— from the Coalition for Orcas Health Care —
In several days, volunteers for the Coalition for Orcas Health Care (COHC) may respectfully request your signature on a petition for a Public Hospital District on Orcas. Who? What? – you might ask.
The COHC is a diverse group of Orcas citizens dedicated to the concept of comprehensive, sustainable health care services for all Orcas residents and visitors – now and into the future. The COHC began as a small group of people with a special interest in health care, some of whom have unique experiences having worked in the healthcare field. They contributed several letters to the editor in our local news media and participated in conversations online – all in support of that elusive goal on Orcas: truly consistent, sustainable primary care, including urgent and after-hours care. They knew from first-hand experience that the clinics on Orcas have struggled to survive financially.
The issues facing rural health care aren’t unique to Orcas; generous philanthropic donations have kept Orcas clinics afloat for many years. “Many people have monitored our health care revenues and expenses, and Orcas clinics have tried various ways to maximize revenues, but it’s always the same story,” said Alison Shaw, retired Clinic Manager and COHC member. “The reasons are many, but the simple truth is, insurance and self-pay revenues cannot support comprehensive medical care in rural practice.”
Thus, the COHC began investigating ways to support our island’s health care, guided by one, golden rule: A solution MUST support health care services for everyone on Orcas. Coalition members met with local physicians, nurses, and health care administrators, the Chief of Orcas Fire and Rescue, and other stakeholders. The concerns all focused on one need: sustainable financial support to shore up the clinics and provide resources to fill gaps in other needed services and programs. And that need pointed to one financial mechanism: a Public Hospital District.
[perfectpullquote align=”right” cite=”” link=”” color=”#778899″ class=”” size=””]The simple truth is, insurance and self-pay revenues cannot support comprehensive medical care in rural practice.[/perfectpullquote]
“There is no intent to build a hospital on Orcas,” said Art Lange, COHC member. “By state law, the definition of a Public Hospital District means a public health services district. Our focus is on health services for everyone, for now and for generations to come.”
The Coalition for Orcas Health Care has submitted a draft petition to the County Council. When approved, Coalition members will be in the community, asking for signatures. “Our primary goal now is to get enough signatures on the petition to place a measure on the ballot in April, 2018. This will give all members of our community time to learn more about the issue, discuss it thoroughly, and come to a vote about how to ensure the provision of primary and urgent care in a financially sustainable manner,” said Dale Heisinger, retired pediatrician and COHC founding member. “Lack of sufficient funding for Orcas health care has been going on for many years. I fear if we don’t act now, our clinics and the ability to tend to the wellbeing of islanders will be in serious jeopardy very soon.”
“This will give all members of our community time to learn more about the issue, discuss it thoroughly, and come to a vote about how to ensure the provision of primary and urgent care in a financially sustainable manner.”
I’ve practiced health care reimbursement law for 40 years and am truly puzzled why you would prepare and circulate a petition to establish a hospital taxing district that has no details about how the tax monies would be spent, which is how I read the comment above. (If I’m wrong, please let me know.) This is an exceedingly complicated issue, as even President Trump finally woke up and realized, and the parts are all moving as we speak.
I’m particularly interested in how this initiative meshes with the UW takeover of the Medical Center, including the terms of the arrangements between UW and the Center.
NOW is the time to decide what you want to accomplish in specifics. What do other rural hospital districts do if they don’t run a hospital?
Peg, You are very correct that the details regarding a Public Hospital District and how the members of our community want to ensure that everyone has access to high-quality primary and urgent care (including after-hours care) in a financially sustainable and predictable manner now and for generations to come is critical. The petition that will soon be circulating to put such a measure on the ballot will do just that. it will enable the members of our community to have a thorough and ongoing public discussion about all the dimensions of this issue from now until the vote in April, 2018. Signing the petition is not an endorsement for such a district. Signing the petition does give us all the opportunity to engage in that public discussion about how we want to address the need for primary and urgent care. I hope you will support having that discussion and that you will be an active participant in it.
Art Lange
Peg Manning wrote: “I’m particularly interested in how this initiative meshes with the UW takeover of the Medical Center, including the terms of the arrangements between UW and the Center.”
I agree with her. I want more information before I put my name to anything.
I believe that we do need some sort of medical-clinic-support taxation, but I want to know more about tax rates, and about where disbursements will go and how they will be apportioned.
As stated by both Peg and Steve, we need a lot more information about the costs before we agree to sign a petition. A source of dull reading about the authority of public hospital districts can be found on:
Chapter 70.44 RCW, PUBLIC HOSPITAL DISTRICTS, Chapter Listing, RCW Dispositions
I’m surprised the initial article didn’t refer to Lopez’s efforts along these same lines. Check out https://www.lopezislandmedical.org/blog/faqs-about-the-proposed-public-hospital-district for their info. They’re a few steps ahead of us in the process.
I’d also like to see details *before* putting it on the ballot.
Deciding on the scope and budget for the district is the work of the commissioners who will be elected on the same ballot as the taxing district. It is critical that we attract smart and able candidates who can work together and transparently to establish a program that will work for the entire community. The maximum taxation rate for this type of a district is 75 cents per $1000 of assessed value (which is what Lopez has set). The COHC group anticipates the rate will likely be more in the 45-50 cent range (which is closer to San Juan Islands rate).
