Old Habit In a New Setting Legislative Session to Commence in Jonah Building as Capitol Undergoes a Facelift

Tobacco Settlement Cuts Have TeleHealth and Loan Repayment on the Chopping Block PAGE 10

Title 25 is a Familiar Topic of Discussion for Lawmakers PAGE 20

WINTER 2016 • VOL.7 • NO.1

A PUBLICATION OF THE WYOMING MEDICAL SOCIETY 892172_Wyoming-HCP_AD_v5-outlines.indd 1 12/21/15 10:09 AM Contents

LEGISLATIVE PREVIEW 2016

The Wyoming Medical Society (WMS) is the Welcome to Wyoming Medicine’s premier membership organization dedicated to First Legislative Preview 4 promoting the interests of Wyoming physicians and physician assistants through advocacy, education ON THE COVER and member services. WYOMING MEDICINE An Old Habit in a New Setting 6 (ISSN-2154-1681) is published bi-annually by WMS at 122 East 17th Street, Cheyenne, Wyoming 82001. NEWS Contact WMS at 307-635-2424 or [email protected]. Tobacco Settlement Cuts Have TeleHealth WYOMING MEDICAL SOCIETY LEADERSHIP and Loan Repayment on the Chopping Block 10 President Sigsbee Duck, MD Budget Session Means Few Health-Related Bills 14 Vice President Paul Johnson, MD Secretary/Treasurer Joe McGinley, MD, PhD Title 25 is a Familiar Topic of Discussion Past President Dean Bartholomew, MD for Wyoming Lawmakers 20 Open Trustee David Wheeler, MD, PhD Direct Primary Care Bill Could Make AMA Delegate Robert Monger, MD Practice in Wyoming Easier AMA Alt. Delegate Stephen Brown, MD 23 WMS Executive Director Sheila Bush LEGISLATIVE PROFILES MAGAZINE EDITORIAL BOARD WYOMING MEDICAL SOCIETY Editor in Chief Robert Monger, MD Upcoming Legislative Session Will Publisher Sheila Bush Focus On Strategic Budget Cuts 24 Managing Editor Tom Lacock WYOMING HOSPITAL ASSOCIATION SUBSCRIPTIONS Wyoming Hospitals Offer a Wyoming To subscribe to WYOMING MEDICINE, write to Solution to Uncompensated Care 26 WMS Department of Communications, P.O. Box 4009, Cheyenne, WY 82003. Subscriptions are WYOMING PRIMARY CARE ASSOCIATION $10 per year. Wyoming Hospitals Offer a Wyoming Articles published in WYOMING MEDICINE Solution to Uncompensated Care 28 represent the opinions of the authors and do not necessarily reflect the policy or views of the Wyoming HEALTHY WYOMING Medical Society. The editor reserves the right to No Further Delay - Expand review and to accept or reject commentary and Medicaid in Wyoming 30 advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorse- NC Medical Society Hosts Insurance Forum 31 ment by the Wyoming Medical Society of the product or service involved. AMERICAN CANCER SOCIETY CANCER ACTION NETWORK WYOMING MEDICINE is printed by Print By American Cancer Society’s Cancer Request, Cheyenne, Wyoming. Action Network 2016 Legislative Priorities 32 POSTMASTER Send address changes to Wyoming Medical Society, Improving Quality of Life P.O. Box 4009, Cheyenne, WY 82003. Through Palliative Care 33

ABOUT THE COVER CHILDREN’S HOSPITAL OF COLORADO With renovations underway at the State Capitol in What Can Wyoming Do To Advance Cheyenne, the Wyoming State Legislature will take Access to Care Via Telemedicine? 34 place in the Jonah Business Center on East Pershing Avenue in Cheyenne. WMS Member List 36 4 WELCOME

Welcome to Wyoming Medicine’s First Legislative Preview

BY TOM LACOCK Wyoming Medical Society

elcome to Wyoming Medicine’s first Legislative • Patient safety through confidential reporting and Preview. The Wyoming Medical Society has pub- correction of health system errors; W lished Wyoming Medicine twice a year since 2011. • Program funding for Medicaid, the WWAMI pro- This year the WMS decided to add a third publication offering gram and UW Family Practice Residencies, as well an overview of the 2016 Legislative session, which begins Feb. as physician recruitment and loan repayment; 8 in Cheyenne. • Scope of practice issues through responsible col- Physician advocacy is one of the fundamental pillars on laboration between physicians and other health which WMS is built, and this publication seeks to explain both care providers; the process of that advocacy and what issues will face the state’s • Tobacco prevention as it relates to public health. physicians in 2016. We hope this will allow physicians the time This year the WMS’s Board of Directors will meet in Chey- to discuss issues of concern with legislators or WMS staff who enne on Jan. 16 to discuss legislation and how it will direct its can also voice that concern to state lawmakers. executive director, Sheila Bush, to advocate on the organiza- The WMS Board of Directors is comprised of 22 members tion’s behalf. The WMS has a reputation as an organization representing their home areas from around the state. It meets which understands healthcare-related issues and is called upon each January as a group to offer the organization’s position on repeatedly by Legislators during the session to offer an honest bills released via the ’s website, or have review of legislation and the impact on Wyoming’s physicians been brought to the attention of WMS staff. The Board votes and patients. on whether to monitor, support or oppose the bills brought before it. While Bush is the lead advocate for the organization, the The litmus test for any bill seeking support by the WMS WMS strives to make the process inclusive for interested Wyo- board has been whether it falls in line with stated WMS priori- ming physicians. WMS staff will alert membership of upcom- ties taken up by the Board of Directors. ing hearings and the opportunities for physicians to testify on a law’s impact on behalf of the WMS or as an independent The WMS places a priority on: physician. • Fair and predictable medical liability reform; It is the hope of the WMS that this issue will help WMS mem- • Access to care for Wyoming’s patients caused by bers understand the issues and opportunities to take part in the physician shortages; process this February in Cheyenne. Collective Strength. One Focus. The Colorado Institute for Maternal and Fetal Health offers mothers and babies comprehensive care and treatment before, during and after high-risk or routine pregnancies.

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BY TOM LACOCK Wyoming Medical Society

The Jonah Business Center houses the State Capitol and has divided large chunks of its interior into sides for the Senate as well as the House. In addition to the chambers for each, the committee rooms and Legislative Services Office are also relocating to the building.

ld habits will be put on hold for a few years as the State when the weather was good,” says Scott. “Of course you don’t Capitol in Cheyenne undergoes a large-scale renova- want to be walking in a stiff wind going over the UP viaduct.” O tion, which will keep it from hosting the state’s annual House Member (R-Lovell) says she too will do legislative sessions until 2018 or 2019. away with some of her favorite aspects of the capitol’s down- The state capitol closed to the public on Dec. 9 to allow for town location such as lunch at Cheyenne Regional Medical the beginning of renovations, which are estimated to cost $219 Center’s cafeteria. Harvey has come to appreciate the under- million and will have state lawmakers meeting in the Jonah ground parking available at the state capitol, and laughs as Building on east Pershing she says she sometimes gets Ave. in Cheyenne for the claustrophobic and appreci- foreseeable future. Holding My suspicion is we are not ates that her new spot at the the legislative session in the “ Jonah Building sits on the former Kmart and call center going to be as efficient. It outside of a row. will mean some changes for “I go so early in the morn- those who work there. Sena- is going to be harder to get ing and go home so late at tor Charles Scott (R-Casper) some of the routine bills night that I really appreciate said he will miss the ability the underground parking be- to walk the two miles from passed and done on a timely cause my car would defrost,” the Holiday Inn to the State fashion. she says. “I think It will be in- House each day. ” teresting to not have a gallery “I’ve been staying at the SENATOR CHARLES SCOTT as well.” Holiday Inn, and that is a good (R-Casper) A lack of a gallery inside the two-mile walk in the morning House and Senate chambers Wyoming Medicine 7

The House of Representatives actually has a larger space than it had inside the State Capitol. Behind the chambers is the gallery where visitors will be allowed to watch session through windows.

will be among the changes visitors to the temporary capitol will restrooms, and improving committee meeting rooms. notice. Those interested in listening to the work of the Senate The state capitol has needed repair for some time because a and House can watch through windows in a separate room be- quarter of the building doesn’t have HVAC, much of the wiring hind the lawmakers thanks has outlived its prescribed to the building’s PA system. lifespan, and the building While the ceilings are certain- So much of what we do is has no fire suppression and ly lower than in the chambers “ sprinklers. Parts of the dome at the Capitol, there is actual- to have radically different have tears, corrosion, dents, ly more floor space for mem- and water infiltration. bers of the House. Committee feelings in the population The Herschler Building rooms are spread throughout and conflicting interests, houses several state agencies the facility. and suffers from water corro- The renovation of the capi- and how do you reconcile sion in the walls and rotting tol itself is part of a $300 mil- window blocks. A four-story lion project called the Capitol that in a way that moves the office building may also be Square Project, which will society forward in a way that built with elected officials and also make improvements to everyone can live with? their offices moving to the the Herschler Building and ” new building. Six state agen- the connector gallery. The cies have moved to temporary SENATOR CHARLES SCOTT capitol will see improvements (R-Casper) quarters in an effort to let to fire suppression, electrical work get started. systems, plumbing, adding According to the project’s 8 STATE CAPITOL RENOVATIONS

website, the state has saved more than $100 million over the past 15 years for this renovation project. The Legislature put together a joint task force to direct the the process with Sen. Tony Ross (R-Cheyenne) and Rep. (R-Sheridan) as chairpersons. Scott says he was first elected to the State House in the elec- tion of 1978 and later moved to the Senate in 1982, and cited some strong feelings about the old building at Capitol and 24th. “My feeling on the floor in those first two days was ‘This is how a free people governs itself,’” Scott says. “I remember be- Visitors to the House and Senate Chambers this year will be able ing real proud, and gratified at being a part of that. I still have to watch the Legislature meet through windows in gallery rooms quite a bit of that feeling. So much of what we do is to have behind the chambers. radically different feelings in the population and conflicting in- terests, and how do you reconcile that in a way that moves the society forward in a way that everyone can live with?” How that process looks in a different building remains to be seen, and Scott says he is interested to know what the impact is on the session itself. “The question is how much will the change degrade the per- formance of the legislature in those temporary quarters?” Scott asked. “I don’t know. We will find out. My suspicion is we are not going to be as efficient. It is going to be harder to get some of the routine bills passed and done on a timely fashion.” “There is so much of it that will be so different,” Harvey says. “We are meeting in a former Kmart building that was turned into a bank that was turning into a processing center that is The Legislative Services Office have set up the Senate Chambers and are ready for the session. turned into the state capitol.”

This room will serve as the new Room 302, where the Legislative subcommittees hear issues of interest to larger groups.

