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Hospital wants input on services

Larry Long, Guest Columnist

We at Tahoe Forest Hospital District are seeking community input on our emergency services programs.

The matter is complex, with physician, hospital and patient care concerns to be considered.

At the core is the question of what specialty services should be readily available to the patient who enters our emergency facilities, and how should these physicians be compensated for their availability?

It is in response to these core questions that we need the input of the community we serve. Please consider the matters discussed below, attend our upcoming board meetings, and help us shape the future of our community hospital.

There are a wide range of medical specialties that could be included or excluded from an on-call ER program. Please be aware that our emergency physicians are already highly skilled care providers, but on occasion an especially difficult or complicated case is presented to the ER for which additional resources might be indicated. It is in these situations that the on-call specialist would be brought into the case.

The hospital is seeking community input on the on-call specialist mix they would like to have readily available to treat them in times of need.

Consider the on-call possibilities: general surgery, orthopedics, radiology, anesthesiology, obstetrics, gynecology, pediatrics, gastrointrology, urology, cardiology, plastic and reconstructive surgery, internal medicine and family practice, ophthalmology, pulmonary medicine, neurology, psychiatry

Given unlimited resources and the availability of all medical specialties, who would opt for anything other than broad coverage?

However, such an approach would not be the most efficient and effective use of our health care resources. In tight fiscal times and ever-decreasing reimbursements from public and private health insurance providers, we are simply not afforded the luxury of a “do it all, provide everything on-call” approach.

At issue is what should be reasonably expected of a small rural facility in terms of specialty coverage. This is why community involvement is essential: we need to know what you want and need from your emergency department.

Directly related to the needs assessment input as noted above is how to fairly compensate those physician specialists who take ER calls. The Hospital District Board of Directors is grappling with the issue of on-call compensation, and would like to hear your thoughts on the matter.

MaryLou Sullivan, board president, suggests that, “The board’s difficult job regarding emergency on-call issues for the hospital district is to determine its own measure of policy and fiscal responsibility within prudent parameters. This issue is a nationwide phenomenon which is now hitting right here at home.”

“Medical staff leadership, within its own set of bylaws, has historically managed the emergency on-call roster and process, but as our community has grown, so have expectations on many physicians, creating coverage situations which are unacceptable to them,” added Sullivan. “Some physician specialties are truly burdened more than others, and the question is to what degree the district should bear the responsibility.”

The ‘on-call’ experience is quite different depending on the specialty, with some doctors being called upon infrequently, while other services are requested repeatedly throughout the year. Additionally, some cases are well insured with a reasonable reimbursement profile, while others are likely to go unpaid.

How does one balance the impact of on-call status on the physician’s practice, personal life, and patient reimbursement? Who should be called upon to finance these services: county, state, and/or federal government, private insurance companies, the physicians, or your community hospital? There are no easy answers, but answers appropriate to our community’s situation must be found.

The Tahoe Forest Hospital family urges you to become informed and involved in the development of your community healthcare facilities and services.

Please take the time to attend our upcoming Board of Directors meeting on Tuesday, Jan. 23, to begin at 6 p.m., on the hospital campus in Truckee in our dietary conference room.

Alternatively, you are welcome to offer your comments via telephone or mail; contact the TFH Administrator, Larry Long, at 582-3481, or Post Office Box 759, Truckee, CA 96160. Your interest and input will be greatly appreciated.

Larry Long is the Tahoe Forest Hospital CEO/Administrator.


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