Jefferson County Medical Society endorses McComas based on inaccurate information

“Physician, Heal Thyself” is a biblical quote, from Luke, who was a physician. The saying meant that during the rejection of Christ, that Christ would be told to fix his own faults before criticizing those of others. It could be applied last week to Dr. Steve Erickson, the head of the Jefferson Medical Society as he led a campaign to get the society to back Bruce McComas over Cheri Van Hoover for Hospital District Commissioner.

Minutes of the meeting were leaked to me and they tell an interesting story. First, the society apparently has never endorsed a political candidate in recent memory. Not even the threat of Donald Trump, a foe of Obamacare, (which has been responsible for helping the hospital stay in the black) was seen as enough of a threat to take a stand.

Now, apparently the threat of a skilled midwife, RN and ARNP,  carrying two degrees and one certification has . A woman with a background as a counselor in a community-based mental health crisis intervention and the  chair of national committees for the American College of Nurse-Midwives, chair of Ethics Task Force for Northern California Kaiser Nurse-Midwives Peer Group and Educator & Health Policy professor and nationally recognized for instructing medical, nursing, and midwifery students seems to have spooked the doctors of our town just before Halloween.  If these aren’t qualification enough to get medical professionals to endorse her, just what is? They can’t criticize her credentials so they go after her motives. They say that we ‘need’ a business person in the role, yet where were they when they elected commissioner after commissioner over 40 years with virtually no specific business acumen?  With that background the argument could just as easily be made that the hospital has done wonderfully without a businessperson on the commissioners.

The minutes stated that,”

Steve Erickson express the majority view of the meeting, which is that the two newest commissioners have been pushing for financially risky endeavors such as a subsidized dental clinic and a takeover of the county mental health services.  As far as anyone can tell, candidate Van Hoover is sympathetic to those views and candidate McComas is more concerned with maintaining the financial health of the county hospital system.

That statement puzzled me. I could not understand why Dr. Erickson was attacking the investigation that Mr. Glenn is leading into the dental clinic and mental health clinic.

The ‘risky financial endeavors’ that Dr. Erickson mentioned were originally raised as part of a multi-year community effort to prioritize county health needs. Called the “Community Health Improvement Plan” nearly 100 members of the community participated, including Mike Glenn, many hospital staff, (not Dr. Erickson apparently), Public Health, and others. The entire CHIP document can be found at :

CHIP Document

with a summary chart here:

CHIP Summary

I have attended or listened to all the Commissioner meetings since last fall, have interviewed both Mr. McComas and Ms. Van Hoover, attended 3 different candidate forums,  and never had come to the same conclusion as Dr. Erickson. I contacted Commissioner Kees Kolff and asked him about this allegation. Here’s what he told me (emphasis added):

Dental Health has been a concern of board members even before I was elected, in particular Tony Deleo. During the first year of my term I worked to get an outside agency, namely SeaMar, to come to the county since they had been so successful elsewhere. At that time Mike Glenn had already stated to the board that he would start in the fall of 2016 to explore options for JHC to provide dental services. With unanimous support from the board, he (Mr. Glenn) has spearheaded getting:

  1. the State to authorize the same reimbursement for Rural Clinics as for FQHCs (like Sea Mar) making it potentially sustainable, b. our legislators included $1 million into the hopefully soon to be approved state capital budget, for a 6 dental chair facility, and c. there is interest on the part of the Wash Dental Foundation to perhaps provide an additional $500,000.
  2. Behavioral Health service integration with medical services will be mandated shortly in our state, and is considered “best practice”. That has been the goal for several years, supported unanimously by the board. We jointly hired a Psychiatrist to spend half her time with JHC and half with Discovery Behavioral Health. Then it became evident that more integration would be best for both entities, especially the clients. Some in the community hoped that it would be a purchase of DBH and others that it would be a merger, when in fact we learned along the way that the only way to continue to get the kind of reimbursement that would make it pencil out, was to do a unique affiliation. Mike Glenn and his team, including Dr. Mattern and others on the medical staff and leadership team, spearheaded the effort, with unanimous board support.

