— by Susan McBain, Orcas Issues reporter —
The Orcas Island Health Care District’s Town Hall on Oct. 28 was standing room only, as more than 100 community members gathered to hear the commissioners’ report and to ask a wide range of questions.
The meeting began with a comprehensive but concise slide presentation on the District’s finances, goals, accomplishments, and next steps. This article will not repeat that information; readers are advised to review that excellent summary (20 informational slides) before reading further here.
In the first 18 months of operation, the commissioners had three overarching goals:
- to launch the District itself,
- to stabilize operations of the Orcas Family Health Center (OFHC) and the UW Neighborhood Clinic (UWNC) so they could continue providing medical care on the island, and
- to determine a model of care that could meet the needs of islanders in a financially sustainable and cost-effective manner.
The first two goals have been met; the third has required, and will continue to require, lengthy and careful consideration of the many complexities of medical care systems. The five commissioners, and District Superintendent Anne Presson, have been giving their all to that process. But the deeper they have dug, the more complicated the options seem to get. So while they believe they are on the path to answers, they don’t have them yet.
The Q&A session that followed the slide presentation probed into details of the process, and the commissioners’ answers revealed more and more of the complexity they are dealing with.
- The most remunerative of the options the commissioners have considered appears to be Federally Qualified Health Center (FQHC) Look-Alike status, which could raise Medicare and Medicaid reimbursements by a half-million dollars per year or more. However, other possibilities exist, such as affiliation with a regional hospital, an existing FQHC, or the Family Care Network of practices in Whatcom and Skagit counties.
- The existence of two separate clinics (OFHC and UWNC) has been a major issue for the board, which has considered the implications of both co-location of the two in one building and consolidation of the two practices. However, the District does not own or operate the clinics. Commissioner Patty Miller observed that “we can’t force the clinics to do anything, but … we can say, this is how we will fund primary care services on the island.” Commissioner Art Lange expressed the opinion that in both clinics “the people are quality people and they’re delivering exceptional care. That’s different from whether or not the model under which they operate is a good fit for this community.” He continued that in his opinion “a single clinic is the best model we can strive for.” But the right structure for that model is not yet clear, and will take time to implement once it is clear. At that point the District will look to the community for its willingness to support the proposed model.
- The commissioners were very clear that the 31% increase in clinic reimbursement costs projected for 2020 and other cost increases were not sustainable; they foresaw that problem months ago. Lange observed that “we can’t sustain it [this level of increase] because of the taxing cap, and we shouldn’t sustain it because it’s too expensive.” Part of the problem is the island’s older population. For UWNC, 65% of patients are covered by Medicare (and Medicaid), compared with 30–35% on the mainland. Those public payors reimburse at much lower levels than commercial insurance. Also, older people often have more-complex medical issues than younger ones, leading to higher costs per patient visit. However, these factors are also what would make an FQHC designation a good one for us, since FQHC status could mean improved reimbursements through Medicare/Medicaid.
- One questioner, referring to the latest draft of the District’s proposed 2020 budget, asked about the costs of replacing the roof and HVAC systems in the UWNC building, currently projected to total $400,000. Multiple factors underlie the high projected costs, including the functional interrelations of the two systems, the difficulties of retrofitting, and state laws on how public entities must contract for services. The commissioners are still exploring the least-costly methods of updating the two systems.
- The commissioners explained “banked capacity” and how it would affect the levy and tax rates. In its first year, the District, striving to keep the levy rate as low as possible, set it at about $0.65 per $1000 of assessed valuation, rather than the maximum $0.75. The District is entitled to claim the amount it didn’t take then—about $239,000—next year or in future years (but only once). Facing increased costs, the commissioners decided to claim 75% of that amount—about $179,000—for their 2020 budget, enabling the long-term budget to remain in the black through 2025, barring unexpected cost increases. Because assessed valuations rose an average of 14% countywide this year, the levy rate will remain at about $0.65 per $1000; however, that will be applied to a higher tax base because assessed valuations increased.
- Replacement of Kaiser insurance coverage with Premera/LifeWise coverage was discussed. Presson has been dealing with Premera/LifeWise representatives frequently over the past few months and was very positive about their commitment to meeting islanders’ needs, including covering costs of air transport off island and allowing UWNC patients to be referred to UW providers, who would normally be considered out of network.
- One of the last questions is perhaps of most immediate interest to you, dear reader: Both clinics offer after-hours care. To reach OFHC after hours, call the office at 376-7778 and follow the instructions. To reach UWNC after office hours, call the office at 376-2561 and press 1, not 2; then follow the multiple prompts until you hear the Community Care Line option, which gets you to the UW triage nurse. (The direct number is 206-744-2500.) More about each clinic’s process is shown in slides 5 and 6 of the slide presentation.
Additional questions concerned electronic medical records, performance metrics for both clinics, what is happening on Lopez, and other topics. These will be covered in the Superintendent’s meeting minutes, which will be posted on the District website once approved.
The next regular meeting of the District commissioners will be Tuesday, Nov. 5, at 5 p.m. at the Eastsound Fire Hall.
The statement “Because assessed valuations rose an average of 14% countywide this year, the levy rate will remain at about $0.65 per $1000; however, that will be applied to a higher tax base because assessed valuations increased” is misleading in that it implies that higher assessments will result in (“because”) keeping the levy at 65 cents per $1,000 valuation. In fact, since overall taxes cannot increase more than 1% annually (plus new construction), the levy would have to be reduced to meet that standard. Keeping it at 65 cents when assessments rise significantly will result in a tax increase.
There were several unstated messages that I took from this very useful meeting. Perhaps the most evident one is this: Our incredibly able healthcare district commissioners are working their butts off to resolve these very thorny problems, with no financial remuneration. Thanks Art, Diane, Patty, Pegi, Richard for your talents, dedication, and tenacious hard work.
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[nicely written piece]
…whether the model under which we operate is a good fit for this community….
..Or whether our shared notion of who we are as a community must change to support the health of all our members.
Our PHD is best practices of transparent governance acting to establish the best prototype for providing future clinical services. But what we seem to need in parallel, is a secular orthodoxy of healing praxis that will bind up old wounds inflicted in the name of “health!”
For unhealthy social systems ultimately cripple systems of health ~care by violating our trust: Orcas’ costly endemic contagion of perverse altruism.
Or perhaps the bimonthly public rituals enacted by our commissioners following carefully the discipline of transparency, will gradually create a new eccumenism that redefines “health” for us. If we will let it.
..waiting to exhale..