Health Care for the Future: Growing the Family Practice Clinic Report to the Community From the Wahkiakum Family Practice Clinic Advisory Board October 2008

DRAFT

Health Care for the Future:

Growing the Family Practice Clinic
Report to the Community
From the


Wahkiakum Family Practice

Clinic Advisory Board



October 2008

Preface

In August, 2007, the Wahkiakum County Board of County Commissioners appointed a group of citizens to work with the Wahkiakum Family Practice Clinic and the County to determine a future course for the Clinic. The Family Practice Clinic came under County ownership in 2005 and has experienced difficulty making sufficient revenue to cover all the Clinic’s expenses. After considerable discussion with the Clinic’s senior management, the only course of action open to the Clinic was to reduce staff substantially, even thought the patient workload was high. This situation seemed untenable to many in the community, the County Commissioners and the Clinic leadership. A Clinic Advisory Board was created and tasked with finding a path which would both bring the Clinic’s operations inline with its revenues and plan for its future.

The Clinic Advisory Board developed a Charter to identify the scope of work the Commissioners expected the Clinic Advisory Board to tackle. The complete Charter appears in Appendix 7. The mission of the Advisory Board bears repeating here:
Develop a successful strategy for stabilizing the staffing, services and funding for the Wahkiakum Family Practice Clinic that ensures the clinic operates sustainably, under the guidance of physicians and clinicians, and at a level supported by the citizens of the county
The Charter also includes the goals and objectives the Clinic Advisory Board and Board of County Commissioners agreed are important to accomplishing this mission. The goals are:
Goal 1:

Identify Strategies that Will Stabilize the Wahkiakum Family Practice Clinic’s Staffing Pattern, Service Levels and Funding in the Near Term.

Goal 2:

Conduct Data Gathering, Analysis, and Research that Will Generate Recommendations For Consideration By the Board Of County Commissioners and the Wahkiakum Family Practice Clinic to Move the Clinic To Sustainable Operational Budgets within the Next 12 to 18 Months.

Goal 3:

Work With the Family Practice Clinic Stakeholders to Ensure Passage of Any Actions Requiring a Vote of the County for Adoption.

The Clinic Advisory Board determined this work would require a period of approximately 8 to 10 months to complete. This report to the Community is an important milestone in the Clinic Advisory Board’s work. It reflects our best understanding of the current situation, the options for the future, and a long-range vision of county health care in the future.

Clinic Advisory Board

Independent Voting Members

Dave Batt, Chair¹ Bank of the Pacific Branch Manager

Sandi Benbrook Rieder, Deputy Chair Benbrook and Associates LLC Principle

Crystal Stanley, Secretary Waste Management Company Owner

Arnold Curtis Retired Timber Executive

David Goodroe Cathlamet City Council Member

Carol Larson Wahkiakum West Executive

Douglas Martin, DMD Retired Cathlamet Dentist

Judy Bright, ARNP Wahkiakum County Health and Human

Services Director

Hank Hanigan PeaceHealth Director of Surgical Services

(Now Columbia Memorial Chief

Financial Officer)
County Commissioners Liaison

Blair Brady Board of County Commissioners

Family Practice Clinic Staff and Subject Matter Experts

Janice McClean, M.D. Medical Director from 4/2008

Keith Wright, M.D. Medical Director prior to 4/2008

Margie Godfrey ARNP

Kathy Patterson Business Manager

Table of Contents

Preface i

Clinic Advisory Board ii

Table of Contents iii

Executive Summary 1

The Community Setting 3

Figure 1. Wahkiakum County Population by Gender and Age, April 2005 4

Health Care in Wahkiakum County 5

Family Practice Clinic Today 6

Figure 2. Age and Gender of Family Practice Clinic Patients 8

Figure 3. Average Annual Patient Visits by Age and Gender by Year 8

Services and Facilities 9

Family Practice Clinic Performance 10

Figure 4. Clinic Revenues versus Costs (2005 to 2007) 12

Near-Term Goals for the Clinic 13

Figure 5. Family Practice Clinic Staffing Mix in late 2007 14

Community Survey 14

Identifying Efficiencies 15

Marketing 16

Marketing Summary 18

Physical Limitations 18

Governance Options 19

Methods of Subsidizing the Clinic 20

Family Practice Clinic In the Future 20

Appendix 1 - Businesses in Wahkiakum County 22

Figure 1 - 1. Average Monthly Employment and Total Wages in 22

Covered Employment, CY 2004. 22

Figure 1 -2. Top Ten Employers in Wahkiakum County 2005 23

Appendix 2 -Regional Medical Resources 25

Appendix 3 - Clinic 2007 Survey 27

Chart 1. Clinic Importance 28

Table 1: Importance Vs Option Selection and Subsidy Selected 28

Chart 2: Clinic Importance versus Clinic Option Selected 29

Chart 3: Clinic Importance versus Form of Subsidy Selected 30

Chart 4. Clinician Preferences 30

Chart 5. Respondents Going to Kaiser or Other Clinics 31

Chart 6. Willing to See ARNP 32

Chart 6. Service Level Selections 33

Table 2: Summary of Other Option Themes 33

Chart 7. Choice of Subsidy Type 34

Table 3. Summary of Themes and Observations 35

Appendix 4 - Proforma Operating Statements 37

Appendix 5 - Clinic Floor Plan 39

Appendix 6 - Policy Issues and Recommendations 40

Appendix 7 – Advisory Board Charter 46