OSAGE COUNTY — A significant portion of last week’s commission meetings focused on plans to establish a quick-care clinic through the Osage County Health Department. Health Administrator Kim Sallin reported Dr. Joseph Rakestraw has agreed in principle to serve as Medical Director, overseeing both general services and a nurse practitioner for the proposed Quick Care. Sallin said the transition is necessary because the current medical director does not wish to remain if quick-care services move forward. She said she and Western District Commissioner Dale Logan planned to meet with Dr. Rakestraw that night to negotiate a contract, but she needed a cap on what the commissioners would be willing to pay him in order to complete the contract.

Commissioners approved a compensation cap of $5,000 annually for the medical director to allow negotiations to proceed. That figure is based on what the Cole County Health Department’s Medical Director is paid, although Sallin said she did not anticipate paying that much.

The discussion highlighted the complexity of launching the clinic, including Medicaid credentialing, staffing, billing and space constraints.

Logan said he’d received a phone call from a constituent concerned the county is biting off more than it can chew, because Community Health already offers services in the community.

“We have had multiple people who have come to our clinic wanting to be seen,” Sallin said, “We don’t do that there, so that’s the first place that we recommend that they go, because it’s right down the road. Most of the time they are not able to be seen the same day.”

“The reason I have that concern is, you know, it’s going to cost us $100,000 plus to do this,” Logan said. “Taxpayer money ... How many patients do we have to see to recoup that?”

Sallin said how many patients the clinic can see and what services they can provide will depend on what services Dr. Rakestraw is willing to allow the nurse practitioner to perform, which would be part of the conversation that evening. After that, the Health Department would have to get credentialed with the insurance companies for those services.

“I don’t know what procedures we’re going to be doing until I have that conversation with Dr Rakestraw, and then we will have to advertise for a nurse practitioner,” Sallin said. “(If) he’s like, ‘Yeah, I’m okay if they do sutures,’ well, not every nurse practitioner does sutures. So, we will have to make sure that we find the right person.”

Sallin said if the clinic sees 10 patients per day and has to bill insurance for all of them, she’ll need an additional employee to do that billing.

“My thought and idea is, we’re going to try to rush getting credentialed with Medicaid,” she said. “Because if we say it’s $50 for you to be seen today, a person that has Medicaid does not have $50 to give to be seen. So, if we can rush to get credential with Medicaid, we can say we do accept Medicaid.

“I can’t predict the future,” Sallin continued. “I just know I will put my entire heart and soul into this and do everything in my power to make it work.”

Sallin also told commissioners she has an upcoming meeting with an electronic records vendor to determine costs associated with transitioning systems, a step she said will be necessary for billing and operational readiness if the clinic moves forward.

Commissioners voiced both support and caution. Logan said he supports the clinic “if this is good for the community, and it is sustainable for the county.”

“We’re playing with other people’s money,” Logan said. “And it’s our job to do a good job with that money.”

Officials also discussed how the proposed clinic would likely operate without x-ray equipment.

Eastern District Commissioner Jeff Peters emphasized the potential long-term benefits.

“I think it’s something that could help drive the health department financially in the future,” Peters said. “And it would be a great asset for the community to have quick care here.”

Commissioners agreed further cost analysis and planning will be necessary before expanding the program.

• Another major topic was the Missouri Department of Transportation’s Highway 63 project affecting Westphalia’s south entrance. Logan said MoDOT has indicated it does not intend to construct a bridge needed to preserve the access point and instead suggested the county assume responsibility for a short stretch of roadway. Logan said commissioners are unwilling to support that proposal.

“Once they eliminate our entrance, we’re never getting it back,” Logan said during discussion. “We’ve been talking about this for years. It doesn’t make sense to lose access now.”

Logan reported contacting Congressman Bob Onder’s office due to federal funding involvement and said a site visit had been scheduled to highlight the issue.

Commissioners also discussed regional mail delivery delays, with officials noting utilities and local governments have had to adjust payment grace periods due to late deliveries.

