— by Susan McBain, Orcas Issues reporter —
Negotiations on the contract between the Orcas Island Health Care District (OIHCD) and UW Neighborhood Clinics (UW) remain slow as a result of delays (thank you snow!), lack of clarity about specifics, and ongoing issues.
At their Feb. 20 meeting, the OIHCD commissioners spent well over an hour discussing the back-and-forth versions of the proposed contract between the two entities. The latest version came from UW and contained their suggested changes, which the commissioners felt generally were made without explanations and were lacking in specifics on services that UW would provide on Orcas. Chief issues, as before, were skills and services, after-hours care, OIHCD input on personnel, and metrics; other issues were indemnification language and the timing of clinic support payments.
OIHCD’s proposed contract had included a detailed list of specific services the commissioners wanted, but UW preferred a more general list, often including the phrase “as appropriate to primary care.” However, Commissioner Diane Boteler, MD, noted that the term “primary care” is very broad, and what UW considers to be primary care may not address the needs of a rural island setting. The commissioners had requested that UW management go through the District’s proposed list of services and identify what they would provide, might provide, and would never provide, but the District has not received a response to date. The commissioners agreed to try again.
On the after-hours care issue, the commissioners agreed again that after-hours access to a physician is critical. Boteler observed, “As far as I can tell, we’re in no different place than we were in May [when the District began operation]. That really frustrates me; I’m concerned they [UW] haven’t been willing to commit to doing what we know is a community need and was one of the reasons that the District was voted in.” Commissioner Art Lange added, “We need a definitive answer,” and said he didn’t see how the commissioners could sign a contract without acceptable language about after-hours care. Although UW has verbally reported some progress, nothing is in writing. Several commissioners took the position that if the District is unwilling to sign a contract unless it contains such language, the commissioners should let UW management know soon.
On the issues of quality metrics and OIHCD input on personnel, the two parties had some areas of agreement, particularly use by the District of existing UW metrics and District input into hiring decisions for medical director and clinic manager. But the commissioners agreed that a meeting between UW management and Lange, Boteler, and Superintendent Anne Presson is imperative and should be held very soon. In the meantime, contract negotiations will continue, focused on clarifying skills and services, suggesting language on personnel management, and clarifying customer satisfaction metrics.
Finally, the commissioners agreed to redo their bid package for roofing the UW clinic building and re-issue the request for proposal. They also created a formal building committee to handle building issues.
The Commission’s next meeting is Tuesday, March 5, at 4 p.m. in the Eastsound Fire Hall.
Thank you to all the OIHCD Commissioners working on our behalf. Thank you for the breadth of knowledge and experience you bring to this, and for the generosity of your time.
Ditto.
The OIHCD Commissioners are tasked with challenging work. Thank you for your service towards a healthier community.
What are the potential conflicts of interests that our Commission may have while negotiating with UW? It is fair to ask, as so much is at stake and UW is the 800 Gorilla in the room with a history of demanding “team” loyalty while skirting the problematic ethical territory unique to healthcare. I do not recall this having been asked of the OMF who initiated this relationship, either.
We have treated the point as mute that the benefits of this costly association with UW management are worth the price, while not considering a cleaner contractual relationship for defined lab/diagnostic & EMR clinical services while supplying OUR OWN, homegrown, management team lead by the Docs we know.
We are, for example, foregoing the Federal payments to qualifying Rural Health Clinics because UW deems them to be not worth their trouble to apply for them. Further, there are benefits down the road to unifying the clinics, now possible under the aegis of our new tax district. These include dental and mental health benefits we cannot receive right now and will never receive under UW management.
And there is the ongoing familiarity with UW management style that for ten months negotiated away our concerns about after hours care, finances and scope of practice by simply erasing them from the list we repeatedly resubmitted to them. Are they partners for the future? Is their negotiating style simply not flexible enough to meet our evolving needs as their most unique & uniquely demanding clinical project far from their usual stomping grounds?
The jury is still out, and it would be nice to be sure that UW does not receive any undue consideration that they may have grown accustomed to elsewhere.
*EMR – “electronic medical record” which we have paid dearly for, but which we retain ownership of separate from clinic management services, and the content of which our own Docs created from our own interactions with them.
Sorry, but I’m still really disappointed that this whole thing went through. We are a small county and we have an excellent resource in Island Peace hospital on San Juan County. I have received excellent care there and I’m very impressed by the facilities that they have on hand. an impressive lab that gets immediate results, a radiology department where you can usually get same-day x-ray, CAT scan and ultrasound and again results same day. There is a great family clinical staff and the practice of bringing experts in one, two and more times per month, including two times a month the portable MRI machine. There is a multiple bay Emergency room, 6 bed stay facility and an operating arena capable of handling my laparoscopic gall bladder operation if needed! I like that they have a series of clinics in Everett, Sedro Woolley and Linden and the main Peace Health – Saint Joseph’s Hospital, and huge specialty clinic behind it, in Bellingham. The service is seamless; in my experience over the past 2 years they have shown an incredible ability to be flexible on how and where to cover my individual needs as they arise. I’m am always covered by the knowledge that they proceed correctly with no trouble or surprises EVER with Medicare or insurance.
Frankly, the Orcas “medical center” still appears to be not much more than a doctors office and one that directs its call-ins for an appointment through Seattle! As a landowner on Orcas I am very disappointed that I was not given, at least, the choice to direct my percentage of the recent taxing district’s tax to Island Peace. We should be supporting this excellent local resource and it’s expansion.
I am curious whether UW is getting a subsidy the entire time it seems to be dragging its heels on a contractual relationship. I assume that it is. If so, on what is the amount of subsidy based? I haven’t seen this topic covered in the press reports.
The best answer can be had from finance guru, Commissioner Patty Miller or administrator Anne Presson with office hours, contact details at orcashealth.org
So, if I understand your question, this has all been determined by the public budgetary process that awards a subsidy based on accounting from each clinic demonstrating the shortfall left by accounts receivable, primarily by CMS.
As I understand things, we started out with an interim funding agreement and want to freshen it up as the relationship progresses with a continuing funding agreement, annually. There is a clause that gives a deadline that is passing presently for a resolution to the process which mandates 180 days of transitional management then an end to it. At last meeting there was discussion of changing that to further extend the negotiating process or make it not such a hard trigger, orrrr something.. “arbitration” etc. bla.
As I’ve alluded in my comments, UW is wonderful at obfuscating the process, even bringing up portentous verbiage that sends our very patient commissioners back to our lawyers for research, or to consider wasteful workgroups or verrrry expensive consultants instead of just .. to my sensibilities .. respecting our wishes at face value and doing what they’re supposed to. Ya know!? And we have too far to go after years of infighting. Primary Care is the hub of coordinating many many things, and we’re sweating the basics. It may be Medicine, but it isn’t Brain Surgery.
There is not really the sense that they are eagerly using their extensive world-class healthcare experience to take the initiative: to teach/assess, define and implement a unique Plan of Care for our Orcas community and build a relevant relationship.. More like pulling teeth without a er, dental plan.
s o t o s p e a k . .