— by Susan McBain, Orcas Issues Reporter —
The commissioners of the Orcas Island Health Care District can stop spending money out of their own pockets for their activities. At their June 26 meeting, they approved Resolution 2018-11, authorizing an interlocal agreement with San Juan County for a $400,000 short-term loan to cover immediate District expenses.
Another important step was to hire a minutes taker. Leif will take that position, freeing Commissioner Patty Miller to focus on the Commission’s needs for information for decision making. She will continue looking into what computers might best meet the commissioners’ needs at the lowest price.
For the superintendent position, two candidates have applied to date. The deadline for applications was Saturday, and the commissioners would like to interview the candidates at their July 3 meeting. However, travel to the islands will be difficult at that time, so the staffing committee may hold preliminary interviews by phone or video, and then plan on further action at the Commission’s July 10 meeting.
The commissioners made some progress on details of long-term financing through a tax-exempt bond. However, the need for a legal opinion from their bond attorney that the bond qualifies as tax-exempt will push the finalization of the loan out for several months. The commissioners want a clear definition of what is needed to issue that opinion. They may ask the bond attorney to attend an upcoming regular meeting.
The Commission has received high-level budgets for 2019 from UW Medicine (UWM) and Orcas Family Health Center (OFHC). Having total amounts is useful, but the commissioners felt they needed considerably more detail before they could begin to provide funds to the clinics. The bond attorney will also need details on what the funds will be spent for in order to issue a legal opinion.
The discussion moved next to the metrics needed within contracts with the clinics. The metrics will be the basis for evaluating the cost and quality of services the clinics provide. The Commission decided to focus first on productivity metrics, such as relative value units (RVUs, a measure of individual physician productivity used by Medicare) and patients per provider per day. The commissioners want to determine the values of several metrics for the two clinics, and also to gather information on industry standards for those metrics. They will contact several organizations that may have information on industry standards, both nationwide and locally. Aaimee Johnson, OFHC office manager, also provided names of organizations that may have local information.
The commissioners will begin considering patient satisfaction metrics soon. And they agreed that while comparisons of the metrics of the two Orcas clinics with industry standards is important, how the clinics perform in meeting the District’s goals will be their most important focus.
Urgent care was the next big topic. Commissioners Diane Boteler and Art Lange have been interviewing people at the two clinics about their urgent care services. Boteler pointed out that the two types of urgent care—open-hours care and after-hours care—will have different processes. The two commissioners agreed to draft a description of the District’s desired model of urgent care in each situation, and are also asking the two clinics to describe the services they currently offer of each type.
The discussion also covered a couple of cautions about District procedures. Miller noted that District practices need to ensure that any changes to contracts are quantified and made in writing. Lange pointed out that patients may come to the Commission for help with issues with a provider, and that while they may wish to be helpful, commissioners must be careful not to take on an ombudsman role.
Public comments addressed ways in which compliance with the Health Insurance Portability and Accountability Act (HIPAA) might or might not be needed, both for the practices and for the District, and the possibility that the number and cost of providers under the current structure might exceed the community’s needs and ability to pay. The two clinics employ a total of nearly six full-time-equivalent providers between them.
The next meeting is scheduled for Tuesday, July 3, 4 p.m. at the Eastsound Fire Hall.
Urgent care should be a priority. In the last week I heard three aid calls come in at once and Dr. Shinstrom handled two at OFHC after EMTs responded initially. (I’m not sure how the third was handled.) I am also aware of a third “emergency” this week where a dog-bite patient had to fly to the Friday Harbor hospital for stitches. The concern is that there should be a local doctor on call to deliver services such as stitches and wound care. Having these patients fly to the mainland or a neighboring island is an unfortunate expense and by-product of not having enough local doctors on call to handle small, but important services that EMTs cannot.
Even large cities are experience doctor burnout without enough doctors on call. Orcas is/will be no exception if UW Clinic does not step up and find a way to provide after-hours care physicians to supplement what Dr. Shinstrom is doing alone.
Agreed! And PAY the on-call professionals (not only doctors)for time reserved to be available to citizens
The concept of “RVU”s disturbs me. I am particularly disturbed by the need to evaluate the metric of “patients per provider per day.”
A good physician will spend as much time with the patient as is required by the patient’s problem.
That time might even include “merely” chatting with the patient, both as a means of reassurance, and also of diagnostics.
Thus a good physician may accrue a sort of “penalty” for being particularly thorough.
I suggest that using a “per patient per day” metric may very likely be destructive to good medicine.
And that’s what disturbs me.