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Employee Benefit Trust Minutes - 09/23/2011 4 f City of Wichita Falls Employee Benefits Trust Board Minutes September 23, 2011 The meeting was held in the City Council Conference Room, 1300 Seventh Street, Wichita Falls, TX 76301. Present: Darron Leiker, City Manager Jim Dockery, Asst. City Manager/CFO Miles Risley, City Attorney Tammy Guerra, Human Resources Manager Angela Bosma, Employee Benefits George Phillis, KPA Med Valerie Phillis, KPA Med Agenda Items: Meeting was called to order at 2:00 p.m. II. Discussion with KPA Med regarding Employee Clinic interface with the City of Wichita Falls, which was in part requested by KPA. Valerie opened by stating that part of the reason she requested this meeting was that she felt like there was a lack of communication between this group of people [EBT board] and the clinic, and that she wanted us to all meet together so we could "get on the same page because we don't think we are." Jim then asked in what areas, to which Valerie replied, "decisions are being made, discussions are being made, that involve the clinic and they are never being shared with the clinic until something has already been decided upon or put into place and then "oh and by the way clinic, this is what we want you to do", or"by the way clinic, this is what we think is going to happen". We think that it would be better if we had more discussions prior to that happening and that the clinic knows best how the clinic should be run as in delivery of medicine and we just think that's how it oughta be." Ken then added "we'd just like to have the opportunity to put our input into the thought processes." Jim asked for specifics to which Valerie answered "EMR; nobody came to the clinic and said, "what do you think about EMR? You all went out there and did everything you wanted to do and then said "Oh by the way clinic, we are going to do EMR" and we want you to participate and do you have any ideas about companies?" Jim disagreed, referring to IPS recommendation for e-medical records and KPA Med sitting in the same meeting. Ken and Valerie both countered that they felt the decision had been made independently of Clinic input. Ken then asked why did we want to switch to EMRs to which Tammy replied that the City needs to get a measure of the value of the service (cost-saving) provided by the On-Site clinic via use of metrics. Ken voiced his concern about spending so much money on a product that was not ultimately cost-effective for such a small clinic. Darron asked what other types of things we could use, to which Valerie responded improving in wellness? Is it cost-dollar effective? Diagnosis codes, billing, superbills — collection of that data can be sorted to compile data. EMDS good for EMR — not for creating data sources. Never was the intention of the program. It just creates medical records. `That's an example that there should have been more discussion." Valerie thinks that EMDs is good but said that there is not one clinician that she knows that is happy with EMR because it slows them down and slows down their patients-seen rate. Tammy was surprised that through numerous meetings, no concern was ever raised. Valerie felt the letter stated "we have decided that we are buying eMDS; would you like to come see it?" The discussion about KPA Med feeling left out left out of discussions and decisions directly affecting the clinic continued. Tammy then countered with when we tried to explore the news of the necessity of reporting to the clinic with a driver's license and an insurance card, we were simply asking so that we could put out news to our customers of a procedural change. And again, when the City asked to be notified of Ken's absences in excess of days, it was so that we would be able to better serve our customers. So we could give a head's up and I feel like that was met with some resistance, particularly the issue about Ken's absences...We (the EBT office) are the ones who field the complaints so it would be helpful to us to know in advance so we could answer." Valerie responded with 'We don't tell you how to run Human Resources; you shouldn't tell us how to run the clinic." Valerie then went on to talk about how EBT should not try to tell KPA Med how to run the clinic when Tammy reminded her that the Clinic is one of the City's [Employee] Benefits. It is one of the bigger benefits that we offer employees. I mean, it's a huge thing to our employees to be able to go and see you all for five dollars. That is one of our benefits. And again, it's not a question of "get my permission"to collect the data, but would you tell us the changes you make so we can share that? I don't want in the middle of your practice, or the good practice of medicine, but in business management, the clinic is one of our benefits. And so we have to be able to share the changes that happen with the clinic, if there are customer satisfaction issues, those are OUR customers, and we have to be able to mediate those and see if we can satisfy them or give them more information that's the nature of the clinic being part of