Dustin Crabtree speaks to the board at the Eastern Plumas Health Care District regarding the hopes of future collaborative efforts, rather than competition, between EPHC and the Portola Village Pharmacy on Thursday, Aug. 22, with a full house in attendance. Photo by Lauren Westmoreland

Pharmacy discussions garner community input

The Eastern Plumas Health Care District held a monthly regular meeting with a full house Thursday, Aug. 22.

The board voted to approve the consent calendar before the floor opened for public comment, which began with Lindsey Compton-Crabtree, a third-generation Portola resident.

She introduced herself and her husband, Dustin Crabtree, and said, “Both of us received our bachelor’s degrees in biochemistry from Willamette University, that happens to be the same university that Mr. Plimpton attended. Currently, we are finishing our final year at the University of Montana, in the Doctor of Pharmacy program, and in May, we will graduate as pharmacists.”

Compton-Crabtree went on to say, “I began working for Mike and Karen Kibble at the Portola Village Pharmacy at the end of high school. It was this experience that led me to the great path of pharmacy. I’ve been fortunate to learn from the Kibbles as a clerk, a pharmacy tech, and lately as a student pharmacist, all with the known intent to purchase the pharmacy.”

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Compton-Crabtree explained to the room that Mike Kibble and she had discussed these plans, as well as a desire to work collaboratively with EPHC. These plans were communicated to Todd Plimpton in person, over the phone, and in writing.

“We are here today to express our concern over EPHC’s aggressive tactics in pursuing the purchase of the Portola Village Pharmacy, and to offer retail services in this community,” Compton-Crabtree expressed.

“We were very surprised to hear of these developments after Mr. Plimpton personally gave me his assurance that EPHC would, and I quote, ‘not interfere with our plans to purchase the pharmacy,’ guaranteed that Dustin and I would be included in all conversations regarding pharmacy services in this area moving forward.”

According to Compton-Crabtree, the communications took place just a few short weeks ago. She went on to explain that she and her husband planned to add to client vitality on Commercial Street.

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“Our plan has always been to devote the front end of the business into a place that meets the wants and needs of our patients, our fellow residents, and local entrepreneurs,” Compton-Crabtree added. “We also wish to provide stability for the patients as well.”

Compton-Crabtree continued to speak, directing her words toward the front of the room. “As independent owners, Dustin and I are making a commitment to spend our careers here and develop personal relationships with each patient, which is not received from transitional pharmacists.

“From a personal standpoint, it was disappointing to see one of the leaders of our community take away entrepreneurial opportunity from young, local professionals with a desire to return to this area. Dustin and I are highly accomplished and have tailored our education to the needs of rural areas, but most of all, we love this town.”

Compton-Crabtree went on to state that she and her husband believed that they are the candidates most fit to provide pharmacy care to the local community and were honored to stand in front of the room with the support of many community leaders.

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This was followed by further comment from Dustin Crabtree, originally of Sherwood, Oregon. “I had the pleasure of being introduced to this area six years ago and have spent the last five summers working here and have grown to love this community and have become personally invested in its success,” Crabtree said.

“As well as the credentials my wife mentioned, I will also be graduating with a Masters of Business Administration from the University of Montana. Lindsey and I specifically chose the University of Montana for their expertise in the needs of rural America, their specialized training for delivering health care in remote areas, and the interdependence on independent pharmacies.”

Crabtree outlined the couple’s plans to return to the area after graduation with numerous resources and contacts that would improve pharmacy services and help the community.

“Another value that will come is providing a better system of checks and balances between those that write prescriptions and those that fill prescriptions, ensuring that they do not work for the same entity,” Crabtree stated.

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“We understand that business is business, and in this community profits matter, but people matter more,” Crabtree said emphatically. “We are committed to this community and the people that make it great. More than anything, we want to work with Eastern Plumas Health Care in order to benefit all.

“We have and will continue to offer our services and knowledge to EPHC, to help give this community the excellent health care it deserves. There’s a situation where this works out for everyone, but regardless of EPHC’s decisions, we will move forward to become independent pharmacy owners in this community, but we hope to have the support of and collaboration with Eastern Plumas Health Care.”

This was followed by comments from current owner of the Portola Village Pharmacy Mike Kibble. “I do appreciate that there is so much interest in the Portola Village Pharmacy,” Kibble opened. “The pharmacy is a very important piece to the array of services provided within a healthcare district. Each piece supports the fragile network of care.”

Kibble described the way that the network of care can quickly turn into a “wobbly three-legged stool” with any disruptions in that fragile reliance, and stated, “Todd is investigating putting forth an offer for the pharmacy. This is flattering, but this is about the community.”

