Letter to the Editor

Descripion of NRMC-NMC relationship in story questioned

Tuesday, August 8, 2017

Dear Editor:

We are the physicians of Nevada Medical Clinic. We have been providing medical care to Vernon County and surrounding areas since 1969. The clinic was founded by Dr. Jim Pascoe, a general practitioner who practiced a wide range of medicine including surgery, obstetrics and medical management. He designed the building and collaborated with local businessmen to finance the recruitment of new physicians to the community.

He successfully recruited Dr. Jim Harms, a general surgeon, Dr. John Torontow, an internist and Dr. Harry Langeluttig, an OB/gyn.

Over the years Nevada Medical Clinic continued to recruit many physicians including family physicians Dr. Nelson Greenlund, Dr. Mitch Magruder, Dr. Candice Moore, Dr. Jan Garwood, Dr. Rick Thompson, Dr. Russ Kemm and Dr. Brian Deem; pediatrician Dr. Ron Jones; internists Dr. John Loney, Dr. Warren Lovinger and Dr. Bruce Baker; general surgeons Dr. Bill Turner and Dr. Dwight Wagenknecht; OBGyn Dr. Scott Beard, many physicians who stayed here a short time and moved on, our current physicians and Dr. Cameron Crymes, a family physician who became NRMC’s first hospitalist. Our current members are family physicians Dr. Jennifer Conley, Dr. Heather Russell, Dr. Jill Spangler, Dr. Rick Kellenberger and Dr. Amanda Turner and internist Dr. Sean Gravely.

As medical care, reimbursement models and regulations have changed we have changed too. When we were founded medical care was less expensive, offered fewer options and insurance coverage was not as able to regulate and direct the course of medicine. Physicians were typically in private practice and rarely employed by other entities.

We used paper for charting, orders and billing, and documentation was quick and efficient. The government had little oversight over medical care. Medicare was a relatively new development. Nevada City Hospital had recently expanded into the new building built in the 1950s. The State Hospital was a huge part of our local economy and utilized services of our surgeons on-site.

During the late 1990s economic pressures and uncertainty caused the partners to sell the clinic building to St. John’s hospital in Joplin and work with them briefly in an ownership model. This was not a successful move and the partners bought the building back from St. John’s and resumed private ownership in 1999.

Nevada Medical Clinic has remained a private entity since that time and is owned by the currently practicing physicians. A key component in that transition was becoming a rural health clinic.

By meeting a large set of guidelines a rural health clinic qualifies for additional reimbursement for visits covered by Medicaid and Medicare. This allowed the clinic to thrive in primary care but was detrimental to surgical specialties. During the early 2000s the surgeons left the clinic and we became solely a primary care clinic.

In recent years we found ourselves struggling with the demands that we cover more hospital inpatient work that required more time-consuming electronic documentation and more burdensome regulations with fewer physicians sharing the load. We were acting as hospitalists for people who received their care in other clinics that did not offer inpatient coverage, including those owned by NRMC.

We were left alone covering the obstetric services in the region as Barton, Cedar and Bates County hospitals discontinued obstetric services. We had difficulty predicting each day’s hospital workload so that we could tailor our clinic schedules appropriately. We faced significant burnout.

As a result, the primary care physicians in Nevada banded together and insisted upon a conversion to the current hospitalist system. That transition took place in December 2014. The hospitalist system was initially very successful but has certainly had many difficulties.

We understand there were benefits to providing continuous care for our patients. Unfortunately, we could not control the workload placed upon us and it was too much to sustain. We lost numerous physicians over the years because of the demands of the work. Three of our physicians do continue to offer continuity care through NRMC.

We provide all the obstetric coverage and pediatric admissions to the hospital. NRMC does not reimburse us for this work. It is doubtful that NRMC would be able to offer these services if we were not working under the current model. We would certainly have difficulty providing these services without NRMC.

Four of our six physicians are currently working with NRMC to cover hospitalist shifts. Our physicians have served in many volunteer roles within NRMC. We have donated numerous hours to meetings of the medical staff executive committee and hospital board and provide medical directorship of hospital departments. We refer our patients to specialists employed by NRMC and order diagnostic imaging and therapy services offered by NRMC. Patients in our clinic who require hospitalization are offered NRMC when appropriate.

The article titled “Stemming Physician Turnover” in the Aug. 4, 2017 edition of the Nevada Daily Mail contained the following sentences, “As many in Nevada know, for some years there has been a frosty relationship between the hospital and the Nevada Medical Clinic. This is an area where Leeper has provided personal and effective leadership.” This statement is an inaccurate representation of the longstanding symbiotic relationship between Nevada Medical Clinic and NRMC.

In any healthy long-term relationship boundaries must be set and maintained. That is true in families, businesses, churches and friendships. We have found it necessary at times to set boundaries regarding the hospital’s interest in Nevada Medical Clinic. We have had to be clear about what services we can and cannot provide and what level of coverage the hospital must provide.

We have maintained our independence from outside entities including NRMC and other outside hospital systems. We have declined to share access to our electronic health record because of our desire to maintain a high degree of security. We never had any direct competition with NRMC until the hospital established the NOW care and Primary Practice Clinics in the past few years.

We do not know the source of information about this “frosty relationship.” Author Johannes Braun did not cite his source, instead referring to public opinion. We would submit that statements of this nature belong on an editorial page, not in an article purporting to be objective news. It is our opinion that Nevada Medical Clinic and NRMC have continued to rely on each other through a difficult time in the delivery of medical care and that we should desire the best outcome for both entities.

We hope to recruit more physicians to our clinic and we certainly hope they will stay for a long time, as discussed in the article. Dr. Conley has already been here 16 years, Dr. Russell 14 years, Dr. Spangler and Dr. Gravely 10 years, Dr. Kellenberger 7 years and Dr. Turner 2 years.

We are privileged to have the opportunity to operate a long-standing locally owned business, which employs 45 people in this community. We appreciate the trust placed in Nevada Medical Clinic by this community and hope to continue this relationship far into the future.

The physicians of Nevada Medical Clinic.