— by Dali Cuthbert —
Concerned islanders — medical patients and practitioners — packed the Madrona Room at the Orcas Center on Saturday, May 13, for the Annual Meeting of the Orcas Medical Foundation, founded in 1956. It has operated the Orcas Medical Clinic on Mt. Baker Road since 1991.
Islanders were at the May 13 meeting to learn of plans for the Medical Center once University of Washington Neighborhood Clinics (UW) assumes leadership of the island’s medical practice. Many asked questions and expressed their concerns about what the future holds for UW on Orcas.
Catherine Henderson, the current president of Orcas Medical Foundation (OMF) addressed the annual meeting. She thanked the many people involved in the project, including the past and present OMF Board members, OMF fundraising team, Senator Kevin Ranker, current staff at the Orcas Medical Center, Island Hospital, and all who helped forge the agreement with UW. Previously, the Center had contracted with Island Hospital in Anacortes, which has declined to renew the contract with OMF.
Now, an agreement has been signed with UW, and the transition has started as Island Hospital leaves and UW takes on the operations and management of the clinic. That transition is expected to be complete by Sept. 2017. “Electronic health records have to be moved, vendors, billing, employee contracts, training, credentialing — all has to happen before the deadline,” said Debra Gussin, Executive Director of UW Neighborhood Clinics.
Dr. Anthony Giefer addressed the group: for over a year, he has been the only physician at the Orcas Medical Center, and over the last two months, he has been the only practitioner there. “The patients need more than that even during the winter months, let alone during the summer flood,” Dr. Giefer said.
This summer, in addition to Dr. Giefer, there will be a physician’s assistant that will work two days a week and half of the weekends during the summer.
Henderson then introduced Debra Gussin, Executive Director of UW Neighborhood Clinics, who, along with Jay Priebe, Director of Rural Primary Care Operations for UW Neighborhood Clinics, representing UW Medicine.
Henderson advised the meeting: “In order to sustain UW being here, we will need to have a tax district. That is the only way to really raise the amount of money that we will need to have an ongoing basis to secure this medical care. So when that time comes, think what it’s going to be for the next generation of people, our visitors, and our businesses that are dependent on the visitors to the island.”
Gussin and Priebe quickly launched a robust question and answer session:
How many physicians could the UW clinic support?
Gussin responded that through optimal utilization of all exam rooms, there could be as many as 4-5 full time physicians although at the moment, UW doesn’t fully have the staffing model laid out. “We know there is a need for probably several more practitioners, and we are planning on staggering them and stretching them across six days a week.” UW will watch this summer through a “narrow lens,“ to see what they can do better next summer. “UW also has residents that want to come out and do rural health, which will help with things,” says Priebe, who is working on housing solutions for them, a concern of some at the meeting.
What will be the Fire Department’s role?
“Firefighters are a big part of the medical care on Orcas Island. Scott [Williams]’s team does a phenomenal job in emergency medicine and EMS work. We think we can carry the load with a lot of the issues on after-hour calls,” Priebe said.
What will UW bring to the clinic in terms of healthcare?
Access to care far beyond what you currently have today, access to specialists and subspecialists. Telemedicine is a very big push for us, including telecardiology, telephsycology, and possibly utilizing telemedicine to do the first level of triage and screening. All of the labs drawn within the clinic will go to UW lab medicine, and the results will go to both the patient’s electronic health record and directly to their physician, via EPIC, which is UW’s electronic system.
We will by synced up to the UW Medical Center Radiology Department so any images taken in the clinic will be sent electronically to our top-notch radiologist who will read and interpret those images and send the results back through EPIC and to your physician for immediate decision-making.
We are also going to implement our virtual clinic. If patients happen to come into the clinic for a sore throat or a rash, and there is long wait and they don’t want to wait, they can choose to have a virtual visit with a physician, and all of it will be documented through Epic. We are still discussing which specialist will be via telemedicine and which will come to the clinic once a month. There is not the level of support to sustain an ER on this island. Fortunately, there are other ways to achieve the goal of 24 hours of urgent care that is less expensive.
If UW takes over, who will do the hiring/firing and run the clinic, and will the community have a part in that?
Gussin and Priebe were adamant that they will be the contracted provider for all services at the center. The OMF board’s role is a partnership, UW Medicine is running the clinic, and will have autonomy in deciding who the staff and practitioners will be and making all the decisions in running the clinic. “In the same way as OMF has said yes, we want you to be in charge of recruitment and hiring, we need the community to do the same, and say yes, you be in charge of recruitment and hiring, and it needs to be done by folks managing the clinic.”
Would other practices also be supported by the tax district?
OMF Executive Committee, President, Leslie Murdock, responded that in order for the tax district to pass, it has to be considered fair, to support not just UW but also other health care services on the Island: “We understand the needs of the other practices, and we want this to work for the whole island.”
An audience member said if the tax district is passed, the law requires independent commissioners be appointed in how the tax will be spent. “They will decide if we will have after hours care, how much, and who will be paid.” OMF and the UW representatives were in agreement with this information.
