Committee delays fee‑schedule overhaul; staff updates committee on pharmacy launch and pet medication plans

The finance committee continued a substantive discussion about the clinic’s fees and charges policy, the related fee schedules (primary care, dental, pharmacy), and the sliding fee scale. Committee members and staff said the fee schedule is large and technically complex — roughly 5,000 lines for primary care alone — and agreed to delay final board action until staff, billing, and committee members can review the material together.

Why it matters: the fee schedule defines clinic charges for CPT and HCPCS codes and establishes a fallback rate for items not listed (currently set at 300% of Medicare). Committee members said the spreadsheet as presented is difficult to review in one sitting and asked staff to bring a clearer, summarized presentation back to the finance committee before the item goes to the full board.

Discussion highlights: staff explained the fee schedule covers three distinct lists — primary care, dental, and pharmacy — and that some fees (for example, clinic‑administered medication during treatment) are priced differently than retail pharmacy prescriptions. Staff also explained that CPT and HCPCS code changes occur regularly and that the fee schedule is reviewed on a two‑year cycle; the committee asked staff to convene clinic billing staff (Melanie and Estee), municipal staff, and committee members to walk through the spreadsheet line by line in a follow‑up working session.

Motion status: committee member Bob Dietrich moved to return the fees and charges item to committee; the motion was seconded but, after procedural discussion, the motion failed on the floor (transcript records the motion attempt and later states it failed). Separately, committee members recommended holding the fee schedule and sliding fee scale reviews until the committee completes the requested joint review; several members specifically asked that draft attachments be labeled as such and that any finalized dates reflect the meeting at which the committee actually approves them.

Pharmacy update: staff said the clinic’s pharmacy has begun filling prescriptions in the new system and processed a prescription that generated $14.08 in revenue and that the amount tracked through to the municipal general ledger. However, staff warned that pharmacy insurance enrollment with payers is not yet complete; enrollment typically takes 45–60 days. Until payer enrollments are finalized, the pharmacy can dispense medications for cash payment only, and patients would need to seek reimbursement from their insurers. Staff said the clinic will also stock a modest inventory that will include some pet medications requested by a local veterinarian; however, retail pharmacy insurance coverage and a separate corporate retail‑pharmacy policy will be required for pharmacy sliding fee administration.

Next steps: staff will organize a working session with billing and municipal staff to clarify the fee schedule spreadsheet and then return a revised, summarized fee schedule and sliding fee scale to the finance committee. The committee also asked staff to mark attachments as drafts until the group finalizes review and to ensure any approval dates match the actual committee meeting date when the item is approved.