10 TOBACCO SETTLEMENT

Tobacco Settlement Cuts Have TeleHealth and Loan Repayment on the Chopping Block

BY TOM LACOCK Wyoming Medical Society

Joint Appropriations Co-Chair (R-Casper) will be one of the major players in determining whether Medicaid expansion makes it out of the JAC. Medicaid expansion is being proposed in the state budget this year, giving the JAC the first chance to debate the plan.

hile the state’s general fund suffers from low prices vice Office, the Wyoming Department of Health will receive on minerals, another shortfall in funding could re- $12 million less than in the last biennium and was asked to W sult in the state cutting both the state’s Telehealth reduce TSF programs by $7.24 million. and physician recruitment efforts. In mid-December, Wyoming Department of Health Direc- Currently, 25 programs across the Wyoming Departments tor Tom Forslund presented his agency’s budget to the Wyo- of Health, Family Services, and Corrections are funded by $18 ming Legislature’s Joint Appropriations Committee. In order million from Tobacco Settlement Funds (TSF). In November to offset the $7.24 million reduction in funding, Forslund says 1998, the attorneys general of 46 states, the District of Colum- he was asked to reduce programs funded by TSF and chose bia and five territories reached an agreement to to remove 56 percent of the funding from the Department of settle lawsuits or disputes with the tobacco industry regarding Health on Drug Courts, along with entire program cuts to Tele- expenditures the states had incurred under their Medicaid pro- health and the Wyoming Healthcare Professional Loan Repay- grams for tobacco-related health care costs. However, based on ment Program. projections of a major downturn in the amount of TSF because “Over the years as a result of legislative action, more and of low investment income by the nonpartisan Legislative Ser- more programs have been determined to be funded with TSF,”

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Wyoming Department of Health Director Tom Forslund answers questions from the Joint Appropriations Committee in December.

Forslund says. “The revenue coming in with that is not as great “This is not just Medicaid that would be impacted,” said as it was in the past, so there isn’t sufficient revenue to fund all Medicaid Medical Officer Jim Bush, M.D. “The technical as- the programs.” sistance grants would go away. The bridge may go away too.” Telehealth on the Chopping Block Wyoming Healthcare Professional Loan Re- Wyoming Telehealth Consortium of healthcare facilities and payment Program providers is run by the Wyoming Office of Rural Health and Keri Wagner runs the Wyoming Healthcare Professional is 100 percent funded by TSF. Its $235,000 budget has been Loan Repayment Program for the Wyoming Office of Rural divided into a $230,000 contract for its vendor, Ptolemy, to Health, housed at the Department of Health. She says the pro- maintain the state-owned bridge (audio-video link between us- gram is open to providers for loan repayment over a three-year ers) and support Telehealth users. The remaining $5,000 is al- period while the provider practices in Wyoming. Physicians located for associated travel expenses. and dentists are eligible for $90,000 over three years while According to Department of Health numbers, there were nurses, physician assistants, nurse practitioners, and chiro- 5,160 unique beneficiaries served by physicians via Telehealth practors are eligible for $30,000 over three years. in 2015, with nearly 50 percent of those being children. During Should Forslund’s proposed cuts go through, the program the state’s fiscal year of 2015, nearly 175 sites were supported would not be funded starting in the 2017-18 biennium. via the Telehealth system. Wagner said the Office of Rural Health uses surveys to deter- Ptolemy also offers the state a number of technical assistance mine the areas with the greatest needs for medical personnel as grants in the form of support for technical, clinical, and ad- well as the greatest shortfalls in providers and uses that data to ministrative workflows, and development of a Telehealth use determine awards. The program receives around 200 applica- which it says is practice-specific. The Telehealth Consortium tions per year with the Office of Rural Health doling out about also offered a number of resources to providers including Tele- eight awards each year due to funding. health protocols, policies and a provider directory of specialists Documents prepared by the Wyoming Department of Health in the state who provide Telehealth services. show seven grants to physicians for repayments of loans in Wyoming Medicine 13

2015 worth $510,000, and 13 Forslund says the difference in 2014 worth $504,297. In in the two is $32 million with all, the program has funded Over the years as a result of the expansion budget provid- 82 awards for physicians “ ing a savings of $9 million since its inception, and pri- legislative action, more and back to the general fund. mary care physicians have re- more programs have been The Department of Health ceived 58 of the program’s 82 is asking for $155 million awards. Sweetwater County determined to be funded for construction on the State has been the state’s largest Hospital in Evanston, as well recipient of these awards with with TSF. The revenue as the Wyoming Life Resource 16 physicians, two dentists, coming in with that is not Center in Lander. The moves and 26 other providers re- would facilitate 100 beds ceiving awards. Albany, Na- as great as it was in the coming to Lander to take care trona, and Fremont Counties past, so there isn’t sufficient of long-term patients from the have had 18 award recipients State Hospital. apiece. Carbon County has re- revenue to fund all the Other budget expenditures ceived 16. programs. Forslund’s group seeks in- ” clude $11.4 million to cover Other Big Ticket TOM FORSLUND Title 25 cost overruns, as well Items on Department Wyoming Department of Health Director as $7.6 million for a new Med- of Health’s Budget icaid Management Informa- Request tion System (MMIS) for the Forslund says the Depart- Medicaid Program. Forslund ment of Health’s budget is actually two budgets. One was set as says the MMIS cost is $75 million though the federal govern- though Medicaid expansion was authorized and another bud- ment will pay 90 percent of that cost. The current system is 30 get as though it was not by request of Governor Matt Mead. years old.

Senator and Joint Appropriations Co-Chair Tony Ross (R-Cheyenne) asks Wyoming Department of Education Director Tom Forslund a question during the JAC’s meeting in Cheyenne this December. 14 BUDGET SESSION Budget Session Means FEW Health-Related BILLS

BY TOM LACOCK Wyoming Medical Society

Rep. Elaine Harvey (R-Lovell) offers her perspective during debate on the floor of the Wyoming House of Representatives last year in Cheyenne. Harvey heads the House Joint Labor, Health and Human Services Committee.

he combination of a 20-day budget session and lower- than $268 million in additional federal funds to Wyoming. than-expected state revenues probably signals a quiet “Are we going to forego the hundreds of millions of economic T Legislative session for health-related bills. driver that would come with Medicaid expansion?” asks Mead Consider, then, the 800-pound gorilla known as Medicaid in his budget message. ”Now the question is how much are we expansion which, instead of coming up as a standalone bill, going to stomp and say, ’We don’t like it,’ as we send money to has been proposed as a part of the state’s budget by Gov. Matt other states when we are short on revenue?” Mead. A visit with the co-chairs of the Legislature’s Joint La- Scott says he is still not convinced that the federal govern- bor, Health and Human Services (JLHHS) Committee suggests ment will maintain its promises to pay 90 percent of the cost expansion remains an uphill battle. of expansion. He said if the state took Medicaid expansion and “As a separate bill it is dead on arrival and they don’t have the federal government decided to move back to the traditional the votes to pass it,” says Senator Charles Scott (R-Casper). 50 percent it funds Medicaid, it would affect the state’s ability “I think there is a constitutional problem with trying to run it to fund roads, cities, and higher education. through the budget. That is a separate issue. I think it is a mis- Unlike previous efforts to expand Medicaid during the 2015 take to do it as a matter of substance.” session known as the SHARE and Medicaid FIT plans, Wyo- Gov. Mead released his proposed budget, in which he pro- ming Department of Health Director Tom Forslund says this posed Medicaid expansion, on Dec. 1. In his budget message he year’s effort is a straight expansion. said expansion would reduce the budget of the Department of “It is not the SHARE, it is not the FIT, it is straight Medic- Health by $9.7 million. Mead also suggested federal participa- aid,” Forslund says with a laugh. “We don’t have any acronyms tion in optional Medicaid expansion is estimated bring more left. We feel we can implement this significantly quicker and

16 BUDGET SESSION

Dr. Bob Chandler and Dr. Mike Tracy testify in front of the Joint Labor, Health, and Human Services Committee during an August meeting in Lovell.

with less expense.” tals with less than 100 days’ cash on hand had $1 million avail- With this year’s expansion effort going through the Joint Ap- able, and seven different Wyoming facilities claimed it. Anoth- propriations Committee (JAC) before it would reach the floor of er $2 million was split between those based on uncompensated either chamber, Forslund says his department has been asked charity care performed and those who used a prospective pay- for more of an explanation on Medicaid, including a Medicaid ment system. information session, which he In the interim, the JLHHS held for the JAC last month Committee dispensed a survey before he was asked before to the state’s hospitals to learn the committee to defend his I don’t expect Medicaid more about governance of agency’s budget. “ hospitals as well as the health Elaine Harvey (R-Lovell) expansion to pass. There of their spreadsheets. Scott co-chairs the JLHHS Com- are many of us who feel says he was not impressed by mittee with Scott and says the response. despite the cost savings of the budget bill is an “We put out a survey asking expansion to the state bud- for basic financial information get, she wasn’t in favor of the inappropriate place to set and two-thirds of the hospi- method for Medicaid passage policy, and we don’t believe tals didn’t even respond,” says this session. Scott. “We talked with some of “I don’t expect Medicaid ex- that on its own it would get them and some refused to give pansion to pass,” Harvey says. the two-thirds majority. us even the most basic finan- “There are many of us who ” cial statement showing their feel the budget bill is an inap- REP. ELAINE HARVEY financials. Our conclusion is propriate place to set policy, (R-Lovell) we don’t have a systematic and we don’t believe that on problem without the hospi- its own it would get the two- tals financially. They wouldn’t thirds majority. We feel there is a bit of gamesmanship in put- have refused that inquiry if it showed they had troubles and we ting it into the budget bill.” needed to do something about it.” Wyoming Hospital Association Director Eric Boley says 14 Hospital Governance and Financial Stability of 26 hospitals responded to the survey and suggests that the Senate File 0145 and $3 million was the Legislature’s answer questions offered up by the survey were difficult to answer as for the state’s hospitals’ claims that they provided $110 million they asked for subjective questions that seemed to seek infor- in uncompensated medical care in 2014. Critical access hospi- mation on how the Affordable Care Act affected the facilities. Wyoming Medicine 17 RELENTLESS

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Senator Charles Scott (R-Casper) speaks during the 2015 Legislative session in Cheyenne. Scott is the co-chair of the Joint Labor, Health and Human Services Subcommittee of the State Legislature.

