||| FROM ANNE PRESSON for ORCAS ISLAND HEALTH CARE DISTRICT |||


It has been another eventful and challenging week for health care on Orcas Island. The announcement by a second UW physician that he is choosing not to pursue employment with Island Hospital has understandably raised concerns and questions from his patients. While statements from both Dr. Russell and Dr. Alperin were brief, we respect that they put a lot of thought into making the decision to not be a part of the new clinic. While it was the District’s hope that all providers would actively participate in the building of a new model, we recognize everyone must determine for themselves what setting they find professionally rewarding and what they have the energy and interest to do.

The unfortunate reality in this country is that health care is as much a business as it should be a basic right for all citizens. Revenue must be adequate to pay competitive wages and benefits, employ sufficient staff, and provide the right tools and technology to deliver quality care in a sustainable manner. As stewards of public funds, the Hospital District must also maintain an eye on moderating expenses to work within the taxing capacity available to us. Striking the right balance is complicated by the island’s small numbers and demographics. The harsh reality is, like rural clinics nationally, the Orcas clinics operate in an environment where there is a significant loss for each patient visit. As is the case in all things, costs continue to escalate and the gap between revenue/visit and expense/visit has grown every year over the past three years. Projecting trends for the next five years left the Hospital District Board with no choice but to search for a sustainable solution.

The Board has been listening and engaging with clinic leadership, providers, and staff. We have heard consistent messages and themes:

  1. There is not enough staff to do the work that is required.
  2. Providers do not have the time to tend to all of the demands placed on them.
  3. Clinic staff and providers feel they have a limited voice and influence over how the work gets done.
  4. Providers find it difficult to handle all of the responsibilities associated with taking care of patients in the clinic after-hours.
  5. Everyone is doing work that is outside of what would normally be considered for their role.
  6. Staff isn’t always able to return patient calls and address requests in a timely fashion.

Based on the seriousness of what we’ve heard from the clinics, combined with concerns we received from community members, it would have been irresponsible to continue status quo. The existing two clinic model simply does not allow for either OHFC or UW to generate enough revenue to cover their costs,even with an almost $1.3 million total annual subsidy. For these reasons, the District went through at horough, systematic evaluation process to create a model that addresses all of these challenges. We are fortunate that Island Hospital’s status as an under 50-bed hospital provides the opportunity to improve the revenue side. When a Rural Health Clinic (RHC) becomes part of this “Provider-based RHC” arrangement the clinic is able to receive enhanced revenue reimbursement for both Medicare and Medicaid patients.

By improving the reimbursement model and partnering with an entity that shares our goal to create a community approach to population health, we will now have the bandwidth to:

  1. Add 5 additional clinical support positions and a patient liaison.
  2. Bring more resources to the island and create a concierge model when care is needed off island.
  3. Allow for staff input in how their positions and workflows are designed.
  4. Grandfather in current salary levels for staff to ensure a livable wage.
  5. Give providers a seat at the table in designing a new after-hours model.
  6. Create meaningful engagement and support with other community partners (e.g., EMS, School District, Coalition for Orcas Youth, OICF and others)

OIHCD took over a relationship that did not have the right expectations for our community nor financial model, as well as a facility in need of significant repairs. We worked hard to stabilize the financial picture and make the necessary repairs to the facility. After studying the issues for almost three years, the Board concluded that the long-standing assumption that a single clinic was needed on Orcas was correct. While we regret the loss of these two providers we remain confident in our decision making and the new model.

As I stated in my last communication, we will keep the door open for future collaboration and engagement with all providers. That said, it would be very unfortunate to perpetuate another fragmented health care system on Orcas. For all of the reasons stated, that would only serve to stretch our limited resources beyond capacity once again and not result in a higher quality of care for all members of our community.

We remain focused on the transition and being able to deliver the best care and experience for providers and staff who choose to come on this journey with us. We also ask the community to give us the chance to deliver on our promise and withhold judgement until we have the opportunity to demonstrate what’s possible. As always, the Commissioners and I are available to answer your questions and concerns. We will also be scheduling a second Community Briefing in mid-February.


 

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