— by Susan McBain, Orcas Issues reporter —
The good news is that the Orcas Island Health Care District has for the first time received a detailed, written proposal from UW Neighborhood Clinics (UWNC) for after-hours (night and weekend) medical care, in the clinic if necessary.
The bad news is that the proposal as presented is not within the District’s budget. However, as District Chair Richard Fralick noted, “A proposal of any kind is some progress!”
In UWNC’s proposal, after-hours call coverage would be divided among six providers. To prevent provider burnout, only half the coverage would be by providers employed in the clinic; temporary providers brought to cover, for example, a weekend would provide the other half. The cost of the proposal, including provider compensation, travel by the temporary providers, and overhead, totaled about $250,000 per year. Acknowledging that this amount is “outside our means,” the commissioners discussed ways of cutting costs, including use of medical school residents or perhaps on-island retired providers.
UWNC also had concerns about safety and support for the provider in the clinic after hours. They proposed that a clinical staff member also be on call at all times, and be compensated for being on call and for any clinic visits. The commissioners discussed other alternatives, including the possibility that, when appropriate, an Orcas Fire and Rescue EMT or a deputy sheriff could join the provider at the clinic.
But the negotiations are not over. After extensive discussion at their April 16 meeting, the commissioners decided to accept UWNC’s previous contract offer, which did not include the after-hours proposal. The only language they hoped UWNC would add is that UWNC’s phone triage staff, which handles all after-hours calls, would offer all callers all the options that are available to registered UW patients, including ability to see the provider on call if medically necessary and if the provider agrees. Negotiations on after-hours issues will continue.
Fralick reported that his investigation of the building’s maintenance needs indicated that replacement of the roof and the HVAC system are interrelated in several ways. Given the cost of these two projects, the commissioners decided to hire a consultant with knowledge of both types of systems, how they interact, and costs for different options. They expect the consultant’s services to cost about $5,000.
Finally, the commissioners authorized reimbursement of approximately $7,000 to Orcas Family Health Center (OFHC) for start-up costs for its vaccination program. They also authorized, per the OFHC contract, adjustment of the quarterly District payment to OFHC because of Dr. Shinstrom’s less-than-full-time status in the last quarter of 2018. Recognizing that OFHC does not offer the disability coverage that UW providers receive, they also approved discussions with OFHC about further adjusting the payment because Dr. Shinstrom’s reduced time in the clinic was due to his accident last year.
The commissioners decided to hold a one-day retreat on Monday, May 13, to discuss their progress during the District’s first year and longer-term issues in the future. The retreat will be a public meeting. The next regular District meeting is scheduled for Tuesday, May 7, at 4 p.m. at the Eastsound Fire Hall.
Why would you sign a contract without the resolution of the after hours care? Doesn’t this weaken your ability to negotiate this issue?
Kate, You ask a good question. The District actually only has an Interim Funding Agreement with UW (which is a temporary contract)and we are still negotiating with them.
Art Lange
There was extended discussion by the Commission of what kind of contracting tool available to them would best serve our needs and leave our options open. One of the unanswered concerns also, expressed by Dr. Boteler was about the disparity of payments between UW and OFHC contracts. This, and the resolution of the after-hours care requirement they are committed to, are unresolved matters that must be swept up in an interim agreement that keeps the doors open.
I have never seen as much ..disappointment on the faces of the Commissioners as after that last missive received from UW. However a born-again cynic of healthcare admin ethology, I am greatly encouraged by this LACK of concrete options at present because ‘best fit’ options do not become apparent until the pro-forma ballast is jettisoned and local resources are fully unfurled. .
Orcas presents a unique circumstance.
It was under UW’s provocation that we became a Public Health tax district, but it is only under local governance that we will eventually create a healthcare system that finds and defines our needs. IMHO we still are recovering from Island Hospital’s capricious management through puppet governance that did not respect our basic/long-term needs but fed into much local dysfunction. We are still waking up to how we may articulate those needs and regain our integrity. UW really did not want that job. We will be better off with their medical system than their management culture, if they can be unbundled. IMHO
Many clinics are not owned and operated by some mega-healthcare system. As a tax-subsidised system we are no longer bound to the convoluted finances and politics of an outside provider. We will not be playing hide-and-seek with their metrics, we will have full disclosure of finances, we will have access to Rural Clinic Medicare funds, we can save on a recombined clinic structure, we will be served by providers that can speak their minds without divided loyalties, we can integrate all local contributors with primary care and speak with one voice to outside health systems. On an island, bigger is not better, smarter, collaborative, is better.
UW appears to continue to be the tail wagging the dog of the healthcare interests of islanders. $250,000 is more than what it would cost to hire an almost full-time family physician who would work just the on-call times, especially in light of our excellent EMT program. And I’m still not clear on what the other hundreds of thousands of dollars we pay them covers.