Now we know…

The Republicans have just floored their health care reform bill. You can read the details all over the internet. But it’s a disaster for rural hospital districts like ours. We have the oldest population of any county in the State and  rely heavily on Medicare reimbursement. We also have a huge poor population, which relies on Medicaid. Let’s just set aside the number of people who come to the food bank weekly.

Our reliance on  Medicare and Medicaid patients being reimbursed from the federal government at rates that make it worthwhile to do the work of caring for them, make it important not to lose what ground has been gained. Before Obamacare we were running a deficit that the taxpayers of this county paid for. Since Obamacare we are running a surplus. Not much, but not in the red. Now this. Who’s going to pay?The general attitude that I hear all the time from acquaintances and on the Internet is that they don’t want more taxes. The poor will come into the emergency rooms regardless if they are covered or not. But if the Feds don’t pay for them, it will be on us. You and I. Or the hospital could eventually close. Just ponder the words of a Kaiser Family Foundation study published in 2016 (JHC is  a 25 bed hospital):

In 2012-2013, rural hospitals had an average of 50 beds and a median of 25 beds. They had an average daily census of 7 patients and 321 employees, and they were 10 years old on average. Compared to urban hospitals, rural hospitals are more likely to be in counties with an elderly and poor population.9 According to The North Carolina Rural Health Research Program (NC RHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, there were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009, and since the 2008-2009 recession, the annual number of closures has increased each year.10 More than half of all rural hospital closures since 2010 were in the South and few Southern states have expanded Medicaid under the ACA.

http://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

The expectations are that we are in for some very hard times in the years ahead. It will take a lot of effort to keep our hospital running efficiently and staffed appropriately. Even now, we are having a hard time retaining quality medical staff even though we offer competitive salaries to Seattle, according to the hospital administration. Unfortunately, we have not done a great job at looking at foreign trained medical professionals, which are in wide spread use at Harrison and other nearby medical facilities. We also are behind the curve in the use of less expensive mid-levels, ARNPs and PAs. To the hospital district’s credit, the number of those mid-levels is up recently, probably due more to federal requirements and an inability to retain physicians, more  than anything else.

Perhaps if the Democrats win back the House and Senate and eventually the Presidency we can hope for fixes to this awful proposal which was created by a cabal of men behind closed doors. No women, even of their own party, were asked to work with them. It was despicable back room politics of the worse kind. They have even screwed their own constituents in places like Spokane and Wenatchee, as rural hospitals there are even farther from urban centers.  You have to wonder just who they represent? Or maybe we already know and this next four years will finally drive that home to their supporters in places throughout the rural west and south. Or maybe those voters and non-voters are so tuned into Fox News that they can’t connect the dots anymore.

We can only hope that we will get through the next four years without seeing a collapse of our hospital and the services it is offering, even though prices are already causing people who are aware of the high charges to drive closer into Seattle to seek competitive rates for services.

Now more than ever we need engaged, knowledgeable people in the role of Hospital District Commissioner, which is an election that is happening now. We don’t need a rubber stamp for the hospital district administration, we need deeply knowledgeable people who can roll up their sleeves and help, challenge the administration when needed and go advocate for the hospital district in the State and Federal arenas.

We need leadership from skilled medical professionals who have spent time in the trenches, understanding  both the issues of health care administration and the needs of our neighbors because they have sat in the rooms with these patients as they poured out their hearts to them about their medical conditions and their ability to pay for treatment or drugs. People who held them as they cried. Who may have given them free treatment rather than walked away. Who might have sometimes given them hard news. People who know what we have to fight for and can help guide the hospital district administration and our elected officials forward through this coming dark night.

First Hospital District Commissioner Candidate Forum!

The race for Jefferson County Hospital District Commissioner is perhaps the most contentious ballot position open this coming fall. With three candidates, a primary will be held with ballots being shipped out on July 12th. Much is at stake, as the Hospital District is facing enormous challenges in the next few years with anticipated cutbacks by the Republican controlled Congress and President Trump. Medicare and Medicaid cuts loom, which supply a large percentage of the hospital districts’ reimbursals. So looking towards a new Hospital District Commissioner is important, as they will likely be leading work guiding the hospital administration forward in whatever changes are in store.

