Vashon Health Care District Commissioners unanimously decided last week to sign an agreement with the community-based federally-qualified health and human service provider (FQHC) Sea Mar Community Health Centers for medical services on the island, ending an urgent search to find a new Vashon health care provider that was made more complicated because of the coronavirus pandemic.

During a special meeting with an attorney present, the board addressed aspects of the contract for primary care services with Sea Mar, modeled after the district’s current clinic services agreement with Neighborcare. The contract commences Nov. 1 for a one-year term and does not include any further services Sea Mar may establish on the island in the future, including dental and behavioral health services.

Sea Mar will receive a hefty $1.5 million subsidy from the district to run the Sunrise Ridge clinic until October of next year, paid in monthly installments of $125,000. Commissioners will review the financial success of the clinic on a quarterly basis with a Sea Mar representative and determine whether the subsidy needs to be revised and adjusted.

Although all commissioners voted in favor of the agreement, some expressed reservations, ranging from the generous size of the subsidy to concerns that the contract does not define adequate performance standards.

The news about the contract comes after the Health Care District Board signed a Memorandum of Understanding with Sea-Mar last month to discuss an agreement to subsidize clinic services on the island. Sea Mar requested the high subsidy based on the experience of Neighborcare this year at the island clinic.

The newly-formed health district found itself swimming against the tide of the pandemic this year just after launching the search for the island’s next primary care provider, with the virus limiting the number of responses from regional health care provider systems to a request for proposal the district circulated earlier this year. Commissioners, said Tom Langland, president of the board, did not expect months ago to find themselves in this situation.

“Even though I personally look forward to a robust relationship with Sea Mar and building back something like the clinic we used to have here in terms of service, I recognize that yeah, this isn’t what any of us saw going backward. But we’re looking ahead,” he said.

Islanders should not expect a prolonged closure of the clinic while the transition is underway. Superintendent Eric Jensen said he was optimistic that Sea Mar will reopen the clinic as soon as possible once Neighborcare Health moves out at the end of the month, after taking stock of equipment that remains on-site, upgrading the IT system, and ensuring that workers know that they have continuity of benefits.

Under the contract, Sea Mar will operate the island clinic in a manner consistent with current procedures and scheduling, and with some of the same personnel in place. Initial negotiations between Sea Mar and current Neighborcare clinic staff and doctors awaiting the transition were beginning on Wednesday, although some specifics have yet to be finalized.

Jensen said the clinic, with Sea Mar at the helm, would thrive as long as islanders support it.

“What’s really important to realize is that this clinic is going to be successful if people utilize it. And we recognize that we have to make sure that the service is good so people want to go there, [and] that the doctors are good,” Jensen said.

Neighborcare’s practices at the Vashon clinic have been criticized in the past by islanders over concerns including booking appointments over the phone to insufficient physician availability. The contract with Sea Mar addresses some of these issues.

For example, Sea Mar is committing to ensure that walk-in and same-day appointments are readily available and that the timetable for scheduled appointments is fair. Islanders also won’t have to make appointments with a call center to be seen by their doctor. At the Vashon clinic, they will speak directly to the front desk, such as how Sea Mar handles scheduling at all of their clinics.

One concern raised by islanders stems from the question of whether or not Kaiser Permanente subscribers will be able to access health care services at the Vashon clinic. Jensen said that based on numerous conversations with Kaiser executives, he is confident they will.

“The intent of everybody is that [Sea Mar is] going to be seeing Kaiser patients there,” he said in a follow-up interview with The Beachcomber.

Elsewhere on the island, Vashon Natural Medicine accepts PPO Plans with Kaiser Permanente.

Situated across western Washington in 13 counties, Sea Mar aims to provide services to low-income, underserved and uninsured populations, specializing in services to the Latino community. In seven years, Sea Mar is now the third health care provider set to operate out of the Sunrise Ridge clinic. After CHI Franciscans Health acquired Highline Medical Group, which had been running the clinic for more than a decade, the Franciscans took over in July of 2013. Three years later, when the Franciscans revealed that they would close the clinic for financial reasons, a mad rush led by community members to find a successor led to the opening of Neighborcare Health on Vashon.

Neighborcare, however, was soon running at a substantial deficit as well, one that increased as patient volumes at the island clinic gradually dropped. After requesting funding from the newly-elected commissioners to cover losses that were even greater than previously reported, Neighborcare declared in May that it planned to leave Vashon.

