PHD passes budget, funds clinic overhaul

Commissioners consider “concierge medical services” for employees

By Soncirey Mitchell
Reader Staff

Commissioners from the five northern counties met June 18 with Panhandle Health District officials to reconsider the organization’s Fiscal Year 2027 budget after voting it down in late May. County commissioners voted 3-2 to adopt the budget, which will provide for expanded clinical services and cost-of-living salary adjustments for the district’s employees.

The FY ’27 budget amounts to $12,299,702 — the lion’s share of which will go to personnel expenses — raised through taxes, permit and licensing fees and health services. Benewah, Bonner, Boundary, Kootenai and Shoshone counties will contribute a collective $2,216,903 — $470,211 of which will come from Bonner County.

At the May 20 meeting, commissioners took issue with increased expenditures for clinical services and worker COLAs, requesting that PHD return June 18 with alternative budget proposals without the adjustment or clinics in some or all counties.

The planned changes to clinical services are part of a monthslong effort by PHD to audit, refocus and revamp clinics within the district, hopefully increasing community usage by expanding days of operation and diversifying offerings. The district intends to hire a social worker, two medical assistants and a nurse practitioner to broaden services and focus on holistic, naturopathic and allopathic preventative care to counter rising national rates of chronic illnesses like heart disease, cancer and diabetes. They also intend to expand women’s health services, which, according to an internal audit, are PHD’s most utilized resources.

According to PHD Board of Health Chair Thomas Fletcher, eliminating the COLA would have freed $180,000 of the budget, while eliminating clinical services entirely would “liberate roughly $78,000” despite its $2.11 million budget.

“You are creating two conditions that converge if you kill the clinic,” said Fletcher at the June 18 meeting. “The first condition is that the clinic, you understand, generates a fair amount of revenue all on its own. It sees patients, and you bill for those clinical events. So if you kill the clinic, you have neutered the generating capacity of that enterprise.

“And the second condition is that there are overhead expenses — there are administrative expenses that are shared by all departments of Panhandle Health, and the clinic is sharing … its fair share of those administrative costs. But if you kill the clinic, you have not eliminated the other administrative costs.”

According to Fletcher, PHD anticipates a 200% return on investment, meaning for every dollar spent on clinical services, the district expects to earn three. This is because the cost of hiring additional personnel will be far less than the money earned from fees and insurance payouts from patients.

“We can look in our own historical records and see that a given nurse practitioner generates, in revenue, 3X her salary,” said Fletcher.

Further arguing on behalf of the clinics, Fletcher proposed that PHD could partner with each county to provide “managed health care options for county employees.” Though Bonner County has recently considered similar arrangements with private entities, the five northern counties had not discussed or budgeted for that option prior to the June 18 meeting.

“It’s an opportunity, potentially, for the counties to save some money — potentially, again — on their health care costs for their employees,” added Kootenai County Commissioner Bruce Mattare.

The counties would pay for “concierge medical services,” meaning employees would have the option to have bloodwork, physicals and other medical services done for free at any PHD clinic. In theory, this would help employees catch and address health issues early, eliminating the need for later county payouts for more costly medical procedures. According to Fletcher, unlike private medical entities, PHD would not provide the “standard cartel establishment medicine” or fall into common practices like the “pharmaceutical escalation trap,” which raise prices for both consumers and providers.

In response to concerns that increased clinical services would compete with rural hospitals, which are already struggling to earn revenue, Fletcher said that PHD would partner with other providers, which, according to Mattare, would ultimately help them eliminate common costs.

“One of the challenges for hospitals is when people show up — especially if they don’t have health insurance — and show up to the emergency room because they weren’t getting care beforehand and that actually hurts the hospitals,” added Mattare. “So, I think that there might be some opportunities where the pain points can be discovered for the hospitals and Panhandle Health can work to address the pain points and not create a deficit for the hospitals.”

Bonner County Commissioner Ron Korn echoed this point, later moving to adopt PHD’s FY ’27 budget with the proposed COLA and clinical services. The motion passed 3-2 with votes from Shoshone, Bonner and Kootenai county commissioners.