Health care on Orcas at a crossroads

— from Anne Presson, for Orcas Island Health Care District —

Orcas Island Health Care District (District) has now been officially operational for one year. To date, our primary focus has been on establishing the District and entering into Clinical Services Agreements (CSA) to provide funding to both Orcas Family Health Center (OFHC) and UW Orcas Island Clinic (UW).

The Commissioners recognize and appreciate the efforts of employees in both clinics and their commitment to providing quality care to us all. We are fortunate to have such dedicated and professional staff at all levels. Both clinics are making continuous improvements in their operations to meet the unique needs of our island community.

In spite of the efforts underway within the clinics, as Commissioners we are currently facing increasing costs, challenges in the provision of care, and staffing issues in our existing system of two separate clinics. In particular, finding and retaining qualified staff to operate the clinics at the level of service they are committed to delivering remains problematic.

OFHC, with its many years of experience operating a clinic on an island, has continued to perform as anticipated financially. The clinic is operating under a CSA that includes providing after-hours, acute care with physical access to a provider, when deemed medically necessary.

UW, with over a year’s experience operating an on-island clinic, is not meeting their forecasted revenue numbers for the current year. In addition, UW is requesting a 45% increase in their annual funding for the 2020 fiscal year in order to deliver the broader primary and acute health care service required by an island community. UW is operating under a CSA that provides phone access only to an on-call provider, when directed by a Triage Nurse. The coverage does not include after-hours access to a physically accessible provider.

These very real challenges have pushed forward the Commissioners’ plan to take a broader look at the current system for delivering primary and acute care. We are focused on our responsibility to ensure that all islanders have access to island appropriate, high-quality primary and acute care, including after-hours care, delivered in a financially responsible and sustainable manner. Over the next few months, we will be researching and addressing issues including whether continuing to support two separate clinics is sustainable; if we are fully leveraging all potential enhanced reimbursement opportunities that are available to Rural Health Clinics such as OFHC; and what partners are the best fit for delivering island appropriate care in a financially sustainable manner.

Health care is a very personal matter for each of us. We all want the absolute best care for ourselves, our families, our fellow islanders and our visitors. The Commissioners recognize that contemplating changes may spark concern. We understand our responsibility to use taxpayer money wisely to support the best health care system for all our constituents. No changes are pre-ordained, but we feel we must be transparent with the public in acknowledging the difficulty of the current model and the necessity for a system wide review.

As we embark on this research, we will continue to seek public input in a variety of ways. We encourage you to go to our website and read the very detailed Minutes of our Regular Board meetings that describe well the process of our work. We solicit public comment at each of our bi-monthly Board meetings. Contact information for all of the Commissioners and our Superintendent, Anne Presson, can be found on our website. Once we have more information to guide our decisions, we will be holding public meetings to present our findings and recommendations for a path forward and to hear public input.

Excellent health care on Orcas is vital to all of us. We welcome your input as we move forward.

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Steve Jung

As an interested but not-directly-involved Orcas citizen, I think our team of commissioners, and the staff they have hired, have exceeded the high expectations I had when I voted for them. On every relevant scale, from due care to transparency to clear communications to wise conduct of difficult negotiations to incredible personal service that has gone well beyond the call of duty, they have been exemplary public servants. I offer my sincerest thanks, and express my deep confidence that this team will eventually get our island’s complex health care delivery problems solved.

Margot Shaw

Steve, I was going to say the same, but much less eloquently ….



joseph murphy

So, we are paying UW for what exactly? And now they want more? From the beginning we have known that the two clinic template does not work, the island cannot support two clinics nor should it. A modest suggestion; Since signal payer is coming and the current system is corrupt and inefficient why not get ahead of the game and create a public option for Orcas residents? Washington State has done so for longterm care, why not use all of this public taxing money for direct care? In one clinic. How long is the OIHD on the hook to UDUB?… Read more »

Fred Klein

I echo the tributes to the fine work of our HCD Commissioners who took on the challenges of directing the funding for island heathcare. My knowledge and understanding of the relevant issues is most certainly incomplete, but as I recall, our relationship w/ UW, because of the urban nature and size of their organization, forced us to lose an appreciable Federal subsidy for rural health care…something along the lines of $300K per year…a subsidy for which we qualified when we had a previous relationship w/ a rural mainland hospital. And…I understand that we lost that relationship due to our lack,… Read more »


Another matter for consideration not yet mentioned is that funding regulations are in flux so it is difficult to do the math in weighing alternatives, and difficult to suss the intent of possible allies while considering their own futures. In fact just recently regulations for payments to hospitals for satellite clinics was slashed, and the American Hospital Association with much political clout is seeking repeal. But the matter of dollars and cents is most pressing in healthcare because torquing one’s organizational/ financial structures to maximize Federal payments is an old old game, and Congress is having no more of it.… Read more »