||| 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:
- There is not enough staff to do the work that is required.
- Providers do not have the time to tend to all of the demands placed on them.
- Clinic staff and providers feel they have a limited voice and influence over how the work gets done.
- Providers find it difficult to handle all of the responsibilities associated with taking care of patients in the clinic after-hours.
- Everyone is doing work that is outside of what would normally be considered for their role.
- 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:
- Add 5 additional clinical support positions and a patient liaison.
- Bring more resources to the island and create a concierge model when care is needed off island.
- Allow for staff input in how their positions and workflows are designed.
- Grandfather in current salary levels for staff to ensure a livable wage.
- Give providers a seat at the table in designing a new after-hours model.
- 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.
In discussions with my primary care physician at UW Medical Clinic this week, one of the most telling comments I heard for his departure, and presumably that of others I respect, was that their input on the transition to Island Hospital was not taken into account seriously, or seriously enough. I have no evidence to tell me, one way or another, whether this statement is justifiable. But the mere fact that it was made in good faith indicates to me that something important was missing in the negotiations.
I ask the community to give the Board the same opportunity to provide their perspective on what was and wasn’t taken into account. I’ve outlined what we heard from the clinic and can confirm how seriously we took their feedback into account. I would ask that more specifics be provided so there’s an opportunity to respond rather than make a general statement that suggests feedback wasn’t considered. The solution might not deliver in every area a provider believes is needed; however, that doesn’t mean their feedback wasn’t valued and factored into the decision making process. We’ve been clear that there remains much to be decided in certain areas, and that we purposefully left room for the providers to be at the table to help inform those areas.
I respectfully ask that the community not be quick to judge so harshly. We are members of this community and are fully invested in the success of any health care model. We will continue to provide honest and factual information as to how this decision was reached and the opportunity that lies ahead.
Thank you.
So what is more important ?
1. Patient Care
or
2. Politics
Touchy, touchy, Anne.
Nobody has been making any “harsh judgements” in these comments, only that something important was missing in the negotiations. Maybe it was just trust, on one side or the other. Or both.
Your response indicates that I must have hit a sore nerve, which is teling. The one thing we can definitively conclude is that the clinic is losing two of its best physicians, and that many Orcas Islanders may have find new primary care physicians.
Anne Presson and District leaders,
I have been the Health Officer for San Juan County for nearly 30 years now. The healthcare challenges on Orcas have been substantial for most of that time. This new effort is the the first time I have had hope for a substantial change in what has been a very difficult process of finding stable, engaged, community based solutions. The Healthcare District’s leadership of a truly community wide effort to find practical, financially sound, medically appropriate solutions gives me great optimism that the Orcas community has found some lasting solutions to several many, decades long, problems. No one will be happy with everything in the plan going forward but it is the first time I have seen realistic plans that address each of the critical issues with compromises that are all in the communities best interests. The challenges of providing comprehensive healthcare services to a population that is older in a rural and remote setting is a very substantial challenge. I welcome the partnership of a regional hospital that has a long history of supporting our providers and community members. But the role of the Healthcare district itself can not be overstated. It has allowed for every voice to be heard and for thoughtful public discussions and difficult decisions to be made that represent the best chance of creating sustainable access to these essential services as efficiently and practically as possible. Thank you to every member of the community that has provided input and guidance to the board, to the long hours the board members themselves have worked to find common ground and to the sensible, practical, kind hearted leadership of Anne Presson.
From the beginning, our Healthcare District Commissioners were faced with a paradox to manage. They did not have the luxury of divining one right answer that would satisfy everyone all the time.
If things were that clear, the job would have been easy. The Commissioners inherited a situation featuring two practices operating the red, and a contract with one practice that was minimally accountable/responsive to community needs and desires.
