UWNC Senior Staff Agree Orcas Needs After-Hours Care

— by Susan McBain, Orcas Issues reporter —

A recent discussion between Orcas Island Health Care District (OIHCD) commissioners and UW Neighborhood Clinics (UWNC) regional officials took center stage at OIHCD’s December 4 meeting. The discussion produced the most positive results to date in OIHCD’s effort to achieve its desired model of care at UWNC.

Commissioners Art Lange and Diane Boteler held a phone conference with Mark Bresnick, associate director of operations for UWNC’s North Region, and Dr. Matt Jaffy, assistant medical director of the region. The commissioners continued to seek UWNC’s agreement to provide after-hours care, at the clinic if necessary, to all residents and visitors on Orcas Island when medically appropriate.

Lange reported that Bresnick and Jaffy had agreed with the commissioners that there is a need for after-hours care on Orcas. “That’s huge!,” Lange said, because UWNC’s initial contract required only primary care during office hours. Their agreement effectively cancelled UWNC’s request for a consultant study of models of care in remote rural settings freeing $50,000 of OIHCD’s budget for 2019.

“That’s Huge!” –Art Lange

Bresnick and Jaffy agreed to seek ways for UWNC to:

• Provide all callers with access to all the care options that are available to established UW patients. The main barrier is the need to register new patients quickly (a “mini-reg”) in order to meet medical records requirements, but Bresnick felt there was a way to accomplish that.
• Provide access to a physically accessible provider on Orcas at all times, even when the provider on call is located on Lopez. At present UWNC providers come in voluntarily, but they are not required to do so. UWNC concerns about “substantial financial, contractual, risk management and compliance implications” are still to be worked out in full, but Lange noted areas of progress. UWNC providers reportedly understand the need for after-hours care but have concerns about frequency, coming in alone, and sometimes needing “a second pair of hands.” Lange also mentioned UWNC concerns about “burning out” providers with excessive after-hours coverage, observing (as he has before) that this problem and many others would be minimized if the two island clinics, UWNC and Orcas Family Health Center (OFHC), could be consolidated into one.
• Collect data on the number and disposition of after-hours calls to the UWNC triage nurse, the after-hours calls referred to the provider on call, and after-hours visits by patients to the provider on call. UWNC will begin collecting those data.
• Provide mechanisms for EMS to reach the provider on call quickly and easily. Discussions between EMS and UWNC and between EMS and OFHC are currently addressing this issue.

The commissioners began reviewing a proposed 2019 contract with UWNC, based on the recently signed contract with OFHC. The proposed contract includes the points agreed upon in the discussion with Bresnick and Jaffy. OIHCD negotiators Lange and Boteler are continuing the contract talks with UWNC.

In a simpler but important decision, the commissioners agreed to fund OFHC’s purchase of a new refrigerator/freezer that meets CDC requirements for storage of children’s vaccinations. The new equipment will allow OFHC to administer vaccinations without issues of increased fear on the part of the child, increased liability, and patient inconvenience. And Lange again commented on the cost savings and operational efficiencies that could be achieved if the two clinics consolidated.

The next OIHCD regular meeting is Tuesday, December 18, at 4 p.m. at the Fire Hall.