Fire chief presents urgent care plan for Vashon

Vashon Island Fire & Rescue Chief Matt Vinci laid out the agency’s full vision for expanding its Mobile Integrated Health (MIH) program at the board’s July 31 meeting — and on Wednesday, announced that the public is invited to another special board meeting at 7 p.m. Monday, Aug. 12, at VIFR’s Penny Farcy Training Center.

There will be one topic only at the Aug. 12 meeting: the plan to rapidly expand MIH’s current program to include urgent care.

The pitch — providing on-demand mobile urgent care with no out-of-pocket costs to patients — comes as the Vashon Healthcare District (VHCD) continues to weigh its own options for providing urgent care, which is a priority the Healthcare District’s board set for itself last year.

VHCD Superintendent Tim Johnson has raised the idea of working with DispatchHealth —a mobile urgent care provider and partner of MultiCare — as a partner to VIFR’s efforts.

Vinci says he believes VIFR can handle urgent care on the island on its own and is concerned that bringing in another party, like DispatchHealth, risks harming VIFR’s efforts and confusing islanders.

(Read VIFR’s full proposal by visiting tinyurl.com/VIFRMIH.)

Using MIH to provide urgent care — in a rural community that desperately needs it — is inspired in large part by the success of the North Mason County Regional Fire Authority, which was profiled by the Seattle Times in June. VIFR and VHCD toured the agency together this summer.

Fire chief presents urgent care plan for Vashon

Vashon Fire’s MIH program, currently, is a King County program partially funded by an existing EMS levy, with the balance of its revenue funded by a 2023 voter-approved levy lid-lift measure for the fire district. Implemented in February, it serves islanders in their own homes with follow-up visits after surgery, wound care, fall prevention assessment, nutrition and wellness checks and other healthcare.

MIH takes referrals from VIFR itself and island organizations, and islanders can also make appointments online. A registered nurse works with the department’s EMTs in the program.

The program has had 213 unique patient contacts since February, Vinci said on July 31, meaning roughly 2% of island residents so far have been served by MIH in some capacity. It currently operates two days a week and typically sees 6 to 10 patients a day, Vinci said.

MIH already has a program manager, Lilie Corroon, and a nurse, Ashley Soares, and contracts with its medical director, Dr. Cameron Buck, the emergency room director at Valley Regional Hospital. It shares a finance manager and command staff with the rest of VIFR’s operations.

MIH’s proposed $350,000-per-year expansion would grow this program so that crews could also respond to island requests for urgent care. If the board approves, MIH will grow both its referral capabilities and add the “response” element.

“I have the opportunity as the fire chief to present it, but it is our team that does all of his work,” Vinci said at the meeting. “This has been a lot of work, a lot of hours, a lot of conversations, a lot of collaboration (with) the county and other healthcare providers.”

The project would roll out in two phases.

The first would add a part-time clinical social worker to MIH and extend the existing registered nurse position (and days of operation for MIH’s referral service) from two to three days per week, ideally by October 1.

Phase two hires a full-time physician’s assistant (PA) and a per diem PA at the department later this year, who would begin delivering urgent care in January 2025.

Then, starting in January: Eight hours a day, seven days a week, a team consisting of one PA and an RN, social worker or EMTs could respond to urgent care needs across the island. The team would diagnose, care and treat islanders at home for services such as arm or leg injuries, asthma, food poisoning, cuts, pink eye, migraines, UTIs, high blood pressure and sinus or viral infections. Telehealth would help crews triage situations before rolling out.

“We’ll do this,” Vinci said. “I can guarantee you that our staff are committed, and we have the bandwidth and the capacity.”

The timing is flexible, Vinci said, operating around peak demand and available around weekends, holidays and after-hours.

“We’re going to send the right care provider team based on the type of incident,” Vinci said. “And … when they’re not doing urgent care we can utilize these services for the MIH. … It’s a very strategic way to spend tax dollars.”

It would reduce the need for off-island transports, offer islanders more same-day medical care, take a little pressure off Sea Mar’s primary care clinic and help islanders follow up on instructions from their physicians, Vinci said.

Breaking down the details

The response-based MIH model would cost $350,000 for its first year and an estimated 5% more for following years to accommodate rising salary, benefit and operational costs.

The proposed budget for the first year consists of:

• $205,000: Full-time Physician’s Assistant (includes salary and benefits)

• $70,000: Per diem / overtime Physician’s Assistant

• $50,000: Part-time social worker

• $19,000: Supplies, equipment and services

• $6,000: Insurance, dues and subscriptions

(The expanded RN hours and part-time social worker would initially fall under VIFR’s existing budget this year, Vinci said. Starting in 2025, the social worker’s position would be included in the costs for the response model, which is reflected above.)

Just as Vashon residents are no longer billed for ambulance transports off-island, they should not be billed for MIH referral or response services, Vinci said. In both cases, only insurance would be billed. The only exception is for lab tests, which are paid to LabCorp directly by patients.

