— from Alison Shaw —
I worked at OMC as its Clinic Manager from 2008 to 2015, which included the transition to working with Island Hospital. Before that, I worked at the UW for 17 years as a Research Administrator in Medicine. With these insights, I urge all Orcasians to support the OMF-UW Neighborhood Clinics partnership.
Some reasons are obvious; others are perhaps less obvious but no less important.
- Depth and breadth of services to patients: Having UWNC on Orcas brings a level of expertise to our island that a small, independent practice can’t provide. Collaboration between the UW’s physicians and ours would benefit ALL island patients.
- Telemedicine: This is making a big difference in rural communities. The ability to see and speak to a specialist without losing a day of work or the cost of the ferry can be critically important to some (and therefore all) of us.
- Coordination of Care: this would be greatly improved with the Epic medical records software, used by nearly all Northwest hospitals and their associated physicians. Epic is the gold standard for many reasons, but especially because a patient’s records can be shared electronically, at a moment’s notice, with other physicians in an emergency situation.
- E-Care: Many Orcas patients can access a modified version of their primary care records now. But with E-Care and Epic, your primary care and hospital records can all be accessible in one place. E-care also provides greater access to your doctors – very important in times of need.
- Purchasing power: As part of a large organization, UW Neighborhood Clinics would be able to purchase medical and office supplies at lower, contracted rates.
- Compliance Oversight: Clinics must adhere to the Dept. of Health’s high standards for patient safety and infection control. Association with a larger, accredited organization like the UW ensures that these standards are met. Inspections are frequent!
- Credentialing Oversight: The Dept. of Health imposes strict rules about the credentials of all clinical staff so everyone performs within the scope of their licenses. A larger organization ensures no slip-ups or rule-breaking, thus ensuring a greater level of patient safety.
- Laboratory Oversight: The UW will ensure that all in-clinic laboratory protocols are up to date and properly followed with results reported directly to the patient’s medical record.
- Access to Continuing Medical Education: The UW has many superior CME resources for physicians and nurses. Training updates are important to all patients.
Please understand that no single, independent practice on Orcas has the ability to provide this level of expertise, depth of care, and additional services. And sustainability of the current individual practices over the long term is simply not feasible, for a variety of reasons.
If we are thinking of our future and that of our children, we must chose what’s best over the long term, regardless of current alliances. OMF has focused on securing medical services on Orcas for about 60 years, and with the UWNC alliance will provide those services for decades to come.
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Nobody is questioning the quality of care offered by UW. All
the reasons stated are valid. What is in question is the Medical Clinic going it alone regardless of the patient count of the other practices on the island. If we are truly interested in health care for all, then arrangements most be made to unify the three practices on Orcas. The Medical Clinic has a responsibility to all residents and tourists and should show their willingness to accept this obligation. Once again it appears they are operating for their own good and not the good of the island. Before you do anything, study the problem, work with others and find a solution acceptable to all.
Would it be correct to describe UWNC as a profit-oriented business enterprize, and not to be confused with the public institution of the University of Washington?
I hope that somebody can answer a couple of almost rhetorical questions for me and others. I think that if the answers are anything but “yes,” then this opportunity will be wasted & lost. From a patient’s point of view, the problems are very simple.
First (and this is relevant because Group Health is the only network that currently provides ACA-subsidized insurance here in SJ County: Does the UWNC organization work with Group Health? (I truly do not know this — sorry for my ignorance — but in the past, in my experience, UW medical providers have not been available as part of the insured Group Health network).
Second: Will Dr. Shinstrom’s patients & Dr. Russell’s patients as well as Dr. Gieffer’s patients be able to go to the Medical Center for care, or will we all have to switch physicians if we want to use the UWNC?
Simple problems — but if the answers are “no,” then this thing pretty much excludes people like me. That should matter; I am not alone.
I am curious.. will Medicare and secondary health insurance cover Telemedicine?
In response to Thea Patten and bj Arnold – Aaimee Johnson, Administrator for Orcas Family Health Center, addressed coverage in a previous letter to Ed Sutton in Orcas Issues, November 22. She said Tele Medicine was not covered by Medicare and it would be an out of pocket cost. Debra Gussin from UW at the OMF supported meeting agreed. As per Orcas Medical Foundation’s proposal, you would have to use the physician that is hired by UW to work at the Orcas Medical Center for care.
In other words, the OMC/UWNC proposal will provide a high-tech solution to our small rural population. at the cost of eliminating the poorer elderly segments of this population who cannot afford the out-of-pocket costs of telemedicine, and possibly paid for by a new taxing district levying across the property tax base, whether or not they choose to become patients of the new OMC.
