The clinic: Searching for funds, future

Wahkiakum County officials are meeting weekly to address the funding and future of the Wahkiakum Family Practice Clinic.

When former owner PeaceHealth announced plans three years ago to close the Cathlamet office because it wasn't profitable, Wahkiakum County officials developed a plan to purchase and operate it. They believed that as a publicly owned clinic, the clinic would qualify for federal Rural Practice Clinic status and receive higher payment Medicare and Medicaid services.

The clinic did qualify for Rural Health Clinic status, but overall payments haven't kept up with expenses. In the first two years of operation, Wahkiakum County covered $100,000 deficits. This year, the clinic faces a $250,000 shortfall, and county officials say they don't have the revenue to continue covering deficits of that size.

County officials and clinic doctors and staff met March 7 in a workshop to discuss the issues. Eagle News Editor Caroline Jennings attended and filed this report:

The choice is to keep the clinic running at current level of service and find money elsewhere, or shut it down completely, workshop participants said. They felt a reduction in quality of service would be devastating and would open the clinic up to malpractice litigation.

Clinic Business Manager Kathy Patterson gave six options to address the situation:

1. General staff cuts in weekly hours would save approximately $136,000. This would impact the clinic’s ability to provide testing facilities, such as X-rays and lab work, and reduce the time for each patient. It would also be very stressful on remaining staff.

2. The loss of the clinic’s two registered nurses would result in savings of $167,000. However that option would also impact the clinic’s abilities to provide testing amenities and adequate patient liaison and education. It may also result in a further deficit as the clinic would fall beneath the Medicare cost cap, decreasing the cost per visit payment.

3. Lose a doctor, an option that would not only overload the two remaining physicians but would decrease revenue by $300,000, would leave the clinic with a net loss of $91,500. It would cost the county further in a severance package and the renegotiation of contracts for the remaining doctors. This would also put an end to all after-hours calls and hospital rounds.

4. Cutting the current Advanced Registered Nursing Practitioner’s (ARNP) hours in half would decrease the revenue by $140,000 and result in a net loss of $92,500. As with the other cuts, this would increase the work load of the remaining clinic staff beyond acceptable measures.

5 and 6. The hiring of an Advanced Registered Nursing Practitioner (ARNP) would increase revenue anywhere from $140,000 to $280,000, bringing in a net gain of $120,000. The clinic could then expand its capabilities to include offsite work and round out its schedule with evenings and Saturdays. The same would happen with an additional doctor, however it is more difficult to find a doctor willing to relocate to rural areas, and with a doctor’s higher salary, the net gain would only be $42,000. That’s not enough to cover the deficit the clinic is currently facing.

Clinic staff recommended that the county find the money to run the clinic at its current levels and look towards hiring another ARNP, which could take six months to accomplish.

County commissioners said they would go over the budget to see if money can be relocated for short term financial needs.

Senior physician Dr. Richard Avalon commented that if the clinic could not continue as it is, as it has already been gutted to operate at lowest cost possible, then he would not stay. He would rather see the clinic close than to offer reduced quality healthcare.

And closing the clinic would have far reaching impacts on the community, he added. These could include:

--Health care is a big draw for the community. Many residents might leave, and few would move to an area without health care. This would lead to an overall decline in the area's economy and a reduction in government services.

--School registration would suffer; a decline in enrollment would mean a decline in state apportionment funds.

--Health care businesses such as the pharmacy, nursing home and assisted living center likely would close, thereby displacing clients and further reducing the area's economy.

--Ambulance service would be overloaded; all personnel would be volunteers. The closest emergency treatment is Longview; many older residents won’t go, and emergency cases may die before they get there.