For that reason, he says some facilities simply refused to send WWAMI the questionnaire back to the Legislative Service Office. The University of Wyoming participates in the WWAMI “From an association perspective we were supportive, but we Medical Education Program, which is affiliated with the Uni- would like to have been included to offer greater compliance versity of Washington School of Medicine (UWSOM) in Seattle, and participation. But it was taken out of our hands before we Washington, also known as WWAMI. The WWAMI program had that opportunity,” Boley says. is going through changes, which will require some changes to This session, Boley says the WHA will ask for a change in the the physical location of the program’s training for Wyoming Upper Payment Limit changes for seven hospitals as well as students taking part in the program. Based on the Governor’s the state’s nursing homes (for more see: WHA section), which budget recommendation, that won’t happen this year. would bring another $25 million in federal funds if each eli- A new integrated curriculum approach for the WWAMI pro- gible facility in the state applied for the funds. gram will put students in their home state for their first two “We are trying to create our own solution to the uncompen- years of medical school. The WWAMI classroom space was de- sated care issue,” Boley says. signed for 10 students, which makes for tight quarters for each Receivership of Medical Facilities 20-student class. With the announcement of keeping two classes in Wyoming Last May, Deseret Health Group announced closure of nurs- for the first year different space is needed. In August, Meredith ing facilities in both Saratoga and Rock Springs before separate Asay represented the University of Wyoming at the JLHHS companies took over the facilities in the eleventh hour. Harvey said that has led to the JLHHS Committee to consider whether meeting in August asking for two appropriations — $300,000 the state needs different rules in place to take over receiver- for Level II study for building a new facility and a $5 million ship of facilities that cannot pay their bills. She said the com- set-aside for construction costs. UW is looking for a consultant mittee spent some time discussing that idea this interim, and to look at current space and ways to get the WWAMI program the attorney general’s office and Legislative Service Office are into current facilities. helping to draft a bill regarding nursing homes or hospitals and The Governor’s budget recommended the $300,000 for receivership. the study, but did not recommend the $5 million set-aside for “What are the implications of the state running those facili- building costs. WWAMI was a $12.5 million piece of the state ties?” Harvey asks. “If we have developmentally disabled pro- budget for the 2015-16 biennium. viders on the edge of financial viability, does that mean we are “We think there needs to be facility improvement and expan- going to go into receivership with hospitals who can’t pay their sion. That comes with a recommendation, though not as a bill,” bills or their help?” Harvey says. YOUR BUSINESS IS HEALING OTHERS. OURS IS TAKING CARE OF YOU.

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310 EAST 4500 SOUTH, SUITE 600 • SALT LAKE CITY, UTAH 84107 • 801-531-0375 • 800-748-4380 20 TITLE 25 Title 25 is a Familiar Topic of Discussion for Wyoming Lawmakers BY TOM LACOCK Wyoming Medical Society n a year where state budgets are tight, the Wyoming Legis- that. However, on average around 20 patients at the state hos- lature is focusing on what can be done with a Title 25 pro- pital have been there for more than one year, leading to a wait- I gram that pushed the general fund $11 million over what list of around another 20 patients who need beds in Evanston. was budgeted over the past two years. “The system needs major revamping,” Forslund told the JAC. According to the Wyoming Department of Health’s (WDH) The State does have a few options on the table. Forslund website, Title 25 of the Wyoming State Statute provides the le- supports a proposal to develop an eight-bed group home in gal process by which a police officer or examiner may detain Evanston for those who no longer meet medical necessity for a person thought to be in danger to self or others or unable hospitalization, but face challenges with immediate integration to meet basic needs as a result of a mental illness. The law in- into communities. cludes information about emergency detentions, continued in- The state is also considering changing the mission of the Wy- voluntary hospitalization, the role of the Wyoming State Hos- oming Life Resource Center in Lander to include some space pital, costs for hospitalization, and other provisions. for elderly and hard-to-place patients, which would then free During a Dec. 14 meeting with the Joint Appropriations some beds at the State Hospital. The plan as proposed would Committee (JAC), WDH Director Tom Forslund said costs for bring 100 new beds for the Wyoming Life Resource Center. the Title 25 program grew to more than $7.6 million in 2015, Another option for Title 25 reform might come from draft and projected costs for the fiscal year 2016 are more than $8 legislation suggested by the Joint Subcommittee to Address million with an anticipated shortfall of $11.4 million for the Title 25 Issues. The task force has recommended a draft bill 2015-16 biennium. which may be taken up by the Joint Labor Health and Hu- At the heart of the issue, Forslund says, is the lack of space man Services Committee at its Jan. meeting if so ordered by at the State Hospital in Evanston, which creates issues further the Legislature’s Management Council. The bill would of- upstream in the process. That means those who need bed space fer an involuntary outpatient commitment option for courts in Evanston stay at more expensive alternatives, which costs the state more money. Forslund says it is becoming more Title 25 | State Hospital Capacity common to see patients 8 stay at the State Hospi- tal for more than a year Average Patient Days at WSH, by month and by setting because they are either elderly or hard to place Title 25 Waitlist in other facilities be- cause of a private facil- WSH staffed capacity ity’s inability to house the patients who may WSH, > 365 days be violent or have mul- tiple needs. WSH, 180 - 365 Forslund says his hope for the State Hospital is WSH, to house clients need- <180 days ing acute mental care, which he terms 180 days or less. Statistics pro- vided by the WDH show the majority of clients at data: WSH Operational Reports the state hospital do just We have positions available to join our excellent medical team.

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around Wyoming. hours, before the cost would “This bill gives the court shift to the state. discretion to say this person, Both Barlow and Forslund with the proper supports and say there is an effort to make court oversight, could have This bill gives the court local community mental care delivered in an outpa- “ health care centers and the tient setting within their own discretion to say this continuum of care a larg- community or close to their er focus of mental health own community,” says Rep. person, with the proper in Wyoming. (R-Gillette), a “One thing that has gotten member of the committee. “If supports and court a lot more attention through the courts use it, there is the oversight, could have care this process is the coordina- real potential for savings in tion of care and preventing several areas.” delivered in an outpatient people from getting into a Barlow adds there has cycle where they hospital- been a process available to setting within their own ize, they improve, and then the courts which would al- community or close to their are put back into the system low them to mandate mental own community. again,” Barlow says. “We health care in an outpatient ” think with better coordination manner if it was voluntarily of care, better discharge plans REP. ERIC BARLOW suggested. Much the same as (R-Gillette) and with the involvement of an involuntary hospitaliza- private and community men- tion, the outpatient commit- tion health care facilities, we ment option would be paid for can streamline how those by the county for the first 72 transitions are made.”

Senator Bruce Burns (R-Sheridan) questions Wyoming Department of Health Director Tom Forslund during the Joint Appropriations Committee meeting in Cheyenne in early December. Wyoming Medicine 23 Direct Primary Care Bill Could Make Practice in Wyoming Easier BY TOM LACOCK Wyoming Medical Society

With Direct Primary Care (DPC) becoming more prevalent practice could be considered insurance. During a January around the country, the Wyoming legislature is attempting to meeting in Cheyenne, the Joint Labor, Health, and Human clarify the practice’s role in keeping the Cowboy State healthy. Services Committee of the Wyoming Legislature voted to move DPC is a model of healthcare that has patients pay a physi- a bill forward that would differentiate DPC from insurance and cian directly and receive primary care health services with both help it to avoid scrutiny by the State Insurance Department. parties agreeing not to bill insurance. Contracts allow patients The bill explains a number of conditions required in a con- to see physicians as often as they want or need to. Physicians tract needed to exempt DPC from being called insurance. receive compensation for the service by charging subscription While the bill is still a work in progress it does require a con- or ala carte fees in some instances. tract with list of health care services covered by a periodic fees, According to Direct Primary Care Journal, there are some and prohibits providers from otherwise charging or receiving similar characteristics of DPC patients. The industry tends to more compensation for health care services covered by the pe- attract its clients through low monthly fees - generally millen- nials and generation Xers. Direct Primary Care Journal also riodic fee. shows 80 percent of those in the DPC business are family phy- The Insurance Commissioner, Tom Glause says he supports sicians and more than 80 percent of DPC physicians operate in the bill and only asked that the committee be wary of retainer a solo practice. agreements with provisions for early termination payments Charging fees ahead of delivering services from physicians to providers. An amendment saying as much was written into has put providers practicing DPC into a gray area where their the bill.

Powell physicians Bob Chandler (left) and Mike Tracy have been instrumental in helping to craft legislation that will differentiate direct primary care from health insurance. Chandler and Tracy operate 307Health in Powell, a direct primary care practice. 24 WYOMING MEDICAL SOCIETY PROFILE Upcoming Legislative Session Will NAME OF ORGANIZATION Wyoming Medical Society

ADDRESS Focus On 122 East 17th Street, Cheyenne, WY 82009 PHONE Strategic 307-635-2424

ORGANIZATIONAL LEADERSHIP AND PHONE NUMBER DURING SESSION Budget Cuts BY SHEILA BUSH Wyoming Medical Society

his winter’s legislative session will focus on setting the budget for the 2017-2018 biennium. The writing is on T the wall that Wyoming faces tightening budgets with oil and gas prices remaining low, as well as federal regulation and

Sheila Bush Tom Lacock market pressures being felt by the coal industry. Executive Director Communications Director The Wyoming Medical Society dedicates the bulk of its advo- 630-8602 277-6127 cacy efforts to understanding and monitoring funds appropri- [email protected] [email protected] ated by the legislature inside the budget of the Wyoming De- WEBSITE partment of Health (WDH). With the majority of Wyoming’s wyomed.org revenue linked to declining energy resources and related sever- ance tax revenue, Wyoming has no choice but to reduce spend- CORE CONSTITUENCY ing to achieve a balanced budget for this year. Wyoming last Physicians and Physician assistants of Wyoming endured a budget cut in 2013 when 6 percent was slashed from ORGANIZATIONAL CAPSULE the budget. This year Governor Matt Mead is recommending The Wyoming Medical Society was founded in 1903 to reducing the standard budget by nearly $19 million, but intends provide representation, advocacy and service to Wyoming to do so strategically rather than with across-the-board cuts. physicians. We strive to be an efficient, member- The most controversial, and interesting aspect of the WDH’s driven, responsive organization, capable of anticipating and responding swiftly to the changing health care proposed budget is Governor Mead’s request to expand Wyo- environment. WMS serves our membership, and their ming’s Medicaid services to the optional population specified patients, and works to improve the health of Wyoming’s in the Affordable Care Act (ACA) through the WDH budget. If citizens. The Wyoming Medical Society is, and always will optional Medicaid expansion is adopted, WDH could fund all be, a staunch advocate for physicians. This is our core. All of its exception requests without additional general fund dol- of our other activities revolve around this core. lars and free up additional dollars for the state’s general fund ORGANIZATION’S PHILOSOPHY DURING SESSION by $9.7 million. The Wyoming Medical Society advocates for the state’s If the state rejects Medicaid expansion, the exception re- physicians and prides itself on being available to quests of $23.7 million plus the $9.7 million needed to support lawmakers during most Legislative committee meetings where medical legislation is considered. The WMS is also existing programs total a net negative difference to the general available via phone or email at any time. fund of $33.4 million. Without Medicaid expansion, WDH is dependent on the legislature to fund existing programs and reimbursement levels through the state’s general fund. If bud- get shortfalls continue into the future, WMS is concerned that provider reimbursements will be a target for areas for expense reductions. WMS favors the governor’s proposal to protect Wyoming Medicine 25 provider reimbursements, keep critical-access hospitals open, friendly practice environment with competitive reimburse- fund long-term care facilities, and keep care in our great state. ment rates inside government funded programs. The 2015-2016 WDH governor-recommended biennium Outside of the Medicaid expansion elephant, the WDH bud- budget totaled $1,949,687,682 of which $1,326,849,010 was get includes $11.4 million for Title 25 involuntary hospitaliza- allocated to the division of healthcare financing (i.e. Medicaid). tion costs, $3 million for Medicaid waiver rebasing for nursing Roughly $120.4 million of that $1.3 billion, or 9 percent, was homes, $248,000 for trauma unit site review, $500,000 com- spent on physician and other puter program replacement provider reimbursement, and costs, $954,000 for preschool approximately $211 million enrollment growth, and the was spent on hospital reim- If budget shortfalls continue remainder to fund programs bursement. into the future, WMS is that serve the elderly, the dis- WMS recognizes the com- abled, mothers and children. plexity of Medicaid expan- concerned that provider WMS will also closely moni- sion, and deeply respects the tor proposed cuts to programs diverse opinions of our phy- reimbursements will be a currently funded with tobacco sician members. WMS has target for areas for expense settlement funds. Tobacco supported the expansion of settlement funds are the re- Medicaid in Wyoming, and reductions. WMS favors the sult of a settlement with to- continued support will ex- governor’s proposal to protect bacco companies in 1999, but emplify our mission to sup- funds have gradually declined port access to quality medical provider reimbursements, since 2009. care for all Wyoming patients. For the 2017-2018 bien- Expanding Medicaid should keep critical-access hospitals nium, Wyoming is expected help towards the stabiliza- open, fund long-term care to receive $37.8 million with tion of healthcare financing in historic fund appropriations our state, at least in the short facilities, and keep care in of $49.8 million meaning Wy- term. Patients would benefit our great state. oming must reduce spending by having the nation’s highest of TSF by $12 million. WDH percentage of Medicaid par- must account for $7.4 million ticipation by physicians in the of that spending reduction country, and physicians would benefit by receiving more rea- and the legislature is currently looking to cut funding for tele- sonable Medicaid reimbursement rates for their participation. health, drug courts, and physician recruitment. WMS hopes WMS is committed to promoting quality patient care by pro- funding will be restored for telehealth and will be working with tecting physician-led medical care teams, and in order to do legislators and key organization partners to do so in the coming so Wyoming must remain committed to growing a physician- session.

