PHC and Seeley hospital board consider local clinic's future

The Seeley Lake community is grappling with the effectiveness and longevity of its medical center, the only spot with primary and dental care in about a 50-mile radius.

Partnership Health Center, the nonprofit organization that provides services to the Seeley-Swan Medical Center, experienced financial hardship during the covid-19 pandemic and Montana’s Medicaid redetermination process, both across its six locations in Missoula County and specifically at the Seeley clinic, according to hospital representatives.

These financial stressors — and with the future of Montana’s Medicaid program up in the air as the next legislative session approaches — are key to the changes at the Seeley-Swan Medical Center. The December meeting of the Seeley-Swan Hospital District Board, which oversees the medical center’s operations, discussed these changes and heard feedback from members of the public on how to move forward and keep the clinic in operation.

It was in August that the board learned Partnership has spent over $1 million in the last seven years subsidizing the medical center in Seeley. The board then started making more efforts to clarify how the clinic and board functions, and tried to figure out how to better inform the public of the clinic’s offerings.

In that vein, the board sent out a survey to Seeley-Swan area residents aiming to get feedback regarding how people use the clinic. Terryl Bartlett, Seeley-Swan Hospital District Board chair, made a point at the Dec. 10 meeting to clarify that the timing of the survey results being shared, which was at the end of November, and when PHC announced service reductions, shortly afterward, was only coincidental.

“These changes are difficult. On the flip side of that we can’t lose this clinic … it doesn’t have to be profitable, but we have to get it back in black,” Bartlett said.

As of Jan. 1, the medical center will be closed on Fridays. Up until that date, there were services offered the fifth day of the week. Primary care and dental services will still be available in-person at the Seeley-Swan Medical Center. The two medical doctors who visited the clinic in-person a couple times a week will no longer be traveling to Seeley’s clinic, but will still be available for telehealth appointments.

“This decision, I understand, really looks like we’re pulling back but the effort and the goal is to reduce our loss in the clinic annually and to find a way to continue to build our care,” Eric Halverson, PHC director of communications, said.

PHC staff fielded a variety of questions at the Dec. 10 meeting related to the nonprofit’s mission — which emphasizes increased access to health care for rural populations — and how the decision to reduce hours in Seeley Lake squared with said mission.

Halverson said it was important to note that the changes aren’t just happening at the Seeley clinic, but that PHC is experiencing financial constraints more generally. The quantity of patients and mix of insurances a clinic sees and bills does affect the amount of money it makes, but Halverson said the need for reduction in services in Seeley is primarily due to the financial pressures Partnership is facing.

“We operate at a loss in Seeley and we can certainly try to close that gap and I’m excited about the conversations to close that gap, but it's about the financial constraints primarily,” Halverson said.

Dr. James Quirk, chief medical officer of Partnership Health Center, said the post-pandemic era has been rocky for health care and the past half year has seen its own challenges as the state went through a Medicaid redetermination process. During the pandemic, a federal-level decision made it so no one had to reapply for Medicaid during the public health crisis. Montana started its redetermination process — intended to make sure everyone on Medicaid still fit the requirements — in April. Issues during the reapplication process resulted in many people with holes in insurance coverage and a reduction in the number of people on Medicaid, Quirk said.

For Partnership, that equaled about a $1.3 million loss in what the nonprofit thought would be a stable insurance environment, Quirk said.

Medicaid expansion in Montana will be up for consideration again during the upcoming legislative session. Whether it continues to serve people as it has since 2017 — the last time Medicaid expansion was approved — will affect PHC’s ability to operate as it does now, Quirk said. According to the state Department of Public Health and Human Services, Medicaid expansion insures over 90,000 Montanans and generates $500 million each year in health care spending.

“That’s part of the overall concern in the landscape we’re currently trying to work in,” Quirk said.

Halverson said the Seeley-Swan Medical Center decisions aren’t set-in-stone and PHC is happy to look at the demands of the community and shift course as appropriate.

Seeley Lake local Andi Bourne pointed out that the area schools shifted to four-day school weeks, and having the clinic closed on Fridays — a day prime for children’s appointments — could be difficult for parents. Halverson said PHC can take that into consideration regarding the clinic’s schedule.

Telehealth was discussed as both an advantage and a challenge pertaining to a reduction in clinic hours.

Tom Browder, chairman of the Seeley Lake Community Council, said there are more remote workers in the Seeley area than people think. Broadband and internet connectivity for well-paid remote workers is more of a given now. But these workers tend to be younger and have good insurance. If they become medical center customers, it could be a financial benefit to PHC, Browder said, but added that those unfamiliar with telehealth might be uncomfortable getting on board initially.

Jon Simon, who volunteers with Browder for a group that helps people with their computers once a month at the Seeley Lake Foundation Building, was skeptical of telehealth being a real benefit to the older and aging residents of the area. They don’t have the equipment, bandwidth or “technology chops” to carry it out, he said.

“The age structure for the population of the valley is older and getting older. The utilization of telehealth is younger and getting younger,” Simon said.

While the changes will take place come the new year, both the hospital district board and Partnership remain committed to figuring out how to keep the medical center operating sustainably.