EBT. " Valerie said the big issue is "making sure we let you know if Ken is going to be out of the clinic. How are you going to notify patients?" Tammy assured them that it was not about going out with news that "Ken is out of town" so much as it was of being able to respond when customers asked a question. Jim added that it was more than that for him; it's a matter of we contracted with Ken to be our PA down there", and that we wanted him to primarily be the PA down there. We knew there would be times off when he had to be gone. Well, I get the sense over the last 4 to 5 years, the amount of time that you are down there, Ken, is not as much as it was 4 or 5 years ago. And so, who are we contracting with? We contracting with Ken? Or are we contracting with Dr. Maguire? Or PA Maguire, however you wanna say it. " Jim wants to know who our PA is down there, and if Ken is going to be gone for an extended period of time, he believes that an employee should have the good courtesy to inform the employer that they are going to be gone a month. You are being paid to provide a service. And if you aren't going to be providing that contracted service, is it too much to ask for some advance notice. Even Darron lets his boss know that he's going to be gone, and who is going to be filling in for him in his absence. Valerie indicated that there was nothing wrong with that request, "that's never even been a thought that that was something that was necessary but that is not how it was presented at all. The notes, the letter—that is NOT how it was presented. It was presented that it was necessary in order to provide good customer service....what Jim's saying and what the letter said are two entirely different things. You're saying, 'you know it would be nice and it is a nice courtesy for you to let us know. Quite frankly that was never an issue because Bill is qualified just like Ken." Tammy indicated there were also issues with new forms that cannot be completed unless Ken or Valerie is available. Lori and Gail don't know or aren't allowed to take action. The business of the EBT needs to be accomplished and they need to be able to respond to their customers. Valerie responded that she had no issue with what Tammy was saying, but beyond that, she thought it was a mute point, and she thinks that the EBT has "a whole `nother agenda" about Ken being gone. She accused Jim of being adversarial towards her and Ken; Jim confirmed that he felt "in the past two years, the EBT has not had your support and that is a frustration that I have right now." He further went on to say"And if I had to take a vote today, I'd go out for a vote and we'd go out with a request for a new service provider but I'm just one vote." Jim mentioned that everything we asked for is met with resistance; anything we ask for, anything IPS asks for; Workman's Comp being brought on line. He said that our requests were met with 'Why do you need to know?" to which he responded, "well, we are your employer, and if we ask for it, we should get an answer. And if we can't get an answer from our contractors, then we'll get a new one. That's what I've said for the last two years. We expect you to work for us, not the other way around. The on-site clinic is an employee benefit of the city of Wichita Falls. It's not YOUR clinic for, to basically, house down here to see a bunch of patients from the city and the city stay out of it. That's not the relationship we're supposed to have. And when we call down and ask, I expect Tammy to get some courtesy from you all. And I don't get that. Every time, I get Tammy coming back to me telling me that she can't get answers, she gets push back every time we ask for something. And so yeah, I'm frustrated with the relationship". Valerie: "So I'm kind of surprised you haven't said anything before now." Jim "Oh I have said things before now. I said things in my office when Ken and Dr. Talbert were in there, and in essence said, "If you don't like it— leave!" Valerie: "Jim, that is such a horrible attitude. If you don't like it, leave." (Jim and Valerie talking over each other.) Jim: "it's obvious that we're having trouble working together because when Tammy asks for something, I expect her to get an answer. And if we can't get the answers, we'll go somewhere else. We're paying you good money to be down there Ken, and we want some answers and we don't want pushback every time we ask you for something. Or every time one of our consultants ask you for something." Darron: "...from outside looking in, it does appear that we get pushback, less than desirable cooperation, and I think we've tried to bring you all to the table and work with you, but I agree 100% with what Jim says in that we are your employer and if you all don't like that relationship, then maybe you know, we do need to seek other options or alternatives. But, we get the sense — I do anyway— going clear back to the workers comp and the electronic billing and other things that, you know, y'all wanna keep us out and you know we're just trying to make the best benefit for our employees as Tammy said better. Uh, we've never set around this