Kaiser purchased Group Health; will we have to transition to another kind of insurance, or will Kaiser be included in coverage for UW?
Gussen responded, “If you have Group Health now, and you’ve been able to use various specialists in Bellingham, or Anacortes or Seattle, that should not change. We don’t expect there will be any difference with that.”
She added, “The big difference, the big issue, rather, is around primary care; because for most people Group Health keeps their primary care in-network. One of the commitments Kaiser made with Island Hospital is that they would basically honor all of those agreements that were previously in operation. So now, we at UW want the same agreement with Kaiser to allow us at UW Medicine to see Group Health primary care patients here at Orcas, to make sure they still have access. We have made an initial outreach to them, there is a meeting happening next week, and we are pretty hopeful that it will come to pass. As soon as we know, more we will let everybody know. “
What about future funding for the Medical Center?
The UW representatives responded, “We’ll step into it, and initially we’re talking about a three-year agreement, we’d like it to be much longer. Our expectation is that this is a much longer relationship but clearly, if there’s not the ability to continue to backstop the shortfall, we won’t be able to stay, and at any point in the agreement if the funding is not available, we will not be able to continue so we share the strong commitment to figuring it out one way or the other.
“The fundraising was amazing, but can’t happen every year. There has to be another model to fund it, and we all need to figure out how that’s going to happen over the long haul.”
If the tax is not passed, what is the shortfall per year? With a million dollars, and UW walking through the door, how long until we need the next infusion of funds?
Is there a time limit in terms of how soon a district tax ideally needs to be passed?
Kevin Walstrom, OMF Board member, responded that the shortfall has increased to $600,000 a year; as with UW coming aboard, there is a Medicare enhancement of $25,000 that goes away. “After funding the startup costs, which are significant”, a very preliminary timeframe, we will need funding next year, around April. Walstrom further explained that they expected a vote on a tax district probably in February 2018, after which the commissioners could financially obligate the tax district which would be a way to sustain the funds until the tax funds started to come through the next year.”
The explanation gave rise to several related questions:
Are you imagining any kind of outreach to the other practices towards a better relationship in order to unify the community?
Will you be reaching out to other practices on the island?
A UW representative said, “For the size of the community, we absolutely should be working together. It would make sense for all of us if we had a more collaborative process going on for sure. We can’t fix years of history overnight, but I do hope that we can set the stage. Our view coming in, is a clean slate for this particular clinic, it’s going to be rebranded, many things will be changed and different, hopefully many good parts will stay the same, but there will be changes, and we hope this is an opportunity to level-set some of that, and make a fresh start that will foster a more collaborative relationship across the community.
“Beyond that, it’s hard for us to assume that we can be the arbiters of what everybody wants to do. It is not for us to say who should or shouldn’t, we are not coming in to take over another practice, or take patients away. We are coming in ‘as Switzerland’ as much as possible. We are really here to say let’s provide the best clinic we possibly can, and to be as inclusive as we can of the community. This is the best we can do to start. We welcome everyone.”
Can the existing facility handle everyone on the island if all the practices joined in?
Gussin responded: “We haven’t built that in, because we don’t know if that is a possibility.”
UW is currently accepting applications for job openings, which they hope to fill as quickly as possible due to their lengthy 3 month credentialing process required by educational institutions. The UW Neighborhood clinic website is: https://www.uwmedicine.org/about/employment/neighborhood-clinics/non-provider-positions
It seems odd to expend $750,000 in donations to enter into a contract with a third party for management of the OIMC, without taking into account the patients of Drs. Shinstrom and Russell. The OIMC appears to be running a deficit because it is structurally inefficient, with only one physician in practice. Surely, that oversight will be addressed by UW? The population of Orcas seems hardly sufficient to support two full-time physicians, much less the three we have currently practicing. Add UW residents, and there could be physicians without patients.
Even stranger is the apparent commitment by the OIMC board of approximately $600,000 ANNUALLY to subsidize the operation of OIMC. Apparently, OIMC will not be raising this amount; rather, it has undertaken to persuade us to agree to create a new taxing district to subsidize the operation of the OIMC, again with no attention to the circumstances of our other two physicians.
What if the citizens of Orcas, and especially those of us who are patients of Drs. Shinstrom or Russell, or physicians in Seattle, have no interest in yet another taxing district? Who is on the hook for the subsidies needed by OIMC?
Today’s Wall Street Journal has an article reporting the “spike” in property values in the San Juan Islands as a result of the rush to come to Washington State which is most probably a spin off of the stance the State’s Attorney Journal took in the Trump Immigration issues. Faced with the increase in property taxes that will bring, plus an new levy from the school district won’t bode well for the passage of a hospital taxing district. As Peg Manning asks, “who is on the hook for the subsides needed by OIMC?” Very troubleing.
absolutely right on Charlie.
