— by Susan McBain, Orcas Issues reporter —
Having secured the continuing existence of Orcas Island’s two major clinics—Orcas Family Health Center (OFHC) and UW Neighborhood Clinic (UWNC)—in 2018 through operating subsidies, the Orcas Island Health Care District commissioners turned their attention to how they could ensure that the clinics provided the services needed by island residents and visitors around the clock.
Negotiating a contract to secure desired services had proved relatively easy with OFHC, a private practice operating as a federally designated stand-alone Rural Health Center, because of its independence and small size. OFHC already offered after-hours services, including meeting with a provider if medically necessary.
Negotiations with UWNC, part of a large UW Medicine system having its own policies and requirements, were more challenging. UWNC’s April proposal to guarantee after-hours services in its contract came with a price tag of $250,000 per year, which the District deemed unaffordable. (UWNC providers do, however, voluntarily see patients after hours when medically necessary.) Also, salaries for UWNC personnel rose 12–17% over last year’s, mainly because of decisions at UW Medicine. Other costs also rose at both clinics.
Recognizing that these cost increases were unsustainable, the commissioners began to seriously consider other structures for the overall island medical system. Two sets of consultants helped them dig deeply into federal designations that could increase revenues, specifically RHC or Federally Qualified Health Center (FQHC) status. Armed with detailed new information, the commissioners ended the year by organizing work groups to determine what partners they might enlist for each of these designations.
Maintenance of the UWNC building, which the District owns, was another big theme for the year. Upgrading the HVAC system and putting on a new roof proved to be interrelated in many ways, all of them with costs increases. The 2019 budgeted amount of $115,000 for these expenses has risen to $440,000 in the 2020 budget.
But the depth of knowledge, level of dedication, and good-hearted teamwork of these commissioners and Superintendent Anne Presson continue to astonish. If anyone can make it all work, they can.
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“But the depth of knowledge, level of dedication, and good-hearted teamwork of these commissioners continue to astonish. If anyone can make it all work, they can.”
I would like to add from the perspective of healthcare advocate, that creating an organizational culture with appropriate values upheld by sustainable practices is the crux of the problem of providing ‘healthy’ healthcare.
Our history has shown that though sustainability alights on the bottom line, it takes no genius to gauge its flight path. This community has refused to grant the former management regime access to its tax wallet over and over. To say we now have a public tax district as the result of unavoidable funding issues alone, is like saying the 737Max is grounded indefinitely because of two flight sensor failures. “Oops”
..(NOT!)
To extend the metaphor, to rush back into production to save the incomes of all those employed in the Boeing supply chain is the same as providing healthcare as an extension of the Chamber of Commerce: tourism and real estate will take a hit without it.
But in Healthcare a big metal box full of 189 living people does not hit the ground at 575 miles per hour when an engineer is bullied into silence. It’s a neighbor who did not get the care they needed timely. And no one noticed.
Times 189, in silence.
Management adage: “Culture eats policy/procedure for breakfast”..
Nurse’s corollary: -and denies indigestion means changing diet.
So we are doing a little more than weighing admin./funding structures, but creating a healing culture. It will take the “knowledge, dedication, and good-hearted teamwork” of us all in the coming year.
(And a smidgin of truth. -L)
Thank you Susan, for your Summary. And Thanks also to the commissioners for their efforts to communicate to the rest of us about the challenges they – and we – face. Very important!
I am so grateful that Orcas has a board of such qualified people so willing to spend the time and energy that I can only imagine it takes to persevere on our behalf! Thank You!!!! And an added thank you to Susan McBain who translates all the information for us to be able to hear and understand the progress.