North Penn Could Expand Staffing at Healthcare Center

Dan Sokil | The Reporter•

North Penn School District CFO Steve Skrocki has his blood pressure taken by Paola Reyes, a Clinical Supervisor with Everside Health, at the North Pen

In the few months since North Penn’s district healthcare center has been up and running, it’s seen plenty of success stories.

District officials made the case for expanding that center on Wednesday night, and heard about one lifesaving success story so far: that of Tonja Garrahan, district administrative assistant for the curriculum and professional development departments, and how the center and its staff helped her.

"I definitely believe that she saved my life,” said Garrahan, referring to the center physician assistant.

Located near Penndale Middle School, the healthcare center opened in March after nearly two years of discussion, planning and construction, and is run by national operator Everside Health who can provide certain medical care to district employees and their dependents. Garrahan told her success story to the school board’s finance committee on Wednesday night: she heard about the center from coworkers at the district’s central office, and made an appointment for her annual physical.

"During that physical, I had never spent that much time with any doctor, to sit there and ask them questions, and have them ask me questions that I never would’ve thought about,” Garrahan said.

"We found out that I had shrunk a full inch in height from my last physical, so Mira suggested that I get a bone density test,” she said.

Mira Patel, the physician’s assistant with Everside Health who is one of two staffers at the center, helped Garrahan get that scan, which revealed that she had stage four osteoporosis, a diagnosis Garrahan called "totally life-changing” for someone who had always been active, particularly when playing with her grandchildren.

"No more cartwheels, no more jumping — you hear that you could fall and break a hip, and that could be the end for you. I always heard people say that, but I never understood it,” she said. Mira "answered every single question that I had,” helped her arrange for a specialist, and developed a two-year prescription and treatment plan, via five visits since May to the North Penn healthcare center.

"It wasn’t until your visit at the healthcare center, because it was a lengthy visit, lots of questions were asked and so forth, that that test was ordered, and allowed you to come up with a treatment method that would prevent further potential serious issues,” district CFO Steve Skrocki said.

Skrocki then outlined the current utilization of the healthcare center since it opened, and made the case for an increase in staffing to better handle the volume of appointments made so far.

"We’re at a saturation point right now. And to be able to provide additional services, we need more staff. It’s really as simple as that,” Skrocki said.

Early Numbers are In

Since opening, the center has logged more than 1,400 visits from more than 700 individuals, with appointments peaking in May, dipping over the summer, then jumping again with the start of the current schoolyear, Skrocki said. Of those visits, just under 600 were classified as office visits, 479 counted as nurse visits, 182 as physicals, and smaller numbers in other categories, with the center operating at an average of 78 percent of capacity throughout the eight months, and reaching a peak of 105 percent of capacity in October.

"We’re really pleased with the utilization so far. We had mentioned the projections were conservative, $10 million in savings over a ten-year period, but we needed to reach certain utilization levels to achieve those savings. We’re well on our way,” Skrocki said.

Staff have been encouraged by Superintendent Todd Bauer to allow flexible scheduling to visit the center during work hours, Skrocki said, which has let staff miss individual periods instead of full days for appointments. From the start of the schoolyear through the first weeks of August 2022, teachers took a total of 894.5 sick days, and over the same period that number dropped to 756.5, a roughly 15 percent decrease that equates to roughly $25,000 in savings from not needing substitutes.

"We stripped COVID out of the equation, we didn’t count COVID days, just pure sick days, last year compared to this year, a 15 percent reduction,” Skrocki said.

Earlier this week, the district received their first look medical rate cost estimates from their insurance carrier, and while previous years have factored in a six percent annual increase due to inflation, early projections for 2024-25 have that number at a zero percent increase instead.

"Our medical spend is about $25 million a year in North Penn, so a zero percent increase on a six percent medical trend is really $1.5 million in cost avoidance, in savings, for the school district,” he said.

And the district’s HR staff have said the center has helped with recruiting: "We had two teachers that were hired this year, they said that both had multiple offers in neighboring school districts in Montgomery County. They said the reason why they chose North Penn for employment was because of the North Penn healthcare center,” Skrocki said.

More Staff Needed?

Everside vice president of business development Stuart Sutley then told the board he’s helped set up nearly 50 similar facilities, and "this is definitely in the top three” in terms of utilization. Similar centers typically try to schedule about 75 percent of the time with appointments and leave 25 percent of the time free for sudden needs and paperwork, and so far utilization rates have trended closer to 78 percent in North Penn, with Mira booked at a 100 percent rate through January 2024, aside from early morning appointment times left open for sudden cases.

