Powell’s primary care doctors talk about rewards, frustrations of practicing medicine today

Powell is in the enviable position of having three options for primary health care, with each operating under a different model of care: Powell Valley Healthcare, 307Health and Heritage Health Center.

“It is so unique for a small community to have three different models,” Dr. Juanita Sapp, the physician at the new Heritage Health Center, said Wednesday during a public forum about health care. “We should be the model for the country. Why are we not in every newspaper in Wyoming?”

The forum, “Powell Docs Talk,” focused on the similarities and the differences between the three models. It also provided information on health care challenges, both locally and nationwide, and how the community can help by supporting its local health care providers.

The forum also illustrated ways the three work together to meet patients’ needs.

Sapp said Powell Valley Healthcare has been very cooperative, supportive and helpful with Heritage Health. Dr. Bob Chandler of 307Health said he and Dr. Mike Tracy frequently refer patients to Heritage Health when 307Health can’t meet their financial needs. And both of those organizations rely on Powell Valley Healthcare for emergency, hospital and obstetrical (OB) services.

Similarities

The common thread that ran through the entire evening was that doctors in Powell care about their patients.

“I didn’t go into family medicine to make money,” said Dr. Sarah Durney of Powell Valley Healthcare. Instead, it was because “I value a personal connection more than most people ... and because I’m a scientist.”

Durney said she helps patients maneuver through the health care system that can be so frustrating, and she works hard to fit the pieces of a medical puzzle together for her patients.

“I don’t brush off complaints,” she said.

Chandler of 307Health said, “The biggest thing for me is the relationships we have with patients. As a physician, we have the privilege of taking care of our patients when they’re at their most vulnerable state, and that’s something that I don’t take for granted.”

Sapp said she wants to “help people live their story and enjoy it as long as they can.”

Dr. Mike Bohlman of Powell Valley Healthcare said he likes watching those stories unfold over their lifetimes in a small community, starting with delivering a baby, then seeing that baby come back in as a child, a teenager and later as an adult.

Bohlman no longer delivers babies, but he said he still enjoys that lifelong relationship.

Dr. Valerie Lengfelder of Powell Valley Healthcare said she also values her relationship with her patients, and enjoys helping them live their lives as happily as they can, in spite of chronic illnesses. She said it’s also an honor to take care of residents in Powell Valley Care Center, and she enjoys being able to visit with them.

Differences

• Powell Valley Clinic offers the traditional model of primary care. It operates under Powell Valley Healthcare (www.pvhc.org), the same organization that runs Powell Valley Hospital, Powell Valley ExpressCare, Powell Valley Care Center and The Heartland Assisted Living Community.

Powell Valley Healthcare treats patients who are covered by insurance, Medicaid, Medicare and self-pay.

“We serve all demographics,” Lengfelder said. “We take all comers.”

Powell Valley Healthcare is the only one of the three models that provides obstetrical (OB) services.

“Cradle to grave,” Durney said. “We’re all on call, and we care for all patients.”

The clinic is open for scheduled appointments during traditional business hours.

Powell Valley ExpressCare is open from 7 a.m. to 6:30 p.m. weekdays and 8 a.m. to 1:30 p.m. Saturdays, on a first-come, first-served basis, without appointments.

The emergency room at Powell Valley Hospital is staffed round the clock.

• Heritage Health Center (www.heritagehealthcenter.org), which opened in September, is a government-funded community health center that provides care on a sliding-fee scale, based on household income. The center also sees Medicare, Medicaid and insured patients. It does not provide OB services, but it does provide mental health care, Sapp said. Dental services also are listed on the center’s website.

Sapp said the center cares for patients of all ages. It is open for four and a half days per week, with hours extended until 8 p.m on Tuesdays.

While Heritage Health is new to Powell, community health centers are not a new concept, said Executive Director Colette Behrent.

“The health center model started in 1965,” Behrent said.

• 307Health (307health.org) operates on a direct primary care model. It does not accept insurance, Medicaid or Medicare; instead, Chandler and Tracy care for patients on a monthly fee basis, which ranges according to each patient’s age. There is no charge for individual visits.