As Art says — the petition is just to allow a measure to be on the ballot. It is not an endorsement of anything. If a measure is allowed to be put on a future ballot, then there will be much discussion, teeth gnashing and hand-wringing about the scope of the taxing district. At that point you can support it, vote against it, stay home and do nothing. Right now — the petition is a way of allowing our democratic electoral process continue.
There are so many factors affecting rural health care nationally – and locally on Orcas – that it would be too much to list in an Orcas Issues or Sounder opinion piece. That’s why we hope to gather sufficient signatures to put this on a ballot. That way, we can share much more detail in constructive, public conversation with as many Orcas residents as possible. Signing the petition is not an up-or-down vote; it simply allows us the opportunity to vote in April.
For some very good background reading, I highly recommend John Baily’s article on “The Top Ten Rural Issues for Health Care Reform,” at https://files.cfra.org/pdf/Ten-Rural-Issues-for-Health-Care-Reform.pdf Also, “About Rural Health Care” by the National Rural Health Association at https://www.ruralhealthweb.org/about-nrha/about-rural-health-care
And, yes, reading the RCW 70.44 governing Public Hospital Districts is indeed dry – no argument there! But some of us have done it several times over, and it’s important to understand those details. I personally care a lot about this issue and thank everyone for being engaged in the conversation!
Respectfully,
Alison Shaw
Wouldnt it be ideal if Orcas could look to San Juan and Lopez, seriously ponder a sustainable model, and thru a very focused effort engage the community for ITS own model.
Creating ownership and commitment early on, Orcas has demonstrated the ability to rise to the top, but it will require transparent and sound leadership.
Happy trails!!
“Deciding on the scope and budget for the district is the work of the commissioners who will be elected on the same ballot as the taxing district.”
Does this mean that we will have a vote on whether to create a district at the same time that we must choose commissioners to decide what the district is going to do? This sounds very much like the initial school bond effort.
I cannot comprehend how anyone expects to be able to determine how “to ensure that everyone has access to high-quality primary and urgent care (including after-hours care) in a financially sustainable and predictable manner now and for generations to come” at all, much less in 6-8 months.
Will Medicare and Medicaid patients receive assistance, and if so, how? What if someone is eligible for Medicaid but declines to enroll? Will any of the funds be devoted to catastrophic costs? Are there plans to cover insurance costs for those who cannot afford them? Or to cover co-pays and deductibles? Or to pay for services outright? Or are we back to talking about subsidizing deficits run by particular practices? If so, do we get to see the formula for what constitutes a deficit? What about patients who don’t get care at a particular practice? How will subsidies of practices affect rural health clinic reimbursement of existing practices? Is there no plan or outline of the issues available to voters now?
I’m spending my energy trying to persuade the electorate that we desperately need Medicare-for-All. Until that occurs, we have a wildly dysfunctional and complex medical “system” that is currently in even more chaos than usual, and its future shape and scope are unpredictable.
If, on the other hand, the district is intended principally if not exclusively to subsidize the UW system for its assumed losses at the OIMC, please just say so. If that is the case, then when will the voters see the terms of the agreement with UW, the business plan, and the definition of “loss” to be used?
BTW, the San Juan experience really should not be held up as a positive. It just about ripped the community apart. Some folks thought that it would be easier and cheaper to get chemo and other procedures on an outpatient hospital basis, because of then-existing favorable Medicare reimbursement for outpatient hospital services as compared to such services in physician offices. What they didn’t consider is that that plan required building, equipping and staffing a HOSPITAL, and that rates for emergency visits and other procedures would reflect the initial and ongoing investment required for a hospital. Many people howled at the cost of ER services, remembering that Dr. X, would have sutured a cut for $100. There was also the issue of contracting with a religious-sponsored hospital that refused to perform certain procedures or to provide certain medical advice on religious grounds alone.
In sum, this is either an enormously complex undertaking in a field of moving pieces, or a plan to pay UW for providing services here. Please tell us which before asking us to sign a petition.
One final question: have the group circulating the petition consulted any regulatory attorneys about its plans? I’ve spent the better part of my career wrestling with similar webs of regulatory and payment issues involved in healthcare and cannot begin to understand the road we’re headed down.
[Art–I’d love to discuss this offline.]
It turns out that the Lopez experience may not be a good model, either.
https://www.lopezrocks.org/page.php?type=item&item_handle=1491686010&menu_type=forum&return=search&comment_handle=1491770954#1491770954
No real information about/from the “coalition”. A very small and non inclusive group operating in private on thier own behalf and that of UW. We have failed these kinds of plans before on election days. Too many activists and “experts” and not enough common sense
Would our tax district own the clinic? Or just pay to support another private clinic. Many other thoughtful questions are being asked.
Let’s consider a slower, more inclusive and thoughtful planning cycle before we let the tax dogs run free again.
Pretty hard to undo a half baked, rushed to the ballot box idea once we grant tax authority.
Certainly, a first step would be letting the public know the makeup of the Coalition, which is not an elected or otherwise designated official body.
Is there a site we can see the minutes of the Coalition or see the petition that was sent to the county. Is there a contact person we can get hold of for any questions. Are the meetings open to the public. Thank you.