Updated Sept. 8 at 11 p.m.
— by Margie Doyle —
After years of losing money and physicians, this month Orcas Medical Center will come under management by UW Medicine to meet the challenges of 21st-century rural medicine. UW Medicine will formally begin its oversight on Monday, Sept. 11 as UW Medicine Orcas Island Clinic.
Dr. Mike Alperin has contracted at the medical clinic as a full-time physician; he will also serve as Clinic Chief for Orcas and Lopez Island clinics. Dr. David Russell and Kirsten Pickard, nurse practitioner, will bring the staff to 2.8 FTE (full-time equivalents), according to Jay Priebe, Director of Rural Primary Care and Operations for UW Medicine. In recent years, the clinic was down to one full-time physician, Dr. Anthony Giefer, who observed that that wasn’t enough to provide medical care services in the winter months, let alone the busy summer season. Priebe clarified that there will be a physician at UW Medicine Orcas Clinic six days a week, through staggered staffing.
Staff will be supplemented by tele-medicine, with a 24/7 community-care nurse call line and with “virtual” care visits, similar to internet FaceTime or Skype. UW Medicine has also developed a provider call group on Orcas and Lopez with all the UW Medicine providers sharing after-hours calls, so, if necessary, the nurse care line can refer the patient to the medical provider on call. The after-hours service thereby will document the care offered which the medical provider can review the next day for follow-up.
Day-to-day clinic management will continue under Jennifer Taylor, with current staff — all Orcas Island residents — remaining under the new management, said Priebe. As Director of Rural Primary Care and Operations, he will oversee the Orcas Clinic/Orcas Medical Center operations and services.
In response to questions about “integrative” or alternative practices such as T’ai Chi, yoga, biofeedback), Priebe said, “Our providers are open to having conversations with patients regarding their interest in the direction in which they’d like to receive care; it’s between the patient and the provider and what they feel is the best for their care.”
UW Medicine is responsible for contracting and staffing at Orcas Clinic. Clients insured by Kaiser-Permanente (formerly Group Health clients) will be covered for primary care services at the Orcas and Lopez clinics. The Orcas Clinic website will provide documentation regarding the insurance coverage that will be accepted by UW Medicine. “We encourage patients to contact the clinic with any questions about coverage,” said Priebe.
Orcas Medical Center/UW Medicine Orcas Clinic’s recent history involves the Orcas Medical Foundation and Island Hospital in Anacortes. Orcas Medical Foundation (OMF) a 501(c)3 non-profit founded in 1991, owns the building and land on Mt. Baker Road, according to Leslie Murdock, OMF President. It also engages in fund-raising for the Center.
In 2011 Island Hospital took over the medical practice, but declined to renew its contract with OMC after 2016. (Island Hospital formally ceased operations at OMC on July 1, 2017). UW Medicine affiliated with Orcas Medical Center following Island Hospital’s decision not to renew its contract with OMC. This year, Orcas citizens raised $750,000 required to complete contract negotiations with UW Medicine for contracting and staffing of the rural health clinic.
“It’s important to note that primary care is not a revenue-generating service; it’s expensive,” said Priebe. The clinic’s financial shortfall takes into account staffing models, expense management and current indebtedness. Analysis of the current state of financial operations shows an annual loss of $526,000. To address that indebtedness, Priebe says, “Expense management allows UW Medicine to use contracts to reduce expenses; and to expand access which increases revenue for the clinic. There will be financial shortfalls that remain with the clinic because of rural health center Medicare financial reimbursement that no longer exists, close to $250-300,000.”
Priebe emphasized UW Medicine’s “Significant operational efficiencies” and the access to “virtual medicine” as factors in reducing the Orcas Clinic’s expenses. “Our goal is to provide resources to our patients to allow them to make the right decisions about their care, through increased staffing, the 24/7 nurse line, and the virtual care clinic,” Priebe said.
Collaboration among UW Medicine and the other two island physician practices, at Orcas Family Health Center, and at Orcas Island Family Medicine is still a topic of discussion. Dr. David Shinstrom of Orcas Family Health Center says, “Over the years I have advocated for unification of medical practices. This critical meeting will determine so much for the future.”
Coalition for Orcas Health Care — a diverse group of Orcas citizens, who first formed in Dec. 2016 — ‘is committed to providing primary and urgent care for all the members of our community in a financially sustainable way into the future,” according to Art Lange communications lead for the Coalition for Orcas Health Care (COHC).
Leslie Murdock, OMF Board President, said last week of the COHC, “We are two different organizations…[and] we are delighted that COHC, is working to form a taxing district.”
