Guest Opinion | Viability of Medical Practices on Orcas Island

— from Paul Kamin —

Dr. Russell and Dr. Shinstrom have both been part of Orcas Medical Center, and subsequently chosen to practice medicine separate from the Orcas Medical Foundation. Both have been operating their own practices for more than a decade. Both Dr. Russell’s Orcas Island Family Medicine and Dr. Shinstron’s Orcas Family Health Center operate privately and without public subsidy.

Why is it not possible for a medical practice to operate in a financially viable way at the Orcas Medical Center facility? The Orcas Medical Center website reports an average operating deficit in recent years of $122,000, with a high of as much as $300,000 in one year? This deficit was sufficient to dissuade Island Hospital from continuing its relationship with the Orcas Medical Center. This deficit is sufficiently troubling that the University of Washington Neighborhood Clinic wants some assurance that the community will cover future deficits.

A medical practice is many things, but one of them is a business. This begs the question: how is a UW Neighborhood Clinic housed in the Orcas Medical Foundation’s building going to be more financially viable than the current practice? I have a difficult time considering the concept of a public subsidy for only one of the three medical practices on Orcas.

The current fundraising campaign to raise the $750,000 required by UW Neighborhood Clinic in order to support establishing a new practice on Orcas is needed for two expenses. First is the transfer of existing Orcas Medical Center patient records to the EPIC electronic record keeping system used by University of Washington health care network. The second cost is to cover “transition funds for the first six months of operation until medical reimbursements begin to come in.” The “transition funds” statement is quoted from the Orcas Medical Foundation website.

I can understand that it will take some time for insurance companies, and Medicare to process claims and provide payments. But for each service provided starting on day one, UW Neighborhood Clinics will eventually get paid, either by the patient or a third-party insurer. Why is the community being asked to cover these costs as part of the $750,000 fund raising campaign? Businesses commonly secure “bridge loans” for these types of start-up expenses. Is there a plan in place where the Orcas Community re-coups the “start up” funding being required to support the early cash flow challenges of this new UW Neighborhood Clinics medical practice?

UW Neighborhood Clinics is asking a lot of the Orcas Community. Perhaps wisely so given the local health care history of multiple isolated practices. We are being asked to have faith that UW Neighborhood Clinic’s presence will improve the medical care on Orcas. I can see that potential. As I understand it we are being asked to insure against financial losses. I struggle with this concept.

At this point, there is no commitment as to who the medical providers at the new UW Neighborhood Clinic will be? UW Neighborhood Clinic is not committed to retaining any of the current staff at the Orcas Medical Center. UW Neighborhood Clinic has not put forward a plan or invitation to consolidate other medical practices on Orcas. If (big IF) Dr. Shinstrom’s and Dr. Russell’s practice were to become part of the proposed UW Neighborhood Clinic, what are the costs of migrating their patient records, and who would be responsible for these costs? Is this a second community fundraising effort?

If Dr. Geiffer is not selected to work at the new UW Neighborhood Clinic (or choose not to), why would he not open a new private practice on Orcas, as Dr. Shinstrom and Dr. Russell have done. What would such a move do to the financial viability for a UW Neighborhood Clinic in the Orcas Medical Foundation’s building?

There are multiple factors influencing the need and timeline for changes at the Orcas Medical Center. Volunteers at the Orcas Medical Foundation are being leaned on heavily to “blaze this new trail.” As others before me have said, I’m hoping for a more comprehensive vision of what the Orcas medical care landscape will look like at the end of 2017.

“Community Health Care” on Orcas has been missing the “Community” part. The walls that have existed between Orcas Medical practices are not the foundation that I’d like to see used to build the community’s health care future on. To continue the construction analogy, I’d like to better understand how this future foundation is going to support everyone under this new roof.