The global studies of health outcomes plotted against per-capita spending on healthcare strongly suggest the current US system spends far more than European peers for no improvement in outcomes. The French medical system, with which I am familiar as a long-term resident of France, cannot afford all the capital investment of the US system, but its medical outcomes are similar to the US’s.
I am not convinced by the global data that the “state-of-the-art” care is worth the investment, particularly for patients of OFHC who might not be able to choose to continue seeing their long-standing physician.
The letter lists many reasons to support UW in a realtionship with the clinic. But everything listed is organizational, computer back end, big health integration, etc. The one thing missing from the list, and to me personally the most important thing, is the doctor(s). The doctor is the actual human aspect of medicine which the most critical link in the chain. Until OMC can figure out how to retain the eminently qualified doctors that do through its revolving door no amount of fancy technical support wil matter.
Agree with Jim. The so called nine patient reasons for supporting OMC contract with UW Neighborhood (most of which we already have) are indeed organizational or computer back systems that have little to do with patient care – in fact their costs are not covered by Medicare and probably not by private insurance. Not exactly a list of things we need or can afford at $300,000 a year. In addition, the reasons 6 thru 9 would lead one to believe that without OMC in contract with UWNC, our facilities are or might be unqualified, unclean and uneducated. That declaration is pretty strange coming from someone whose job it was to see that these items were attended to for 7 years.
A couple of things that keep standing out to more than one of us and implore OMC to answer.
Why can’t OMC be managed by local administrators who understand our island needs and island culture if OMC is obligated to come up $200,000-$300,000 a year anyway (the loss with or without UW? Then there is an additional need to come up with $750,000 to change over the inner systems plus $200,000-$300,000 as a promise to UW just in order for UW to take care of all of the administrative and technological needs at OMC doesn’t seem practical. There are technological options and local management that would not incur such costs.
And finally and a lot more important is that with all of the community comments regarding unification of the practices, why is OMF is still saying “no” and at least agreeing to explore the logic and finances of a merger?
It seems to me that the creation of yet another special taxing district (presumably, a “health district”) and associated levies to support the UWNC management of the OMC will be difficult to justify without much more information concerning who owns and controls the OMC and under what terms; why a facility that apparently has no mortgage or rent expense is losing so much money; and how all physicians with an interest in practicing there can be accommodated.
I’d also like to note that San Juan Island launched into a hospital district without considering a range of issues, and the resulting controversy caused serious damage to the community.
With respect to Compliance Oversight, Credentialing Oversight, Laboratory Oversight, and Continuing Medical Education: these are all state standards that all physician practices must meet.
While expressing no opinion about the UW proposal, I can say that the claim that a “larger organization ensures no slip-ups or rule-breaking” is inconsistent with my 35 years of experience. Nothing “ensures” no slip-ups. Regardless of the size of the provider, it is the experience, commitment, and compliance culture of a provider that contribute to high-quality care.
Fred Klein–UWNC is a part of UW Medicine, which is, in turn, part of UW, and unless I’m missing something truly unusual, not-for-profit.
What area does the taxing district cover? Waldron as well as orcas and crane? How would Waldron be served, and would we have a separate vote? Given the present board we certainly would not be interested in providing support for a non democratic structure.
for BJ Arnold
Medical coding and billing is complicated. Rural Health Clinic coding and billing is even more complicated. The answer to Virtual Telehealth being covered by Medicare and secondary/supplement in a RHC is a two part answer. The first, is NO, it is not a covered patient service by Medicare in a Rural Health Clinic. Only in person office visits, home visits, and Skilled Nursing Facility visits are covered by Medicare (and secondary insurers who follow Medicare rules). Medicare requires an in person face-to-face encounter between the provider (MD, PA, NP) and the patient. The second part of the answer is that a patient can go to a Rural Health Clinic, be hosted in that clinic with the required live streaming technology, have a virtual encounter with a provider who is somewhere else, and the Rural Health Clinic can collect from Medicare a “hosting” fee of about $25 because it has acted as the originating site. The actual payment for the virtual encounter goes to the provider on the other end of the live stream. The provider on the other end of the stream may not be in a Rural Health Clinic. The downside is that none of the costs for being the originating site can be included in the cost report to Medicare at the end of the fiscal year. The cost report calculates what the average cost is to see a patient, which Medicare uses to determine what the next years payment per visit (or All Inclusive Rate–AIR) is going to be. As I mentioned, it’s complicated. If you are interested, the following link is to a very nice summary about Rural Health Clinics. Telehealth is addressed on page 4.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/RuralHlthClinfctsht.pdf
Thank you Aaimee.
Comments in the Guest Columns of Orcas Issues about the future of medical care on Orcas have been both discouraging and heartening. I am discouraged to realize there are some misconceptions going around, but am heartened and grateful that so many of us care about this issue and are deeply concerned about the future. It sounds like many of us would like to see a merger of practices, improvement in relations, and reduction of waste. Quite so!