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Wyoming Wyoming Hospital Association Hospitals Offer NAME OF ORGANIZATION a Wyoming Wyoming Hospital Association

ADDRESS 2005 Warren Ave, Cheyenne, WY 82001 Solution to PHONE 307-632-9344 Uncompensated ORGANIZATIONAL LEADERSHIP AND PHONE NUMBER DURING SESSION Care BY TOM LACOCK Wyoming Medical Society

fter a 2015 Legislative Session where lawmakers men- Eric Boley Neil Hilton tioned the need for a “Wyoming solution” for several President Vice President healthcare issues, the Wyoming Hospital Association 307-727-7545 307-287-7446 A [email protected] [email protected] will arrive at the 2016 session with a pair of bills that offer a Wyoming solution to the issue of uncompensated medical care. WEBSITE “We have met with the governor and the Department of www.wyohospitals.com Health and we have told them we are coming up with our own CORE CONSTITUENCY plan to try to offset that $114 million in charity care that we give The 26 Community Hospitals in Wyoming away every year. We have support from them. There is a little ORGANIZATIONAL CAPSULE bit of empowerment in that,” WHA President Eric Boley says. The Wyoming Hospital Association is a statewide The WHA’s highest priority this session is legislation on organization dedicated to providing leadership, the upper payment limit, which is the limit of what a hospital representation and advocacy for Wyoming hospitals. The or nursing home could receive if it billed Medicare instead of Association, through leadership and collaboration among Medicaid for the same service. Currently there is a cap on how all healthcare providers, promotes information and much Medicaid can pay into the state, and facilities in Wyo- education that enables Wyoming hospitals to deliver high quality, adequately financed, cost-effective healthcare ming have not reached that cap. that is universally accessible to all Wyoming citizens. “The upper payment limit is created when a comparison is Formed in 1945, the vision of the Wyoming Hospital made between what Medicaid pays and what Medicare would Association is to be Wyoming’s most trusted, respected pay for the same services. Medicare pays at a higher rate and and influential leader in health policy and advocacy, and a the difference between the two payers is what we are attempt- valued resource for information and education. ing to eliminate through the upper payment limit program,” ORGANIZATION’S PHILOSOPHY DURING SESSION Boley says. The Wyoming Hospital Association advocates for Darren C. Coates is an attorney with the offices of Husch Wyoming’s hospitals, from the largest regional medical Blackwell, a law firm with 16 locations across the US and Lon- centers to the smallest rural critical access hospitals – with one effective voice representing all. The WHA don, including Denver. He and fellow Husch Blackwell attor- focuses on all proposed legislation that may impact ney Eric Weatherford have worked in the upper payment limit hospitals statewide, and the respective communities arena in Texas, Louisiana, and South Carolina previously. He they serve. The WHA staff is open and available to all said nearly every state in the union has some version of an up- legislators regarding issues pertaining to hospitals and per payment limit. healthcare within Wyoming. The WHA is willing and able “It isn’t an extra payment. It is to cover the unreimbursed to provide clarification and details regarding the potential financial and operational impacts of proposed legislation. cost of treating Medicaid and uninsured patients,” Coates says. The WHA stands ready to advocate and educate on behalf “Nearly all states have some form of provider assessment built of the hospitals of Wyoming. into their Medicaid system.” He says this program was written into federal law in 1991, Wyoming Medicine 27 and requires a provider assessment to take part in the process. the Affordable Care Act and were enacted long before the ACA The process would involve the state’s private hospitals assess- was even under consideration. ing themselves a fee, which would be given to the state, then submitted to the federal government. The feds would then pay The Redefinition of Emergency Rooms back the state portion and matching federal funds, turning the The Wyoming Department of Health’s Licensing and Surveys $4.6 million assessment of state hospitals into $9.2 million. Division proposes language to clearly define what a freestand- Among the facilities which could benefit from this program ing emergency room would look like in the state of Wyoming. are hospitals in Lander, Riverton, Evanston, Worland and up Currently, there is no provision for a freestanding ER within to four in Casper. the rules or regulations of hospitals. Boley says the Upper Payment Limit already exists in several With trends in Texas and along the Front Range for free- other states. If the legislation were to pass, it would result in an standing ERs to be constructed and opened without the need extra $4.6 million for the state’s hospitals annually. for licensure or oversight by The Wyoming Department of The WHA is also working on a gap payment plan. While Health’s License and Survey Division felt it was important to the upper payment limit is available only for private hospitals, put a clear definition and rules in place in the event someone the gap program would allow non state-owned governmental wanted to construct a freestanding ER in Wyoming. The WHA entities (such as a rural health care district, hospital districts, supports the Department of Health’s desire to gain control and and memorial hospitals) to partner with a private, for-profit regulate these facilities. Boley says Texas and the Front Range nursing home. It also applies to non state-owned government allow for provider-owned emergency rooms, which are free- nursing homes. The program standing and unaffiliated with would allow the governmen- a hospital facility. This al- tal entity to pay the state por- lows the emergency rooms to tion of the Medicaid dollars If everyone in the state take only well-insured clients and draw down the match- “ while not billing Medicaid or ing state funds. This money who was eligible for this Medicare. The legislation be- would be divided between the program participated in this ing proposed would require governmental partner and free-standing ER’s to be af- nursing homes. program, it would bring in filiated with an existing Wyo- “If everyone in the state $16 million per year. ming hospital. who was eligible for this pro- ” “I believe we are seeing gram participated in this pro- ERIC BOLEY patients receiving care in the gram, it would bring in $16 WHA President wrong setting,” Boley says.”If million per year,” Boley says. a patient needs to be admitted Because contracting and a a freestanding ER would need change in ownership take place between the private nursing a transfer agreement with a real hospital, delaying care and homes and their governmental partners, Boley acknowledg- requiring a patient to be transferred to another facility. There es some concern from the administrators of private nursing are already urgent care centers and physician offices to care for homes worried that the change in ownership to a public en- patients needing non-hospital care.” tity puts fiduciary responsibility on the governmental partner. There is also concern that a clause in the program gives the Nursing Licensure Compact board of directors of that governmental partner veto power Boley says the WHA also supports the Nurse Licensure over the administrative decisions of the nursing home. Compact, an interstate agreement allowing a nurse to have “Some of the for-profits are concerned they will get into one license (issued by the primary state of residence) with the these agreements and they will get rid of their administrators,” privilege to practice in other states under the compact. Since it Boley says. “I think it will take time to build steam, but this pro- started in 2000, there are 24 states that have joined the com- gram has been in place for 15-16 years in Indiana, five years in pact. Wyoming border states part of the compact include Colo- Texas and two in Utah. Not all nursing homes or governmental rado, Nebraska, Utah, South Dakota, and Idaho. entities are required to participate but there are benefits for The WHA has advocated for the compact for the past 10 those that choose to do so, and as the benefits are realized by years because of a shortage of nurses in Wyoming, Boley says. some, I believe others will choose to utilize the program.” Joining the compact could cut hire time by nearly two months This program can be used to help with staffing problems, for a Wyoming facility, he adds. capital needs and overall operational improvements for all “With this, if the nurse is in the compact, we can bring them those that participate. These programs, if set up properly and onboard and we don’t have to go through the licensing process with the correct plan amendment filed with the Feds are prov- which could take 6-10 weeks,” Boley says. “That could really en to stand inspection. The programs have nothing to do with help with nursing care where we see a large shortage.” 28 WYOMING PRIMARY CARE ASSOCIATION PROFILE Primary Care Association

NAME OF ORGANIZATION Supports Wyoming Primary Care Association

ADDRESS 1720 Carey Ave Suite 601, Cheyenne, Wyoming 82001 Changes in

PHONE 307-632-5743 KidCare CHIP ORGANIZATIONAL LEADERSHIP AND PHONE NUMBER DURING SESSION BY JAN CARTWRIGHT WyPCA

he coming 2016 is a key year for the growth and ad- vancement of Wyoming’s health centers. The Wyoming T Primary Care Association (WYPCA) has an opportunity to help set the course by continuing to support public policy efforts to improve access to healthcare at federal, state and lo- Jan Cartwright Mary Lynne Shickich cal levels. 307-631-5914 307-632-5743 [email protected] [email protected] Our policy priorities for 2016 are: WEBSITE • Expand eligibility for Medicaid www.wypca.org • Support efforts to expand coverage and access to Wyoming citizens CORE CONSTITUENCY • Ensure adequate payment for safety net providers Patients and Families, Other Healthcare Providers • Funding to expand and support community ORGANIZATIONAL CAPSULE health centers. The WyPCA acts as part of Wyoming’s healthcare safety One important and potentially overlooked issue is the Chil- net and works alongside federally-qualified health dren’s Health Insurance Program (CHIP) and changes to the centers. The safety net is integral to provide care to those federal reimbursement. Kid Care CHIP is Wyoming’s Chil- who lack the financial means or access. While we don’t offer direct care, we do offer several services to help make dren’s Health Insurance Program which provides affordable serving the community’s health needs a little easier for health coverage including check-ups, dentist visits, vision care, health centers. prescriptions and more for children whose families may not have the financial resources to ensure access to health care. ORGANIZATION’S PHILOSOPHY DURING SESSION When the program began in 1999, CHIP was a safety-net pro- To work collaboratively with legislators and stakeholders to improve the health of Wyoming kids. gram for children birth to 18 who were not eligible for Medicaid but whose family income was up to 133 percent of the Federal Poverty Level (FPL). In 2003, a separate CHIP model provided coverage for children from birth to 19 in families whose income was between 134 percent and 185 percent FPL. Since 2005, the upper income level has been 200 percent FPL ($48,504 annual gross income for a family of four). Federal Medical Assistance Percentages (FMAP) are the per- centage rates used to determine the matching funds rate allo- cated annually to certain medical and social service programs in the United States of America. On October 1, 2015, the federal match rate for Kid Care CHIP went from 65 – 35 percent fed- Wyoming Medicine 29 eral state match to 88-12 percent, providing cost savings to the State of Wyoming: • Blue Cross/Blue Shield of Wyoming administers Kid Care CHIP. • Increase to 250 percent of Federal Poverty Level (FPL) would help an additional estimated 1300 children under the age of 19 who currently have no insurance coverage, providing them with med- ical, dental and vision care. • The enhanced match generates nearly $2 million in annual savings to the State of Wyoming com- pared to Fiscal Year 2015 while covering the ad- ditional children up to 250 percent FPL. • Uninsured numbers are highest in Albany, Camp- bell, Fremont, Laramie, Natrona, Sublette and Teton Counties.