Meanwhile, just a reminder that when the inpatient psych unit did not pencil out financially in spite of a grant for over $1 million, the board unanimously turned down the grant.

Finally, the CHIP effort also included the County and the City. A director for the program will hopefully materialize, since both the County and JHC committed money to hire one.

Although the CHIP has many ideas and priorities, they will be implemented by the different entities in the community only if they are affordable.

Hope that helps.

Cheers, Kees Kolff, MD, MPH

 

Dr. Katie Ottaway, also in attendance at the meeting brought this issue up, as the minutes state:

“Ottaway objected that community access committees have argued in favor of the dental and mental health services and that the hospital district should take those concerns seriously.”

Dr. Erickson and the others were unconvinced.  However, the vote, while claiming to be representing the “majority” of the physicians in the organization, which, according to Dr. Erickson has 25 members, had only five were present at the meeting. Dr. Erickson claimed that at the meeting they decided that they would endorse if 75% of the members who chose to express an opinion. Those who didn’t attend the meeting or responded via email were not counted as part of the threshold, so in essence, the decision was made by a minority. Dr. Erickson told me that not a single member endorsed Ms. Van Hoover, but Dr. Ottaway told me she was the lone dissenter present at the meeting.

This election for a minor county position, usually draws little to no attention. It has taken an ugly turn as some supporters of Mr. McComas have taken to a smear campaign of Ms. Van Hoover, fueled by stories like this one that Dr. Erickson used to convince the medical association of the supposed danger to the hospital by supporting Ms. Van Hoover.  I’ve also heard the stories myself directly from Bruce’s supporters that Dr. Kolff recruited Ms. Van Hoover. That is wrong. Commissioner Kate Dean was responsible for urging Ms. Van Hoover to run . Additionally, Facebook posts have lent more fuel to the misinformation campaign being waged by those same people. At this stage, I have no idea who will win. Mr. McComas has a huge amount of signs but a long time political campaign manager in town told me that “signs don’t matter, knocking on doors does.” Ms. Van Hoover has worn out her shoes doing just that.

At a recent hospital district commissioner meeting, a special consultant was hired (at a not to exceed non competitive bid of $20,000) to help mend the fences between the feuding factions. On one side are Matt Ready and Kees Kolff. They represent a belief that the Commissioners role should be more expansive than simply managing the CEO and rubber stamping all that he does. They would like to see the Board of Commissioners act more as a champion for getting health care to *all* the people in the county. There are issues at the hospital worth addressing from a policy point of view. While the hospital is doing well it has it’s share of issues, just as all bureaucratic organizations do. The faction of Marie Dressler, Jill Buhler and Tony Deleo are on the side of saying that the job is narrowly defined. They don’t want to ‘color outside the lines’ and accuse Mr. Kolff and Mr. Ready as interfering in the day to day operations. I can’t agree with that assessment, and it seems like more stories to tell Bruce’s supporters.

I listened to the opening hour of the meeting, and you could cut the tension coming from Mr. DeLeo and Ms. Buhler with a knife. You can listen to the whole recording here. The first hour is probably all you need to review.

Given the level that even the distinguished members of the Medical Society has sunk to, by not holding off making a decision until they clearly understood the facts behind the allegations, (which was requested of them),does not bode well for this election or next year’s election. Regardless of who wins the sour taste of accusations made against qualified candidates will linger. The Democrats have been warring between themselves as the Bernie faction challenges the traditional party people who brought us to a near domination of the political landscape with their hard work. The  Republicans seem willing to say and do anything to try and regain their positions in the county.

It also shows the depths that the medical society will go to in order to protect the status quo. There are plenty of positive things going on at Jefferson Healthcare. Mike Glenn and his staff have done an outstanding job of building reserves and expanding services. However, issues such as physician recruitment and retention, costs of services, and a lack of transparent pricing are just a few issues that continue to drive possible patients, such as myself, to take my healthcare elsewhere. That, in the end, will do more to harm Jefferson Healthcare than a well qualified woman who has spent a career in healthcare and health policy, which is the primary focus of the Hospital Commissioners.