In order to help keep Neighborcare afloat until Oct. 31, commissioners voted to hand over a total of $440,000 to cover the clinic’s expected losses for its remaining months open, money budgeted from King County as part of an interfund loan obtained last winter.

Commissioner Don Wolczko was the first to make a point about the large subsidy the district is poised to offer, saying he was disappointed the district would not compensate Sea Mar for its actual losses of up to $125,000 a month, as opposed to what the contract stipulates — a promise, whatever Sea Mar’s finances, to commit the district to $1.5 million for 12 months.

That is far greater than the investment made by similar public hospital districts in their own networks of health care providers, including two that the commissioners closely looked at. A line item in the proposed 2021 budget for nearby Mason County Public Hospital District #2 lists $350,000 in support of clinic services there. Up north, a recent report from PeaceHealth Peace Island Medical Center to the San Juan County Public Hospital District #1 commissioners summarizing losses across the last six months in all health services recommends a tax subsidy of $516,838 to close the gap.

Of the district’s subsidy, Jensen stressed at the meeting that the board recognized $1.5 million is steep, but that the agreement was only for one year and would be reevaluated. He added that while there is a strong rationale for wanting to subsidize Sea Mar only for clinic losses, there are benefits to the contracted arrangement.

His remarks were followed by commissioner Eric Pryne, who said that like Wolczko, he also would have preferred if the district had agreed to pay Sea Mar actual losses rather than a flat, guaranteed amount. Reading from a prepared statement before commissioners formally voted to approve the contract, he acknowledged the hard work of the board to reach the final stages of an agreement with a new provider. But said he was concerned about how the district would fund operations at the clinic over time.

“$1.5 million guaranteed is a lot of money,” he said, later calling that figure “the non-negotiable price tag.”

“We all know it’ll be a big challenge to put together a 2021 budget that covers that amount plus all of our other expenses. It’s not impossible, but it won’t be easy,” he said.

Commissioners plan to levy money raised from property taxes in 2021 to finance the district, but Pryne said at their last meeting that the board is waiting for information from the county before they decide on a levy rate.

Pryne added that he would have liked to see a provision in the contract giving the district credit against the subsidy if Sea Mar should obtain other funding for the clinic not included in its current pro forma, such as aid from another federal Coronavirus stimulus bill.

In addition, the contract does not specify acceptable performance expectations, Pryne insisted. In similar cases as the district’s, he said, other public hospital districts have negotiated arrangements with health care networks that provide more specific performance expectations, from staffing levels to productivity metrics.

“As matters stand now, we’re committing to give Sea Mar $125,000 every month for the next year to run the clinic with not a lot of certainty about what we’ll be getting in return. It’s a leap of faith of sorts. We’re betting that they’ll do right by us. I sincerely hope that happens,” he said. “If it does, I will be the first to admit my concerns were misplaced.”

The health care district met after press time for their regular meeting on Wednesday, Oct. 21. The contract with Sea Mar Community Health Centers is available online at vashonhealthcare.org.

Neighborcare lays out final days on Vashon

A spokesperson said the Neighborcare clinic at Sunrise Ridge will close to patient care at 2 p.m. today, Monday, through Thursday this week, and at 12 p.m. on Friday. The reduced hours will allow medical practitioners and staff time to carry out prescriptions, arrange treatment and follow-up on any pending patient needs prior to the closing of the clinic.

After the clinic closure on Oct. 31, Neighborcare will spend the week finishing the final inventory and shifting its equipment from space. By the end of the day on Nov. 6, they will be fully moved out.

“We appreciate that a fellow community health center has engaged with the district, and hope that a new clinic will be up and running soon. We have been very cooperative in providing both the Vashon Health Care District and Sea Mar with financial information, staffing levels, and patient use information,” the spokesperson wrote in an email. “We have also shared with the district and Sea Mar the details on equipment at the clinic that can be sold or leased, for their consideration.”

Neighborcare Health will continue to offer medical, dental and mental health services to students on the island through the school-based health center at Vashon Island High School.

Patients can request a copy of their health records by calling 206-548-3043 or they can obtain them online at neighborcare.org/records. The MyChart online system for health records will still be accessible to island patients after Neighborcare Health leaves the Sunrise Ridge clinic.