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

Methods of Subsidizing the Clinic

The proforma operating statement illustrates that break-even can be achieved under a four clinician model. The patient base must grow and the physical limitations of the clinic must be addressed before a fourth clinician can be added to the staff. The three clinician model is unable to generate sufficient revenues to achieve break-even and without continued support from the County or some form of subsidy.

The Clinic Advisory Board believes that the subsidy requirement should be satisfied by some form of fee or contribution from the patients that utilize the clinic. The results of the community survey also support this method of subsidization. Initially, the clinic will try and raise these contributions on a voluntary basis and a communication campaign has been started to inform the community about this need. We don’t believe that the financially disadvantaged or the Medicaid patients should be asked for this type of contribution. We also believe that children under 18 years of age should be included in the contribution from the parents. These adjustments reduce the total patients available to make contributions to 2200. At that patient level, a subsidy or contribution of $120 per patient per year would be required to stabilize the financial performance of the clinic. Should a voluntary campaign fail to generate the amount of subsidy required another approach or an alternate funding source will be required.

Family Practice Clinic In the Future

As the community continues to grow, the Clinic Advisory Board believes that growing the Clinic's business is the best approach for the future. The opportunity to return the Clinic to private ownership depends entirely upon stabilizing the current Clinic and making it self-sufficient. As outlined above, these interim steps will require recruitment of additional clinical staff, increasing revenues through increasing the patient panel, and expanding the existing building to provide more efficient work space. These are the steps that will occupy the Clinic and its advisors for the immediate future.

The long range vision for the Family Practice Clinic is to become the anchor for a true Community Wellness Center that brings together health care services in an integrated fashion. The Community Wellness Center would be both a physical place and a virtual space. In addition, the Community Wellness Center would work in harmony with and support of the Columbia View Care Center, the Hotel Cathlamet, and any other health care facilities located in the county.
This vision includes the construction of a new medical facility which would include a Level 5 trauma center, and adequate facilities to serve the range of needs for the medical and mental health of the community. While the Family Practice Clinic staff would serve as the core medical practitioners, there would be spaces available for use by visiting practitioners such as cardiologists, podiatrists, physical therapists, and dermatologists. These visiting specialists might only be here once a week or once a month depending on the needs of the community. The Community Wellness Center would also provide education and training for the community in a range of subjects including, but not limited to, healthy living, nutrition and diet, exercise, yoga, and related activities that can improve health and wellbeing.
There are number of steps that must be accomplished to achieve the vision for the Community Wellness Clinic. These are described below:

1. 
   Continue to Grow the Family Practice Clinic Base Panel – fundamental to achieving the long range vision described above includes being able to operate the Family Practice Clinic sustainably and growing the practice.
   

2. 
   Seek New Partnerships For The Family Practice Clinic – there may be new opportunities in the future for the Family Practice Clinic to work collaboratively with other organizations to enhance the level of care available to the Clinic’s patients.
   

3. 
   Return The Family Practice Clinic To Private Control – one of the core milestones for the Board of County Commissioners involves the Family Practice Clinic achieving a level of viability and sustainability that will attract private ownership for the Clinic. The Clinic Advisory Board believes that the most efficient way of achieving this goal is to build the Family Practice Clinic patient base and revenues.
   

4. 
   Seek Grant, Foundation, And Community Investments – the Clinic Advisory Board believes that funding to expand the existing Clinic space can be identified including a reasonable local match. Expanding the existing facility will provide time to plan for and implement the far larger goal of building a Community Wellness Center that is designed to house many of the existing private and public health practitioners together in one facility.
   

Appendix 1 - Businesses in Wahkiakum County

Wahkiakum County’s civilian, non-farm labor force is approximately 1,720, with a 2005 unemployment rate of 6.1%. The key industries and employment levels are listed in Figure 2 below:

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

Covered Employment, CY 2004.