room and said "let's figure out ways to push Ken Phillis out the door. What can we do to make his life miserable? It's never been about that. It's been about "Hey, we need to kick it up a notch, we need to keep improving things, and that was one of the reasons we spent the money to bring IPS onboard. And from what they tell us, a lot of these things we are asking you all to do is not that big a deal. It should be something minimally expected. So as you get the impression that we are not communicating well , it's two directions here, and you know, I've seen emails that Tammy's sent out that you know from you that sure doesn't seem that you're a willing partner in the communication so that's kinda how I feel about it. Miles then added perspective of a professional being employed by the city. Tammy reiterated that she felt like she had received pushback on different things that she has asked for, that it generally takes a few emails going back and forth, a few conversations to get to that point. She indicated that she thinks that there is an interpretation of the KPA Med role where they see themselves as having their practice but it's not a private practice; KPA is our [City] contractors, they staff our clinic, the clinic is our[City's] clinic, and the patients are our employees so it's a benefit the city provides. Saying that, none of us want in the middle of your medical practice, "I mean, you make the medical decisions, those kinds of things, but when it comes to the business operations, there are things that we have an interest in, mostly so that we know that it's running as efficiently as it can. I've talked to you before about a lot of things in the City's past were just"handshake deals" and they went on from that and I'm more about getting things in writing and having systems and protocols so that if I'm gone next year, you guys are gone next year, business continues. We have continuity of business, and sincerely that's been our ONLY motivation. There has been pushback ....workers comp, I think you guys remember that was quite a hassle for you all and for the communication between us to get you guys in a happy place where you could do the billing the way that the TX Department of Insurance wanted it done and it took the change that came about in January, it was April or May before we got it running along smoothly. And I know that that increased, I believe that we had a EBT meeting and we threw in another $150 a month to compensate for the records or billing or whatever was going on at that time. I thought that relationship kind of soured you guys when it came to consultants and third party administrators so when IPS came on board, it was already kind of , you know you weren't really wanting to hear from them but they have been contracted to help us improve our benefits across the board not just the clinic the clinic is one of those so they had some feedback on the clinic and especially when it comes to collecting records to collecting data so that we can show Randy, you all remember him, he's of a mind that it's hard to say right now (He's the Principal with IPS) and he's of a mind you know on the fence as to whether or not we could actually show that we're saving money having this employee clinic. We all kinda have a gut feeling that we are, so our goal is to collect that data and be able to see how much; the only way we can do that is to compare to the ICD9 codes, or you know whatever. We're trying to improve business. You know, but I do think , sincerely from my perspective, when I'm emailing you and telling you we're doing this or this is the change or hey, can you tell me when you're making a change that we can communicate in my mine that is me including you all. You know there are some decisions you guys don't get a vote in. And there are some decisions you make that I don't get a vote in. But that is how the teamwork works. I've told Ken since I came, he wants to get more involved, sharing information on the departments and stuff, we're all about getting there. You know I think Ken knows how wellness clinic should run, and how we can get our employee population well, we're all about wanting to do that. It just seems every little change that we make it becomes kind of a battle on email of going back and forth Miles and I walked down the piece to get the agreement that you give us a head's up that you were going to be out, I'm thinking it's no big deal, you know, routine business; never would have expected the reaction that I got but you know we got it and we're moving on from there. I just think you have a perception, you've brought up several times that you think there's a hidden agenda and I've told you several times: we don't have one. Darron just told we've never sat around this table you know thinking of ways to get rid of you guys; we're thinking of ways to make the clinic better, to make more people use the clinic. I don't know if our relationship is damaged beyond repair at this point but that has been our goal since I got involved with EBT and I'm sure it's been there goal since before I came around. III. Meeting was adjourned at 3:00 p.m.