Wyoming Primary Care Association Wyoming Primary Care Association is a statewide organiza- tion whose mission is to increase access to healthcare for all Wyoming residents. It is a membership organization made up of Community Health Centers (also known as Federally Quali- fied Health Centers) that serve 13 Wyoming communities. 30 HEALTHY WYOMING PROFILE No Further Delay - Expand Medicaid in NAME OF ORGANIZATION Healthy Wyoming Wyoming ADDRESS 419 S 5th Street, Suite 1, Laramie, WY 82070

PHONE n December 1, Governor Matt Mead released his 2017- 307-228-4163 2018 budget for the State of Wyoming, a plan to create smart budget savings and fund essential state services ORGANIZATIONAL LEADERSHIP AND PHONE O NUMBER DURING SESSION in the face of declining oil and gas revenue. Included in the budget is an important proposal: Medicaid expansion – a way to save our state millions of dollars and deliver quality health coverage to hard-working Wyomingites who are currently left without any affordable coverage options. Expanding Medicaid is a win-win for Wyoming. It will bring back an estimated $268 million in tax dollars to our state, and help significantly reduce our $200 million budget shortfall. This funding frees up state dollars being spent on programs for Bri Jones Dr. Eric Wedell the uninsured, allowing the governor and legislature to redirect funds to other important areas like building roads and invest- ing in our schools. In Wyoming, expansion would cover over 20,000 resi- dents who earn too little to receive financial help to purchase insurance but too much to receive Medicaid under its current eligibility limits. These people have fallen into a gap with no options for affordable health insurance. These are our friends and neighbors, ranchers and construction workers, people who Linda Burt [email protected] work to put food on the table and yet still can’t afford to get the basic health care they need. Creating affordable coverage options will also protect our WEBSITE local hospitals, especially those in the most rural areas of our www.healthywyoming.org state. At last count, our state’s hospitals are left with more CORE CONSTITUENCY Wyomingites who want affordable, quality healthcare In Wyoming, expansion ORGANIZATIONAL CAPSULE Healthy Wyoming is a group of community and business would cover over 20,000 leaders, doctors, nurses, and other healthcare providers working for quality, affordable healthcare for all Wyoming. residents who earn too little

ORGANIZATION’S PHILOSOPHY DURING SESSION to receive financial help to Healthy Wyoming works to engage citizens from purchase insurance but too community leaders and small businesses owners to healthcare providers and healthcare consumers to much to receive Medicaid advocate for affordable, quality care, including medicaid expansion. under its current eligibility limits. Wyoming Medicine 31 than $114.6 million a year in uncompensated care costs from savings directly related to their legislature’s decision to ex- treating the uninsured. This puts them at risk of closing, pand Medicaid. which threatens to take away jobs and a way of life in our rural It’s time to face facts and do what’s best for state budget, our communities. economy and for hardworking families across our state. Ex- North Dakota, Montana, Alaska, and New Mexico are among pansion makes sense for Wyoming, and the legislature needs the 31 states across the country that have already made the de- to work with governor to make it a reality. cision to bring their federal taxpayer dollars home instead of sending that money back to Washington, D.C. And many states Signed by: have chosen to expand Medicaid on their own terms. We can take a similar state-specific approach, creating a plan for Wyo- Wyoming Medical Center, Casper, WY ming, by Wyoming, that brings tax dollars back home. Board of Directors Despite the proven benefits, there is still a lot noise, a lot of Vickie Diamond, NEA-BC, President and CEO politics, and a lot of false statements surrounding Governor Mead’s proposal – mostly consisting of recycled arguments St. John’s Medical Center, Jackson Hole, WY that have been proven wrong in the 31 other states that ex- Louis I. Hochheiser, MD, Chief Executive Officer panded Medicaid. Marc Domsky, DO, Chief of Medical Staff In fact, accusations that the federal government won’t hold Bruce Hayse, MD, Family Practice, Board of Trustees its end of the bargain are unfounded – states have received Mike Tennican, Chairman of the Board of Trustees billions in funding since 2014 and the match rate, written into law, is set to continue at 90% after 2020. And this is happen- Cheyenne Regional Medical Center, Cheyenne, WY ing while expansion states see continued and long-term budget Margo Karsten, PhD, Chief Executive Officer

NC Medical Society Hosts Insurance Forum BY TOM LACOCK Wyoming Medical Society

espite cold temperatures and a winter storm bearing variations from county to county regarding what is important to down on Central Wyoming, nearly 70 physicians, legis- that area. The individuals in the county are the ones who know D lators, insurance executives, and facility directors took what is important there. A strong county society also gives the part in an early November insurance forum at The Petroleum state society a better idea to direct the information across the Club in Casper. state. Without a lot of information at the county level, we are left The event was sponsored by the Natrona County Medical So- making an educated guess on what is important to physicians in ciety (NCMS) with its president, Joe McGinley, MD, PhD mod- the state.” erating the panel discussion with Rick Schum (Blue Cross/Blue The discussion went for nearly two hours with questions Shield); Tom Glause (State Insurance Commissioner); Tom submitted ahead by NCMS of time on patient care, insurance Forslund (Wyoming Department of Health); Kim Bimestefer service, and the hope of getting patients more involved in their (Cigna); Dean Groskopf (Cigna); and Mark Laitos, MD (Cigna); own care from a wellness standpoint. Representatives from the and Cara Beatty(United HealthCare). State’s health care infrastructure offered updates with Glause “I was pleased with turnout, participation, and the support. discussing WINhealth’s receivership process, while Forslund We had 10 legislators, physicians, and hospital administrators explained the state’s efforts for Medicaid expansion by putting from all of the facilities in town. We have 110-112 members total. expansion into the state budget instead of making it a stand- To have all of those insurance companies come into town with alone bill. the bad weather, shows they are committed to what we are doing McGinley said the event showed insurance companies are in- as a society and want to hear what we have to say.” terested in participating with medical societies, pointing out the McGinley added that the event showed the importance of participating groups from Tuesday were going to share each of meeting at the county society level. He said in addition to some the resources, such as phone apps, that they have available for terrific conversation, the meeting also netted five new county patients, as well as doctors. society members and another organization announced it would “We are coming together to figure out answers,” Glause said. also sign up each of its physicians. “Collectively, if we bring all of the stakeholders together, we can “It creates a grass roots base,” McGinley said. “There are come up with some answers to some really tough questions.” 32 AMERICAN CANCER SOCIETY CANCER ACTION NETWORK PROFILE American Cancer Society’s Cancer Action Network 2016

NAME OF ORGANIZATION Legislative Priorities American Cancer Society Cancer Action Network Protect existing state-funded cancer PHONE prevention and screening programs. 307-287-1401 • Colorectal cancer screening program • Breast and cervical cancer screening program ORGANIZATIONAL LEADERSHIP AND PHONE NUMBER DURING SESSION • Tobacco prevention and cessation program • Comprehensive Cancer Control Program • Wyoming Cancer Resource Services

Expand access to health coverage through Medicaid. • ACS CAN will continue to advocate for increased access to the full spectrum of care from preven- tion through treatment and quality end of life Jason Mincer Deb Simpson care, especially for our nation’s most vulnerable Government Relations Grassroots Manager and medically underserved populations. 307-287-1401 307-272-7895 • For additional information on Medicaid Expan- [email protected] [email protected] sion see article on page 30. Erin Begeman Create a Palliative Care Task Force to ACS CAN Contract Lobbyist 307-899-8889 improve quality of life for cancer [email protected] patients and their families. • This bill would create a statewide task force to study the challenges of palliative care in Wyo- ming. The task force would report to the Labor Health and Social Services Committee yearly. WEBSITE • For more information see the article on the www.acscan.org/wyoming next page. www.facebook.com/ACSCANwyo/

CORE CONSTITUENCY Cancer patients, survivors and their caregivers

ORGANIZATIONAL CAPSULE Palliative Care ACS CAN is the nation’s leading cancer advocacy organization that works every day to make cancer issues Citizen Lobby Day a national priority. Many of the most important decisions about cancer are made outside of your doctor’s office. Want to make sure Wyomingites with Instead, they are made by your state legislature, in chronic illnesses like cancer have the best Congress and in the White House. quality of life before, during and after treatment? ORGANIZATION’S PHILOSOPHY DURING SESSION Join us for our Palliative Care ACS CAN is the voice of cancer patients, survivors and Citizen Lobby Day! their families in the halls of government. We support legislation that prevents cancer and that provides a better quality of life for these patients and survivors. February 11 • Cheyenne Email [email protected] to RSVP and for more information. Wyoming Medicine 33 Improving Quality of Life Through Palliative Care BY JASON MINCER Government Relations State Director, Cancer Action Network

