. Rude stated on Thursday that he is waiting to receive this information.

Various possibilities were discussed at the meeting, such as to move Hough up a management level such that he could oversee several facilities, while bringing in a new CEO to concentrate solely on CCMSD.

While Erickson still felt adamant that Hough – or any other CEO – should be exclusive to the district, not every board member was in agreement. Habeck and Lindmier felt that sharing Hough with Lusk could be allowable if “full-time” was defined, with Lindmier commenting that, as a business owner, she would not blame an employee for being unhappy if they were told what they could and couldn’t do with their time outside of work.

No matter the outcome of negotiations, the board still intends to explore the possibility of replacing HMS when the contract comes to an end. Erickson made it clear that the board has a duty to consider all options for the district’s finances – including other management companies.

“We are trying to put our hands around how best to serve the community,” he said. “Overall, we have made great strides.”

The contract with HMS is due to expire later this year, he said, any by the time it does the district will have paid $2 million to the management company.

Obviously, said Erickson, the board needs to make sure it is spending the county’s mill levy money appropriately. There has been “phenomenal growth, amazing growth” within the district, he admitted, but this was achieved as a team and not by a single person.

The board needs to look at the contract and consider what is best for the community and the district, Erickson said. “We also have to be realistic,” he continued, referring to the district’s finances.

HMS will continue to be an option for the district, however.

“We are now publically going to enter into negotiations [with HMS],” said Erickson. The board and HMS have six months before the contract expires to complete negotiations and he feels things could be “even better” than they already are within the district if this is achieved.

How much better are things?

We asked HMS for data that speaks to any improvements that have been made during the four years they have managed the hospital district. We were provided with the following information:

Long Term Care:

* Increase from 1 star (lowest rating) in 2015 to 5 stars (highest rating) since 2017.

*Recognized in 2017 and 2018 as one of the top three quality of care providers in Wyoming

* Awarded Quality Excellence award as top LTC in the state in 2019

* 2019 Quality Innovator Award

* 2018 and 2019 Women’s Choice Award – America’s Best for Extended Care.

Hospital:

* First Critical Access Hospital in Wyoming to achieve a Top Box score of 100 – Top 3% in the nation

* Certified trauma resuscitation facility

* Current treatment/stabilization time is half the state average with state-verified good outcomes

* Post-acute care and outcomes of post-acute care currently in the top 7% in the nation per ACHCA.

* Patient Performance Improvement scores for swing beds top in the state reporting group for Q3 and Q4 of 2019.

*Decrease in clinic, LTC and hospital state survey deficiencies of nearly 70%.

Finances:

24% overall growth over last three years based on Total Patient Revenue (TPR) with all charge master prices consistent through this timeframe. No CCMSD Charge Master prices are above the 50th percentile/median price in the four-state region.

Hospital: TPR increase of 49%

Sundance Clinic: 24% Increase

Moorcroft Clinic: 36% Increase

Hulett Clinic: 2% Increase

LTC: Stable (+-1%)

*Every full fiscal year since arrival, the organization has finished with a bottom line better than budgeted.

Board seeks new trustee

The Board of Trustees officially accepted the resignation of Trustee Joey Kanode on Thursday. The board will now begin seeking a replacement to fill the empty fifth seat.

Kanode was specifically elected as the trustee for the Moorcroft area and his replacement will also need to be from and to represent Moorcroft, said Chairman Mark Erickson. The position will be posted shortly and the board will choose from the candidates who put their names forward.

The new trustee will serve for the rest of the year, as Kanode’s term was due to expire in 2020. The seat will be voted on at this year’s elections.

If no candidates step forward to fill the seat until the elections, said Erickson, the Crook County Commissioners will be asked to appoint a new trustee.