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Kibble went on to say that Plimpton had stated that if he couldn’t strike a deal, he would compete. “To me, that’s a great way of eroding the provision of health care locally,” Kibble said. “We don’t need to go very far, ladies and gentlemen of the board, to benchmark what happens when districts think they can do it better. I owned Quincy drug store for 15 years, saw business grow, and then plateau, then slowly erode, because Plumas District Hospital decided to siphon off the same patient population.”

Kibble went on to explain that ultimately, he had to sell Quincy drug, stating that he had taken a hit on his business value as a result of the unfair competition with Plumas District Hospital.

“Now you know… how ill conceived and narrow in scope business decisions not supported by fair market county practices can impact the community,” Kibble said in closing.

Matt Kruse, owner of Gumbas Family Pizza in Graeagle, came forward to comment, explaining to the room that he had lived in the area for over 37 years.

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Kruse began by reading a letter from Kirk and Dana Lambert of Lambert and Lambert Insurance, which stated how excited they were that young professionals were coming back to Portola and using their education to strengthen the community.

“Dustin and Lindsey are two professionals in the community that we have the honor of knowing; their work ethic, knowledge, and passion is a recipe for success. We’re excited to have such amazing people coming back to improve our area,” the letter read.

The letter went on to state how important it is to have locally owned business in a community like Portola, with trustworthy people running the businesses. “People in this area care about having a connection with the owners,” the letter continued.

The Lamberts went on to fully endorse the couple in the letter, with the belief that the couple will be an asset to the community and stated concern over potential competition from Eastern Plumas Health Care as a threat to bringing more young professionals to the area.

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Kruse then added, “I personally have raised two kids in this area and done a lot of high school sport coaching. It is important to me as a small business owner in a small community to have these kids go out, get an education, come back to their community, and improve our community.”

EPHC CEO Todd Plimpton asked if he could then give his report early, rather than waiting until later in the agenda, and with consent, responded to the concerns of local business owners.

“I do appreciate the comments by everyone, and I’ll start by simply saying I agree with them,” Plimpton said. “I’ve got no issue with it and in fact encourage it. I feel like there is a lot of room for public discourse here, but I want to share what’s gone on with our team and why we were at least entertaining the idea of doing the pharmacy.”

Plimpton went on to elaborate further on a recent district hospital meeting, which gave an opportunity to learn best practices, and one thing noted was discourse with various hospitals that changed the direction EPHC had been taking on pursuing a pharmacy venture.

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“A lot of hospitals have failed by doing stand-alone pharmacies,” Plimpton said. “In talking with other hospitals, it’s really difficult to do.”

Plimpton went on to state that one reason that the idea of a stand-alone pharmacy was being entertained was due to thought toward the medically self-insured.

“We spend a couple hundred thousand dollars a month on health insurance costs and we’ve got to try to get better services for employees while saving some money,” Plimpton explained.

Plimpton went on to state that after research, it was discovered that the option was not viable, mainly due to the fact that Eastern Plumas Health Care, while experiencing growth, was not large enough to justify going into a private pharmacy.

“Also, there has been a lot of change in the last 60 days regarding the 340B program, and 340B is a program where the federal government reimburses the state of California to allow cost-based purchasing of pharmaceuticals, so you can pass the savings along to the  indigent and uninsured,” Plimpton explained.

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“It’s a program that, whatever we do, is something that we could socialize over the next year or two,” Plimpton added. He went on to state that currently, Katherine Pairish and himself were of the opinion that “it doesn’t work” and stated that he felt the leadership approach to the matter had changed.

“One of the things that really rung the bell for me is seeing the sincerity of these folks, and I couldn’t agree more. The last thing we want to do is discourage exactly what’s taking place here,” Plimpton said.

“We’ve got to have to have best practices,” Plimpton stressed. “We’ve got to find ways to save some money or make a little money so we can underwrite behavioral health for $600,000 a year, so we can underwrite MediCal. It comes down to sustainment dollars.”

Plimpton then stated the support of Eastern Plums Heath Care to the couple, and said, “Maybe there’s some real discussion about how EPHC and the pharmacy would work so that everybody views it as a very collaborative relationship.”

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Plimpton concluded by reasserting that the hospital would need to be at least twice the size to venture into a stand-alone pharmacy, stating that EPHC wants to move forward in supporting the new ownership, as well as looking to the future best care of the community as a whole.

CBD

With that, public comment closed, and the agenda moved to a report from Chief of Staff Eric Bugna, M.D. Bugna noted that he had spoken several times about the topic of opioids in the past, and raised a question to the Crabtrees about the topic of CBD being encountered in the field more often. The couple stated a lack of concrete studies showing long-term safety or significant topical absorption.

