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SRH and CV affiliation with UW - why it matters and where we go from here

Last week, Skagit Regional Health and Cascade Valley Hospital announced they are entering into an agreement with UW. You can read more about the deal here.


If you'll remember, the two hospitals had previously announced they would be forming an alliance with PeaceHealth. Later, after much additional public discussion and input, PeaceHealth and the two hospitals announced that deal was no longer on the table.

The new deal with UW is a great outcome for patients and taxpayers in the Skagit area.

The public statements are circumspect, as you might expect. As a citizen advocate who's been in regular contact with patient rights advocates from the area (including a retired attorney with extensive litigation experience), I'm going to add some context to this announcement. Remember that I am not an attorney - and some people (rightfully so) will say that this is "speculation" - but it is informed speculation.

Here's why I think the deal happened:

1) The Law. The ACLU recently filed suit against Skagit Regional Health because they provide maternity care but do not provide equivalent services for patients who want to terminate a pregnancy, in clear violation of Washington's Reproductive Privacy Act. Immediately, this deal doesn't affect that litigation, but I suspect one of the reasons Skagit - which has a birthing center - wasn't providing the full spectrum of reproductive health care is because it was trying to make itself attractive to PeaceHealth. I also suspect Skagit Regional Health may soon decide to start following the law.

2) Costs. Very specifically, the wealth of data is now emerging that shows costs to patients and taxpayers are likely to skyrocket after PeaceHealth moves in. PeaceHealth woos communities by talking about their charity care and compassion - what they don't do is inform communities about restrictions on services and how prices are likely to skyrocket once they hold a monopoly on services.

Fortunately, as advocates have focused in on some of these issues, some hospital commissioners have been paying attention. The fact that an average outpatient visit on San Juan Island now results in gross revenue of more than $1100 and in-patient visits of less than three days averaged gross revenues of more than $10k has not gone unnoticed. PIMC serves 12K; grosses $14 million in 2014

Neither has the fact that Catholic hospitals actually provide less charity care than other nonprofits, something that was documented in a report by the ACLU and MergerWatch late in 2013:  www.aclu.org/files/assets/growth-of-catholic-hospitals-2013.pdf

3) An engaged citizenry that was paying attention. People for Healthcare Freedom ( www.healthcare-freedom.net) is an advocacy group, based in the Skagit area, that sprang up from nothing when people realized that PeaceHealth was poised to take over their health care.

The "members" of People for Healthcare Freedom come from many walks of life, including the law and medicine - but mostly they are people who care about patient rights, women's reproductive health, maintaining access to Death with Dignity, and not having any one religion dictate the care that people receive from a provider who takes taxpayer money.

The idea that promising treatments for diseases like MS and rheumatoid arthritis (a condition my father suffered from) might be forbidden because bishops oppose the use of embryonic stem cells strikes these people as absurd.

They're also the type of people who understand that when a health care provider systemically routes people through the ER instead of Urgent Care for cuts and ear aches that are not life threatening, it creates a problem for working people paying the bills.

By contrast, here on San Juan Island, things evolved very differently.

When the people here on San Juan Island who put the deal together with PeaceHealth did their negotiating, it was not a public process. According to press reports, the deal was only presented to the public after it was pretty much final:

http://www.sanjuanjournal.com/news/38037849.html. No options to PeaceHealth were ever presented.

In fact, a letter of intent with PeaceHealth was signed in the summer of 2008. www.prnewswire.com/ It wasn't until January 2009 that Tom Cable, who led the negotiating process with PeaceHealth with Charlie Anderson, said "We've finalized negotiating a contract with PeaceHealth," and "We're at the point where we want to start bringing the community into the process."

Because so much of the negotiation happened behind closed doors, I wanted to know more about what happened and specifically, why UW was not considered as a potential partner for San Juan Island.

To do this, I met with very senior UW Medicine officials face to face and followed up by phone. According to them, UW has always been very willing to work with communities around the state, including San Juan Island, but apparently, the committee that put the deal together here on San Juan Island didn't believe it was appropriate to flesh out a proposal that included UW.

From my conversations with UW officials, what becomes clear is that the UW is very upfront about costs and what will and won't work. This is unlike the PeaceHealth approach, where in initial discussions, they make an appeal based on emotional themes such compassion, charity care, and friendly nuns, with no mention of restricted care or the ultimate cost to the community.

As an example, one of the crucial issues that comes up when building a new medical facility is financing. UW couldn't and wouldn't come in and say, "We'll build a hospital." Unlike the Catholic systems, they don't have capital to commit.

What they do have is their reputation, which attracts financing that makes it work. My understanding, and again this is after talking to senior UW officials, is that it would have been very possible to structure a deal where UW physicians rotate through and are involved in patient care, and the reputation and brand of UW would have made it easier to get financing for a sustainable community-owned facility.

We don't know what such a deal might have looked like, because the committee that ultimately put the deal together didn't present it, didn't open it up for discussion, and didn't address the tradeoffs publicly. What we do know is that they met with a friendly nun from PeaceHealth early on and negotiated a deal BEFORE going through a public process. This is all documented in the public record.

Now we have a situation where health care costs at Interisland Medical Clinic and EMS totaled $6 million in 2012 (according to WA State officials), and combined gross revenues for PeaceIsland and EMS for the year ended June 30, 2014 exploded to $17.5 million as documented in a report submitted to the Department of Health. And of course, that was after generous donors from the island contributed $10 million to make it all happen.

In an alternate universe, the public hospital district commissioners might have developed a proposal that identified pros and cons of working with various partners and invited potential partners to meet with islanders in a public process.

Island donors might ultimately have contributed toward a package that resulted in a community-owned facility that leveraged the experience and talents of UW Medicine, an organization that earned the #1 ranking in the entire country for its primary care teaching program and that is renowned for many areas, including cancer care, geriatrics, and gynecology ( www.uwmedicine.org/about/awards/uw-rank.)

Which brings me to where we go from here.

We need people on the hospital district commission who believe in positive change and their own ability to make it happen. We need people who will work on making health care more accessible and affordable. We need people who understand the gravity of a situation where pregnant women are denied prenatal care at PIMC because of concerns that if they do, the public hospital district will be found in violation of the Reproductive Privacy Act. We need people who believe physicians should not be forbidden from even discussing Death with Dignity with their patients.

What we don't need are self-appointed community leaders to make important decisions and backroom deals on behalf of the community in a nonpublic process, effectively committing 50 years of taxpayer subsidies to an entity that is not held accountable for the cost and quality of the health care it delivers to that community.

We need hospital district commissioners who understand it's their responsibility to step up and commit to transparency, effective oversight of the vendors who provide services, and to working productively to end the legal quagmire San Juan Island is currently facing.

As citizens, we need to make our voices heard and bring accountability to the process. What HAS happened doesn't need to dictate what will happen.

In the next several weeks and months, you'll be hearing more from candidates for the Public Hospital District Board and you'll be hearing about a concrete proposal to empower patients and protect the rights of physicians who want to provide patient care consistent with best care medical standards. Please stay tuned.