“I’m adamant about that,” Vinci said, “(that) people don’t pay out of pocket. … We want to continue with current district policy, which does not charge islanders for anything outside of insurance.”

VIFR would seek an annual contribution of $350,000 for three years to start the program. Vinci hopes to partner with the Healthcare District to do so, “as that is the best fit for the island and the best use of taxpayer funds,” he wrote in an email.

“If the VHD chooses to go a different route, we feel strongly that this should be a VIFR-based program that we will creatively work to fund our expansion of our current and well-established MIH services program,” he wrote.

MIH’s existing referral program costs about $80,000 annually, primarily for its part-time nurse, firefighter overtime, supplies and insurance. It will grow to about $95,000 with the MIH expansion.

The district added about $165,000 to its coffers last year by tapping into the county’s Mobile Integrated Health program — accessing several year’s worth of money already taxed on, and set aside for, islanders under the existing King County’s EMS Levy.

“We’re able to go back three years of levy money and bring that money back to the island,” Vinci said. “… That’s islanders tax dollars. … We made a pitch to the county: we’re going to start our MIH program, we want to recapture those funds that weren’t used in (previous) fiscal years.”

This year, VIFR received $48,574 for MIH from the EMS levy, which is up for renewal next year.

Vinci laid out the following timeline for MIH:

• August: Present to major stakeholders, hold community meetings and secure funding for the program.

• September: Begin recruiting for their LICSW, PA and additional RN positions.

• October: VIFFR interviews, hires and begins training those staff members.

• November and December: Roll-out of marketing campaign, community meetings and public education about how to use the expanded MIH program

• January 2025: Full implementation begins.

Vinci said “August would be ideal” for the board to take a vote on the MIH proposal.

“The community needs it today,” he said.

Board digs into specifics

The meeting was attended by VHCD Board Commissioners Tom Langland and Sarah Day, as well as Superintendent Tim Johnson.

Vinci has repeatedly said he doesn’t agree with bringing on the third-party mobile urgent care provider DispatchHealth, which the Healthcare District is seriously considering.

But getting data on the precise need for urgent care on Vashon is tricky.

Vashon’s county-leading high rate of non-transport emergency medical calls points to the need, Vinci said. And both VIFR and the Healthcare District have said urgent care is a top priority among islanders they speak to.

But “I don’t think anybody knows the exact number on Vashon, to everyone’s credit that’s been doing work on this,” Vinci said. “… We know the 911 need, we know the walk-in need, and we’re starting to learn the MIH need.”

Commissioner Amy Drayer asked Vinci: With VIFR administrative staff already busy, would the expansion not also demand more administrative staff hours? (Vinci’s MIH expansion proposal doesn’t call for this.)

“We don’t believe we’d need to add another admin position,” Vinci said. The department does currently have a vacant chief position, he added, which is “another potential area to help alleviate some of the pressure — if need be. But currently, we believe we’ve got the infrastructure in place to run this.”

Board member Candy McCullough asked the Hospital District members for their feedback.

Langland called the presentation “very informative” and said he was there to learn rather than ask questions.

“I’m hoping since we have had a similar process … we might have an opportunity to co-meet … to show each other at a special joint meeting what we have, and through that, [find out if there is] a pathway forward — one direction, or the other, or a combination of the two,” Langland said.

McCullough agreed with the notion of scheduling a public meeting between the groups and other island healthcare providers.

“We can facilitate that,” Vinci said.

The desire to collaborate on a solution remains strong, said Tim Johnson, who said he’d have questions for the district after the meeting.

“I’m obviously going to have a bunch of questions on this, and I’m not going to bore you with the minutiae of (those) questions (here),” Johnson said.

On Tuesday, Johnson said he was thankful for the chance to hear VIFR’s proposal and said the Healthcare District looks forward to working together to find the best urgent care solution for the island.

Also at the meeting…

• Vinci announced that VIFR has received a roughly $212,600 FEMA assistance grant to launch a two-year fitness program for VIFR. The grant is a 10% match, which VIFR undertook with Mountain View Fire and Rescue; VIFR ultimately contributed $9712 for the match. The funding will let VIFR bring in onsite nutritionists and strength, conditioning and wellness coaches, who will meet with staff two days per quarter. The service is used by other fire agencies and even the Dallas Cowboys, Vinci said.

“They really have a tactical athlete approach to their program,” Vinci said. “They look at how to prepare an athlete, how to prepare a firefighter for being out in the field.”

• The board unanimously passed a resolution recognizing the tenure of Vashon Community Emergency Response Team (CERT) manager Jan Milligan.

• Vinci and the board recognized volunteer firefighter Jenny Gogarten, who recently graduated from the volunteer academy in Everett as the valedictorian of her class.

“She’s worked really, really hard,” Vinci said. “So, congratulations. We’re extremely proud of you.”

As is tradition in the fire service, Gogarten’s badge was pinned by her wife during the VIFR meeting, with their two children eagerly watching.

“It has been such an incredible honor,” Gogarten told the board. “It really is such a joy and such an honor to serve this community, and I really appreciate the investment in training me up to serve this community in more ways.”