— by Susan McBain, Orcas Issues reporter —

The Orcas Island Health Care District’s meeting on July 21 consisted of two parts:

  • A commissioners’ meeting, where more information about Island Hospital’s (IH’s) proposal to operate a consolidated medical clinic on the island was discussed; and
  • A Town Hall, at which community members were invited to ask questions that they would like IH to address in its public presentation to the community on Thursday, July 30.

In the first part, the commissioners discussed the answers they’d gotten from IH to a list of their questions regarding the proposal. Rather than the current subsidy based on projected annual revenue and expenses, IH proposes a fixed annual management fee in its contract with the District. The $1.2 million annual fee would include the additional services IH has offered: extended hours, including after-hours care; an RN working with EMS to coordinate services with the clinic; and integrated behavioral health (funding a licensed Clinic Social Worker). Without those services, the annual fee would be about $938,000.

The fixed fee, which incorporates startup costs for the practice, would provide stable annual funding through 2025. At the end of that period, the District would have a projected surplus of $218,000 if the annual fee were $1.2 million. With an annual fee of $938,000 for fewer services, the surplus would be far higher, $1.5 million. In contrast, the current two-clinic model would have a projected loss of $429,000 in 2025.

IH projects that in 2025 the hospital itself will still have an overall loss of about $500,000 based on the contract, but they hope for a long-term relationship that will let them recover that loss in the subsequent five years.

IH representatives acknowledged the importance of extensive community outreach and education to help ensure island-appropriate care and scope of services. They plan to work with the Orcas Community Resource Center, the Senior Center, the school district, the County Public Health Dept., and other organizations on this effort. They expressed a commitment to collaborate with EMS to effectively address patient access and needs for acute care during and after clinic hours, and seemed willing to adjust how those services were delivered if necessary.

The second part of the meeting was the public Town Hall, and more than 50 community members were present. Seven people submitted lists of questions to the commissioners via email, and those will be passed on to IH for them to address in their July 30 presentation. Questions asked at the meeting covered the following:

  • Does IH have a “medical home” model?
  • How will staffing be divided between physicians and nurse practitioners/physician assistants?
  • Does IH have a web portal allowing people to send questions directly to their IH providers?
  • Will IH contract with other providers who offer chronic disease prevention services, like nutrition education, fitness, and stress reduction?

Commissioners also suggested more questions:

  • IH’s budget shows a higher-than-expected amount for “Other Expenses.” What is included in those expenses?
  • Can the District get an assessment of actual versus budgeted costs every few years to support possible adjustments to the management fee?
  • Can the District continue to work with IH to identify further reasonable cost reductions?
  • Could IH provide an overview of the Skagit Public Hospital District (which operates IH), COVID impacts, and financial recovery plans? How would our losses be managed if COVID affects our revenues long-term?
  • Why did IH leave, and why do they want to come back?
  • What will IH’s central call center process be? Will patients be able to talk directly to clinic personnel?
  • Will clinic patients be treated as “new patients” on initial visits, as they were when the UW Neighborhood Clinic opened?

Commissioner Patty Miller concluded the meeting by noting, “We’ve learned over the last six months that partnering with a PB-RHC substantially increases revenues and will make the economics of the partnership more viable. But we’ve learned over the last two years that services provided are equally important, so want to make sure we understand what the service delivery model is and is not, so we can clearly communicate that to the community … We could still go back to the drawing board!”

The public presentation by IH representatives will take place on Thursday, July 30 at 5 p.m. The Zoom link for the meeting is currently posted on the District’s Meetings Calendar; click the link on July 30 to see it.

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