"One of the benefits of these health centers that we always promote to people is same day, next day access. And that’s getting harder to do — good problem, but how do we address that?” Sutley said.

As he spoke, Sutley showed a series of charts comparing district visit times and costs versus those in the private sector, and depicting how adding capacity could lead to further reductions in future medical claims and costs, while expanding the services offered. Skrocki added that he recently tried to make an appointment and had a three-month wait time, until January, and Bauer said he checked during the meeting and found a one-week wait time for an appointment.

"We’re required to do random drug testing of our bus drivers, and we wanted to bring that to the healthcare center. That would be a cost savings, but we don’t have the capacity,” Skrocki said.

The average visit has lasted 37 minutes, largely because they’re first-time visits with detailed questioning, Sutley told the board, and similar care at private facilities would equate to a roughly $765,000 bill for similar service.

"We find patients really open up, and that allows us to dive into other things that can be handled” via treatments, prescriptions or referrals, Sutley said.

Expanding capacity could help district employees better handle chronic conditions, which could further reduce future healthcare costs, and providing generic instead of name-brand medications could yield savings for those who use it, the consultant added. Board President Tina Stoll asked about how wait times are handled, and Skrocki and Bauer both said they’ve each visited the center three times, and every time they’ve had no wait, while substitutes or teachers with flexible time in their schedules cover the periods for those at appointments.

"One time I got in real quick, and I was like, ‘it’s because I’m the superintendent?’ And then I asked around the office, and they said no, they had the same experience,” Bauer said.

Plenty of Questions

Board member Al Roesch asked if staff at the North Montco Technical Career Center adjacent to the district’s high school could also use the center, and Skrocki said district staff have been in discussion with formalizing an arrangement for their staff to do so: "We thought it would be a natural fit, since in essence they’re on our campus, for all intents and purposes, at the high school.”

Added staff would be needed to handle the roughly 100 North Montco staff who could be eligible, and about 200 dependents of theirs, Skrocki said, and while no talks have yet been held about adding space for the healthcare center at the high school during renovations, the district is also in early talks with several similar centers across the county to provide shared access.

"North Penn would be one of four or five sites that, as long as you’re a participating district, then you could make an appointment at any one of the sites. If one of our employees lives in Collegeville, for example, and it’s more convenient for them to go to a site in Collegeville, they could use that one,” he said.

The current center, a prefabricated building installed next to Penndale, currently has enough space to handle added staff, and in time additional services like physical therapy could be added if more space is constructed, Skrocki said, and Sutley said he’s seen other clinics expand capacity by staffing for more open hours in the same facility. Board member Jonathan Kassa asked if staff have revised the initial projections of $10 million in savings over ten years on medical costs, and Skrocki said "If this isn’t just a blip, and I don’t think it is,” those figures could climb as high as $15 million to $16 million over that decade.

Board member Elisha Gee said she was the only vote against setting up the center because she had concerns about the payback period, and asked Skrocki if and when the facility would have paid for itself. Skrocki answered that the $1.3 million construction cost could in theory be offset by the $1.5 million in savings from the zero percent increase on medical costs for 2024-25, with more savings on medical costs possible, and the increase in staffing could be rolled back if it doesn’t yield savings.

"Six months from now, if the new provider is seeing one patient per day, we’ll scale that back. I don’t think that’s going to be the case. I think quickly, within a matter of months, the second provider will be at capacity also. That’s my expectation,” Skrocki said.

Board member Cathy Wesley asked how appointments are handled around the holiday season, and Sutley said the facility is typically open on the same days as district schools. Wesley then asked if staff could provide info on savings to each individual employee to try to increase utilization, and Skrocki said staff would do so.

Increasing the staffing would require a formal amendment to the district’s contract with Everside, and Skrocki said a vote from the finance committee would direct staff to prepare that amendment to add another physicians assistant at the clinic, likely for full board approval in December. As the board discussed that motion, Gee said she had heard stories similar to Garrahan’s from other employees who had seen similar successful treatments, and said the stats on the long-term savings had sold her on the payback period.

"You’ve officially proved me wrong. I knew it would only take you a little bit of time,” Gee said.

North Penn’s school board next meets at 7 p.m. on Nov. 16 at the district Educational Services Center, 401 E. Hancock Street. For more information visit www.Lansdale.org.

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