OIHCD Superintendent Anne Presson responds to provider announcement

||| FROM ANNE PRESSON for ORCAS HOSPITAL DISTRICT |||

We are approaching the half-way point in the transition of the UW and OFHC Clinics into a single entity. As is the case with any long journey, it’s helpful to remind ourselves of our purpose and what put us on this path. For almost two decades, there has been disruption and fragmentation in health care on Orcas.

While some may suggest that the island has been able to sustain multiple practices over the years, the truth is that even with substantial philanthropy the smaller clinics struggled to pay staff a livable wage and, in most cases were unable to offer health insurance or other employee benefits to provide security for staff and their families. The fragmentation and inability to share resources created inefficiencies and placed a heavy burden on each practice’s efforts to provide adequate after-hours care. There has also been collateral damage to other agencies, specifically our reliable EMS agency that became the default “urgent care walk-in clinic.” The lack of adequate support and collaboration has stretched the limited EMS team and is something that needs to be reset in order for them to meet the growing demands on their resources.

Fortunately, the PHD was passed in April 2018 and as soon as the Commissioners were elected they followed through on their commitment to stabilize the two existing primary care clinics on the island. From there, they began the very long and difficult process to determine how to design an effective long-term model. Following several years of substantial increases to the requested subsidies for both Clinics, it was obvious there was a need to either improve revenue or reduce expenses. In the absence of making strides on either end, within a few years the District would need to go back to the voters to raise the levy beyond the maximum rate of $.75/$1,000. The process to find a solution that minimized the tax burden, maximized what was believed to be island-appropriate services, and provided adequate staffing to reduce burnout of the teams was not an easy task.

What had been suspected for many, many years became clear – moving to a single clinic model was the best way to create a more stable and comprehensive health care system on Orcas. Bringing everyone together in the District-owned medical facility would create operational efficiencies and reduce expenses (e.g., sharing after-hours call across all providers, eliminating duplication of equipment, etc.).

From there, it became apparent that necessary improvements in revenue could only be realized by moving to a Provider-Based Rural Health Clinic (RHC) model. Island Hospital is one of the few systems in the region that meets the requirements for Provider Based RHC status, which qualifies the Clinic to receive substantially higher reimbursements for Medicare and Medicare patients. The fact that these two segments represent over 70% of all patients results in revenue received per visit much lower than the expense per visit – meaning there is a loss for every Medicare or Medicaid patient visit, and the resulting gap is what the OIHCD’s subsidy covers.

In our meetings with the staff, we regularly heard there was a need to provide more staffing support. Both the staff and providers were performing work well beyond what would be a normal scope for their respective role, yet they stretched themselves out of a sense of commitment to their patients and to ensure the work got done. Even with their efforts, it often wasn’t enough to meet the demands. The improved reimbursement was necessary to be able to fund this much-needed expansion of Clinic staff and allow the Clinic to continue to pay competitive wages to attract and retain high quality professionals. In addition, increased financial capacity will allow us to expand services, bring specialists to the island, and add an integrated behavioral health component to address the growing mental health challenges. The consolidation is an important first step on the road to being able to protect and improve the health of our community. The new model will leave us in a much stronger financial position and bring long-term stability for the providers, staff, and the Orcas community.

I recognize last week’s announcement from Dr. Russell that he is not planning to join the Island Hospital Clinic is unsettling news for his current patients. From personal experience, I understand the importance of the relationship with your Primary Care Physician (PCP) and the concern when that relationship is disrupted. While it’s understandable questions will remain, I ask the community to look forward not back. We respect Dr. Russell’s decision and hope to keep the door open to a future engagement. In the meantime, we must move forward and we do so with optimism and excitement.

We have the best opportunity in decades to ensure that all the members of our community have access to high quality primary, same day, and after-hours care in a financially sustainable and cost-effective manner. Island Hospital is very much aligned with the community-based approach to care delivery and has already started engaging with local organizations to begin to understand their needs and how the new Clinic can provide programs and support. Together, we are working hard to deliver on our shared vision and bring value to our community.

As always, the OIHCD very much appreciates the support of the Orcas community. As the process continues, you will soon receive details on the providers, how to transfer records, make appointments, etc. Everyone is working hard to finalize the details and get you the information you need. In the meantime, the Commissioners and I remain ready and eager to respond to your questions and feedback.