County discusses who should provide ambulance services
Scott Stuntz TVN Staff
When someone in Teton County dials 911, the ambulance that responds to that emergency could be staffed by either the Teton County Fire District or Teton Valley Health Care (the hospital). However, that could soon change. Last week the Board of County Commissioners heard a proposal from the fire district on ways to restructure how emergency services are provided.
That proposal was in response to a request made by BOCC chairman Bill Leake last July. According to the minutes of the July 13 meeting, he asked the fire district to “analyze their staffing and budget needs and provide a detailed proposal within the next few months.” Leake stressed that no major changes would take place soon and said all aspects would be reviewed carefully before a decision is made to disband the Ambulance Service District (ASD) and transfer all assets to the Fire District.
The hospital asked for $200,000 more than the Ambulance Service District had in funds for the year. Leake said he asked for the proposal from the fire district after he asked those at the table for a solution and was met with silence.
“When there’s a funding problem I have to do something to address it,” Leake said.
The fire district presented its proposal at a meeting of the Ambulance Service District on Jan. 25. Teton Valley Heath Care responded to the proposal by taking out ads in a recent edition of the Teton Valley News. One featured a letter from doctors endorsing hospital involvement in emergency services and the other was an ad rebutting the financial claims made in the fire district’s proposal.
Leake said that it is much too early to be batting around those huge overall numbers.
“Arguing about the numbers right now won’t get anyone anywhere,” he said.
He said the county first needs to sit down and lay out what services they are legally obligated to provide and what other services they can afford.
Hospital CEO Keith Gnagey said the hospital would probably be able to shoulder some of the extra costs this year, as it was forced to last year, in order to pay for ambulance service. Gnagey said the main issue is quality and that in order to ensure a high level of care, the hospital needs oversight over ambulance services. He said quality links directly to the financial sustainability of the system; how hospitals are paid for the care they provide is changing rapidly.
Under traditional payments, providers were paid for the services they provided, such as for the casts they put on or the cuts they stitched up. Gnagey said the industry is shifting to paying for “outcomes,” meaning preventative care and in-home treatment, the kind provided by ambulances, is key. He said to thrive in this new philosophy, the hospital needs to be able to manage all types of clinical care, including emergency services.
“It’s not about the money, it’s not about who [the fire district is] is, it’s about the hospital’s mission of providing the best health care we can, all the other issues are secondary,” he said. Gnagey said of course the financial picture is important, but the value the county gets for the money it’s spending is vital as well. He said the hospital doesn’t want to take over the operation of the ambulances in the county, but to maintain the current joint operation that he said is working quite well.
“Now, how can we make it better?” he said. The ambulance service district will take up the matter again at a county meeting this Monday, Feb. 8.
Driggs Health Clinic has expanded its clinic space with the addition of 6 new exam rooms, a shared physicians’ office and renovated echo-cardiology stress testing room. The new area is located inside the east entrance of Teton Valley Hospital, replacing a physical therapy rehabilitation space that was relocated closer to in-patient rooms. The expansion was needed to accommodate growing clientele for specialty services such as cardiology, neurology, and pain management.
Cardiologists Dr. Patrick Gorman, Dr. Blake Wachter and Dr. Douglas Blank travel from their practices in Idaho Falls to hold regularly scheduled clinic hours in the new space. Neurologist Dr. Brad Talcott, also from Idaho Falls, has added dates to his local schedule in response to patients’ requests. Dr. Marc Porot offers a minimum of 5 days per month to visit with patients about pain management. Echo-cardio technicians from University of Utah Hospital and from Eastern Idaho Regional Medical Center provide rotating appointment dates.
“We anticipate adding more specialties in the near future in direct response to patient requests and our community’s level of need,” says Keith Gnagey, CEO for Teton Valley Health Care.
“Teton Valley is fairly isolated and it can be especially hard to drive out of town during the winter. I would rather have one doctor make the trip from Idaho Falls than have 20 local residents make the trip.”
Teton Valley Health Care is entering phase two of a project to update and refresh the appearance of the facility. Phase One started with the refurbishing of the Driggs Health Clinic reception area followed by a total makeover of the Medical Imaging suite that included a new digital X-ray and fluoroscopy unit. In spring, the Aesthetics exam area was completed and now, after three months of construction, the specialty clinic has opened. Phase Two will bring about completion of hospital patient room updates, hospital hallway re-flooring and renovation of the laboratory clinical area.
“I avoid giving timelines for projects such as these because facility improvements depend largely on the financial health of our organization. TVHC doesn’t own the hospital bricks and mortar, the County retains ownership of the building. It’s our responsibility to maintain and improve the property for our community and that’s one reason for setting these renovation goals,” said Gnagey.
The Teton Valley Hospital Foundation provided $75,000 in funding for this project.
TVHC invites everyone to come and visit the new specialty clinic during a Community Open House scheduled for Wednesday, Dec. 2 from 5-7 p.m. Appetizers will be served along with a chance to win raffle prizes including $50 gift cards to Peaked Sports or The Wardrobe Company. Please contact Ann Loyola at (208) 354-6301 or firstname.lastname@example.org for more information. As always, full hospital tours are available throughout the week.
A trip to the E.R. is never something to look forward to but if the need arises, be assured that you’re in good hands if you have to make a weekend visit to Teton Valley Hospital’s E.R. or Driggs Health Clinic. Teton Valley Health Care has contracted with Intermountain Emergency Physicians to provide physicians onsite 24/7 throughout the weekend. The doctors will also see patients during the Driggs clinic’s Saturday and Sunday business hours.
Intermountain Emergency Physicians, also known as IEP, is made up of 12 physicians with over 140 years of combined ER experience between them. IEP is based in Idaho Falls, currently serving Eastern Idaho Regional Medical Center, and now, Teton Valley Hospital. Some members of the group also work at Madison Memorial Hospital and Bingham Memorial Hospital. Eleven members of the group are currently board-certified by the American Board of Emergency Medicine with one board eligible physician awaiting his certification notification.
Currently, Physician Assistants and Family Nurse Practitioners provide hospital ER care during weekdays in conjunction with TVHC physicians. For weekend coverage, TVHC had previously contracted ER care with a national staffing group. When it was time to renegotiate that agreement, CEO Keith Gnagey was pleased to discover a regional emergency care group.
“We already have a strong relationship with the IEP doctors through our shared patient care with EIRMC. These physicians know our valley, our facility and they’ve worked with our staff. All of this translates into great patient care,” said Gnagey.
When asked why Teton Valley Hospital needs to contract weekend ER coverage, Gnagey responded that TVHC would have to hire several additional doctors to be able to cover the weekend shifts and that the overall ER experience levels, EIRMC knowledge, and number of providers available through the relationship with IEP makes that a better alternative for providing care to our patients.
Dr. Eric Maughan, IEP physician, said he is “excited to be a part of this new agreement. Teton Valley Hospital is a great facility with excellent staff and impressive diagnostic capability. As physicians who were born and raised in Southeastern Idaho, we’re proud to be able to serve the community on a more local, personal level.”
For further information, please call Ann Loyola, director of Marketing and Public Relations at (208) 354-6301 or email email@example.com.