Health Care District tackles after-hours care, building maintenance, financing

— by Susan McBain, Orcas Issues reporter —

The major continuing topics for the commissioners of the Orcas Island Health Care District (OIHCD) sound familiar: provision of after-hours care; costs to support the two clinics, Orcas Family Health Center (OFHC) and the Orcas UW Neighborhood Clinic (UWNC); and maintenance of the clinic building that houses UWNC.

OFHC already provides after-hours consultation to anyone who calls when the clinic is closed. If the provider determines that an in-person visit is needed, the caller is seen at OFHC’s offices. UWNC offers several options to after-hours callers via a triage nurse process, which starts with a call to the clinic number. The nurse receiving the call will suggest one of five options to the caller:

• Calling 911.
• Home care recommendation with clinic follow-up.
• Virtual Care with a provider via video or phone for a $35 fee.
• Connecting caller with the provider on call (Orcas or Lopez provider) if the triage nurse deems this appropriate. This option is available only for callers who are currently established with the practice.
• At the provider’s option, meeting the provider at the clinic for an in-person visit when the provider deems it medically appropriate.

Community members “really want after-hours care,” says Commissioner Diane Boteler, but finding a way to create a sustainable model without being able to share calls across the two clinics and all providers has been a challenge. Boteler is concerned that without similar after-hours coverage at both clinics during the busy summer months, the burden on OFHC providers may become unduly heavy.

One issue that commissioners thought had been resolved arose again when they received a letter from a visitor to Orcas who was refused assistance by UWNC’s after-hours triage nurse because the patient was not an established patient with UW Medicine. OIHCD has been actively pursuing this issue with UWNC and expects any agreement between the two to include providing all options to all after-hours callers.

Building maintenance has become an unexpectedly complicated issue, partly because the building actually has five separate roofs, each with specific HVAC equipment. The cost of an evaluation by an HVAC engineer of the best approach to replacing the roof and HVAC system will be $10,000–$15,000. The commissioners voted to approve an agreement for an evaluation by Hargis Engineers, with some additional expense restrictions.

The finance committee reported on a meeting with UWNC representatives to discuss costs of different staffing models, the largest element of clinic expenses. In response, UWNC provided budgets for four staffing options, all including Drs. Alperin (0.7 time), Fleming, and Russell. The options related to recent staff resignations and whether or not those positions would be filled. The options included:

• no replacements for a nurse practitioner and an RN who recently resigned;
• replacement of an RN only;
• an increase in the medical assistant and front-office staff; and
• an increase in the nursing staff.

The amounts that OIHCD would need to subsidize ranged from the $554,000 in OIHCD’s current budget to $901,000, not including any additional costs for after-hours care. The commissioners still have questions about UWNC’s assumptions regarding projected number of visits and revenue.

The commissioners decided that because of their current issues and workload, they would be unable to participate in a feasibility study by the Inter-Island Healthcare Foundation concerning the need for long-term care in San Juan County (see earlier Orcas Issues article).

The next regular OIHCD meeting is scheduled for June 4 at 4 p.m. at the Eastsound Fire Hall.