Islanders came together last week (September 19th) for the second of three town hall style meetings to look into the future of health care on Vashon and how to make it sustainable. The discussion, sponsored by Vashon-Maury Health Collaborative, focused on building a community wish list of health care improvements. Attendees offered a wide range of options – everything from primary care expansions such as extending open hours at the Neighborcare Health clinic to potentially opening urgent care services on the Island.
“We are focusing in these three community discussions on what we have, what we want and how do we get it. This evening is about what we want,” said Tim Johnson, a member of the Collaborative who facilitated the informal brainstorming session.
The first meeting in the series centered on the “what we have” part of the process, providing information on sustainability issues such as the clinic’s current $350,000 annual shortfall in revenues versus expenses. Audience members also pointed to gaps in clinic services such as issues with the new telephone call center and the length of time it takes to get an appointment. An audience handout at this second meeting reviewed the fundamental challenge on Vashon that the patient mix doesn’t include enough high reimbursement Medicaid patients to cover clinic costs compared to reimbursement rates for Medicare and private insurance patients. The handout also pointed out that Neighborcare operations on the mainland receive grants from the city of Seattle that are not available for unincorporated Vashon.
Participants developed a wish list of ways to improve Vashon’s basic primary care services. All the ideas were recorded on charts posted on the walls of the Land Trust building where the meeting was held. Common requests included shorter wait times for appointments, longer appointment times for working with medical providers, geriatric and pediatric expertise, as well as synchronizing records between Neighborcare and the area’s major providers such as Kaiser, University of Washington and Multicare. “Blue sky” dreams were also recorded such as an MRI capability, urgent care, chemotherapy infusion center and dialysis services.
Neighborcare Health CEO Michael Erikson journeyed to the Island for the meeting in order to provide estimates on costs for citizen suggestions. In addition to the existing $350,000 annual shortfall for current operations, Erikson estimated an additional $250,000 to $300,000 shortfall in revenue to extend clinic operations into the evening hours and weekends. Extending the time for individual appointments beyond the current three per hour and adding a higher percentage of physician providers would add another $250,000, Erikson estimated. The total cost of closing the current funding gap, extending hours to seven days and evenings, adding physicians and longer appointment times would therefore approach an estimated $1 million shortfall based on current revenue patterns.
“An urgent care service on Vashon would double or triple the current clinic cost,” Erikson estimated. In addition, he reported, urgent care services require a patient base of 30,000 to 55,000 patients in order to generate enough volume to make urgent care practical, far more patients than the Island’s population of around 10,000 people.
Vashon-Maury Health Collaborative member John Jenkel closed out the meeting by setting the stage for the third meeting in the series, which will take place October 30th at the Land Trust building. It will explore the “how do we get it” aspect of the community-driven process. He emphasized, and many of the evening’s participants agreed, that health care sustainability on Vashon will require a reliable source of additional funding beyond patient insurance. Jenkel provided some highlights of solutions that have been attempted in similar small communities in the region including foundations, community donations and public hospital districts.