With those concerns in mind, that’s why a full house of approximately 20 people showed up for a Hospital District Commissioner candidate forum held by the Jefferson Citizens Healthcare Access group (CHA). CHA is a subgroup of Local2020 and is made up of concerned individuals and representatives of community groups, such as Indivisible PT Huddle, Jefferson County Health Department, The Olympic Community of Health, the hospital administration, ex-healthcare industry professionals as well as others.  These representatives were there on behalf of many dozens of other county citizens, patients and providers.

The three candidates all fielded a wide range of questions on their backgrounds, why they feel they are the right candidates, beliefs in priorities and goals for the county hospital district. The CHA group spent one and a half hours with the candidates, which gave plenty of time to let them introduce themselves to the audience and explain their positions.

All three candidates have significant backgrounds in community health issues for Jefferson County and long time involvement in the community.

Cheri Van Hoover who lives in the Chimicum area, brings the longest record of actually providing healthcare to patients, as a Registered nurse, ARNP, midwife, and mental health clinic counselor.  She also teaches healthcare policy for Philadelphia College and has written award winning articles on midwifery & women’s healthcare. She  has run several small businesses over 40 years.

Bruce McComas brings the most background in corporate management from his experience managing the mill and it’s hundreds of employees. This included working on providing healthcare for the employees. He also is currently involved in volunteer hospital committees exploring issues relevant to patient access and quality control. He was a member of the PT school board between 1993 and 2000. He was voted “Citizen of the Year” in 2008. He currently works for a management consulting firm. He holds a Bachelor of Science degree in Chemical Engineering and a Masters in Business Administration.

Bernie Donanberg brings significant mental healthcare management experience both here on the Peninsula and on the north I-5 corridor.  He has a master’s degree in psychology and worked  as a child therapist. He stated that he was bringing experience that could help with the upcoming purchase of the Discovery Behavioral Healthcare, as he has been a clinical director in the past. He expressed concern about the lack of co-location of mental health from the hospital. He is retired.

There were few surprises in the forum. Ms. Van Hoover and Mr. Donanberg expressed support for Single Payer Health Care while Mr. McComas said he supports universal healthcare. Ms Van Hoover pointed out that it was not likely to be an issue that the local Commissioners would be able to help implement a single payer system without state wide support.

Mr. Donanberg’s response to questions on his support of universal healthcare coverage was that he had questions about how  to achieve the goal given funding levels. He then suggested that we could look to implement some kind of universal funding by having the county run an “insurance pool”. Further details need to be supplied to help us understand that idea.

Ms. Van Hoover stated that she did not see a way for the county to provide this kind of funding level in some kind of insurance pool.

Mr. McComas stated he didn’t have an answer to how create Universal Coverage, and reinforced that by saying that even the best minds in politics hadn’t yet either, but he thought it could be implemented by looking to “quality improvements” as a way to lower costs.

When asked  about what he as a commissioner could bring to the table, Mr. McComas stated, “How do you do more with less.” He provided no details about what areas of the hospital might be looked at on this issue. Mr. McComas stated that he saw the role as overseeing performance, financial oversight and customer advocacy. He said that safety, quality of service and affordability were his main concerns.

Ms. Van Hoover stressed that the Commissioner role was not a management role, but a role of guidance and policy, two of her strengths.  She said that she would bring more adherence to public process and discussion on all topics. She expressed concern with the lack of public input some of the current commissioners seemed to feel was adequate.

Perhaps the biggest difference mentioned over the issue of what could be an issue added to  the Commissioners portfolio was when asked the same question Mr. Donanberg stated that he would have the Commissioners look into the issue of early childhood immunizations. He stated he does not support infant vaccinations around the time of birth, saying it was “wrong and that there are other methods of supporting immunization.” He admitted he did not immediately vaccinate his own children, but offered no scientific reasons as to why the community should support that.  The other two candidates did not  agree with that stand. It was pointed out that Jefferson County has one of the lowest vaccination rates in the State, putting us at risk of an outbreak of diseases that are addressed by vaccinations.

