Vashon may soon be home to two urgent care providers — DispatchHealth, a national mobile healthcare provider subsidized by Vashon Health Care District; and a homegrown expansion of Vashon Island Fire & Rescue’s already-existing Mobile Integrated Health (MIH) program.

MIH decision

In a special board meeting on Monday night, Vashon Island Fire & Rescue (VIFR) commissioners passed a motion to endorse Fire Chief Matt Vinci’s two-phase plan to expand the district’s MIH program and seek partners for funding the program.

Vinci’s proposal emulates a similar expansion by a fire department in Mason County recently described by The Seattle Times as a possible innovative fix to a shortage of primary healthcare providers and overflowing emergency rooms. That program receives funding from a local hospital district.

At the meeting, the motion passed 3-1, with Commissioner Candy McCullough voting no, saying she believed the district should work on securing Vashon Health Care District’s (VHCD) collaboration before moving forward with a specific game plan. Commissioner Jim Whitney was not in attendance at the meeting.

Vinci, earlier in the meeting, said he believed the MIH plan needed the backing of the full board before it was brought to VHCD in a joint discussion.

“I want to emphasize that is a wraparound, holistic approach to taking care of patients on Vashon,” he said. “We feel that this is much more inclusive of people’s needs than the model [VHCD] has proposed with DispatchHealth.”

Vinci’s plan, as detailed in full at tinyurl.com/VIFRMIH, would seek funding of $350,000 per year from VHCD or another funding source. But on Monday, Vinci said there could be a $50,000 reduction in that cost, because VIFR’s budget could absorb MIH’s Phase One plan to add, by October 2024, a part-time licensed independent social worker and extend MIH’s registered nurse position by one day.

Phase 2 of the expansion would add a full-time physician assistant who would be onboarded in late 2024 and begin operations in January 2025. This timing would roughly coincide with the completion of a renovation of Fire Station 55 to add an exam room for walk-in care, providing another attractive option for islanders who preferred to seek urgent care in that setting, rather than in their homes.

Brigitte Schran-Brown, chair of the fire board, spoke strongly in favor of the plan to expand MIH, saying urgent care was nothing new for the VIFR — with many walk-in islanders already seeking urgent care at Fire Station 55, and others summoning the district on calls that did not result in transports.

According to data in the district’s plan to expand MIH, 43.2% of calls made to VIFR do not result in transfers to hospitals, compared to 34% of King County Emergency Medical Services (EMS) calls.

“I just need to say that we’ve been doing urgent care in the almost 100 years we’ve been around — urgent care is part of what we do,” Schran-Brown said. “We have urgent calls that are immediately life-threatening, and then we have the urgent calls that are not immediately threatening, and we’ve been taking care of people on that level forever. What [MIH] does is help us streamline it and make it much more efficient.”

Decision looms

Meanwhile, VHCD may vote to contract with DispatchHealth for urgent care on the island at its next meeting, VHCD Superintendent Tim Johnson and board chair Tom Langland told The Beachcomber on Monday afternoon, before the VIFR meeting.

Langland said he has placed the matter on the district’s Aug. 21 agenda for discussion and possible decision.

VHCD anticipates paying DispatchHealth a subsidy of $560,000 in the first year, according to Johnson and Langland.

VHCD has been ready to strike a deal with DispatchHealth for months, they said, but put the brakes on doing so earlier this summer to make time to talk with VIFR about the fire district’s concerns. The district identified urgent care as a priority more than a year ago.

“It’s hard for me, because I’m listening … to what my neighbors are telling me and asking me, and they needed this service yesterday,” Langland said.

After the fire district’s July 31 meeting, members of VIFR and VHCD’s boards had briefly discussed the idea of a joint board meeting to hammer out the urgent care question together.

Vinci, at VIFR’s Monday night meeting, said he was now willing to proceed with that plan — after fire commissioners voted to endorse MIH’s expansion.

Johnson, in attendance at the VIFR meeting, said after the vote he would be happy to invite VIFR’s board and Vinci to VHCD’s Aug 21 meeting and put them at the top of the agenda.

Regardless, both districts now appear to be moving toward launching their urgent care programs for the island.

“We really were hoping for a joint [public] conversation to look where these two plans fit,” Johnson told The Beachcomber earlier in the day. “… At some point, it becomes self-defeating to wait on a collaborative approach when your potential collaborator is going to go ahead and make decisions anyway.”