If you are on the fence, or a supporter of Bruce because of these allegations, I urge you to at least research the facts before voting.

Was your physician’s clinic recently sold? Here’s how it might affect you

And the proof is in the pudding. Yes, virtually all Port Townsend physicians work for the hospital. Are costs higher here? You bet. Lots. Now a study by UC Berkeley shows it’s more than just us.

If a local hospital recently bought your physician’s practice, chances are the costs of your treatment will go up.

The intent behind hospital/physician consolidation was to achieve better coordination and care for patients. However, some experts think consolidation reduces competition, resulting in higher prices.

https://voicesforaffordablehealth.com/your-cost-watch/physicians-clinic-recently-sold-heres-might-affect/#

NYTimes: Shouldn’t Doctors Control Hospital Care?

This is a cautionary tale, especially with the current Jefferson County hospital district commissioner election and the drumbeat to elect a businessman over a medical professional. The good news is that there have been a lot of unanimous votes to support the hospital administration here in Jefferson County by the board of commissioners, even as they argue amongst themselves.

The article points out that business forces are continuing to take over our medical systems. it is the most common complaint that I hear from medical professionals. Some of the issues raised in this story are at play here in Jefferson County, mainly the issues of measuring doctors performances, and the licensing of doctors to practice at the hospital. Oddly, many of the doctors here want more business people to run the hospital and it’s Commissioners, it’s like they can’t even seem to see the forest for the trees. Those same doctors have complained that they dislike the fact they no longer control their practices. They also have no idea of what the hospitals are charging for all the tests that they are continuingly wanting to have people do before they issue a diagnosis, nor the fact that patients have little to no idea of what any of it costs.

Shouldnt Doctors Control Hospital Care?

NYTimes: New Blood Pressure Guidelines for Children

A disturbing report that seems to show that even with our much vaunted electronic records systems,along with the demands of the insurance companies to pay for only one issue per visit, our medical system is failing many children with high blood pressure.

Study after study has demonstrated that elevated blood pressure is correctly diagnosed in less than one-quarter of the children who have it.

NYTimes new blood pressure guidelines

Health care mergers often driven by patient access – Kitsap Sun

Good short article detailing the problems facing independent medical practitioners today. This is the state of medicine we are in. Jennifer Hanscom is the CEO and executive director of the Washington State Medical Association.

When I began my career at the Washington State Medical Association in 1996, 38 percent of physicians were in solo practice; today that number has plummeted to less than four percent. For comparison, during that same period only 18 percent of physicians were in practices of 100 or more physicians and a good percent of those practices were large independent clinics. Today, over 61 percent of physicians practice in groups of more than 100 physicians, with most employed by integrated systems.

http://www.kitsapsun.com/story/opinion/columnists/2017/09/07/my-turn-health-care-mergers-often-driven-patient-access/639402001/

Health Care Coverage Is Not Enough. We Need Delivery System Reform. Huffington Post

Another downside to the options the Republicans are considering behind closed doors.

It’s well known that the bill to repeal the Affordable Care Act (ACA) now making its way through the Senate would deny coverage to tens of millions of Americans.  Less well known is that it would also hit the brakes on “delivery system reform,” the work of doctors and hospitals to improve quality and reduce costs. In other words, it would make quality of care worse.

http://www.huffingtonpost.com/entry/health-care-coverage-is-not-enough-we-need-delivery-system-reform_us_596b777de4b0d6341fe98c85#

How Healthcare Orgs Offer Price Transparency to Patients – Patient Engagement HIT

Jefferson Healthcare continues to struggle to provide patients with transparent pricing. This article from 2017 touches on the issues and benefits of providing patients with transparent pricing.

Few healthcare providers are successfully offering price transparency to patients, but those who are, see drastic benefits…  Offering price transparency also has its benefits for the organizations themselves. A report from the Health Care Cost Institute showed that price transparency could eliminate 7 percent of patient costs by allowing patients to shop around for affordable care

https://patientengagementhit.com/news/how-healthcare-orgs-offer-price-transparency-to-patients