— 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.
I think that the Orcas District needs to look as to what is working or not for the Lopez District and be cautious as to what is possible on Orcas ? When you see that the Hospital District on San Juan just lost 5 million dollars for the first six months of 2018 ! Then we need to look at the cost of supporting basic care and proceed carefully with after hours care and it’s cost. It will be interesting to find out what the outcome of the discussion with UW at the special meeting on August 24th ?
After reading on San Juan Islander about the 5 million dollars lost for Jan through June 2018 for the San Juan Hospital District. So what is happening with the Lopez District and why is the Orcas District looking as to what the Lopez District doing since it is similar to the Orcas District ? Let’ s look as to what is working ?
I love the fact that the question of how to provide after-hours care on Orcas is being discussed – by members of a Commission elected by Orcas voters – and compromises proposed when sticking points arise – along with concrete plans for research, consultation, and community input.
In our wildest dreams could any of us have imagined such a scenario on our island 15 years ago? 10? Even 5? I’ve been focused elsewhere since the election of our OIHCD Commissioners, but I want to express my gratitude to all the participants, both commissioners, members of the medical and support staffs, and to the public. I know plenty of work lies ahead, but I believe that it is being undertaken by people of good will. We will all be the beneficiaries.
And on re-reading . . . my comment wasn’t focused on the after-hours care under discussion at this particular meeting. I hope you know I’m talking about the whole enchilada; medical care on Orcas.
As a frequent user of medical services throughout my life I have watched with great trepidation as both quality and affordability have slipped down the dark ladder.
My experience tells me that physicians are no longer able to practice medicine to their ability but , rather, are hamstrung by liability issues, as well as cookie cutter laws that fail to consider the individual needs of, yes, individuals. .
There is a name for the system under which we suffer – and yes, despite the libertarian wishful thinking of some, it IS a system – it’s called capitalism.
Whether its the local sawbones or the coking air we must all breath, Capitalism is killing us.
Which is to ask; What is it about single payer health care that you don’t’ understand?
This is not a rhetorical question.