I suppose, before I get too into what I really want to talk about, I have to make a passing nod to the story The Sheet first reported on our Twitter account last Friday about Mammoth Town Council mulling a possible change in Town Managers. Local businessman Tom Cage is rumored as a possible replacement if current Manager Marianna Marysheva-Martinez gets whacked at a closed session of Council scheduled for Friday, August 30.

If Council dumps Martinez, it would be looking for its fifth Manager in three years. The succession pattern has gone Clark-MMM-Wilbrecht-MMM-???

Reminds me of the early Steinbrenner years in New York, where Billy Martin was hired as Yankee manager on five separate occasions. MMMartinez only has three hirings left to go.

The real lesson in all of this: If the Fifty Center threatens to honor you as a Person of the Year, politely decline. Their Persons of the Year for 2012? Former Town Manager Dave Wilbrecht and MMMartinez.

Meanwhile, the “Don’t Cage Mammoth” drumbeat has already started, because in Mammoth, we’re like John Kerry, but in double negative. Kerry was famously “for it [funding the Iraq military operation] before I was against it.”

Whereas in Mammoth, we’re never for anything. We’re always against it before we’re REALLY against it.

As an FYI, I did research one allegation made by a Cage detractor who said Cage’s record of attendance as member of the Water District Board is horrendous.

Turns out he’s made 80 of 83 meetings over two years.

So, if you’re gonna find fault with him, not showing up to work wouldn’t be the issue.

 

Loot now, loot later

I don’t understand the health industry. I’m not sure anyone does.

I thought I understood my Anthem policy – at least the basic concept of a deductible. Pay the first $1,000, and then a co-pay on anything above that.

Until I was informed recently that my policy had been changed.

Even though my plan is called the Clear Protection Plus 1000, I was told that I now have two deductibles. My in-patient deductible is 1000, but my out-patient deductible is now 4500.

Conveniently, the out-patient deductible was reset at the perfect number … for Anthem. Low enough to pass for reasonable, and high enough to never hit.

Further, when my daughter Margaux turned one this March, I expected a significant decrease in my premium, as once kids turn one, they’re officially reclassified as weeds – past the vulnerable infant stage and now fairly indestructible.

Except I was told that Anthem reclassifies its ages once a year, and that reclassification happens in February, so my daughter is being rated as a “zero-year old” for another year.

Thanks to the above two events, I will pay a good $5,000 more in out-of-pocket health costs this year than anticipated – never mind the $946/month I pay for my family health insurance premium “coverage.”

I mention this, well, a.) because everyone likes a good Darth Vader story about the health insurance oligarchy, but also b.) because my perception, based upon the above, is that given the uncertainty surrounding Obamacare, the healthcare industry figures it better start looting my wallet now.

Mammoth Hospital CFO Melanie Van Winkle wrote a Health Care Reform synopsis in the May issue of Vital Signs, the hospital’s official newsletter.

She wrote, “It is estimated that the United States spends an average of $8,000 per person per year on health care compared to $3,000 per person in other developed countries … studies show that Americans do not have better health or life expectancies than other developed countries … So why is health care in America costing so much money when outcomes are not better … and we still have 44 million [uninsured]. This is the root of the problem propelling the sweeping health care reform initiatives.”

In the meantime … local hospitals will continue to feel the squeeze. When I ran into Van Winkle yesterday at Black Velvet Coffee, she indicated that Medi-Cal payments to the hospital will be slashed by 50% over the next three years, further shifting the burden of care for needy patients onto the hospital. Why? She anticipates that even with the advent of Obamacare and universal insurance, insurance still requires meeting a deductible, and if someone can’t meet their deductible, who ultimately pays? The hospital.

So there is even a greater premium on hospitals maximizing revenues, maximizing efficiencies …

And this can lead to a little testiness between hospitals and doctors, hospitals and providers.

Mammoth Hospital CEO Gary Myers said in a recent interview, “If I had a magic wand, I’d create an Eastern Sierra Healthcare District, merging Southern Mono Healthcare District with Northern Inyo Hospital.”

The issue in rural areas, he continued, is achieving critical mass, and offering a combination of services is the only way to create it.

But if you’re not on the same team, you’re on opposing teams, and both Myers and Northern Inyo Hospital CEO John Halfen are no shrinking violets when it comes to waging turf battles.