Not taking insurance, Medicaid or Medicare frees up doctors to spend more time with their patients, Tracy said.

307Health also provides care for all ages, but it does not provide OB services.

The clinic is open during traditional office hours, but Tracy and Chandler provide patients their cell phone numbers and email addresses for 24-7 access.

Challenges

Challenges for doctors include increasing federal requirements for data.

“Electronic records are both a health and a hindrance,” Durney said. “There are volumes and volumes of data we are supposed to keep track of. It takes a lot of data gathering, and a lot of people — who may or may not be connected electronically — may or may not have the data.

“You may be here for a cold, but we’re now mandated to ask you about the date of your last colonoscopy, do you smoke, wear a seat belt. Please be patient; these are questions we’re required to ask.”

Bohlman said doctors currently are able to spend only about 15-20 percent of their time with patients.

“The rest is spent doing computers and documentation,” he said. “We can’t generate enough patient encounters to run the machine.”

That is very frustrating for doctors who chose their profession in order to help and have a relationship with their patients, he said.

Lengfelder said one possible solution being considered is hiring scribes to be in the room with the doctor and the patient. The scribe would record what happened during the doctor visit, leaving the doctor free to move to the next room with another patient and another scribe.

Dr. Kelly Christensen of Powell Valley Healthcare said another frustration is when Medicare or insurance companies lose track of the paperwork they require.

“You have to get it all approved,” he said. “So, yesterday, you got a letter addressed to a patient, ‘Dear patient, we’re not going to send your test strips to you. We contacted your doctor and he didn’t get back to us.’ But we sent everything they asked for 12 days earlier. Then they send you a letter saying, your doctor is a jerk. No, we’re not.”

Tracy said that frustration is one of the reasons he and Chandler chose to adopt the direct primary care model. It removes the insurance companies, and, therefore, much of the paperwork. That increases the time they can spend with patients, he said.

Sapp said one of the challenges for the future is the fact that one-third of the family practice doctors in the United States are age 55 or older, and there aren’t enough new primary care doctors coming out of medical school to replace them.

The problem looms even bigger locally when you consider the fact that the Big Horn Basin, including the area surrounding the city of Powell, has one of the oldest populations in the country, she said.

Supporting local health care

Christensen stressed the importance of supporting Powell Valley Hospital.

“The hospital has lost a bunch of money,” he said. “They really are in trouble, but you want to have a hospital in town. ... When you have your heart attack, you’re going to want there to be an emergency room here to take care of you.”

The best way to make sure the hospital is here when you need it, he said, is to choose Powell Valley Hospital for elective and other surgeries.

“What keeps a hospital going is surgery, plain and simple,” he said. “If you’re leaving Powell to get your surgery done, if you take your knee replacement to Cody or Billings, you take $30,000, and you’re going to give it to somebody else, and you’re not going to get better care.”

Christensen said the hospital now has a good pain clinic and “a great OR staff (and) great surgeons. Dr. Rieb and Dr. Jarvis are amazing.”

“All of those people get along great,” he said. “They’re a wonderful team. They do a great job, and they all step up.”

Christensen said the post-surgery infection rate at Powell Valley Hospital is less than 1 percent.

Bohlman said people seem to think bigger is better, “but you get more personalized care here. We know you. We can’t do all surgeries here, but the ones we can, we do well.”

Durney said people also can support local health care by volunteering with and donating to the Powell Medical Foundation.

“There’s nothing better than volunteerism,” she said.

Lengfelder said people should return the surveys they get in the mail after receiving care at Powell Valley Hospital.

“If you do have an experience that didn’t go the way you wanted it to, write it down,” she said. “We try to address those.”

Durney asked people to deal with their frustrations in positive ways.

“When you’re frustrated ... address the people you think are responsible for the issue” instead of broadcasting it over social media, she said. “One negative experience seems to last forever; we remember them like elephants,” she said. “But positive experiences seem to go away very quickly.”