Over the past year, the Commissioners have worked diligently, assessing a variety of possible options and searching for an optimal (not a perfect) solution. They have worked hard to keep us informed along the way. They have listened to islanders’ input and worked to accommodate those desires within the sustainable options possible. They have been transparent in that process, realizing that not everyone will be pleased.
I too will miss having Dr. Russell as my physician. He is excellent and has always treated me and my family with high quality service, patience and care. He is the greatest! Whatever the personal and professional reasons are for practitioners deciding not to continue with the new, unified practice, I respect them. They are private and not mine to know or speculate about.
From my own work starting and managing a community health center, I know that the parameters and constraints of working in a publicly funded, publicly accountable group medical practice are very different than working in one’s own private practice. The two models present a tradeoff in autonomy and capacity, when the mission is to serve everyone regardless of ability to pay.
The new unified clinic has a clearly defined job to do. It is important to all of us that our work and our vocational/professional aspirations are a good match. That a practitioner elects not to join a new practice is not necessarily about the goodness or badness of providers, managers or administrators. It may simply be a choice and preference for what is the best fit.
It takes a good five years to develop a sound medical practice (without a pandemic!) This is a time for patience, civility and grace- while continuing to raise concerns we want resolved. For the new practice, all the practitioners and staff, our Commissioners, and our community I wish success and a good future. And I extend my gratitude to all of them- former and new- for their service.
Personally, I’m very much looking forward to the opening of our island medical clinic under its new Island Hospital operating arrangement, which has been painstakingly negotiated with extensive public disclosure over the past year. The fact that professional staffing negotiations were conducted in private is par for the course, as is the apparent fact that they did not produce acceptable contracts for some. And I sincerely hope that our Commissioners will not even contemplate the notion of trying to subsidize multiple medical practices on the island. Never again.
I am a patient of Dr. Russell’s. He has always treated me well. He does it with great care, empathy and respect. He is one of the best primary care docs I have had.
As a healthy type 1 diabetic for 45 years and one who had diabetic retinopathy for 25 of those years, I have spent a lifetime seeing doctors on a very frequent basis. Great doctors have come and gone. This is no different for me, and I know there will be others to come and go.
I do not judge these doctors for leaving. We all have to make decisions which are suited for ourselves, and we do not want to keep people a part of something that they do feel in their heart especially when what they do is so important to our health and well-being. They will find the things that work for them. I know they will, and I would want nothing less for any of us.
I have confidence that Anne Presson and her team will find equally good doctors to care for our community. Change can be hard. Harder on some than others, but change is our only constant in life.
When our new docs come on board, I will gladly sign up for my next appointment at the Clinic when I need it. It’s the right thing to do for me. I need to believe this will work and trust the people who are working so hard for us and know a lot more than me about these issues. For the well-being of our community, we need this clinic to work.
With great respect and admiration to you all.
Clarification: “I do not judge these doctors for leaving. We all have to make decisions which are suited for ourselves, and we do not want to keep people a part of something that they do *not* feel in their heart especially when what they do is so important to our health and well-being. They will find the things that work for them. I know they will, and I would want nothing less for any of us.
This district was created after many attempts. I believe it passed this last time because most of us believe that UW brought a standard of care that was previously missing. The community raised an additional $600,000 plus for an electronic medical system. It is a shame we need to relinquish that. After all, Lopez had their contract extended another three years. I will miss the current clinic staff and structure.
It’s difficult to choose the existing operating entity for the clinic when the existing operating entity doesn’t submit a proposal.
I also assume that the District will be putting our tax dollars to work in one clinic and one clinnic only when it opens on April 1.
Dear Anne,
Your promise of “honest and factual information” is heard, and appreciated.
You, along with all who display your competence and commitment, deserve a most charitable reception.
Paige
What is time frame for becoming a FQRHC with highest reimbursement rates? And option for dental + medical services? We have seen this work in Hawaii with excellent success. New state of the art facilities and great practitioners afforded thanks to FQRHC status and leverage. (Federaly Qualified Rural Health Center)