Bigger picture planning

The Seeley Swan Hospital District met Tuesday, Jan. 14 to discuss challenges and changes within the health care system broadly — the future of Medicaid expansion this legislative session — and more locally at the medical center in Seeley.

After a survey went out to Seeley Lake area residents in late November and responses indicated a need for better communication regarding what Seeley’s medical center offers, the board has been discussing how to better share information with the public and how to be in better communication with Partnership Health Center, which operates out of the medical center.

Hospital District Board Member Suzanne Phillipus-Palm presented a draft strategic plan for the Seeley Swan Medical Center. The plan aims to map out the medical center’s direction for 2025 and encourages developing a three or five year plan.

One of Phillipus-Palm’s main goals with the plan is to develop a growth strategy that addresses questions like how does the board improve access to high-quality health care in the Seeley-Swan Valley, how the board will explore different market opportunities, what the board’s relationship is to PHC and what PHC’s plan is through 2028, when Partnership’s lease is up at the medical center.

“These are just questions right now, just across the board, to help us make wise decisions going forward,” Phillipus-Palm said.

A lot of the goals, visions and impetus for the strategic plan came from the survey the hospital district board sent out. Many responses indicated a need for more services, increased hours of operation and clearer communication regarding what the medical center offers. Shortly after survey results were presented, PHC announced a change in the medical center’s schedule, shifting to four days a week instead of five, and moving two medical doctors to telehealth-based appointments, leaving one nurse practicioner in-person at the Seeley Swan Medical Center. Board members reported in past meetings that the timeline of these changes were coincidental.

Phillipus-Palm said she felt “blindsighted” after PHC announced these changes, and concluded that both the board and PHC need to work together in “lockstep” on the strategic plan for 2025.

Better communication between PHC and the board but also between the board and the public were brought up as goals within the plan, Phillipus-Palm adding that being more connected with other community and civic groups in town would be beneficial.

Phillipus-Palm said the current financial state of the clinic needs to be further analyzed and goals set for each quarter, and areas of growth regarding revenue expenses and profit need to be considered.

In past meetings, PHC representatives said the Seeley clinic is operating at a $1 million loss built up over seven years, and that PHC has been subsidizing the local clinic. Phillipus-Palm requested looking more into that subsidization and working together to improve from that status.

The board discussed adding another meeting to the schedule to keep brainstorming the strategic plan and different ideas, starting at the end of the month.

“We’re hoping, I’m hoping, that PHC stays with us beyond 2028 but if not we have to gear up, we just don’t know. These are questions, they’re very scary questions, to ask, but we’ve got to start asking them because it’s 2025 already and we just have to know what the future of the clinic looks like,” Terryl Bartlett, hospital district board chair, said.

Martin DeHaven, the hospital district’s facilities director, said the strategic plan was “kind of high level” and brought up more near-term things he felt needed to be addressed, like various facility upgrades. Some of those examples, like freezing pipes and cold water coming out of taps, need to be paid for regardless of a higher level plan. DeHaven said the board should move forward with some of the smaller items in the plan, while keeping bigger picture ideas in mind. Board members agreed that basic maintenance upgrades and fixes should happen as quickly as possible.

Georgiann McCoy, PHC’s clinic manager for the medical center, provided an update on the implementation of a system called Epic, or a medical records system, which will go live at the Seeley clinic on April 5, McCoy estimated. Epic will allow for better sharing of patient records in a HIPPA-compliant way with doctors in other clinics or hospitals, like Providence entities in Missoula, that are also using the software.

Dr. James Quirk, PHC’s medical director, said this is a big change for PHC, a once in every 10 or 15 years upgrade.

“On the patient services side, it should just be an easier product,” Quirk said.

Medicaid expansion will be voted on this legislative session, and Quirk provided some background on the process.

The phrase “Medicaid expansion” generally refers to the process of approving the current landscape of Medicaid coverage that Montana passed in 2017. Since then, low-income adults not covered by traditional Medicaid have been added into the coverage. After the Affordable Care Act passed in 2010, the federal government pays 90% of coverage costs for states that voted to expand Medicaid coverage. Montana is one of 40 states that added coverage.

Quirk said Medicaid is often a lifeline for people who live in rural areas and the impact to rural health care will be “rather large” if it gets dropped this year. If it doesn’t pass, Quirk said a number of “safety net” health care items, like behavioral health 911 calls or people who stop seeing providers because they’re not able to acquire insurance from employers or on the private market, will begin to diminish or increase, respectively.

“The way the rural economy is, people love to live in Seeley and they want to live in Seeley and they make what they make and it doesn’t have health insurance, and this is one of their only ways of making that work,” Quirk said.

At Partnership, Medicaid reimburses the facility pretty well, Quirk said. Partnership gets paid more for Medicaid than Medicare visits, Quirk said, which is a distinction within federally qualified health care centers like PHC, which get reimbursed for each Medicaid patient and are supposed to wrap those services with social services. Medicare is a health insurance option for people 65 years and older.

“A lot of those folks occasionally need a lift up. If you’ve got your private insurance and you’re working and everything’s going good for you, you don’t necessarily need that,” Quirk said. “But that’s at least the idea behind it is really providing some more services to some folks.”

A hot topic last legislative session was the low rates that Medicaid reimburses various providers, from adult behavioral health services to nursing home or assisted living care. Lawmakers ultimately passed an increase to these provider rates in 2023, which Governor Greg Gianforte signed into law.

McCoy updated the board on the medical center’s efforts regarding vaccinations as cold and flu season continues.

Different upper respiratory illnesses have been coming through the medical center, and McCoy said there are cases of whooping cough in Missoula. The Seeley Swan Medical Center is gearing up to do pertussis, or whooping cough, testing with that in mind.