A taxing district makes sense, but only if all current non-OIMC practitioners, as well as those who until recently were here but left for various reasons, are invited to join the newly branded UW clinic. That’s the only way the clinic will reach the volume and the inclusiveness needed for the majority of us to support a taxing district.
It seems like a dumb and dumber situation here. If the conceptual tax district were to be approved, we would be paying more than $100 per year per resident to subsidize a system that pushes users to tie into UW specialists when for the most part, those of us who need in-patient services will probably go to Anacortes, Mount Vernon or Bellingham – not Seattle. What is wrong with this picture?
There are lots of holes in the UW Q&A but it is helpful. Some answers don’t make any sense or are only half. For example, Ms. Gussin & Mr.Priebe make it absolutely clear that contract with OMF gives UW absolute autonomy in the hiring and operation of Orcas Medical. Then in response to question about reaching out to other practices on Orcas they hand the responsibility to make that happen back to OMF. If UW does in fact have autonomy, why can’t UW at least recognize Shinstrom’s offer to join OMC and if there are still aspects of the offer that are unacceptable see if they can be negotiated. Using “past history” as a reason to not reach out is a classic “cop out”. In the long run, a Hospital Tax District is probably the only way primary health care on Orcas Island can be affordable and available. Since tax districts are geographic and commissioners are elected, not appointed, it isn’t possible to achieve any kind of cost effective taxation and distribution with three major recipients
Greetings! Sorry to join this conversation so late! We were away for a few weeks and missed the OMF annual meeting. The people I have spoken to about the need for a hospital taxation district all seem to agree that it must benefit ALL citizens of Orcas. Last winter, when this discussion was going around, I also believe there was agreement that Orcas Medical Center and Orcas Family Health Center are financially unsustainable in their current form. They are heavily dependent on subsidies in the form of donations, foregoing salary (in Dr. Shinstrom’s case), and some supplemental funding from Medicare and Medicaid. I worked with the OMC budgets for seven years, both before Island Hospital took over and after. I can assure you we did all we could to make it a lean organization. But medical practices are costly and reimbursement from health insurance companies simply does not cover the total expense required to keep a practice going. And when a large percentage of that comes from Medicare and Medicaid, the situation is even more dire. It’s hard to say what’s going to happen with health care nation-wide, but from this writer’s perspective, it’s not pretty. If more people are uninsured, it will place an even greater financial burden on our practices. This fact was acknowledged by San Juan Islanders in 1989, and most recently by Lopez, when they voted to have taxation districts to support their health care. I strongly feel it’s time for Orcas to do the same. And yes, it must benefit all of Orcas.
PLease bear with me as I address a couple more points:
One person seemed to believe we only need two doctors on Orcas. Currently, there are three AND each of them employs 1-2 part-time nurse practitioners or physician assistants, who also see/treat patients. My understanding is all those practitioners are very busy. A 2016 paper in the Journal of the American Board of Family Medicine states an average patient “panel” is 1,200-1,900 patients. And that number should be at the lower end if the population is elderly, as it is here. Orcas has about 5,500 permanent residents, and many more when snow birds and visitors arrive. During the summer, all our health care providers are stretched to the max, and worn to the bone by the time October comes around.
Second, I do not read the UW’s statement about reaching out to other practices the way some others do. The UW has taken the opportunity to establish a practice on Orcas. In this case, they will use the building that many people on Orcas donated money to build. UW intends to become part of our community, NOT as an extension of OMC or OMF – but simply as UW with it’s amazing record in providing health care. They say they are open to collaboration with the other practices. However, it is not the UW’s responsibility to draw in the other practices. If WE believe the practices should be joined, it’s OUR responsibility as a community to try to make that happen. Exactly how to do that operationally, I’m not sure. Such transitions are complicated and can’t be done right away. But Dr. Shinstrom’s comments in the recent Sounder article seemed to support the idea. If there’s a sincere will, there’s a way. But it’s got to be our will, and the will of the other practices, to make that happen. Technically, it’s not feasible to lay that burden at the feet of the UW.
Thirdly, regarding taxes. Yes, we have high property taxes. However, if we don’t have sustainable health care on this island, I anticipate the value of our property will decrease, and the difficulty in selling will increase. I think the real estate agents on Orcas might agree. But, if we look at an increase in property taxes for a hospital taxation district, might we also not look at other types of taxes (a very slight increase in sales tax, for example) that would allow our visiting tourists to supplement health care funding? They certainly use our health care services!
There’s so much to discuss around this topic! I sincerely look forward to more conversation.
Thank-you, Alison, for your thoughtful comments.
Does anyone have visit data for the past few years for the three practices? And data regarding what % of residents get their primary care in Anacortes, Bellingham and/or Seattle?
Note that the San Juan experience is not one that we should emulate, as it appears to have raised the costs of primary care by setting it in a certified hospital, as well as split the community in terms of what services should be provided and by whom. Lopez has just begun its adventure.
Thank you Alison for the clarity.