“People love it and they stand by it, and I think there’s something to be said for that as well,” Compton-Crabtree said. Bugna responded that some of his patients had inquired on the subject and the board discussed it a bit further before moving on to the finance committee report given by Director Trey West.

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Revenue

“July was definitely a strong revenue month,” West said. He went on to state that EPHC had brought in $3.9 million, and noted a net loss of $61,000, largely due to unusual expenses, with about 203 capitalized items such as replacing beds and a new skid steer.

“We are way above budget of negative $377,000,” West said. “Really looking good for the year coming.” West thanked the office, saying that there was currently a 56 percent collection rate, without any outsourcing. West also noted that revenue centers have been a hot topic.

Director Dr. Paul Swanson added that a lot of the revenue for the hospital comes in lump sum payments later on, but it seemed clear that in the big picture, the hospital was in the black.

Nursing

Chief Nursing Officer Sharon DiNicholas then reported that nursing had been extremely busy in every area. “Last Thursday we had a record 69 outpatients through the lobby in one day. That includes ER patients, x-rays, mammograms, and labs. We continue to see this volume — the amount of the community that we’re able to serve is really great,” DiNicholas said.

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DiNicholas went on to report that the morning census on the acute floor had been running six to eight in the last few weeks, the Portola Skilled Nursing Facility (PSNF) was at 26 residents, and the Loyalton Skilled Nursing Facility was at 32 patients.

“We still have a wait list, and staffing has become an issue, so we are reaching out to agencies to ensure that we provide that excellent care. We are also focusing our CNA and nurse education with a focus on incorporating best practices,” DiNicholas said.

Thanks were given to EMS personnel for their willingness to assist in Portola and Loyalton, making a valuable contribution to patient care, and a new van was purchased to transport residents from Loyalton to various places.

A new physical therapy assistant has been hired, and DiNicholas also noted that a physical therapist and his wife, also a physical therapist, from Washington would be visiting the area for the weekend to interview for the position at EPHC, which would kick off the badly needed outpatient physical therapy program.

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Other news

Director Theresa Whitfield mentioned that she wanted to see a rejuvenation of the monthly quality committee meetings, as well as planning meeting updates, at monthly committee reports.

Clinic Director Rhonda Grandi then reported on the results of the second quarter patient satisfaction survey results and noted that suggestions for improvement were already being addressed, from replacing seating in the waiting room at the Graeagle clinic to things as simple as putting a clock in a waiting room.

Survey results were handed out to the board members, and after brief discussion, Plimpton noted that customer service had made progress, including the registration experience.

Grandi also noted that EPHC clinic had seen 269 patients since the beginning of the year and that number was likely to stabilize further with the approach of Labor Day and the seasonal departure of some residents.

Follow-up mechanisms were touched on by Clinic Outpatient Supervisor Shawna Leal, with a report that typically patients receive lab or physician visit results or a reminder to schedule a follow up via mail, and also that a lot of information is made available to patients on the online Patient Portal.

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It was also noted that a submitted application that adds to the initial behavioral health PRIME project had been approved, with additional funding going forward totaling at $1.1 million, or $550,000 net added to the original PRIME grant.

Director West pointed out that Loyalton had experienced growth, getting up to 100 visits, and the board discussed the extended sports physicals for students that have been completed in Loyalton.

HR Director Jayne O’Flanagan gave a brief report, speaking about the hard work being done in the office. “We’ve been discussing the impact of all of the new residents in Loyalton, and the changes it has meant. We have a lot of employees who are stressed and unsettled about those changes, and we are working to try and respond to the employees’ concerns, and I will be meeting in small groups with them beginning next week,” O’Flanagan said.

Chief Financial Officer Katherine Pairish reported on the financials for July, with Eastern Plumas Health Care posting gross revenue at $3,954,790 and a net loss at $61,010.

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Growth trends continue across all revenue centers, and inpatient revenue was over budget by $170,000. After contractual adjustments and bad debt, net patient revenue came in over budget by $360,000.

Total operating expenses for the month were over budget by $31,000, and gross accounts receivable ended the month at $5.8 million. Total assets as of July 31, 2019 were $21,589,191, compared to $18,237,123, showing an increase of 18 percent.

Plimpton then gave his report, speaking to the board about an annual letter received from the state on AB 2190, and spoke about looking to the future as far ahead as 2030 to ensure that EPHC is able to continue to address standards.

With a final decision made on the new Eastern Plumas Health Care logo, the board moved into closed session.