In response to a decision by the federal Medicare and Medicaid agency, St. Peter’s Hospital severed rental agreements with visiting specialty doctors, at least one of which had been using hospital space for decades.
St. Peter’s Hospital had long rented space in its two clinics to niche physicians based in other Montana cities who would visit Helena several times a month to provide their unique services to area patients.
The hospital administration was recently notified by the federal Centers for Medicare and Medicaid Services that renting clinic space disqualifies the hospital from provider-based status, a distinction that means about $1 million a year for the hospital, according to CEO Nate Olson. Specifically, because one of St. Peter’s clinics is in the same building as the main hospital, CMS stated “they do not believe that the public can adequately differentiate between hospital-employed physicians and the specialists that visit from out of town,” according to information provided by the hospital. CMS reportedly gave the hospital a deadline of Friday, Oct. 23 to be in compliance.
The hospital sent out-of-town providers a letter on Oct. 9 giving them two weeks of notice they could no longer operate in either of St. Peter’s clinics. Effective Friday, the outreach providers had to find another base of operation or stop offering services in Helena.
“Sometimes laws have unintended consequences,” Olson said in a statement. “St. Peter’s was trying to enhance healthcare services for the people in our community, and, unfortunately in this case, we were dealt a ruling that makes it difficult for us to do the right thing for patients.”
“We’ll be doing everything we can to keep these services in town even if it’s not at our clinics,” he also said in the statement.
Olson said St. Peter’s hospital had asked CMS for clarification about the setup 18 months ago, and didn’t receive a response until recently. In its decision, CMS also asked St. Peter’s to refund payments for the last 18 months, essentially asking the hospital for a $1.5 million check.
Olson said the $1.5 million isn’t out of the hospital’s reach, but he said the hospital is petitioning that portion of the decision.
Hospital spokeswoman Katy Peterson said St. Peter’s administrators met with representatives from Montana’s congressional delegation, who agreed to advocate at the federal level for St. Peter’s. It was unclear as of Friday whether the Washington, D.C., offices would be asking for a reversal of the entire decision or just a forgiveness of the $1.5 million ask.
Meanwhile, the outreach providers were left scrambling to find space.
Dennis Ruggerie, a pediatric cardiologist based in Great Falls, said he started providing clinics in Helena in 1989 and has served as a consultant to St. Peter’s physicians since 1993. He now visits Helena one day a week to see 10 to 13 patients. Ruggerie said he has hundreds of children and adults in Helena who were born with heart problems and are his clients.
“It was not a very well thought out decision,” Ruggerie said of the St. Peter’s mandate. “But the decision was probably made for appropriate reasons, based on Medicare, Medicaid and federal government regulations.”
Despite the challenges of operating in a shifting health care field, Ruggerie said he felt the responsibility ultimately landed in the halls of St. Peter’s.
“My sense is that this is not CMS bearing down on a small little community hospital,” Ruggerie said. “They knew this was coming and somebody dropped the ball.”
He said the hospital did offer to connect providers with real estate agents in an attempt to help them find a new base of operation, something Ruggerie said was an unrealistic task given a two-week window.
Instead, word of the decision spread and the pediatric community in Helena stepped up. Providers at the Helena Pediatric Clinic and in the Partners in Pediatrics group reached out to ask how they could help. Ruggerie said he will be temporarily operating out of space in the Helena Pediatric Clinic.
At the same time, some hospital staff who Ruggerie said had been “like family” approached St. Peter’s administrators in an attempt to reach a solution. Ruggerie said he heard from those physicians that hospital administrators made a commitment last week to “come up with a solution in a timely manner, to solidify and keep the pediatric services that have been coming to the community for a long time; they’re going to see to it that clinic space is provided.”
Ultimately the message was a positive one, Ruggerie said. Regardless of the consequences of the CMS mandate, he said the health care community in Helena has stepped up generously and St. Peter’s is making positive moves.
Spokeswoman Katy Peterson, however, said Thursday she was not aware of that or any other commitment by the hospital.
David Anderson, a pulmonologist and sleep doctor, said he traveled to Helena twice a month and would spend two days each trip treating area patients. He offers treatment only available through a few other physicians in the state and said he would often see 15 patients a day.
Anderson said he knows many doctors who provide outreach in cities around the state and often operate on hospital property. Outreach is critical in Montana, he said, because small Montana markets have a difficult time supporting specialists.
Until he identifies a permanent space, Anderson said he worked a deal with Montana Academy of Family Physicians to use their space for a couple of visits, but said he can only operate out of there one day each month.
“I really believe the outreach clinics are very important to the quality of health care delivered in the state,” he said. “I’d like to see them continue.”