— by Orcas Issues reporter Matthew Gilbert —
The latest meeting of the Orcas Island Healthcare District (OIHD) was essentially a continuation of issues discussed at their most recent two meetings, the conversation focusing on clinic infrastructure improvements and choosing a consultant who specializes in helping communities choose appropriate health care delivery models that maximize reimbursement from payors.
Medical Clinic Improvements The Building Committee reported that it is still working out the best approach and materials to replace the roof and HVAC system. Getting in the way are “requirements documents” that are necessary to complete an RFP for soliciting bids to ensure contractors are bidding on the same system. The commissioners are now waiting for a proposal to prepare those documents. This is preferable to hiring a firm to prepare a full RFP, which would likely cost twice as much. When cautioned that an early estimate to get the work done was likely low, and that it’s now estimated the HVAC replacement would run $275+k, Richard Fralick channeled the group’s frustration: “This is painful.” While admirably sensitive to cost issues, the commissioners admitted that the best-case scenario still won’t deliver a final estimate before next year’s budget is finalized.
Communications The group set a time to hold two Town Hall meetings: October 5 from 3 – 5 p.m., and November 4 from 5:30 – 7:30 p.m. It also approved a Health Care District “advisory” on children’s vaccines by Superintendent Anne Presson, which was posted immediately on Orcas Issues.
UW Contract Issues A recent request from UW for an additional $40k in the budget to bolster their medical assistance staff – agreed to by the District if UW could also come up with a $40k reduction in other expenses – led to a long discussion on the original intent of the money. This was revisited based on a shift in how UW planned to use the funds and its inability to come up with those extra savings. The commissioners wondered if the request still made sense given that visits to the UW clinic fell well short of the projected number for the fiscal year: 9,800 v. 11,075. More staff for fewer patients did not pencil out. There was also concern as to why UW couldn’t come up with the additional savings. In the end, the motion to approve the original budget, which was adopted at the June 18 meeting, held.
Consultant The search for a financial specialist to advise the District on the best healthcare delivery model going forward – described by one commissioner as “the most important thing we will do during our term” – identified two final candidates: WIPFLi, a national firm with an office in Seattle, and Spokane-based DZA. Both have more-than-adequate credentials and both are capable of recommending the best model as well as implementing it. While WIPFLi is considered the best in the business, that expertise comes at a price and may be more than what is needed, so the District decided to go with DZA.
Request for After-Hours Support and Compensation A long-standing request by local physician and cardiologist Vincent Shu of the Integrative Medicine Clinic to provide the District and be compensated for after-hours medical services was formally denied. Comments made included “The complication of having two clinics is challenging enough,” “Does this really fit a need,” and “There is no way to integrate him into an existing practice.” In public comments afterward, Dr. Shu said he would re-work his request to address what he felt was a misunderstanding in what he was proposing.
The next meeting will take place on September 3 at the Eastsound Fire Hall.
It is interesting that both UW and OFHC are asking for a $30-40k mid-contract stipend, one to improve quality and the other to improve competitiveness.
Yet the appropriate response of the Commission to each would seem to be that it is quality of care that has succumbed to inappropriate business culture.
Each clinic but another version of the same false dichotomy which ultimately, in the microcosm that is Orcas, is giving us ineffective healthcare at unsustainable rates.
“One clinic or two?” -another red herring caught in the tangled net we’ve so carefully woven – together. QUALITY the key to AFFORDABILITY, longterm in rural America.
The cost for the consultant is $17,000.
The Board also approved a $5,000. increase
in compensation for Anne Presson the Superintendent
As reported on the financial ending June 30th
Operating expenses of $1,882,845.
My recommendation is we should have everybody under one roof and do we need the affiliation with UW ?
It seems to my observation you have the gist of where we are heading, P.
Methodically.
The long sorry history is that basic structural issues underlie both quality and affordability, to focus on either is to resolve neither. The fraught question of “one clinic or two” is Orcas code for this, but it is not a simple business proposition to be resolved at the bottom line but a more nuanced one that was not being asked when UW was invited.. And Island Hospital never held accountable to.
It’s like buying a home because you like the color (black or red ink). So we’ve asked a structural expert to evaluate the foundation etc. $17k investment once for a ~$2M annual commitment to our health future in a climate of uncertainty?
[And our Super, Anne hired at 0.5FTE apiece with Lopez is doing about 0.85FTE just for us during this transition.] I’d say we’re getting our money’s worth.
I was just giving information that was not reported in the above article. Anne Presson is doing a great job and the Commissioners have worked very hard. But the escalating costs of maintaining two clinics, maintenance for the building, after hours cost. Tax revenues for 2019 budget $1,473,784. + $455,000. (from loans) = $1,919,075
So it looks like we need more money ?