Concerns were raised over rising prescription costs, but no candidate really came up with a solution to it that they supported. Mr. McComas stated that “I really am not knowledgeable on this issue.” Ms. Van Hoover said that she was concerned with rising prescription costs but did not see a way to solve the problem locally. She was more concerned with a lack of prescription delivery service in the south county as a local issue that could be addressed. She wondered whether the hospital district could look into better methods of delivery of medications  with the Quilcene Clinic. Her concern was forcing patients to drive to Port Townsend to fill prescriptions. Mr. Donanberg stated that buying via the Internet and other bulk buying options existed and should be further explored.

Additional concerns were raised by Ms. Van Hoover over the ongoing lack of primary care professionals and the turnover of many in the near past. She said she would focus on working with the hospital on retention and recruitment issues. None of the other candidates addressed this issue.

When asked about the Community Health Improvement Plan (CHIP), a multiyear effort by the Hospital District to set healthcare goals, only Ms. Van Hoover had input on areas that could be improved on it, which she outlined were around a potential lack of continuing efforts to reduce teen pregnancy. The county alone has done a great job at lowering teen pregnancy but not including it in CHIP goals concerned her.

Mr. McComas stated that the CHIP was “very ambitious” and that the Hospital Commissioners were only “one part” of the effort. He offered no areas of it he would change.

 

Jul. 12: Ballots mailed
Jul. 24: Deadline for in-person registration – only for those not registered in WA State
Aug. 1: Election Day (Results at 8:00 p.m.)

Web Presence/More info: 

There is no web site for Bernard Donanberg. He will rely on the voter’s pamphlet mailed to county voters in a couple of weeks.

Web site of Cheri Van Hoover – https://www.facebook.com/Cheri-Van-Hoover-for-Community-Health-1879516315656505/

Web site of Bruce McComas  –   http://brucemccomas.org/

 

Bernie Donanberg – Candidate for Hospital Commissioner – Q&A Responses

Q and A Commissioner BRUCE CHA FINAL

Q and As Commissioner CHERI – Answered

 

Medicaid is for everyone – New York Times

The war on the poor in America continues. As the Republicans work in secrecy to come up with a healthcare bill to serve someone other than the average American,  The New York Times ponders the destruction of Medicaid, high on the Republicans list. If ever there was a rich vs. poor issue, this is it. If this gets implemented as the Republicans and Trump want, it will have disastrous consequences for Jefferson and Clallam Counties. Both of them have high levels of both Medicaid and Medicare beneficiaries and our hospitals budgets are based on those reimbursals being available. It is the calm before the storm here.

American Cancer Society Journal Promotes Quackery

This article will no doubt shock some, especially in Port Townsend. Some thoughts first to help put context to it.

Dr. Stephen Barrett has been a tireless advocate for exposing fraud and quackery in the medical field. I have read his newsletter for years and have never found myself at odds with his opinions. I’m reposting this here not because I necessarily agree with his opinion on the ACS running this article, but because he points out some very valid questions. While I have witnessed cancer patients, including terminally ill ones, having alternative treatments and “feeling better” none of them that I witnessed ever changed the outcome from terminal to remission. And unfortunately, some of the people promoting these “therapies” are making very good money from promoting them. It is sad but true.

I personally agree with Dr. Barrett’s thoughts that if the therapy ‘makes the patient feel better’ and is not a burden on their families financial situation, then there seems to be no ‘harm’ done. But all too often these are presented as cures.

With that said, here’s the analysis by Dr. Barrett. I am underling what I believe are the key thoughts here.

The American Cancer Society (ACS) has published the Society for Integrative Oncology’s Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment in the May/June 2017 issue of CA: A Cancer Journal for Clinicians. The monograph, whose co-authors include three naturopaths and an acupuncturist, states that its “recommendations” should not be regarded as the standard of care but are warranted as “viable but not singular options for the management of a specific symptom or side effect.” (In other words, they have no effect on the course of cancer but might help some patients feel better.) The “therapies” include acetyl-l-carnitine; acupuncture; acupressure; aloe vera; ginger; ginseng; glutamine; guarana; healing touch; hyaluronic acid cream; hypnosis; laser therapy; manual lymphatic drainage and compression bandaging; massage; meditation; mistletoe; music therapy; reflexology; relaxation techniques; qigong; stress management; soy; and yoga.