Industry	Employers	Average # of Employees^2	Percent of Total Employment	Wages Paid	% Total Wages Paid
Agriculture, Forestry, Fishing and Hunting	20	196	23.96	$6,527,235	30.71
Mining^1	--	--	--	--	--
Utilities^1	--	--	--	--	--
Construction	10	34	4.16	710,433	3.34
Manufacturing	5	46	5.62	1,467,881	6.91
Wholesale/Retail Trade	10	53	6.48	692,842	3.26
Transportation & Warehousing	8	16	1.96	500,909	2.36
Information^2	*	*	*	*	*
Finance, Insurance, Real Estate	8	18	2.20	402,893	1.90
Professional & Technical Services^1	--	--	--	--	--
Management of Companies & Enterprises^1	--	--	--	--	--
Administrative & Waste Services	4	15	1.83	142,414	0.67
Educational Services	3	89	10.88	2,724,896	12.82
Health Care and Social Assistance	7	83	10.15	1,519,262	7.15
Arts, Entertainment and Recreation	3	10	1.22	117,439	0.55
Accommodation and Food Services	10	67	8.19	601,500	2.83
Other Services, expect Public Administration	30	27	3.30	337,718	1.59
Government	10	136	16.63	4,625,578	21.77
Total	133	818	100.00	$21,251,343	100.00
Notes
1. There are no employers in these fields in the county. The utilities in the county are provided by a Public Utility District and are counted in the government figures.
* The number of employers and employees is so small that these data are not provided to protect the privacy of those employers.
2. The average number of employees in a year is the number reported by the Bureau of Labor Statistics, recognizing the employment levels may rise and fall with some seasonal work.

Wahkiakum County is still making the transition from a natural resource extraction based economy to a more diversified, tourism driven economy. This change in economic activity has been underway for more than 20 years. In the 1940s, the population in the county was nearly 5,000 and logging and fishing were the primary industries. Today, the economy is changing as more people retire in the county and as businesses diversify. The top ten employers in Wahkiakum County provide a general understanding of nature of the counties economic activity.

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

Company	Product or Service	# of Employees
1. Jerry DeBriae Logging Company	Logging	130
2. Wahkiakum County Government	Government	80
3.Wahkiakum County School District	Public Education Facilities	68
4. Sunbridge Care and Rehabilitation Center	Skilled Nursing and Rehabilitation Center	44
5. Dandy Digger and Supply	Light Manufacturing – Post-hole Diggers	24
6. Wahkiakum West	Telecommunications	21
7. Elochoman Millworks	Custom Door Manufacture	18
8. St. James Family Center	Day Care & Family Services	18
9. Campbell Group	Forest Management	9
10. Wahkiakum Public Utility District	Power and water provider	9
Source: Lower Columbia Economic Development Council Web Site (www.lowercolumbiaedc.org)

In 2006 and 2007, there has been growth in construction, retail trade, and tourism related businesses such as bed and breakfasts. In addition, there is a growing network of organic and specialty agriculture producers in the county including an organic dairy, an on-farm fresh foods market (seasonal), and a number of high value grass-feed livestock operations. The food and farm businesses not only cater to the community but to tourists in the area as well.

T

he Cathlamet Marina is a central feature of the growing Wahkiakum County recreation sector. During the spring and fall, recreational fishing keeps the marina packed with visitors and boats. Throughout the summer boating season, the marina is home to major yachting clubs and visiting boaters in great numbers. The marina is also the focus of several community events including the Wooden Boat Show and the Buzzard’s Breathe Chili Cook-off.
Visitors to the community can also enjoy Skamokawa Vista Park with its diverse camping opportunities and gorgeous sandy beach on the Columbia, the Julia Butler Hansen Columbian White Tailed Deer Refuge, and numerous opportunities for kayaking, fishing, hiking, biking, as well as wildlife observation. During the summer months, the Two Islands Farm market offers both community supported agriculture subscriptions and a wide variety of locally grown fruits, vegetables, as well as eggs and grass-fed meats and poultry.
Many Wahkiakum County residents work outside the county. They travel east to Longview, Kelso and Vancouver, south to Rainer, Wauna, and Astoria, and west to lower Pacific County. Additionally, there are workers coming into the county on a daily basis