Finance committee lowers equipment markup to 15% and forwards multiple policies to full board

The Dahl Memorial Clinic Finance Committee voted on March 18, 2025 to amend the clinic's establishment of fees-and-charges policy, changing the proposed markup for equipment and supplies not included in procedure fees from twice the item's cost to 15% above cost, and forwarded several finance-related policies to the full board for review.

The change was proposed during a discussion of the fees-and-charges policy. Bob Dietrich, president of the Dahl Memorial Clinic board and chairing the meeting, moved the amendment: "I move that, we amend policy, establishment of fees and charges policy section C subsection A to read any equipment or supplies not included in the procedure fees will be charged an additional 15% above the item's cost." Brittney Thomas seconded the motion. Committee members voiced support and the motion passed without recorded opposition.

Why it matters: committee members said the 15% markup is intended to cover stocking and shipping for clinic-dispensed items while avoiding an "exorbitant" double-cost charge for expensive durable medical equipment such as wheelchairs. Albert Wall, executive director, explained the distinction between in-clinic dispensary pricing and future retail pharmacy pricing, saying the pharmacy will have a separate, higher markup and a separate fee schedule.

Committee actions also included forwarding the federal cash management and grant drawdown policy, the sliding fee discount program (with an amendment to the sliding-fee eligibility application), and an amended billing-and-collections policy'each sent to the full board for review with a recommendation to approve. The committee recorded these referrals as part of routine governance to allow the full board to review policy language and finalize adoption.

Committee discussion highlighted several specific points that shaped the 15% decision: members said some durable medical equipment is prescribed without an attached procedure fee, shipping costs vary (especially for large items), and insurance coverage varies by item and whether the item is dispensed through a licensed pharmacy or an in-house dispensary. Wall said: "insurance will cover more if it's obtained at a licensed pharmacy than it will at the dispensary." The committee added that a separate retail-pharmacy fees-and-charges policy will be developed before the clinic opens a retail pharmacy.

Votes at a glance: - Amend establishment of fees and charges policy (change markup to 15% above cost). Motion: "I move that, we amend policy..." Mover: Bob Dietrich. Second: Brittney Thomas. Outcome: approved (no recorded objections). - Forward federal cash management and grant drawdown policy to full board with recommendation to approve. Mover: Bob Dietrich. Second: Brittney Thomas. Outcome: approved unanimously. - Forward sliding fee discount program policy to full board with recommendation to approve; and amend sliding-fee eligibility application (remove requirement that a patient be enrolled on the sliding scale before dental service to receive the discount). Motion and amendment moved by Bob Dietrich; seconded by Brittney Thomas (second to the referral) and by K. Kennedy for the attachment amendment. Outcome: approved. - Amend billing and collections policy to define catastrophic or significant events and allow the executive director discretion for fee waivers/reductions. Mover: Bob Dietrich. Second: K. Kennedy. Outcome: approved and forwarded to the full board.

Committee members asked that the separate retail pharmacy fee schedule be developed before the pharmacy opens and that corporate policies governing donations and corporate funds be drafted to avoid commingling municipal and corporate money. The committee recorded those as forthcoming policy work to be presented to the full board.

The committee's approvals were procedural referrals to the full board; the full board will consider final adoption at a later meeting.