• Peters said the hoop building for the lot on Hwy. 100 should be delivered over the weekend. Commissioners later noted installation of the hoop building is delayed pending completion of the property transfer and receipt of the deed.

• Alan Faye of Higgenbotham Insurance stopped in to see if the county is happy with their current health care provider. Deputy Clerk Juanita Libbert said no one has complained.

• Peters was reappointed to represent the county on the regional solid waste management board as officials consider whether a shift in regional representation could better reflect rural needs. Commissioners expressed frustration with inconsistent attendance and organization among both the solid waste management and housing boards.

• Courthouse maintenance was also discussed, including exterior lighting that recently malfunctioned. Inspection determined the fixtures themselves were the issue rather than electrical connections.

ROAD & BRIDGE

Commissioners approved $7,000 to hire Mitch Bonnot Excavating to replace seven culverts on CR 303 in preparation for upcoming chip-and-seal work. The county will purchase pipe and rock while the contractor provides labor and equipment.

“I personally don’t think that we can do that as a team at Road & Bridge, with their own equipment and our own dump trucks, our own manpower,” Peters said. “I don’t think we can do that for that.”

Officials noted the work will require temporary road closures. CR 303 is scheduled to be closed on Tuesday and Wednesday of next week, unless delayed by weather.

• Commissioners also discussed anticipated reimbursement from MoDOT of about $6,766 for a bridge replacement on CR 611.

• They also reviewed and signed documentation allowing right-of-way acquisition to proceed for the CR 522 bridge project, with engineering representatives reporting preparations are underway to submit acquisition materials to MoDOT pending final paperwork.

• Commissioners also reported progress on the Pentecostal Bridge project, where equipment has begun arriving and tree clearing is expected to follow.

HEALTH DEPARTMENT

Sallin notified the commissioners that the Osage County Health Department has been awarded the contract to provide drug-testing services to State Tech.

Sallin said the testing will be provided at a rate of $150 each. Commissioners also discussed plans to transition certain county employee drug testing to be conducted in-house through the Health Department. Officials said Road & Bridge and 911 departments are expected to transition when existing arrangements expire.

911/Emergency Management

911/EMA Director Ron Hoffman proposed a 40-foot steel container for EMA storage, costing $2,681.

FINANCIAL

• Bills totaling $302,538.01 were approved by commissioners, with the following totals by department: 911/EMA ($2449.11),Assessor ($3,480), Building & Grounds ($520), Circuit Clerk ($1,073.42), Commission ($387.80), Election ($14,951.93), Health Department ($4,205.2), Juvenile & Family Court ($2,767.09), Misc. ($33,105.04), Prosecuting Attorney ($31.20), Public Administration ($1,003.35), Recorder ($200), Road & Bridge ($206,011.76), Sheriff-Jail ($14,918.60), Treasurer ($69.48). and Road and Bridge Misc ($17,364.03).

• The January Statement of Monthly Collections from the collector showed county tax distributions of $13,519.75 to General Revenue, $14,381.62 to the County Retirement Fund (CERF), $3,422.27 to the County Assessment Fund, and $26.08 to the County Collector’s Office. Taxes collected for the school districts were: $13,695.06 to R-1 (Chamois), $63,330.14 to R-2 (Linn), $59,191.12 to R-3 (Fatima), $18,434.72 to Maries County R-2, and $80.26 to Gasconade County R-2. A total of $8,876.53 went to special road districts, including Osage County ($7,684.85), Belle Special Road District ($65.80), Chamois Special Road District ($354.22), West Special Road District ($82.00), and Linn Special Road District ($689.66). Ambulance districts received the following: Osage ($4,973.46), Ozark ($1,588.59), and Maries ($1,060.41), for a total of $7,622.46. Fire Districts received a total of $8,443.77, including Belle ($991.60), Bland ($241.98), Chamois ($498.02), Cole ($204.06), Linn ($5,567.24), Meta ($198.61), and Osage ($245.01). Cities received a total of $2,686.14, including Argyle ($24.07), Belle ($218.58), Chamois ($549.12), Linn ($1,726.43), and Meta ($167.94).

• Checks were submitted for signatures.