Group working to gauge community interest in Deaconess, Billings Clinic

By Emily Wolfe Explore Big Sky Managing Editor

BIG SKY – The downstairs room at the chapel on July 10 again served as a stage for the ongoing discussion on expanding health care in Big Sky. Of 30 people in attendance at the Big Sky Health Care Directions Committee meeting, 22 were part of the newly formed committee.

Bozeman Deaconess Health Services CEO Kevin Pitzer and Billings Clinic Vice President of Regional Services Scott Duke were also in attendance, as were representatives of the Big Sky Town Center, where Deaconess owns a plot of land. Both hospitals recently completed feasibility studies on expanding medical services in Big Sky.

The committee’s five core members first convened in May 2013, led by co-chairs Jack Eakman, a former hospital administrator, and Mike Scholz, co-owner of Buck’s T-4 and a resort tax board member. This was the second time the group has met in this larger form.

Its work: gauge which hospital would best serve the greater Big Sky-West Yellowstone area, and make that recommendation in a month’s time. Funded by $20,000 in Big Sky Resort Tax money, the committee is working with an independent consultant, Howard Gershon of the New Heights Group, to assess and compare each hospital’s feasibility study and answer additional questions.

“This is an open discussion about health care,” committee member Erin Bills told Explore Big Sky. A local resident with a Masters in Public Health, Bills works at the Montana State University Montana Office of Rural Health, which helps improve access costs and quality of care in Montana, and works closely with critical access hospitals.

“Oftentimes communities don’t get to be at the ground level like this with improving access to care,” Bills said.

The self-appointed committee functions as an offshoot of the local social services nonprofit, Women in Action, and includes representatives from the Big Sky Resort Tax Board, the Big Sky Fire Department, the ski resorts, the Medical Clinic of Big Sky, former hospital administrators and physicians, private homeowners, and residents of West Yellowstone, among others.

The committee that day split into four panels to consider different aspects of the conversation: partnership, governance, finances and timing; the feasibility studies; health care providers; and health care quality and service.

The hospitals

Duke, who is new to Billings Clinic, previously worked as CEO of an independent community hospital in Glendive for almost 11 years.

“I would imagine this process being rooted in what’s best and what’s right about communities in Montana,” Duke said. Billings Clinic operates 10 critical access hospitals in Montana and northern Wyoming, and is part of the Mayo Care Network.

Pitzer of BDHS agreed the “committee process is a good one to go through,” noting it would bring out “transparency for both participants of what they’re proposing for the community.”

While Deaconess presented a clear proposal of its plan for a 24-hour emergency facility in Big Sky, Billings Clinic has been less specific, saying it would rather craft a plan through discussion with the community.

“I do question how we can have a collaborative community process without having that information available in the community,” said Pitzer, who also has a background in rural healthcare. “It’s difficult to evaluate the strengths of competing proposals if there is only one proposal.”

BDHS has served the Big Sky area for decades, and has operated a pharmacy in the Meadow Village since 2007.

“We’re looking at the tenor of the entire community and our patients, and the hundreds of residents that have long term relationships with Deaconess,” Pitzer said. “We get [this information] through unsolicited phone calls, being present at Big Sky events, from patients visiting our facilities.”

“This committee is doing very good work, but I wouldn’t necessarily say it’s fully representative of the voice of Big Sky,” Pitzer continued.

Eakman, co-chair of the committee, has suggested the two hospitals collaborate on a facility, something both Duke and Pitzer said they would consider to differing degrees.

“We’re open, quite frankly, to working together,” Duke said. “When we’re involved in working together in a community, it’s the community first, what’s needed for the patients. We would be open to exploring any of the opportunities which would come forward.”

“BDHS and Billings Clinic work collaboratively in a number of communities already, like Bozeman and Livingston,” Pitzer said. “We have many shared patient relationships, and they are a strong tertiary referral center for us. I think we both want to have presence in this community… I don’t see an opportunity to do that under a formal joint venture.”

New questions

Once reconvened, the panels presented their questions.

Bill Farhat, Big Sky Fire Chief, led the discussion on health care providers. His group wanted a complete explanation of the staffing models either hospital would provide.

“It’s our preference that there be physicians present at all times,” Farhat said. “But is that even possible?”

They also hoped to ensure local providers could use the facility but remain independent.

Eakman’s group, which discussed health care quality and services, brought up questions about budgeting and the necessity of gaining critical access designation to offer 24-7 care.

Scholz’s group covered partnership, governance, finances and timing. They wanted more about how a community foundation would work with either hospital, and about local support.

“The community should know what would be the goals for a foundation, what would trigger coming to resort tax, and what magnitude it would be in,” Scholz said.

WIA Executive Director Lisa Beczkiewicz went over the similarities and differences between the two feasibility studies. The differences they noted were that Billings Clinic had proposed having outpatient services, and Deaconess had not, while Deaconess owns land in Big Sky, and Billings does not.

“We have more of a complete picture with Bozeman Deaconess,” Beczkiewicz said. “With Billings being new to the community, we wanted to know more. Theirs was not a complete proposal.”

What’s our future?

The committee is hosting a series of public meetings in the next several weeks. These will be a chance for Gershon, the consultant, to review his work with the committee and the public, for the committee to host further discussion and form its recommendation, and for the public to speak out and ask questions.

At the final meeting on Aug. 7, Gershon and the committee will both present their recommendations, with the committee making its final public vote.

As of now, it’s up in the air where the coin will drop.

“They both have compelling stories,” said committee member Jamey Kabisch after the June 10 meeting. “Billings Clinic has had success with the critical access hospital model across the state, and it’s been profitable. Bozeman Deaconess clearly has dedication to this community – with a land purchase in 2007, an existing pharmacy and it being the primary health care provider of this area – they’ve been a partner for a long time.”

Kabisch is also a resort tax board member and manager of Lone Peak Physical Therapy, which has six clinics and 13 physical therapists and wants to remain independent.

“What’s our future?” he asked.

Public meetings:
All future Health Care Directions Committee meetings will be at Buck’s T-4. The meetings are public.

July 17
9-11 a.m. – Committee meets with Howard Gershon, consultant
7-9 p.m. – Gershon presents findings to community at large

July 24
7-9 p.m. – Bozeman Deaconess and Billings Clinic present their proposals

Aug. 7
7-9 p.m. – Gershon and committee give final recommendations