As a former employee of the OMC who had a lot of contact with the Orcas Medical Foundation (OMF) board of directors, I hope to clear up a few misconceptions here. In a future column, I hope to discuss the quandary we face in health care, and my thoughts about a possible solution. My intent here is to be unbiased, with respect for all concerned. (And with my thanks to Aaimee, who has answered a complicated question about Medicare billing in Rural Health Clinics, above.) Here’s a bit of history, as I understand it that I hope will answer some questions:
The OMF is a 501(c)3 non-profit that was founded 60 years ago with the mission to support medical services for all on Orcas Island. That mission has not changed. Board members serve a term of three years, and up to three partial or complete terms. OMF (under its prior name, Orcas Island Medical Building Association) raised the funds to construct the medical center building, which was completed in 1992. There is no mortgage; OMF owns the building outright. From 1993 – 2003 (roughly) Island Hospital had a contract with OMF to operate the practice. During that time, the Hospital contracted with Dr. Shinstrom and a few other practitioners to provide medical services. The practice lost money and in 2003, the hospital ended its contract. There may also have been an issue with some doctors leaving for other pursuits, but I don’t know much about that aspect. The OMF board sought the help of a consulting firm for guidance. I don’t know the nature of the negotiations that took place, only that OMF and Dr. Shinstrom did not renew their contract. Subsequently, Dr. Shinstrom established Orcas Family Health Center, a Rural Health Clinic and 501(c)3 non-profit. Around 2004(?), OMF contracted with Dr. Russell to establish a private practice at OMC. In 2005, Dr. Giefer was hired by OMF to be the second physician at OMC. At the end of 2005, Dr. Russell decided to leave and establish his own private practice. Then OMF asked Dr. Giefer to establish a private practice at OMC, which he did from Jan. 2006 to Aug. 2011. For a variety of very legitimate reasons, OMC still struggled to make ends meet and the OMF board sought a larger, outside partner. Peace Health was considered but – take note – they said the three island practices would have to be joined, and Orcas Island would need a hospital district before they would get involved. Then Island Hospital stepped in and negotiated with OMF to administer the practice at OMC. In Aug. 2011, OMC staff and practitioners became employees of Island Hospital. In 2012, OMC obtained RHC status. Around 2011 – I believe at Dr. Shinstrom’s request – the Dept. of Health sent a representative to determine the feasibility of setting up a Federally Qualified Health Center (FQHC) on Orcas. The conclusion was that an FQHC needs a minimum of 4,000 patients to operate successfully and only functions well when the whole community is behind it. With its disparate medical practices, Orcas did not qualify. Currently, the contract between OMF and Island Hospital ends on 6/30/2017.
Collaboration: it has been asked why OMF made no effort to collaborate with the other island practices. It did. In 2010-2011, extensive efforts were made by the OMF board to make it possible for Drs. Shinstrom and Russell to relocate to the OMC building and operate as separate practices under one roof while administrative, billing, and nursing services would be provided for a fee. Those efforts did not bear fruit. More recently, Dr. Fleming met with Drs. Shinstrom and Russell to explore ways the practices could work together. And I believe the most recent efforts by OMF board members, to collaborate on after-hours call, have also been rejected. It’s important to note: any practice’s rejections of offers to collaborate are not simply a blanket unwillingness to cooperate. It generally means that some of the conditions posed by one party are not tolerable to the other. So far, it seems no one has been able to get beyond this point, but it’s not for lack of trying!
The statement that OMC only cares for 25% of the island’s population is questionable. I ran those data for OMC back in 2011 and again in 2013, using a specific set of parameters. I would estimate that the percentage was closer to 40% of the island’s population, after correcting for visitors, etc. Those numbers fluctuate from year to year, and some patients tend to use more than one doctor depending on the type of visit. It can get complicated. Unless all practices use the same parameters and time period for their data queries, it’s really difficult to pin those numbers down with any accuracy.
Regarding Group Health – yes this is a problem if you want to go you the UW hospital. Generally, Group Health refers its members to Virginia Mason in Seattle for tertiary care. However, the Group Health primary care network includes contracts with many primary care clinics and the UW representative, Ms. Gussin, was confident that a UWNC clinic on Orcas would also be able to contract with Group Health.
Thank you Alison for your service to our community during your time at OMC and in your recent writing and fact finding.
I would also like to thank the current Clinic Manager, who is a member of our island community and I would imagine is doing a lot of juggling at the moment.
We often forget about the staff that is handling the load and the majority of the work. To the manager, the receptionists, nurses, and PA, I applaud you for not letting this chaos stand in the way of proper patient care. Your patients are lucky to have you.