MHCC provider numbers deep, despite recent high-profile turnovers, CEO says

If it was a soccer or baseball team in the days before season openers, the coaches would be talking about depth and versatility.
But it’s health care, and Memorial Hospital of Converse County – like any sports team – ebbs and flows over the years. 
Coaches often talk about their strengths, down play their weaknesses and often have to admit that a loss of this player or that one will hurt.
MHCC CEO Matt Dammeyer is no different, except he is very willing to talk about changes and what is driving those changes in the health care industry . . . and, most often, it is about money.
Physicians, who are frustrated with changes in the healthcare industry and with MHCC’s policy shifts – especially in terms of pay expectations and hours work – are leaving, either headed for retirement or another practice. (Each resignation cited a different reason, and Dammeyer declined to discuss individual providers’ reasons.)
Dammeyer doesn’t make any apologies for those policy shifts.
He says he’s simply reacting to the changes in the healthcare industry across the country especially in terms of reimbursements from Medicare and Medicaid and private insurance companies.
Reimbursements are the level at which those entities pay for hospital charges, often far less than the charges on the original bill. 
Currently, the hospital is running between 43 and 44 percent reimbursement, meaning MHCC writes off as much as 57% of the bill. Dammeyer  points out that every percentage point drop is costly to the hospital’s bottom line, which is already shrinking despite record revenues.
If that rate dips to 40%, he warned, that equals about $12 million less revenue for operations . . . and that would result in major shifts in staffing and pay.
 That low reimbursement rate hurts even now, and Dammeyer reacted by changing the pay scale and the expectations of physicians and other providers – and, that change is causing some discomfort among the providers who are used to a certain level of work environment, he said.
Historically, MHCC has paid providers in the 75th percentile in their field, meaning they pay in the top 25% across the country, not just in Wyoming and the Rocky Mountain Region.
Dammeyer points out that is a hard level to maintain, yet the hospital is committed to doing that. But for it to work, providers must increase their patient load.
If the reimbursement rate keeps dropping, that level of pay is probably not sustainable long-term, he said.
Thus, he’s trying to get ahead of that curve. 
The CEO, who’s been at MHCC for about four years, inherited a strong physician and provider team, but the cost of maintaining that has been high. And four years in the health care industry can seem like a long time ago.
However, MHCC retains a strong first-string and bench, to use the sports analogy. Dammeyer said the numbers prove that out.
Memorial Hospital’s list of providers – even after five fairly high-profile resignations of doctors in recent months –  shows a amazing depth of not only doctors but other providers.
“This is a huge number of primary/specialty providers for a town the size of Douglas,” Dammeyer said. “We are a little light in OB, but that is not unique across rural America, and we have some interesting recruits we are looking at.”
He noted five new physicians recruited to MHCC (some with practices that extend in Douglas) during the last year. 
He argues that the high cost of recruiting and retaining physicians (all of whom are under contract with MHCC directly) requires high patient volumes and the ensuing revenues.
The new contracts with doctors take into account the reality of lower reimbursements from insurance and other payers, such as Medicare/Medicaid. To counter that lower reimbursement rate, providers must see more patients to cover the costs, Dammeyer said.
That doesn’t sit well with some providers who have had what Dammeyer terms part-time practices based on the number of patients seen. Others are frustrated by an on-call rotation that disrupts their quality of family life.
Dammeyer said he understands that frustration, and sympathizes with their plight. His plight, however, is one of trying to balance revenues with costs, as costs continue to rise while the revenues (actual reimbursement rate of charges compared to what is billed) slip further and further behind.
“Every hospital and every medical field across the country is facing a seismic shift in how it’s being treated in terms of reimbursements, and those are dropping,” he said.