I recently experienced symptoms of painful diverticulitis and needed immediate care. The on-call Kaiser nurse recommended I visit a walk-in clinic or an emergency department.
Wary about the quality of care I might receive at WhidbeyHealth Medical Center’s emergency room, based on a past experience, my husband drove me first to the ER in Anacortes. When we learned its CT scanner—which confirms the presence of diverticulitis—was down, we drove to the ER at the Skagit Valley Regional Medical Center to access its CT machine. Though I was at the center for more than four hours, the quality of care and diagnoses I received were excellent.
I am highlighting my personal experience to illustrate how little I know about the current pulse of the WhidbeyHealth Medical Center. The center’s financial woes and firing of its CEO last year underscored in my mind reasons why I wished to avoid being treated there. Last year, staff wages and employee morale were at a low point.
However the hospital board has appointed a new CEO, Nathan Staggs. He spoke at a Rural Health Care Forum June 22. Staggs and four others updated the public on Challenges and Opportunities of Health Care on Whidbey.
Former county commissioner Helen Price Johnson moderated the forum. She has a new job, and her title is State Director of Rural Development for Washington State. Its mission is guided by the President and secretary of the USDA.
“Creating prosperity and health in rural Washington state is my goal,” she wrote in a recent email. “Rural health care is a common problem. Housing is so expensive (in Island County, for instance, that it is] hard to get professionals to live here.We’re working with folks in Okanogan County who are struggling with similar issues.Their local hospital was a recipient of a USDA Emergency healthcare grant. They also struggle with affordable housing. The idea is to explore challenges, and figure out what the priorities are. We seek community-driven solutions.”
The USDA Rural Development, according to its website, “…offers loans, grants and loan guarantees to help create jobs and support economic development and essential services, such as housing, health care, first responder services and equipment, and water, electric and communications infrastructure.”
The agency has funded numerous projects in Island County. A presentation Price-Johnson made in Greenbank in 2022 can be viewed below. Of the various missions supported by the funds, health care support is one of them. In 2020 the USDA financed $35.7 million in upgrades to the WhidbeyHealth Medical Center’s medical and electric systems.
In the wake of the hospital’s structural improvements, there are ongoing challenges that are being addressed, according to the recent forum’s panel of speakers.
Eric Lewis, CFO of the Washington State Hospital Association, which oversees 114 rural and urban hospitals, spoke at the forum. About 75% of the island’s population are on Medicare/Medicaid, or Tricare, which reimburses the health care provider at a lower rate than do commercial health insurers. There are workforce shortages in doctors, nurses and lab technicians, especially in the wake of the Covid pandemic.
Tricare is a health care program provided by the U.S. Dept. of Defense.
“These are challenging times for rural hospitals,” Lewis said. “Whidbey Health, like 48 other hospitals across the state, is publicly owned and operated. 2022 was a challenging financial year. Federal aid, which helped hospitals in 2020/2021, was used up. [Rural hospitals] experienced huge financial losses. Expenses went up 9%. It is the worst performance I’ve seen in my career. The net loss in 2022 was $2.7 billion. Not a sustainable number. Most hospitals are losing money.”
Like its rural cousins, the Whidbey Health Medical Center is a Critical Access Hospital operating 24/7. It is limited to 25 beds. The average stay is 96 hours or less. Workforce wages comprise nearly half of the hospital’s total expenses. Inflation and recent cuts in Medicare/Medicaid reimbursements have squeezed its budget even tighter.
“Inflation is far greater than the reimbursement increases,” Lewis said.
Lewis described other puzzles rural hospitals have yet to solve. The difficulty in discharging patients who need advanced services (which cannot keep pace with demand). Patients—disabled with no caretakers, the unhoused, people with mental health challenges—remain in beds if they have no safe place to be discharged to.
“They can get stuck for months in hospitals,” Lewis noted, “which lack resources for care.
Considering what needs to be done, Lewis said remedies are underway or are being considered:
- Increase Federal reimbursement for Medicaid. A Medicaid hospital safety net program, HB 1850, passed in this legislative session and will be implemented in 2024.
- There is lobbying in Congress to prevent further Medicare cuts. Physicians saw a 2% decrease in Medicare reimbursements this year.
- Workforce shortages—invest in training programs at the federal, state and local levels. More physicians need to be hired. The state is focusing on hiring more RNs. Community Colleges are offering more certification courses for RNs and caregivers.
- With inflation far greater than federal reimbursement—ensure that Medicare/Medicaid/Tricare reimbursements keep pace with inflation.
- Difficult to discharge patients—greater investment in Behavioral health services—at the federal, state, local levels.
Nathan Staggs Whidbey Health’s recently appointed CEO, said recruitment is ongoing to fill a lack of special and primary care providers. Nurses are needed.
“Now a significant number of nurses are private contractors,” he said.. “It costs us double to pay them. With our shortage our of primary care physicians, nurses and lab techs, it’s the worst I’ve seen in a long time. It’s difficult for a small hospital to recruit and retain good people.”
WhidbeyHealth also provides care for military families, whose population has increased and impacted the hospital’s bottom line. While the Department of Defense operates a naval health clinic in Oak Harbor, it is open business hours Monday through Friday, leaving folks who need care outside those hours to seek help at the hospital or its walk-in clinics. Veterans are seen primarily at the VA center in Mt. Vernon and at the new center in Everett.
Dana Sawyers, program coordinator for the Whidbey Veterans Resource Center, was one of the forum’s speakers.
“Island County has the highest number of veterans per capita of the counties in Washington,” she said.
With Whidbey’s most recent population as of April 2023 at 69,353, 11,414 of that population are veterans.
“Less than 40% of the veterans are connected with VA benefits and healthcare,” she said.
James Golder, a commissioner serving with the property tax-funded Whidbey Island Public Hospital District, was the last to speak. He presented an optimistic picture over what was seen a year ago.
“We’re not the same hospital as last year,” he said. “Last year we were one payroll away from closing our doors. Staff was upset about management. Our CEO left. Most of the senior staff left. Our ship was adrift.”
Then the ‘ship’ was set back on course.
“Our chairman stepped in and three things happened,” Golder added. The county helped us. Advanced us payments. We obtained a line of credit of $10 million. We hired a professional management company—at once the clouds cleared and the sun came out.”
Golder said staff was hired, accounting problems cleared up, staff frustrations were addressed. Salaries were raised—$48 an hour for nurses, for example. Furthermore WhidbeyHealth care began collaborating with the Sheriffs Department and the County Commissioners to collectively address mental health issues.
A list of WhidbeyHealth’s issues that were successfully resolved or being addressed can be found at this website.
“Morale has improved substantially,” Golder added. “Staff are starting to come back. Some staff stuck with us. They made one heck of a commitment. We are going to survive.”
“WhidbeyHealth’s turnaround is impressive,” added Eric Lewis, CFO of the Washington State Hospital Association. “Whidbey Island is blessed with a good model for health care.”