How Would the Public Hospital District Affect Medical Services on Orcas Island?

— by Susan McBain, Orcas Issues reporter —

Providers of primary, urgent, and emergent health care came together Thursday evening, March 29, to answer questions about their services and how these might be affected by voters’ approval or disapproval of a Public Hospital District (PHD) on April 24. The meeting was organized by the Orcas Island Community Foundation and moderated by Hilary Canty.

Leslie Murdock and Kevin Walstrom spoke for the Orcas Medical Foundation (OMF). Dr. Michael Alperin, physician and clinic chief at UW Medicine Orcas Island (UWOI), represented that clinic, as did Debra Gussin (by phone), executive director of UW Neighborhood Clinics. Fire Chief Scott Williams answered questions about services provided by Orcas Fire & Rescue (OIFR). Dr. David Shinstrom, medical director, and Aaimee Johnson, office manager, spoke for the Orcas Family Health Center (OFHC).

The meeting began with a brief description of services from each group. OFHC receives 6000-7000 patient visits per year to its three providers. UWOI has had 4500 patient visits to its three providers in its first seven months of operation, and the monthly number has been increasing. OIFR’s Emergency Medical Services are provided by one paramedic and one EMT, assisted by volunteers, during each of the day’s four work shifts. OMF has been involved in operations of the Orcas Medical Center for 62 years but provides no direct medical services itself.

Audience questions covered a wide range of issues. Among the most pressing was how the services of each organization would be affected if voters do not approve the PHD. Dr. Shinstrom responded that OFHC needs a subsidy to survive; without PHD funds, OFHC will have to close its doors. It has received $120,000-$130,000 per year plus a little more in in-kind support. To cover all costs, it would need about $330,000 per year.

Dr. Alperin noted that the Orcas clinic has also needed subsidies and that the question is how the community would support medical services without the PHD. Walstrom said that the clinic needed about $200,000 per year under Island Hospital (IH), but that without IH’s designation by Medicare as a Critical Access Hospital, an additional $325,000-$350,000 per year is needed.

Walstrom stated that OMF has enough funds to last through May 2018 and is trying to raise another $59,000 to get through June, when it hopes the PHD can begin to help with funding. If voters approve the district, OMF hopes to transfer the property, building and equipment to the PHD and cease OMF’s operations; however, it will retain a reversionary interest to maintain ownership by a community entity in case the district is ever terminated. If the PHD does not pass, OMF would be unable to both maintain the building and cover monthly operating costs, so it would plan to close the clinic by the end of October.

Chief Williams noted that the OIFR call volume has been increasing by about 100 calls per year. If the clinics shut down, OIFR will need to increase staffing and volunteer numbers, which will increase costs. OIFR hopes to hire a community paramedic to help with post-hospitalization and chronic illness care, which will also require more funds. Williams also observed that if the medical practices close, all islanders will need to become more proactive and more careful in planning for their health care.

OIFR provides only emergency care, designed to stabilize patients who may be facing life-threatening situations and then get them to an appropriate higher level of care. The two clinics offer primary care, which generally includes chronic conditions, routine care, and minor medical problems. Urgent care “is in between, and depends on the individual,” according to Dr. Alperin. Broken bones, lacerations, and pain can have different levels of severity. How urgent care is defined will guide the services that are provided.

Questions for UWOI included what would happen to its contract with OMF and how it would address improving patient satisfaction. Gussin responded that UWOI hopes to renegotiate its current three-year OMF contract with the commissioners of the PHD, ideally under similar terms. UWOI also intends to work with the commissioners to continue fine-tuning its services. She noted that in response to patient concerns, for example, UWOI will begin performing lab services for non-UW doctors in April. It will use patient surveys to help decide what changes in services are needed, and is open to the idea of a community advisory group that includes patients.

Additional questions and answers included the following:

• How does UWOI’s relationship with Kaiser and other specialists work? UWOI has exactly the same contract with Kaiser that Island Hospital had, which lets UWOI be the primary care provider on Orcas. Kaiser requires people to use its specialists or obtain authorization to use others. UWOI can request such authorizations, but Kaiser makes the decision. UWOI and Kaiser do work together to address specific situations on Orcas. Specialists do not have to be part of the UW system either; UWOI can refer patients to any specialist with approval from the insurer. Both UWOI and OFHC also work with the Veterans Administration and the TRICARE military health care system.
• Will all insurance programs be accepted if the PHD is approved? Both clinics take all insurances, and both have policies about not turning anyone away for lack of ability to pay.
• If patients have after-hours medical questions, what should they do? For OFHC, a patient should call the office, where an answering machine will take the message and forward it to practitioner cell phones within 3-4 minutes. For UWOI, a patient should call the office, where they will be transferred to UW’s Seattle triage system for all clinics. A practitioner will be paged if needed.
• Is UW restricted in giving abortion services or counseling? UWOI is not set up to offer those services, but UW Medicine (UWOI’s parent organization) offers abortion services and counseling, as well as end-of-life counseling. OFHC refers people to appropriate providers off island.
• Could our PHD combine with those on Lopez and/or San Juan? Legally, yes, but not until our PHD is created. The Lopez district is similar to that proposed for Orcas, so alignment with that district could be most useful.
• How much money would be raised if the maximum levy rate of $0.75 per thousand dollars of assessed valuation were put in place? The funds would total approximately $1.6 million.
• Should the PHD be approved, would the clinics be willing to work together to improve efficiency and coordination? The PHD commissioners will be the ones to address this issue.

In closing, all of the panelists favored passage of the PHD, acknowledging that creation of the district is only the beginning of the work to solve the problems of permanent, appropriate care for everyone on Orcas Island.