Medical marathoner

Dec. 15--The CEO of Tri-State Memorial Hospital in Clarkston compares his job to running a perpetual race, with his board and a staff of more than 600 health care professionals.

On any given day, Don Wee might be expected to adjust the hospital's budget because of a reduction in Medicare reimbursement, seek ways to meet an emerging health care need or help recruit a new health care provider in an increasingly competitive market.

Wee was named the Lewiston Tribune's Businessperson of the Year for his ability to manage those tasks, keep the hospital in the black and stay open to innovation.

"It's, to me, kind of like the marathon that doesn't have an ending, because you always have to keep improving," he said. "That's the positive attitude that's here."

The Lewiston Tribune talked with Wee about Tri-State's status as a critical access hospital, new services the institution has introduced, what role it will play if St. Joseph Regional Medical Center in Lewiston no longer participates in Regence BlueShield of Idaho insurance plans and other issues facing the hospital.

Business Profile: Like all of the hospitals in the region, other than St. Joseph Regional Medical Center, Tri-State Memorial Hospital is a critical access hospital. How does that Medicare designation help?

Don Wee: It's a federal program that was created in the late 1990s and has evolved over time. It came about because the vast majority of rural hospitals were in financial straits because of a high Medicare and Medicaid payer mix. Back then, we were getting anywhere from 40 to 60 cents of each dollar of care covered. So you had to figure out how you would pick up the other 40 or 60 cents.

That's where critical access came about, was to hopefully sustain or at least stabilize rural health care with higher reimbursement. I think initially it has done that.

But the program has changed because ... the federal government ... now only covers what it deems as allowable costs. I'll give you an example: In our emergency department we have a physician in there around the clock. When the program first started, it covered that whole cost because we have to pay them to be there whether there's a patient there or not. Today we have to do what are basically time studies or verify when a physician is with a patient, then they'll cover that cost. But if, say, it's the middle of the night and no patient shows up, we don't get that cost covered, even though we're paying the physician to be available. There's other scenarios like that.

It's kind of like a death by 1,000 cuts, because Medicare continues to carve out things that used to be allowed. It makes it a little tougher to fight the battle. Overall I think it's a decent program, but I think it's getting tougher for everybody.

BP: Tri-State doesn't have inpatient mental health services, but it has expanded its outpatient mental health services by adding two providers, Dr. Nick Phillips, a psychiatrist, and Dr. Elina Chernyak, a family practice physician with training in addiction. Phillips is the son of Lewiston Realtor Rolly Phillips. Chernyak relocated from Salt Lake City. What can you share about that?

DW: Phillips' wheelhouse, or area he likes, is young adults. He also treats adults. He's been very, very busy. We had entered a contract with him prior to the completion of his training.

I can't remember exactly ... how we got his name or when we first started talking to him. Psychiatrists are very, very hard to find. We in the community are fortunate he wanted to come back, and he's doing a great job. Our board felt there was a definite need for the community, and that's proven true.

Dr. Chernyak works in the same clinic with Dr. Phillips. She works with patients who are addicted to a variety of different substances, whether it be alcohol or other drugs.

BP: One way Tri-State has tried to increase access to health care has been by adding clinics at Rosauers in Lewiston and Moscow. How is that going?

DW: We're evaluating it. It's gone slower than we hoped. But it's interesting. They are cash or credit card only, because we don't file insurance. So really it is six or seven questions at the most. (Patients check in), and we check whatever the ailment might be and then they're on their way. I think some people like that, because we're seeing a good percentage that don't have a traditional primary care physician relationship. We try to help them establish one, because that's the best thing. We're still evaluating the success or not success of that. We'll see how it plays out, and, if it doesn't, we'll move forward.

BP: One of the biggest wild cards with health care locally is if St. Joe's will continue to participate in Regence BlueShield of Idaho insurance plans, especially because St. Joe's is the only hospital in the Lewiston-Clarkston Valley that delivers babies. What role will Tri-State play if the two sides don't reach a resolution by Jan. 15?

DW: If something happens with the contract at St. Joe's, which we have no control over, we'll do what we can to help the patients that need access. That's the bottom line. That's always been the driving mantra of this organization: to try to be there for the patients and provide what services we can. Our grocery store and minor care clinics could be used as a stopgap measure until they got signed up with a medical care provider.

Obviously we don't do obstetrics and don't have any plans to add that.

I don't expect a huge influx. That's just my guess. I believe some businesses would switch, just drop Regence and go to a different commercial insurance provider. And they'd probably have to negotiate all the terms to make sure hopefully ... there are equal benefits. But that, too, could take time if that happens. It's not a quick transition.

BP: Evergreen Estates, a subsidiary of Tri-State Retirement & Assisted Living Community, is adding a three-story, 34,000-square-foot addition to its 76,000-square-foot complex. The expansion has 35 units, bringing the total to 131. A 20-person, secured area for dementia patients is being created, too. What is the update on that project?

DW: The first phase of the project is complete. The dementia unit should be ready at the end of January. There is a waiting list of folks wanting to get in over there.

BP: One reform that's been proposed is having hospitals publish a list of what they charge for certain services. What makes you think that wouldn't be helpful?

DW: We could post a price for a colonoscopy for example. We could figure that out. Well guess what? If you have polyps, ... you've got other charges. You might have been told it's X amount, and it's more and you get mad. Plus only people without insurance who don't qualify for charity care are charged the list price. Medicare and private insurance providers negotiate their own rates. The list price is pretty much meaningless.

BP: When you became CEO of Tri-State 10 years ago, the hospital had just a handful of physicians, nurse practitioners and physician assistants on staff. Now the hospital employs more than 50 medical care providers. What is responsible for the trend, and why do you believe it will continue to define the hospital's future?

DW: You have to use an electronic medical record. So the cost of running a solo practice or even a small group is higher. It takes the pressure off from the business side of it, which ... they didn't go to school for. It's very tough to make ends meet in a solo or small practice.

Wee's answers were edited for clarity.

Williams may be contacted at ewilliam@lmtribune.com or (208) 848-2261.

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