Given the work DispatchHealth has already done to learn the island, both Langland and Johnson expressed confidence that DispatchHealth could start operating on Vashon by September, i.e., within a month of a signed contract — a better timeline than their previous estimation of 90 days.

“This isn’t a quick decision,” Langland said. “We’ve been at this for the better part of the year, using lots of local expertise in the medical field. … We’ve been sitting on a contract that we were, theoretically, ready to move on about four months ago. … We paused our work, and I still think that was appropriate, to take a breath and listen to the alternatives … Now, after seeing those proposals, I’m kind of sorry we didn’t just move ahead four months ago, but that’s water over the dam.”

Vinci will need a funding partner to raise the $350,000+ per year needed to operate the MIH expansion.

Could that partner be VHCD? Maybe, Langland said, if the commissioners deem it a better system. But for now, the board is likely to spend their time and funding on DispatchHealth rather than an “unknown,” Johnson and Langland said.

Still, VHCD remains interested in helping VIFR expand MIH, including as a funding partner, Johnson said.

VHCD makes its move

At its Aug. 21 meeting, VHCD’s board will consider a two-year contract with DispatchHealth; VHCD would decide, 18 months into that contract, whether to extend the relationship, Langland said.

“Our desire … is that this be a fluid, open relationship, and it’s short term,” Langland said, adding that it can be to the benefit of VIFR’s expanded MIH.

“They should be, I think, grateful that we’re taking the lift while they have plenty of thoughtful time … to enhance MIH, because there’s huge potential there, (even) beyond urgent care services. … I’m in charge of spending my neighbors’ money, and in a fiduciary sense, I really have a problem with investing in an unknown, even though the fire department and Matt in particular, are very capable. … We want to move ahead cooperatively, and I bet we will, once we get over these little hiccups.”

DispatchHealth is well developed across 29 states, ready to fully deploy quickly, fully accredited and deeply staffed, and run by a vendor with more than a decade of expertise providing mobile urgent care, Johnson said — providing what Langland called “far and away the most proven model” for reliable urgent care while VIFR builds their system.

It’s not an “either-or” decision, Johnson stressed repeatedly in an interview: DispatchHealth can start soon, while MIH expands to provide its program, and bow out if and when MIH outgrows it.

“We’re committed to the exactly-right local solution, and we’re committed to the MIH program (and) expanding it,” Johnson said. “We’re committed to collaborating and cooperating. We’re just not committed to making either-or decisions that seem more based on territory than functional cooperation.”

But Vinci has repeatedly disagreed with the move to bring DispatchHealth to Vashon — including at the VIFR meeting on Monday night, when he said that bringing the provider to the island would reduce VIFR’s revenue in terms of the amount of Emergency Medical Services (EMS) money it receives from the county — based, in part, on the number of patents the districts see annually.

“If [VIFR] is not seeing these patients, and someone else is seeing them — a for-profit, off-island subsidized healthcare provider — we would lose EMS revenue that comes to Vashon,” he said.

He also added that VIFR could also lose federal dollars from Ground Emergency Medical Transport (GEMT), a federal program that provides allocation back to the fire district to serve Medicaid patients if DispatchHealth instead served those patients.

Any loss of funding from the EMS levy and GEMT would negatively impact VIFR overall as those funding sources help support all of the fire district’s operations.

What happens next?

Even if neither side wants a fight, obvious disagreements remain.

So is friction between VIFR and VHCD inevitable if they both work, in different ways, to provide urgent care?

Johnson says VHCD wants to collaborate, not compete: “The fact that we disagree on a fundamental piece of this is not the end of the world, and it’s not wrong,” Johnson said. “It just is.”

Nevertheless, VHCD will do what they feel is the right thing — “even if it’s not necessarily the thing that another potential partner would want,” he said. “We’ll figure it out.”

At VIFR’s meeting, asked the same question by The Beachcomber, Vinci said he hoped for a solution that embraced the MIH model.

“We’ve tried to find ways that this will be a collaborative effort with DispatchHealth, but … their existence will impact Vashon Fire,” Vinci said. “There’s no way around that. [But] Tim and I have a good working relationship. I’m open, he’s open … and we’ll continue to have good communication. You know, we don’t want to impact either district negatively — we want to impact the public positively. That’s what we do every single day, and what our staff does when they come to work and volunteer here.”