In 2014, in response to an earlier edition of the guidelines, David Gorski, M.D., Ph.D., noted:

Treatments that are truly effective and safe do not need the training wheels of a title like “alternative,” “complementary,” or “integrative.” They will stand on their own to scientific testing and should not be used until they have.

The real purpose of the guidelines is to use an ostensibly critical analysis buying into the false dichotomy of “integrative oncology” in order to rebrand potentially science-based modalities as “alternative” or “integrative” and to provide ammunition for advocates of “integrative oncology” to start “integrating” quackery with science-based medicine. [Gorski D. Selling “integrative oncology” as a monograph in JNCI. Science-Based Medicine, Dec 1, 2014]

Smilemobile in Port Townsend

From: Karri Amundson <KAMUNDSON@deltadentalwa.com>

Subject: SMILEMOBILE COMES TO PORT TOWNSEND

Date: June 9, 2017 at 3:00:24 PM PDT

 

Good Afternoon, 

I wanted to share with you that the SmileMobile will be in your community!

We have been partnering with the health department for years to bring the van and to address the oral health needs of Port Townsend and surrounding communities.

The SmileMobile is a 3 chair mobile dental van and will be parked near the Jefferson County Health Department (parking lot) the weeks of June 19  – 23 and 26 – 30. The SmileMobile (van) is 39 ft. long with two slide outs and three dental chairs.  The dental team provides oral health education, examinations, fluoride varnish, digital x-rays (as needed), cleanings, fillings and simple extractions to babies up through high school age and pregnant/post-partum women.  We may see additional uninsured adults if the schedule allows. 

Please share the following information with all of your contacts and community organizations to assist us in recruiting and creating awareness on oral health and the importance to overall health.

I have attached our SmileMobile logo, flyers and jpgs for use in social media.

Please feel free to stop by and check out the van and meet the staff.

Warm regards,

Karri

Karri Amundson

Senior Program Officer

Washington Dental Service Foundation

9706 Fourth | Avenue NE | Seattle, WA 98115-2157

First to lose Obamacare? The sickest county in the state – Seattle Times

The Seattle Times has a good article about the outcome of the Republican led move to sow uncertainty and doubt about Obamacare’s future. Gray’s Harbor joins the growing ranks of county’s without healthcare insurance for over 2200 of it’s residents. And if the Republicans in Washington get their way, there will be over 7000 more joining them soon. Oddly, out of all this, we may end up getting single payer, due to the Republicans apparently hell bent on committing political suicide by alienating their base of white rural lower to middle class voters. 47 counties nationwide now don’t have health insurance companies serving them, most of the counties voted Republican. Read it and weep. Because counties like ours, which are largely using Medicare and Medicaid to supply us with health coverage are next up on the Republicans chopping block.

Obamacare is starting to crack, starting in our state’s sickest spot, Grays Harbor County. But the plan isn’t to fix it. It’s to make it dramatically worse.

http://www.seattletimes.com/seattle-news/politics/first-to-lose-obamacare-the-sickest-county-in-the-state/

Some possible good news on prostate cancer- The Guardian

This was in today’s Guardian.

Prostate cancer trial stuns researchers: ‘It’s a once in a career feeling’ – Study with ‘powerful results’ finds that combining two existing therapies could extend the life of men with advanced, high-risk prostate cancer by 37%. Combining two existing prostate cancer therapies could extend the life of men with advanced, high-risk prostate cancer by 37%, according to a study presented at the world’s largest cancer conference. The new findings could change how doctors first approach treatment of prostate cancer.

https://www.theguardian.com/society/2017/jun/03/prostate-cancer-therapy-study-abiraterone?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+USA+-+Collections+2017&utm_term=229027&subid=9822000&CMP=GT_US_collection