Take orthopedics, for example.

Dr. Mark Robinson recently had his contract with Mammoth Hospital terminated by Myers. While he still takes call in Mammoth, he maintains a full-time office in Bishop.

Historically, Robinson said that when he first came to the area, orthopods took calls regionally and patients could choose whichever hospital suited them for surgery.

And as Robinson said, his recruitment to this area was based upon his desire to work in both places.

However, the landscape changed when Jack Perry left and Mike Karch and Tim Crall arrived. Both Karch and Crall have small children, and soon decided not to take call in Bishop.

Instead, Mammoth Hospital created a satellite S.P.O.R.T (Sierra Park Orthopedic) clinic in Bishop, with the idea that Karch and Crall could see patients in Inyo County, and then schedule surgeries up in Mammoth.

As Dr. Douglas Will, another doctor (neurology) whose contract was not renewed by Mammoth Hospital, told The Sheet, “It’s all about where the surgeries are performed, where the P.T. (physical therapy) goes.”

“Mammoth Hospital would truck people up from Bishop Care Center and kill orthopedics completely [at NIH] if they could,” he added.

However, according to Halfen, in an effort to prevent Civil War, a Memorandum of Understanding had been crafted by Halfen, then-Mammoth Hospital CEO Gary Boyd, Crall and Robinson to reinforce the original tenets of cooperation between the hospitals with regard to orthopedics. However, before the MOU could be presented to the Southern Mono Hospital Board, Boyd became ill and went on indefinite leave and the MOU got shelved.

With the MOU dead, Robinson said his continued fulfillment of the Bishop obligation wasn’t entirely popular with Myers and Van Winkle. “There were allegations I was losing Mammoth Hospital money,” he said.

Sheet: Was your contract not renewed because you perform surgeries at Northern Inyo Hospital, thereby taking money out of Mammoth’s pocket?

Robinson: That’s plausible. Only Gary Myers knows what Gary Myers thinks.

Will thinks Mammoth’s termination of Robinson’s contract, as well as that of Pediatrician Maria King, constitutes a restraint of trade and is illegal.

“The hospital [Mammoth] gets away with doing whatever it wants. Their legal advice, I believe, is incorrect, but they’ve got deep pockets … when they terminate a service agreement, they don’t expect you to stick around.”

Dr. King, on medical leave as she recovers from recent surgery, left Sierra Park Pediatrics a few years ago to open her own Day and Night Pediatrics Clinic.

While she is on staff at Mammoth Hospital, she does not have a contract and is therefore not allowed to take call.

Halfen says that according to medical staff by-laws, those on staff are required to take call. “It’s illegal not to let King take call,” he said.

“It would be a $1 million lawsuit to establish the right to take call,” said Halfen, noting that no one’s going to spend that kind of money on a challenge. Therefore, Mammoth Hospital is bulletproof – if not fair, in Halfen’s view.

“They’re bullies,” he said, referring to Myers and Mammoth Hospital’s legal counsel David Baumwohl.

Will said he told Myers at one point, “You’ve got a mission statement, but not a values statement.”

As one can imagine, Myers views this all a little differently.

Regarding call (and the reason a doctor would want to take call is the same reason why realtors take turns fielding walk-ins – every opportunity to see a patient is an opportunity to land a long-term client), Myers said in pediatrics, Drs. Johnson, Wilson and Conrad have the contract. “It’s up to them as to whom to include or not include within that contract,” he said.

Robinson still takes call in Mammoth, according to Myers, because he was invited to participate as a subcontractor by Karch, Crall and Torrey Pines, who have the direct contract with Mammoth Hospital.

As far as orthopedics in general is concerned, Myers observed that with N.I.H’s new construction and corresponding overhead, Halfen naturally wants more of the orthopedic business staying in Bishop. What this creates is an “arms race” of sorts, an arms race which may intensify further when Dr. Richard Meredick arrives this fall.

Halfen said Meredick is from the same fellowship program that produced Karch, and that he does everything that Robinson doesn’t do. Meredick will be based in Bishop.

To bring us full circle, Robinson pointed to a 2009 LAFCO (Mono County Local Agency Formation Commission) report which advocated for a regional health care system no less than 18 times within its 33 pages.

United we stand, divided we …