Health District decides on subsidy for UWNC new fiscal year

— by Susan McBain, Orcas Issues reporter —

More than 20 community members—an unusually large number—attended the June 18 meeting of the Orcas Island Health Care District. They were there to observe the commissioners’ very public consideration of the amount of subsidy the District would provide to the UW Neighborhood Clinic (UWNC) on Orcas Island for UWNC’s 2020 fiscal year, which begins on July 1.

The decision concluded months of meetings, data analysis, and information exchange between the commissioners and UWNC senior and regional managers and clinic personnel. The budget proposal that UWNC presented at the meeting boiled the options down to three, based on the costs of different staffing models:

• Staffing at the level allowed by the $554,152 the District budgeted for the subsidy in its original financial model. This subsidy would support a staff of 2.75 full-time-equivalent (FTE) providers and 7.87 FTE support staff, including one RN and one licensed practical nurse.
• Staffing at the current level, which would require a subsidy of $683,601 to support the same providers and 8.77 FTE support staff, including the two RNs in the current model.
• Staffing at UWNC’s recommended level, which would require a subsidy of $802,787 to support the same providers plus 10 FTE support staff, including three RNs working 0.7 FTE each and two medical assistants.

The four commissioners at the meeting (Dr. Diane Boteler was absent due to work obligations) agonized aloud individually over their preferences. All were acutely aware that the increases over last year in UWNC’s budget—20% for providers (because of UW Medicine’s decision to standardize provider compensation across its entire system, not because of a local increase), 7.1% for support staff, and 15% for other expenses—are not sustainable. Yet the clinic’s staffing needs are well documented and widely felt in the community, and addressing those needs is critical to ensuring the delivery of high-quality primary care. Commissioner Patty Miller noted that the increase is forcing the commissioners to take a comprehensive look at the island’s overall health care structure—whether they can support two clinics, and whether they need to consider relationships with other systems. (See the letter recently published by the District on this topic.)

All the commissioners agreed that the first model was untenable, so the discussion focused on the second and third. Art Lange suggested approving the second model with a proviso that the amount could be adjusted depending on how well clinic operations proceeded and that any increased funds would go directly to staffing.

Patty Miller said she was “torn” between the responsibility to spend taxpayer money efficiently and the need for adequate staffing that she had heard expressed by the clinic staff. She was concerned about why the number of patients seen per day per provider and per support staff was slightly lower for UWNC than for the other major clinic, Orcas Family Health Center, and yet staff stress levels appeared to be much higher at UWNC.

Pegi Groundwater preferred the second option, observing that the time required to find and hire staff would probably create some savings. Richard Fralick was in favor of the third option, wanting to see the clinic operate at the level needed to be successful for both staff and patients.

In the end the commissioners voted, reluctantly, to set the budget and associated subsidy at the level of the second model, $683,601, with the option to increase funding up to $725,601 provided that the additional dollars go to increasing the level of clinical staffing. That decision leaves it up to UWNC whether it will increase its number of RNs to three, or will stay with two RNs and add a medical assistant. In order to reach adequate funding for any additional staff, UWNC would need to revisit its “Other Expenses” category to try to find enough savings to support an additional hire.

Their reluctance was intensified because Fralick had earlier delivered the latest news on replacing the roof and HVAC system in the clinic building. A consultant’s report on the best approach to the work has raised the potential costs to double the budgeted number. And the issue of UWNC’s provision of after-hours care, and attendant costs, remains to be settled.

The next regular District meeting will be Tuesday, July 2, at 5 p.m. in the Eastsound Fire Hall.