his year more than 2,500 Wyoming citizens will hear the council; the dreaded words, “You have cancer.” Thousands of • The council will report its outcomes to the Labor T individuals and families will cope with not only the Health Committee each year. physical symptoms of cancer, but will ride the emotional roller Due to the tough financial climate in Wyoming, we will not coaster of a cancer diagnosis and treatment as well. How is it ask for state funding for this task force. Those appointed will possible to provide for and treat all of these symptoms simulta- be expected to pay their own way to attend meetings. neously and successfully? One answer is palliative care. One of the first priorities for the task force will be to examine Palliative care teams focus on making sure that the whole the challenges of delivering palliative care services when many person is treated, not just the disease. For anyone facing a patients with chronic diseases, including cancer, in Wyoming chronic disease, palliative care can be life-changing. Yet, so travel great distances to receive treatment. These patients then few patients know this type of return home to recover and care may be available to them. need their team of health care Studies indicate that most One of the first priorities providers to coordinate their American adults know noth-  treatment and follow-up care, ing about palliative care. for the task force will be to which can be challenging. In an American Cancer So- Public opinion research ciety Cancer Action Network examine the challenges of finds that once people are and Center to Advance Pal- delivering palliative care aware of palliative care, 92 liative Care survey, 70 percent percent report they are highly of participants reported they services when many patients likely to use it for themselves were “not at all knowledge- with chronic diseases, or their loved ones. The cre- able” about the topic. Ad- ation of a statewide task force ditionally, many individuals including cancer, in Wyoming is the first step in helping Wy- who have heard of palliative oming residents with serious care believe it is used only travel great distances to illnesses survive and thrive. when a patient is dying, when receive treatment. Again, palliative care is not curative treatments are no limited to cancer. Anyone fac- longer an option. This sim- ing a chronic illness, including ply isn’t true. One of our early challenges will be to educate family and loved ones of patients, will benefit from this team- the public and legislators on what palliative care is and that based approach to managing physical, emotional and psycho- it affects not only cancer patients, but almost anyone witha logical symptoms and side effects. chronic disease. To pass this legislation, ACS CAN will work with the Wyo- Most importantly, for palliative care to be effective, patients ming Medical Society, Wyoming Hospitals Association, the must not only know it exists, but have access to it. Wyoming Nurses Association, AARP, Wyoming Medical Cen- ACS CAN will push for a bill in the 2016 Legislative Session ter and the Wyoming Association of Mental Health and Sub- to create a Palliative Care Task Force of 10-15 health care pro- stance Abuse Centers. We need additional partners. Please fessionals, patients, caregivers and hospice specialists who will contact us if your organization is interested. study palliative care challenges in Wyoming. We need patients, doctors, nurses and caregivers who want • The council will meet and make recommenda- to advocate on behalf of cancer patients and others Wyoming tions that will be taken back to their respective citizens with serious illnesses maintain their quality of life. organizations or businesses; Contact ACS CAN Grassroots Manager Deb Simpson at deb. • The Department of Health will staff the council; [email protected] or 307-272-7895 to learn more about • The governor’s office will appoint members to these opportunities. 34 CHILDREN’S HOSPITAL OF COLORADO PROFILE What Wyoming Can Do To Advance NAME OF ORGANIZATION Children’s Hospital Colorado Care Via ADDRESS 13123 E 16th Ave, Aurora, CO 80045 PHONE Telemedicine 720-777-1234 BY DR. MICHAEL NARKEWICZ ORGANIZATIONAL LEADERSHIP AND PHONE Medical Director of the Pediatric Liver Center and Regional Care, NUMBER DURING SESSION Children’s Hospital Colorado, Professor of Pediatrics, University of Colorado School of Medicine

or children and adults in Wyoming, accessing subspe- cialty services can often require traveling to regional F medical centers both inside and outside the state. For- tunately, telemedicine delivery of some of these services is in- creasingly possible.

Affie Ellis Dr. Michael Narkewicz For physicians delivering telemedicine services and for pa- Ellis Public Affairs 720-777-3966 tients and families receiving them, the value of telemedicine 307-287-9095 michael.narkewicz@ is simple — easier access to effective, timely care without the [email protected] childrenscolorado.org need for extensive travel. But the technical details of telemedi- WEBSITE cine policies regarding coverage, reimbursement, and other www.childrenscolorado.org standards can be enough to make one wish for a potent e-pre- scribed headache medicine. CORE CONSTITUENCY Lawmakers probably won’t have time to consider all those Patients and families, other healthcare providers details in the upcoming budget session. But they might do well ORGANIZATIONAL CAPSULE to consider an interim committee to study telemedicine issues Children’s Hospital Colorado is one of the top 5 best in more depth. Wyoming patients and clinicians stand to ben- children’s hospitals in the nation, as ranked by U.S. News efit significantly. & World Report. A 479-bed non-profit academic medical Public policy advocacy is a core part of Children’s Colorado’s center, Children’s Colorado is internationally recognized for providing leading-edge patient care, research, mission to improve the health of kids across the region. That’s education, and child health advocacy. Providers at why the hospital contracts with Cheyenne’s Affie Ellis to rep- Children’s Colorado see more, treat more, and heal more resent the hospital’s advocacy mission with legislators and kids than any other hospital in the seven-state region, in other policy advocates. Simply put, when it comes to delivering part through more than 1,200 outreach clinics in more healthcare to underserved and rural/frontier areas, telemedi- than 24 cities across Colorado, Montana, and Wyoming. cine is one of the best ways to help keep patients close to their ORGANIZATION’S PHILOSOPHY DURING SESSION home communities whenever possible. To work collaboratively with legislators and stakeholders Providers at Children’s Hospital Colorado treat thousands of to improve the health of Wyoming kids. Wyoming children each year, many of them with complex or chronic medical conditions. In fact, Children’s Colorado sees more, treats more, and heals more kids than any other hospi- tal in the seven-state region. Physicians at Children’s Colorado and the University of Colorado School of Medicine deliver some of these services—for example, pediatric diabetes care—by tele- medicine. Yet there is a significant opportunity to enhance the delivery of subspecialty care to children in Wyoming. Wyoming Medicine 35

Children’s Colorado believes supporting Wyoming’s local capacity to care for higher-acuity children is the best thing for kids’ health. When Children’s Colorado can help local providers better manage complex medical conditions, par- PROVIDING ents don’t have to take time off work to drive their child down to Denver. Keeping kids close to home means less INSURANCE disruption to family life and work schedules and ultimately yields better outcomes at a lower cost. Telemedicine is one of the best ways to do that, and tele- AND RISK medicine technology is advancing rapidly in the United States. With it comes an increasing level of comfort with telemedicine services. But technology and physician and MANAGEMENT patient willingness are not the main barriers to increasing Trust. Expertise. adoption of telemedicine services. SERVICES FOR Instead, payment and coverage are among the biggest Commitment. challenges, a 2015 American Telemedicine Association report says.[1] Providers and patients alike are caught in WYOMINGProviding Insurance and a “patchwork of arbitrary insurance requirements and Risk Management Services disparate payment streams” that restricts adoption of for Wyoming Physicians telemedicine. PHYSICIANS For decades USI has been In response, Wyoming lawmakers might providing the solutions and services that physicians count consider some of the following potential on to protect their businesses solutions: and employees. We’d like to • Private insurance payment parity would en- Michelledo the Schum same for you. sure that telemedicine-provided services are [email protected]

covered and reimbursed at levels comparable 1904 Warren Ave to in-person services. The same could be ap- GarthCheyenne, Boreczky WY 82001 307-635-4231 | 800-950-7776 plied to the state employee health plan. [email protected] www.usi.biz • Expanding eligible patient settings could boost access, too. For example, Wyoming Medic- 307Michelle 635 4231 Schum | 800 950 7776 aid currently excludes the home and school [email protected] as allowable patient settings. For children Garth Boreczky with medical complexity—who cost Medicaid [email protected] and therefore taxpayers a disproportionate amount—accessing services from the locations where kids spend most of their time is an im- portant part of successfully managing a chal- lenging condition. • Options like expanding eligible technolo- gies, providers, and services are similarly worth a look. Those and other solutions might or might not make sense for Wyoming policymakers, healthcare providers, and pa- PROUDLY REPRESENTING: tients. But they are worthy of detailed consideration in an effort to enhance access to care across the state.

[1] http://www.americantelemed.org/docs/default- source/policy/50-state-telemedicine-gaps-analysis--- Risk Management | Property & Casualty | Employee Benefits coverage-and-reimbursement.pdf Personal Risk Services | Retirement Consulting ©2015 USI Insurance Services. All Rights Reserved.

50386 AD_Wyoming Medical Society_Opt3.indd 1 7/7/2014 11:52:55 AM

Wyoming Physician Ad_Vertical Half pg 4.1667x11in FINAL-revised 4.7.15.indd 1 4/7/2015 11:25:14 AM 36 MEMBER LIST

