Hospitals propose different funding, governance methods

By Emily Wolfe Explore Big Sky Managing Editor

GALLATIN COUNTY – Money and governance. Those are the two significant differences between the proposals Bozeman Deaconess Health Services and Billings Clinic have for Big Sky, according to independent health care consultant Howard Gershon.

Funded by $20,000 in resort tax dollars and hired by the self-appointed Big Sky and West Yellowstone Health Care Directions Committee, Gershon has reviewed the feasibility studies conducted by the hospitals this year, both of which propose building a hospital in Big Sky.

Otherwise, Gershon said, the hospitals have comparable patient ratings, financial capability and patient services, and are both on par with national levels.

Funding and governance

Bozeman Deaconess has proposed a $21 million facility, and has promised to secure and guarantee all initial funding. Its feasibility study, Gershon reported, stated that the facility would be a local nonprofit 501(c)3 owned and managed by BDHS, but with a local board of directors responsible for reviewing quality, service and performance.

Under BDHS, future funding could come from Big Sky Resort Tax, and also from a foundation formed in partnership with the Bozeman Deaconess Foundation.

Billings Clinic has proposed a $22 million facility, with $5 million in funding coming from within, $5 million from fundraising in Big Sky, and another $12 million from USDA or HUD grants. The facility would be a local nonprofit 501c3 managed by Billings Clinic. A 9-to-13-person local board of directors would govern the facility, with two of its positions appointed by Billings Clinic.

With Billings, Big Sky would be required to provide $300,000 annually to cover operations for the first three years, and West would provide $100,000. A local foundation would be established to help with future fundraising.

Health services

Both hospitals proposed building a hospital facility and then applying for critical access licensure, which receives federal funding. However, the services they’ve proposed to offer differ to a degree.

Bozeman has proposed a 35,000-square-foot primary care clinic with a patient-controlled medical home containing five inpatient beds, expandable to 10, with 24-7 emergency services, a helicopter pad, and space available for lease to other local providers.

Billings has proposed primary care physician clinics in Big Sky and West Yellowstone. The 30,000-square-foot facility in Big Sky would have four beds, expandable to eight, and 24-7 emergency and triage services and helipads in both towns.

Bozeman would expand the pharmacy it’s had in Big Sky since 2003, while Billings would use a telepharmacy, in which a technician prepares prescriptions by communicating with a pharmacist and patient through audio and video computer links. Billings would have an MRI available at all times, Bozeman’s would be a mobile unit.

Both would have CT scanning, laboratory and ultrasound capabilities under their proposed plans.

In the case of Billings Clinic, the Big Sky community would ostensibly have more local governance in terms of decision making and staffing, something local physician Dr. Jesse Coil, also a Health Care Directions Committee member, says has two sides.

“You’d have more say on how things are run,” Coil said. “But how much energy and time is going to take for a local board to run this facility?”

Population, timeline

The two also had differing assumptions about the greater Big Sky-West Yellowstone area population. According to the 2010 census, Big Sky has a permanent population of 2,308 and West of 1,271.

Bozeman is using 4,100-6,100 as its total year round and seasonal population, with a mid-range estimate of 5,000 used for the feasibility study. Billings, estimating the average seasonal/transient population within Big Sky as three times the size of its year-round population, used a total effective population of 10,515 and West 3,422.

The two hospitals also projected differing levels of use, with Bozeman looking at 344 inpatient discharges and 18,886 outpatient visits for 2016 and Billings estimating 274 inpatient discharges and 16,850 outpatient visits for 2015.

Bozeman has said it would start prep work on the site as soon as this fall, with groundbreaking to occur in spring 2014 and a facility to open in 2015. Billings would continue planning through spring/summer 2014, and complete its facility by summer 2016.

Going forward

The Health Care Directions Committee and Gershon have asked both hospitals to answer additional questions about governance and management, details of funding and timing, and working with local providers.

The committee and the public will hear updated proposals from both hospitals on July 24, with a public meeting at Buck’s T-4 starting at 7 p.m.

Jack Eakman, co-chair of the committee, imagines both proposals will have changed by then.

“I think both facilities are learning about the process and what the community needs as we move along. I already know there have been slight changes in the proposals since the start of it.”

On Aug. 7, the committee will make a final vote and Gershon will give his final recommendation.

But what then? Without any legal authority, the committee’s recommendation just that.

Mike Scholz, co-chair of the committee and a resort tax board member, said that since the committee’s recommendation is nonbinding, it is meant to have two main outcomes.

“One, we hope that the hospitals will look at this and use it for guidance in their own decision to move forward, and two so that both the community and the hospitals did due diligence so that both have a better understanding of both the levels of service and the type of partnership that each can offer,” Scholz said.

The July 24 meeting, he said, will be key to finding out what’s next.

“It’s the culmination everything we’ve done, in terms of raising questions, letting the community [say] what concerns them, and for both hospitals to do their best presentation. Whether those are one option from each or if they come forward with a couple options, we don’t know yet. We will know a lot more after Wednesday. Both will be looking at what the community told them through the last couple of meetings and making the offer that makes the best sense to them to match our needs and our abilities.”