COHC is now collecting signatures for a petition for forming a Public Hospital District. COHC member JoEllen Moldoff said, “There is a lot of work to be accomplished before we can ask members of our community to vote on whether or not to approve a Public Hospital District. Signing a petition is a way of beginning a process of educating, informing and above all, listening with respect, to questions and concerns. Signing this petition does not signify approval.”
Art Lange clarifies: “There is no intent to build a hospital on Orcas. “By state law, the definition of a Public Hospital District means a public health services district. Our focus is on health services for everyone.”
Should voters decide on a Public Hospital District, Preibe says that publicly-elected commissioners would then “assume existing agreements” and contract with UW Medicine for health care services. “We would become partners in assuring successful delivery of medical services.”
The community meeting introducing UW Medicine Orcas Clinic was held on Thursday, Sept. 7 from 5 to 7 p.m. at Orcas Center.
“Signing a petition is a way of beginning a process of educating, informing and above all, listening with respect, to questions and concerns. Signing this petition does not signify approval.” I disagree. Signing a petition without knowing who, what, where, and how the tax money will be used makes no sense.
Now we’re told that the publicly elected commissioners WILL assume the obligations undertaken by OIMF without informed consent by the citizens of Orcas.
And what “health care services” would the Commissioners contract for? Sorry, but none of this makes any sense to this health care regulatory attorney.
P.S. Of course primary care is a “revenue-generating” service. I assume that Mr. Priebe means that it is not a profitable service. It will be interesting to see some of the analysis used by UW.
I’d like to clarify the relationship between a Public Hospital District (PHD) and any clinical facility or practitioner within that district. The publicly-elected Commissioners are empowered to make contractual arrangements with health care providers and for facilities that they agree will best serve the health care needs of the District’s entire population. Future contractual arrangements must be negotiated and should not be assumed a “done deal.” The Coalition for Orcas Health Care, which is proposing a PHD, recognizes full well the complexities of current health care delivery on Orcas (i.e.: three practices) and the need to support all three if needed. The Coalition is amassing a great deal of information to share during the petitioning process and throughout the time leading up to a vote. We will ensure there are many opportunities for all of us to learn more and discuss the issues.
Respectfully, Alison Shaw
PS: just to clarify my own comment about about negotiations not being a done deal, I mean to explain that a PHD – if passed by the electorate – will collaborate with all existing health care entities to provide a level of support that meets the health care needs of patients on Orcas.
I am curious as to the attendance at the meeting last evening.
Ed, I was not there, but heard that the main auditorium was filled to capacity.
I firmly believe that UW specialists are among the best in the business, and recently went to two in the Seattle area. Although the visits were satisfactory, the travel was not..parking difficulties, and traffic tie-ups getting out of the city….you know the story.
As was stated at the meeting, we will be given referrals to top-flight UW specialists by our “new” primary care physicians.
How can UW facilitate shuttle transportation to help make these referrals more tempting? The Senior Center, for its off-island trips, has found a way to make it work, utilizing its own vans.
I am very leery of UW taking over, having had several botched surgeries there that were then corrected at Swedish.
Kenmore Air flies from WestSound to Lake Union, which is just a short taxi ride to UW Medicine.
The Orcas Center theatre was filled to capacity. It was announced that Dr. Ruseell has joined the UW staff. It was also announced that a copy of the agreement between UW and the OIMF will be available to the public in a day or two.
Alsion–there are no guarantees what the PHD would do, because the power is left to the Commissioners to do whatever they decide within the statutory authority of the PHD. That remains the key question. There reportedly are going to be five commissioners, each to be chosen from an Orcas district. No word on who the commissioners will be.
Margot, One of the nice things I like about the new UW approach is their bringing more telemedicine to the clinic. This will allow video-linked discussions and exams with UW specialists, from within our clinic, saving a trip to Seattle. Telemedicine is a rapidly expanding service linking rural healthcare services with larger medical facilities. It allows for rapid early consult, without the inconvenience of travel to a metro area.
We will elect (presumably) five commissioners. They must be top tier individuals known to our community to be trustworthy, transparent, diligent, and business wise savvy.
If we elect these kinds of people to represent us – I am confident they will serve us with integrity and with our collective best interests at heart.
They are – after all – our neighbors.
I do believe that there are restrictions in the use of telemedicine with Medicare, which would impact a significant portion of our population.
As a physician, I have been dealing with telemedicine/telehealth for years. While it may offer some conveniences, does anyone really believe it is better than face to face contact with a caring doctor who know you and your family? Admit it, telemedicine is being pushed for economic reasons and not because it is the quality care good health care clinicians want to deliver. Communities such as Orcas need to think about ways to recruit clinicians to live there, to be part of the community, and to give superlative care.