Afton, WY Alexandru David, MD Steven Orcutt, MD Debra L. Walker, PA-C Lakhman Gondalia, MD Shauna McKusker, MD Michael Pieper, MD Frederick Deiss, MD Rafael Perez, MD Mary Weber, MD Rayna Gravatt, MD Scott McRae, MD Brian Tallerico, DO Zachory Deiss, MD John W. Pickrell, MD Bob L. Welo, MD Amy Gruber, MD A. John Meares, MD Appling, GA Frank Del Real, MD Eugene Podrazik, MD *David Wheeler, MD George Guidry, MD Jonathon Medina, MD Tarver Bailey, MD Matthew Dodds, MD Lida Prypchan, MD Daniel White, MD Phillip Haberman, MD Arthur Merrell, MD Mark Dowell, MD John Purviance, MD Allan Wicks, MD J. Sloan Hales, MD R. Larry Meuli, MD Basin, WY David Driggers, MD Michael Quinn, MD Todd Witzeling, MD James Haller, MD Samantha Michelena, MD Heather Sanders, PA-C Mesha Dunn, MD Thomas Radosevich, MD Cynthia Works, MD Thor M. Hallingbye, MD Anne Miller, MD Big Horn, WY Diane R. Edwards, MD Jo Ann Ramsey, PA-C Demian Yakel, DO Jean Halpern, MD Gary Molk, MD Jonathan Herschler, MD Martin Ellbogen Sr., MD Robert Ratcliff, MD Linda Yost, MD Amy Jo Harnish, MD *Robert Monger, MD Edward D. Hobart, MD Rita Emch, MD Karri Reliford, PA-C Jerry L. Youmans, MD James Harper, MD Michael Nelson, DO D. Scott Nickerson, MD David J. Erk, MD Dustin Roberts, MD William Harrison, MD Julie Neville, MD Centennial, CO Shawn Ficken, PA-C Beth C. Robitaille, MD Scott Hayden, MD Evan Norby, DO Big Piney, WY Mark Lea, MD Carolyn Albritton-McDon- Michael Flaherty, MD Michael Romer, DO Taylor H. Haynes, MD Dimiter Orahovats, MD ald, MD Adrian Fluture, MD Joseph Rosen, MD Cheyenne, WY John P Healey, MD Douglas S. Parks, MD William David Burnett, MD Sherrill Fox, MD John Roussalis, MD Rodney Anderson, MD Michael C. Herber, MD Ambrish Patel, PA-C Shannon Evans, DO Jennifer L. Frary, PA-C Louis Roussalis, MD Janet Anderson-Ray, MD J. Richard Hillman, MD Zachory Pearce, DO Timothy N. Frary, PA-C Stuart J. Ruben, MD Scott Andrew, PA-C Peter Perakos, MD Billings, MT Rene Hinkle, MD John Babson, MD Seema Policepatil, MD Alan Dacre, MD Ghazi Ghanem, MD Annette Russell, PA-C Basu Hiregoudar, MD Ronald Gibson, MD Cora Salvino, MD Steven Bailey, MD Jessie Hockett, PA-C Gergana Popova-Orahovats, MD Buffalo, WY Steen Goddik, MD Angelo Santiago, MD Jean Denise Basta, MD W. Joesph Horam, MD Brian Darnell, DO Daniel Possehn, DO Valerie K. Goen, PA-C Sam Scaling, MD Maristela Batezini, MD Doug Hornberger, PA-C Hermilio Gonzalez, MD Robert Prentice, MD Henry P. Gottsch, MD Robert Schlidt, MD Steven Beer, MD Brian Horst, MD Grace Gosar, MD Take Pullos, MD Todd Hammond, MD Eric Schubert, MD Jeffrey J. Behringer, MD Mark Howshar, MD *Lawrence Kirven, MD Mark R. Rangitsch, MD Bruce Hansen, DO James Shaffer, MD *Kristina Behringer, MD Eric Hoyer, MD Fred A. Matthews, MD Steve Reeb, MD Todd Hansen, MD Kamlesh S. Shah, MD Jacques Beveridge, MD Ting-Hui Hsieh, MD Patrick D. Nolan, MD Harlan R. Ribnik, MD Diane C. Henshaw, MD Benjamin Sheppard, MD Wendy Braund, MD James Hubbard, MD Mark Schueler, MD Phillip Brenchley, MD Margaret L. “Peggy” Rob- Wesley W. Hiser, MD Susan Sheridan, MD Donald Hunton, MD erts, MD James F. Broomfield, MD Casper, WY Douglas Holmes, MD William Shughart, PA-C Donald G. Iverson, MD D. Jane Robinett, DO Kimberly Broomfield, MD Brock Anderson, MD Dana Ideen, MD Karlynn Sievers, MD Alireza Izadara, MD Kevin Robinett, DO John Bryant, MD James Anderson, MD Oleg Ivanov, MD Michel Skaf, MD Cara Johnson, DO Earl W. Robison, MD Marian Bursten, MD John Bailey, MD Ronald D. Iverson, MD Michael Sloan, MD *Paul Johnson, MD John Romano, MD David Barahal, MD Seth Iverson, MD Geoffrey Smith, MD Lisa Burton, MD Randolph Johnston, MD Andrew Rose, MD , MD Oliver Jeffery, MB ChB Lane Smothers, MD James Bush, MD Theodore Johnston, MD Stanley Sandick, MD David Baxter, MD Ray B. Johnson, PA-C Laura Smothers, MD Jerry Calkins, MD Robert Kahn, MD Carol J. Schiel, MD Todd Beckstead, MD John Paul Jones III, MD Grady Snyder, MD Tracie Caller, MD *Robert R. Kanard, MD Philip Schiel, MD Jerome Behrens, MD Mahesh Karandikar, MD Carol Solie, MD Carol Campbell, PA-C Matthew Kassel, DO G. Douglas Schmitz, MD Bruce Bennett, MD Sharon Karnes, MD Albert Steplock, Jr., MD Jeffrey Carlton, MD D. Michael Kellam, MD Joel Schwartzkopf, PA-C Scott Bennion, MD Anje Kim, MD Anita J. Stinson, MD *Jasper Chen, MD Mary Louise Kerber, MD Greg Seitz, MD Joseph Bicek, MD Caroline Kirsch-Russell, DO Ronald G. Stinson, MD James Cole, MD William Ketcham, MD Larry Seitz, MD John Billings, MD Thomas A Kopitnik, MD Cory J. Stirling, MD Mary Cole, MD Afzal Khan, MD Reed Shafer, MD Jonathan Binder, MD Phillip Krmpotich, MD Lee Stowell, MD Tamara Cottam, MD David Kilpatrick, MD Kirk Shamley, MD Warren Birch, MD Tom Landon, MD Werner Studer, MD Harmon Davis II, MD Kenneth Kranz, MD Michael Shannon, MD Darren Bowe, MD Eric Lawrence, DO Daniel Sullivan, MD Robert Davis II, MD Charles Kuckel, MD Philip Sharp, MD Charles Bowkley III, MD Anne MacGuire, MD Daniel Sulser, MD Don Dickerson, MD Michael Kuhn, MD Brent D. Sherard, MD Gregory Brondos, MD James A. Maddy, MD Matthew Swan, MD Dirk Dijkstal, MD Donald J. Lawler, MD David Silver, MD Robert O. Brown, MD Paul Malsom, PA-C Jay Swedberg, MD LeAyn Dillon, DO Ronald LeBeaumont, MD Martha Silver, MD *Stephen Brown, MD Allan Mattern, MD Rowan Tichenor, MD Joseph Dobson, MD Robert W. Leland, MD Paul V. Slater, MD Michael Bruno, MD *Joseph McGinley, MD, PhD Robert Tobin, MD Douglas Edgren, MD David M. Lind, MD Bruce Smith, MD Mary Burke, MD Lynnette McLagan, PA-C Berton Toews, MD Sarvin Emami, MD Pat Lucas, PA-C G. L. Smith, MD Thomas Burke, MD Joseph Mickelson, MD John M. Tooke, MD Sharon Eskam, MD James Lugg, MD Reuben Smits, MD Jeffery Christensen, DO Meredith H. Miller, MD Kati Tuma, PA-C Phillip Eskew, DO Charles Mackey, MD Danae Stampfli, MD Lydia Christiansen, MD Michael V. Miller, DO Brooke Umphlett, PA-C Arthur Farrell, PA-C Julie Maggiolo, MD Greg Stampfli, MD Jeffrey Cloud, MD *Matthew Mitchell, MD Brian Veauthier, MD Herman Feringa, MD Ronald L. Malm, DO Jakub Stefka, MD Malvin Cole, MD Eric Munoz, MD Joseph Vigneri, MD David Findlay, MD Michael Martin, MD Ronald Stevens, MD Alana Cozier, MD John L. Noffsinger, PA-C Robert A. Vigneri, MD Carol A. Fischer, MD Mohammed Mazhar, MD Jeffrey Storey, MD Matthew Crull, MD David Norcross, MD Samuel Vigneri, MD Mary-Ellen Foley, MD Theodore N. McCoy, MD Rex Stout, MD Eric (Frederick) Cubin, MD Robert Novick, MD Mark Vuolo, MD William P. Gibbens, MD Ronald McKee, MD Joyce Struna, PA-C Wyoming Medicine 37

Robert Stuart Jr., MD Douglas, WY Michael Stolpe, DO Keri Wheeler, MD Randall Martin, MD William Jarvis, MD Sandra Surbrugg, MD Deeanne Engle, MD William Thompson, PA-C Rafael Williams, MD James Martinchick, MD Valerie Lengfelder, MD Donald B. Tardif, PA-C Terri Marso, PA-C Grace Wang, MD Clinton Merrill, MD Jacob Merrell, MD Kelly, WY Sodienye Tetenta, MD *Mark Murphy, MD Darren Mikesell, DO Billie Fitch Wilkerson, MD David Shlim, MD Bradley North, DO Kathleen Thomas, MD Mark Narotzky, MD William Boyd Woodward Hermann A Moreno, MD Angela Redder, PA-C Thomas V. Toft, MD Patrick Yost, MD Jr., MD Lander, WY Tom Nachtigal, MD Juanita Sapp, MD Charles Allen, MD Richard E. Torkelson, MD Dennis Yutani, MD Glenrock, WY Robert Onders, MD Elizabeth Spomer, MD Mary Barnes, DO Bane T. Travis, MD Charles L. Lyford, MD Harold Pierce, MD Michael Tracy, MD Evanston, WY *Richard Barnes, MD Lindsay Tully, PA-C *Michael Adams, MD Kenneth Robertson, MD, Mark Wurzel, MD Greeley, CO Lawrence Blinn, MD FACP Kristine Van Kirk, MD John Wurzel, Sr., MD Jared Barton, MD Dennis Lower, MD Lisa Vigue, MD Nancy Brewster, PA-C Shaun Shafer, MD Rebecca Ching, MD Rawlins, WY Ronald W. Waeckerlin, MD Green River, WY Cornelius Britt, MD Galyn M. Stahl, MD Jason Haack, MD Duane Abels, DO Philip L. (Bert) Wagner, Charles J. Amy, PA-C Perry Cook, MD William Thornton, MD Ardella Kemmler, MD David Cesko, MD MD, MD Gordon Lee Balka, MD Peter Crane, MD Gregory Wallace, MD *Thomas Simon, MD Gregory Johnson, MD Alison Watkins, PA-C Connie Fauntleroy, MD David Doll, MD Michael Wasser, MD Bailey Snyder, PA-C Palur Sridharan, MD Eric J. Wedell, MD Michael Holland, MD Thomas Dunaway, MD Kim Westbrook, MD Russell Williams Jr., MD Evansville, WY Robin K. Thompson, MD Jacob Johnson, MD Brian Gee, MD Lovell, WY Jack V. Richard, MD Bret Winter, MD Kristine F. Sherwin, PA-C Phillip Gilbertson, MD Brendan H. Fitzsimmons, Riverton, WY John E. Winter, MD Donald Gullickson, MD MD Brooks Allison, MD Fort Collins, CO Hudson, WY Natalie Workman, MD Justin Hopkin, MD David Hoffman, MD William Brohm, MD Jason Merritt, MD Robert L. Darr, PA-C John Wright, MD Richard Simmons, MD Hart Jacobsen, MD Lyman, WY Jason Brown, MD William Wyatt, MD Hulett, WY Troy Jones, MD Michael Fisher, MD Gillette, WY Steven Babcock, DO Robert York, MD *Robert C. Cummings, PA-C Cori Lamblin, MD Michael J. Ford, MD Lowell Amiotte, MD Marbleton, WY Georgia Young, DO Clint McMahill, MD Roger L. Gose, MD Laura Anders, MD Jackson, WY Deborah S. Brackett, MD Charles McMahon, MD Richard M. Harris, PA-C Cody, WY Gerald Baker, MD James Balliro, MD Robert Nagy, MD Meeteetse, WY Ralph Hopkins, MD Ted Ajax, MD David Beck, MD Joshua Beck, MD Susan Pearson, MD Diane Noton, MD Tom Anderson, MD Garry Becker, MD Robert Berlin, MD James Taylor, MD Charles R. Phipps, MD Jeffrey Balison, MD Angela Biggs, MD Andrew Bullington, MD Moran, WY Richard C. Wecker, MD Douglas Phipps, MD Jimmie Biles, Jr., MD Rodney Biggs, MD Dennis Butcher, MD Dale A. Lavallee, MD James White, DO Adair Bowbly-Joskow, MD Lars Conway, MD Carmen Pisc, MD Darlene Brown, DO Newcastle, WY Rock Springs, WY Gregory Clark, PA-C Steven Platz, PA-C Kris Canfield, MD *Lisa Jo Finkelstein, DO Michael L. Carpenter, PA-C Peter Allyn, MD Ross Collie, MD Carol Quillen, PA-C Thomas Davis, MD Roland Fleck, MD D. Charles Franklin, MD Neal Asper, DO Gregory Cross Jr., MD Jan Siebersma, MD John P. Dunn, MD Angus Goetz, DO Willis Franz, MD Charles Bongiorno, MD Kathleen DiVincenzo, MD Cynthia Stevens, MD David Fall, MD Christopher Haling, MD Aaron Jagelski, MD Michael Bowers, DO Stephen Emery, MD Karla Wagner, MD Mindy Gilbert, PA-C Bruce Hayse, MD Michael Jording, MD Elina Chernyak, MD Rand E. Flory, MD Travis Walker, MD Landi Halloran, MD Christopher Hills, DO Tonu (“Tony”) Kiesel, MD Gerard Cournoyer, MD Randy Folker, MD John Whipp, MD Sara Hartsaw, MD David Khoury, MD Peter Larsen, MD Steven Croft, MD *Allen Gee, MD Mark Woodard, MD, PC Jonathan M. Hayden, MD Ludwig Kroner, III, MD Jan E. Mason-Manzer, PA-C Brianne Crofts, MD Lee K. Hermann, MD Helen Iams, MD James Little, MD Laramie, WY Lanny Reimer, MD Wallace Curry, MD Charles E. Jamieson, MD Erik Johnsrud, MD Thomas McCallum, MD Nicole Alexander, PA-C Pinedale, WY David Dansie, DO James L. (Bo) Johnson Hein H. Kalke, MD John Mercer, MD Debra Anderson, MD II, MD J. Thomas Johnston, MD Amy Dolce, PA-C James LaManna, MD Heidi Michelsen-Jost, MD John Bragg, MD Donald R. Koehler, MD David Kappenman, MD *Sigsbee Duck, MD Joseph Lawrence, DO Mary Neal, MD Dave Brumbaugh, PA-C Bradley L. Low, DO Rebecca Stroklund, DO Chad Franks, MD *John Mansell, MD William Neal, MD Marten Carlson, MD Gregory McCue, MD Stephen “Buck” Wallace, Melissa Gowans, MD Breck McCarty, MD Kathryn Noyes, MD Charles Coffey, MD Clint Merritt, PA-C MD Preetpal Grewal, DO Craig McCarty, MD Richard Ofstein, MD J. David Crecca, MD Dale Myers, MD Pittsburgh, PA Augusto Jamias, MD Margaret McCreery, MD Holly Payne, DO Nathan Eliason, MD Mark O. Riley, PA-C Bernard Leff, MD Peter M Jensen, DO Philip McMahill, MD John Payne, DO William Flock, MD Catherine Schmidt, MD Jeffrey Johnson, MD Kelly McMillin, MD Thomas Pockat, MD Marie Gempis, DO Polson, MT Frank Schmidt, MD Samer Kattan, MD James J. Naramore, MD Travis Riddell, MD Andrew Georgi, MD Ronald Gardner, MD Charles Welch, MD David Liu, MD Robert Neuwirth, MD Michael Rosenberg, MD John Haeberle, MD Sally Whitman, PA-C Powell, WY Brytton Long, DO Donald Parker, MD Paul Ruttle, MD George Haight III, MD Lisa Williams, MD Michael K. Bohlman, MD Brandon Mack, MD Kirtikumar L. Patel, MD William Smith, MD Mark Hoffmann, MD Jay Winzenried, MD Robert Chandler, MD Guillermo Marroquin James Price, MD Simon Stertzer, MD Angele Howdeshell, MD Kelly Christensen, MD Galvez, MD Dallas, TX Paul Rigsby, DO Ruth Anne Tomlinson, MD Lawrence Jenkins, MD Sarah Durney, MD James Nelson, MD James Randolph, MD Shelley Shepard, MD Martin Trott, MD Harry Jones, MD Robert Ellis, MD Pritam Neupane, MD Denver, CO John Stamato, MD Larry Van Genderen, MD Kent Kleppinger, MD Lyle Haberland, MD Joseph Oliver, MD James E. Stoetzel, MD Nicholas Stamato, MD Laura Vignaroli, MD *Travis Klingler, MD Lynn Horton, MD *Melinda Poyer, DO 38 MEMBER LIST

