Think About It: Build it and they will come

And they have.

But first, husband Paul and I are celebrating the exact anniversary date of our arrival in Sequim 20 years ago on the day this column is published.

By way of celebrating, I am dedicating this column to the reason we moved here; that is, the confluence of years of experience and my professional mission in health care and being offered a position at Olympic Medical Center (OMC), then Olympic Memorial Hospital, to cap my career.

Never mind that within three months of being offered the position and uprooting from Seattle and beginning to unwind my consulting business, the administrator who hired me unexpectedly and unceremoniously left, taking my vision with him.

Noting the obvious, I stayed at OMC and in the community, albeit in a different role than I expected, but one that offered me a ringside seat into the evolution of a rural hospital into an integrated medical center. As the Assistant Administrator of Planning and Development, I can claim membership in the team that started the development and expansion of health services in Sequim.

I resigned my position more than 10 years ago and turned over my role in what have become a community cancer center, specialized services such as cardiac services located in Sequim, home health services, integrating physician service, strategic planning and being the Sequim liaison.

I will be forever grateful for my OMC experience.

Near death experience of primary care on the peninsula

The most significant, unexpected and seismic shift in the role of OMC began later in my OMC tenure. Some of you will recall the general unease, panic in some quarters, when Virginia Mason unexpectedly and unceremoniously left our community, first Sequim and later Port Angeles.

Up until then, Virginia Mason had invested in hiring numbers of primary care physicians who would refer patients needing more complex treatments and surgeries to their Seattle medical center. Apparently it wasn’t working out for them, so they left the patients, the physicians and the community.

Physicians and OMC became reluctant suitors, and, in the end, both accepted the inevitable direction of establishing an employee/employer relationship. It was the only way OMC could sustain a hospital and outpatient services and one of the limited options available to physicians to manage an evolving complicated medical reimbursement system.

Fortunately for OMC and the community, the Jamestown S’Klallam tribe stepped up and became an active partner in providing primary care services.

This bit of history is important to understanding the issues that face OMC today in maintaining services at the level a growing, dynamic community needs. So far, the board and administrators of OMC have navigated the complexities of being a sole community hospital and provided our community much needed and desired services.

Back to the future

OMC CEO Eric Lewis has ably led the effort for the past 10-plus years. My friend and former colleague gave me some time to catch up with what he sees as priorities now and in the future.

He started by reminding me that rural health care is in crisis. It’s not quite as serious for smaller hospitals called critical access hospitals because they are paid at 100 percent of cost.

OMC, far too big to be designated anything but a community hospital, is paid at 80 percent of cost for services billed to Medicare and 75 percent for services billed to Medicaid.

I have yet to have a conversation or presentation about OMC that doesn’t include the startling fact that 82 percent of its reimbursement comes from Medicare/Medicaid and is paid at 75-80 percent of what it costs.

That leaves 18 percent to cover the shortfall, except the 1 percent of services provided as uncompensated and charity care. OMC levy dollars received through our taxes represents 2 percent of OMC’s revenue and currently covers most of uncompensated care in addition to maintaining a trauma level 3 emergency department and labor and delivery services.

(Note to community: Care without any source of reimbursement used to be up to 5 percent until the Affordable Care Act —aka ACA or aka Obamacare — took some of the burden off.

On the other hand, Lewis explains, “The expanded coverage in the ACA (Medicaid expansion and Health Insurance Exchange) was fully paid for by cuts to Medicare reimbursement and new taxes. These cuts to Medicare were significant to OMC given our high Medicare volume of 60 percent of our patients.”

The slow de-funding and gutting of the ACA will erode that advantage if less people enroll. In addition, Lewis worries about the real possibility that Medicare reimbursement cuts will not be restored to compensate the loss of ACA revenue.

OMC is in near constant contact with federal/state legislators to remind them of sole community rural hospitals’ struggle to remain viable, especially in communities with high Medicare/Medicaid populations.

Second on Lewis’ smart list of ongoing challenges is the existing workforce crisis. There simply aren’t enough, especially for filling the critical need of primary health care providers – MDs, DOs, ARNPs, PAs.

OMC always is running to catch up to the population growth and looking ahead. They recently announced planned additions to the cancer center and to Sequim’s medical office building to provide office space for primary care.

Strong community commitment

Build it and they keep coming to live, work and retire in our beautiful corner of America. Our own history reminds us that it can fall apart and, if it does, so does the community.

I asked Lewis about fiscal year 2017 that saw OMC in a hole for the year to an amount over $2.5 million. Should we worry? Lewis is reassuring and explains the loss is part of the cost of growth. OMC opened the new medical office building on the Port Angeles campus. Moving out, moving in and settling in takes people and time and resulted in onetime high labor costs for the volume of services.

OMC is on track for year 2018. Lewis said he feels confident that OMC can maintain its community owned and governed status for at least five more years. He’s reluctant to look any further ahead. He knows, too, that he can never be complacent, a strategy bound to fail in the politicized and complex industry of health care.

We — the community — cannot be complacent either. Our job is to continue to support our strong health care system which includes supporting federal/state legislators who recognize the importance of an effective health care system in our growing community.

A healthy health care system is essential to the health of our community and all individuals living here. Any less and they won’t come … or stay.

Bertha Cooper spent her career years as a health care organization and program administrator and consultant and is a featured columnist in Sequim Gazette. Cooper has lived in Sequim with her husband for nearly 20 years.

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