Health District Works on Compromises with UW

— by Susan McBain, Orcas Issues Reporter, updated Aug. 28 at 11:30 a.m. —

At their regular meeting on Tuesday, August 21, the commissioners of the Orcas Island Health Care District (OIHCD) faced the prospect of being unable to secure some of the medical services they want on island from the local University of Washington Neighborhood Clinic (UW). But what looked like one major barrier to the Commission’s efforts turned out to be not so big after all.

In discussions the previous Friday, commissioners Art Lange and Patty Miller learned that UW management could not agree to some points in the Commission’s proposed island-wide acute care model. As part of a large health care provider system with a clear model of services, UW management felt they could not commit to actions outside that model, such as always having a provider physically available after regular hours, or collaboratively sharing the provision of after-hours call with non-UW providers. Nor could UW increase open hours without substantial costs, although some shifting of open hours into evenings or weekends might be feasible.

In response, on Tuesday Miller suggested some compromises:

• Work with UW to allow its providers to come in voluntarily after hours if they deem it medically necessary, and to pay the providers for that service. The same agreement would be offered to Orcas Family Health Center (OFHC).
• Work with UW to clarify the skill set necessary to support acute care on island, to minimize the need for patients to travel off island for noncritical procedures. The overall UW model of services focuses on primary care, with referrals for acute and after-hours care; but given the island’s isolation, the commissioners want to encourage a broad skill set for local providers.
• Continue exploring options for different open hours at the clinic, at no increased cost.
• Begin tracking all acute and after-hours calls to the clinics and to Orcas Fire & Rescue’s Emergency Medical Services (EMS), to gather data on patient needs and how they were met. EMS is also collecting data on walk-in patients during the day, to determine which patients have medical emergencies and which come in for other reasons.

Another sticking point appeared to be providing after-hours care for people who are not registered as UW patients. However, that issue became minimal when UW clinic staff at the Commission meeting described the “mini-reg” process needed for new patients. Only basic information must be collected at that point, in order to enter new patients into the medical records system. On Orcas, any after-hours call that is not urgent enough for 911 or an emergency visit to the clinic is followed up by the local triage nurse early the next day, and all patients are seen if needed.

Lange pointed out that the most pressing need in developing a workable system is getting better data on what actual medical needs on the island currently are, and that a trial of this approach could provide such data. The commissioners agreed to present the compromises to UW management as soon as possible. Reaching compromise positions soon is essential in order to meet the District’s budget deadlines. (Subsequently, a special meeting was set up for Aug. 24 on Lopez Island to discuss these issues.)

The commissioners also agreed to schedule two Town Hall meetings, the first on Saturday, Sept. 8, 3 – 5 p.m. and the second on Thursday, Sept. 20, 5 – 7 p.m. The purpose will be to answer the community’s questions and address concerns about the major issues, such as acute and after-hours care, financing, and transfer of the OMF building.

The next regular Commission meeting is Tuesday, Aug. 28, at 4 p.m. at the Eastsound Fire Station.