Richard Shamo, MD Erin Strahan, PA-C Steve Peasley, MD Max Kopitnik Meghan Driscoll, MD University of Jed Shay, MD Michael Strahan, MD Willard Woods Jr, MD Claire Korpela Steven Flynn, MD Wyoming Residents Jean Stachon, MD William Taylor, MD Aislinn Lewis Jacquelin Foss, MD – Casper Wilson, WY Matthew Fournier, MD Nathan Anderson, DO Michael Sutphin, MD Seymour Thickman, MD Robert Curnow, MD Karren Lewis Sandra Gebhart (Smylie), Mark Babcock, DO Wagner Veronese, MD James Ulibarri, MD Annie Fenn, MD Krista Lukos MD Hallie Bischoff, DO Jad Wakim, MD Cheryl Varner, MD Gary Heath, MD Craig Luplow Kyle Hancock, MD Daniel Burris, MD Jeffery Wheeler, MD Charles F. Walter, MD Elizabeth Ridgway, MD Andrew Maertens Brian Hardy, MD Nicole Comer, MD Chandra Yeshlur, MD William M. Williams, MD Jacques Roux, MD Mathias McCormick Barry Wohl, MD Daniel McKearney Eli Harris, MD Gabriel Fitton, MD Rozet, WY Anna Tryka, MD Dietric Hennings, MD Jaime Hajjari, MD George McMurtrey, MD Jeremy Zebroski, MD Richard Whalen, MD *Natalie Meadows Katelyn Miller Dane Hill, MD Elizabeth Hills, DO Spearfish, SD Saratoga, WY Worland, WY Katie Houmes, MD Adam Hoopes, DO William Forman, MD Lauren Millett *Dean Bartholomew, MD Richard Rush, MD Eric Howell, MD Galen Mills Brian Iutzi, MD Edwin Sheils, PA-C John Thurston, MD Christopher Ideen, MD Steamboat, CO Arla Mayne Mistica Eric Larsen, DO William Ward, MD Donald Cantway, MD Lauren Johnson, MD Wright, WY Dana Morin Katie Lee, MD Jeanne Hennemann, MD Krystal Jones, MD Seattle, WA Scott Johnston, MD Kayla Morrison Brian Melville, DO Amy Kennedy, MD Robert Hilt, MD Sundance, WY Brittany Myers Tyler Merchant, DO WWAMI Students Dean Lorimer, MD Janice Lumnitz, MD Widya Adidharma Coulter Neves Nena Panasuk, DO Sheridan, WY Elise Lowe, MD Jason Ackerman, MD Michael Alley Ross Orpet Kyle Price, MD Teton Village, WY Stephanie Lyden, MD Juli Ackerman, MD John Feagin, MD Marcus Bailey Rishi Patel Katrina Quick, MD Mattson Mathey, MD Dan Alzheimer, MD Jack A. Larimer, MD Tyler Baldwin Hannah Phillips Brody Reid, MD Maxwell Matson, MD Fred J. Araas, MD Stanley E. Siegel, MD Makenzie Bartsch Rachael Piver Jarod McAteer, MD Kody Seeley, DO Mary Bowers, MD Kenneth J. Wegner, MD Kelly Baxter Jason Reynolds Megan McKay, MD Alexandria Ukleja, MD Christopher Brown, MD Sean Bell Hope Richards Thermopolis, WY Brian Menkhaus, MD Cameron Werner, MD William Doughty, MD Danielle Borin Justin Romano William Bolton, MD David Mills, MD Kim Whitaker, MD James Ferries, MD Millie Boyd Anna Rork W. Travis Bomengen, MD Trenton Morton, MD Heather Zimba, MD Rebecca Franklund, MD Hannah Chapman Benjamin Ross Colleen Hanson, PA-C Mary Mrdutt, MD Lawrence Gill, MD Lydia Clark Kymberly Ross University of Joy Magruder, MD Michelle Neice (Cassidy), Wyoming Residents Luke Goddard, MD Alexander Colgan Michael Sanderson Kevin Mahoney, MD MD – Cheyenne Hannah Hall (Tenney) MD Allison Dawson Brian Schlidt Vernon Miller, MD Jacob (Jake) Opfer, MD Griffen Sharpe Samina Ayub, MD Bradley Hanebrink, DO Tobin Dennis Dhairyasheel Patel, MD Kurt Pettipiece, MD Amy Butterworth, MD Amy Herring, PA-C Lindsay Dodds Casey Slattery Debbie Roper, PA-C Travis Pecha, MD Sarah Sowerwine Phillip Carron, MD Marilyn K. Horsley, PA-C Brandon Douglass Tony Pedri, MD Nicole Summers, DO Dustin Durham, MD Karl Hunt, MD Melissa Dozier Janelle Strampe Howard Willson, MD Tyler Quest, MD Elise Sylar Christian Flanders, MD Ian Hunter, MD Bryan Dugas Emily Read, MD Ellen Thompson Christopher Godwin, DO Tracy Jons, PA-C Timnath, CO Roberta Enes Jacob Rinker, MD Dale Brentlinger, MD Jory Wasserburger Cameron Grove, MD Corey Jost, MD Bryan Feinstein Amer Salam, MD Isaac Wentz Brad Jepson, MD Brian Laman, MD Torrington, WY Andrew Fluckiger Kristen Schaefer, MD Lindsay White Jeremy Kessler, MD Kelly Lieb, PA-C Millard Todd Berry, MD Aaron Freeman Alyse Springer, MD Stephanie White Gregory Marino, DO Kay Buchanan, MD Rage Geringer Greetha Sridharan, MD Bryce Lunt, MD Sawley Wilde Robert Marshall, MD Norma Cantu, MD Alicia Gray Kevin Sun, MD Mahalia Marcotte, MD Thomas Mayer, MD Ezdan Fluckiger, MD Sarah Gregory Derek Wille Filip Turcer, MD Michael McGlue, MD Brenton Milner, MD Bonnie Randolph, MD Ryan Griesbach David Wilson Ashley Ullrich, MD Casey Miller, MD Scott Morey, PA-C Kayo Smith, MD Daniel Grissom WWAMI Residents Jason Vergnani, MD Kathlene Mondanaro, DO Howard L. Mussell, MD *Marion Smith, MD Carley Grubbs Ryan Abbaszadeh, MD Doug Watt, MD Stewart North, DO Suzanne Oss, MD Sheila Sterkel, PA-C Andrea Habel Jeff Bank, MD Orion Wells, MD Megan Schaaf, MD Jason Otto, PA-C Levi Hamilton John Barnes, MD Spencer Weston, MD Lyndle Shelby, MD Tucson, AZ Erica Barrows-Nees, MD Anthony Quinn, MD William F. Flick, MD Weston Hampton Megan Woodward, MD Mark Wefel, MD Scott Bibbey, MD Jamie Alex Ramsay, MD Thomas J. Gasser, MD Isaac Hayward John Ritterbusch, MD Daniel Holst Landon Bluemel, MD Italicized Names denotes New Members in 2016 Vancouver, WA Amber Robbins, MD Erik Jacobson Alan Brown, MD *Highlighted names denote Wyoming John Glode, MD Stephanie Sander, PA-C Kyle James Clayton Brown, MD Medical Society Board Members Walter Saunders, MD Wheatland, WY Tricia Jensen Catherine Cantway, MD Kristopher Schamber, MD *Ty Battershell, MD Amanda Johnson Lindsay Capron, MD Dennis Schreffler, MD Jeffrey Cecil, MD Morgan Johnson Tanner Clark, MD Timothy Scott, MD James Hawley, MD Nathaniel Kaan Steven Clements, MD Kenneth Sickel, PA-C James Kahre, MD Matthew Kapeles Kimberly Cranford, MD Chris T. Smith, MD Lauri A. Palmer, MD Sarah Koch Joseph (Greg) Dolan, MD ON CREATING A CULTURE OF EXCELLENCE! CONGRATULATIONS

ON CREATING A CULTURE OF EXCELLENCE! One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.

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Wyoming Medicine Ad, Jan/Feb,2016.indd 1 12/2/15 10:34 AM