BDHS plan does not include collaboration with Billings Clinic

By Joseph T. O’Connor Explore Big Sky Senior Editor

BIG SKY – It’s done. Or it appears to be. The sign on the Big Sky property Bozeman Deaconess Health Services purchased from Town Center declares it.

After seven contentious months spent discussing whether Bozeman Deaconess or Billings Clinic was better suited to provide a healthcare facility in Big Sky, BDHS has announced it is building a critical access hospital. And they’re going it alone.

On the morning of Aug. 20, Kevin Pitzer, CEO of BDHS, talked via phone with Billings Clinic CEO Dr. Nicholas Wolter.

“We spoke a few times over the last week to talk in response to the community’s wish to look at [whether] there are joint venture opportunities,” Pitzer said. “I told Dr. Wolter this morning that we didn’t feel it would be beneficial to continue those discussions.”

BDHS is now moving forward with a plan laid out in a May 2013 feasibility study performed by Maine-based Stroudwater Associates. The hospital plans to break ground in spring 2014, and “estimates a 24-month design and construction timeline,” according to the study.

Billings Clinic hired ECG Management Consultants to complete its feasibility study in June. Although Wolter would like to continue discussions with the Big Sky and West Yellowstone communities, he knows Big Sky can only hold one facility.

“The thought that there could be two critical access hospitals built, we don’t think that’s a good approach,” Wolter said. “We hoped we could at least talk about it. But the devil’s in the details. There are a number of steps between putting a sign up and building a facility.”

Beginning in May, both hospitals met with the Big Sky/West Yellowstone Healthcare Directions Committee – comprised of 28 residents from both communities, including six from West – to outline these steps and explain the details.

Throughout this process, Billings Clinic said it would abide by the committee’s recommendation as to which facility should build in Big Sky. BDHS never committed to this agreement.

Committee members say they believed both hospitals would abide by their recommendation, but a July 11 email from Pitzer to committee co-chair and former hospital administrator Jack Eakman indicated otherwise.

“Bozeman Deaconess will appreciate working with the committee, and [is] interested in results of the [recommendation], but that’s just one part of our planning process,” Pitzer wrote.

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In mid-May, local social services nonprofit Women in Action amended a $60,000 resort tax request for a feasibility study, reasoning it didn’t need to duplicate – or in this case triplicate – efforts by the hospitals, which had already started their own analyses.

On June 12, the Resort Tax Board approved WIA’s amended request for $20,000 in public money to hire a consultant to determine which proposal would best serve Big Sky.

The committee in early July hired Howard Gershon , a founding principle with the healthcare consulting firm, New Heights Group. Gershon has more than 35 years of experience in the field and he, along with the committee, held four public meetings between July 17 and Aug. 7 to present and assess the studies completed by BDHS and Billings Clinic.

After the final meeting, Gershon recommended Bozeman Deaconess. The committee in turn, voted in favor of Billings Clinic, leaving the Big Sky community with concerns.

“There was a stunned silence when the vote was announced,” said Bill Simkins, developer for Big Sky Town Center. BDHS in 2007 bought 1.2 acres of land for the future critical access hospital site from Town Center. Simkins says the remaining land – approximately three acres – has a closing date of Sept. 7.

Simkins was surprised that the Healthcare Directions Committee voted against the consultant’s recommendation.

“[Gershon] analyzed all the factors very thoroughly and then to go against his recommendation seemed very odd,” Simkins said. “If you pay $20,000 for an expert, it seems to me you’d listen to him.”

Some members of the committee feel Gershon’s recommendation was just that.

“That’s the way consultants are used – as a professional,” said Mike Scholz, a committee member who also sits on the resort tax board. “They don’t make ultimate decisions very often. He had so many points where he said someone won and someone lost – each [point was] equally weighted.”

For their part, the committee members weighted each issue individually, Scholz said following the Aug. 7 meeting. “He had his own rating system. I believe the people sitting there [on the committee] had their own systems.”

Scholz explained that the six West Yellowstone committee members represented the minimum amount of West patients required – 25 percent – in order for the respective critical access hospital proposals to be successful.

Billings Clinic’s proposal would require this 25 percent.

Pitzer said because BDHS already receives patients from West at its Bozeman facility, it didn’t set a required percentage for Big Sky. Whether it was a facility in Big Sky or on Bozeman, Deaconess would still receive the same amount of patients from West, currently a third of the town’s population with medical needs.

“[BDHS] has one third representation from West, so we figured they should have close to one third of West represented on the committee,” Scholz said.

The remaining two-thirds of West Yellowstone residents currently seek medical attention in Idaho and Ennis, according to Pitzer.

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At the final HDC meeting, the committee members sat at tables in a semicircle around Gershon. Facing them, nearly 100 community members took chairs in the audience and listened as the consultant showed a PowerPoint presentation indicating the nine criteria he used to break down the plans presented by both hospitals. They were:

-Scope of services in Big Sky

-Scope of services in West Yellowstone

-Community funding sources

-Governance/local control

-Experience with satellite medical facilities and CAHs

-Local commitment/investment

-Specificity in proposal

-Timeline

Both hospitals scored a positive rating in scope of services in Big Sky, resulting in a 4-4 tie before the “timeline” result went in Bozeman’s favor – BDHS is set to complete a facility in 2015, a year before Billings Clinic had proposed completion. After a brief recap, Gershon made his final recommendation to the committee: Bozeman Deaconess.

The committee members then voted via silent ballot. The result was 15-13 in favor of Billings Clinic.

“I think that Gershon brought an expertise and perspective to the process that was helpful and very well done,” said committee member and term-limited RTB chairman Les Loble. “Questions the committee wouldn’t have known to ask were asked.”

Kitty Clemens, executive director for Big Sky’s Chamber of Commerce since last August, sat with other area residents through each of the four committee meetings. She feels the community benefitted from the committee’s efforts as well as those made by Gershon.

“Public engagement is extremely critical,” Clemens said. “What I saw was a very professional process managed by the consultant that created a robust public engagement process.”

Although the CEOs discussed collaborating in an Aug. 13 initial phone call, Deaconess staked its claim three days later, placing a sign on its Town Center property that reads: “Future site of Big Sky Medical Facility.”

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Bozeman plans to start preliminary work this fall on the two-story, 35,000-square-foot critical access hospital. The plan is for it to be a not-for-profit 501(c)3 owned and managed by BDHS, but with a local board of directors responsible for quality, service and performance.

According to the feasibility study, this BDHS facility will contain five inpatient beds, expandable to 10; 24-7 emergency services; a helicopter pad; space available for lease to other local providers; and an Imaging Center with radiology, CT, ultrasound and MRI capabilities.

BDHS plans to secure all initial funding before building the $21 million facility, which would add an estimated 30-plus new jobs in Big Sky.

Billings Clinic plans to continue discussions with the Big Sky and West Yellowstone communities to gain further input, Wolter said.