In the past five months the Jamestown Family Health Clinic has experienced a 15-percent new patient increase which totals nearly 2,000 new patients.
Because of the patient influx the clinic is experiencing it has had to stop accepting new patients with the exception of Medicaid insured patients.
“The demand of patients coming in was higher than the speed we could ramp up,” Jamestown Family Health Clinic director of Health Services Brent Simcosky said. “I think that did catch us by surprise a little bit.”
Simcosky and Jamestown Family Health Clinic Budget and Planning manager Gene Burwell said they anticipated an increase of new patients with the onset of Medicaid expansion under the Affordable Care Act effective January 2014, but they thought the patient increase would spread out over time.
Large patient influx
“All kinds of things fell into place with a couple of people closing their practices and retiring, an increase of seniors moving to Sequim and retiring and Affordable Care Act patients and those were a combination of Medicaid expansion and quality health plans,” Simcosky said.
Overall Simcosky feels the amount of new patients is a good thing because perhaps “people that didn’t have health care now do,” but the steep increase also causes problems. For example, the time to see a new patient requires a 40-minute appointment opposed to the 20-30-minute appointment for established patients; thus with nearly 2,000 new patients in need of 40-minute appointments the ability for the clinic to maintain its scheduling system is compromised.
Open access scheduling
The Jamestown Family Health Clinic uses an “open access scheduling” system explained Simcosky. The idea of open access scheduling is to try to get patients seen at the time they’re experiencing a health problem or concern.
“Our goal is take as many patients as we effectively can and still maintain our open access scheduling,” Simcosky said. “That’s very important to us and it’s been very difficult.”
Open access scheduling is difficult to maintain because there needs to be the right supply and demand, Simcosky explained, but the scheduling system shows improved medical outcomes because it encourages people to come in before their symptoms are out of control. In order to maintain an open access schedule system, Jamestown Family Health Clinic tries to avoid making appointments multi-months in advance and instead tries to have the next third appointment available for a patient’s primary care provider.
Insurance
In anticipation of a patient increase Burwell and Simcosky have been actively recruiting new doctors for the past six months. Even with a new physician, a new Advanced Registered Nurse Practitioner (ARNP) and two new physician assistants hired within the past three months hasn’t been enough to ease the demand of patients.
However, even if a physician became available, one reason the clinic is unable to accept new commercially insured patients is because the newer providers have not been contracted by regular commercial insurances yet, Burwell explained. It can take up to three months for a new doctor to have the ability to see commercially insured patients. In contrast, Medicaid in Washington is very quick to add new providers.
“To the best of my knowledge we are the only clinic in the area that’s taking Medicaid,” Burwell said. “We’re definitely the largest.”
And in addition to being the largest primary care clinic in Clallam County and despite that more than 95 percent of patients are non-Native American, as a tribal clinic Jamestown Family Health Clinic receives a better reimbursement rate from Medicaid.
“It works out better for us and we’re therefore able to provide the service to the community,” Simcosky said.
Unique demographic
About half of the new patients are younger than Jamestown Family Health Clinic’s existing patient demographic and are using Apple Health. Washington Apple Health is Medicaid expansion in action within Washington as part of the Affordable Care Act.
“I think some of our new patients are a mixture of young people who didn’t have insurance and young families who also benefited from Medicaid expansion by falling into the area where they could get access to state-sponsored health insurance,” Burwell said. “There’s still a lot of families where the parents make too much money to be on Medicaid, but don’t make enough to buy health insurance.”
Currently the clinic serves 14,000 active patients and 15 percent of their patients use Apple Health.
Creating a younger patient demographic is less expensive for Jamestown Family Health Clinic because younger people tend to require less medical attention.
“Our average visits per year is 3.9 visits,” Simcosky said. “The industry average is 3.1 visits per year so we’re a little high, which means it’s very expensive for us to provide health care so to get a younger demographic in our mix it good for us and the community.”
But Simcosky and Burwell agree they need to continue to concentrate on the senior demographic and improving their health outcomes as efficiently as possible.
“The population is aging, which means patients are aging, but so are the caregivers,” Burwell said. “There’s going to be rapid retirement of health care staff when the population ages and that’s also a national issue.”
Serving an older patient demographic in Sequim is somewhat a unique problem, but what staff at Jamestown Family Health Care are having to figure out now everywhere else will soon be experiencing.
“All you have to do is look at the baby boomers and where they are at right now,” Simcosky said. “Soon people are going to be looking at us to see whether we did it (efficiently provided a older patient demographic health care) right or didn’t do it right.”
Epic
Looking to the future of health care, Jamestown Family Health Clinic is in its preliminary stages to join Olympic Medical Center and the Providence Community Connect by changing from its current electronic records system to a network known as Epic.
The implementation kick-off is in a couple of weeks, but the clinic expects to “go live” Aug. 17, Simcosky explained.
However, Simcosky and Burwell don’t anticipate immediate results and expect a learning curve for their staff.
When all training and costs are accounted for, Burwell expects the clinic’s transition to Epic to be more than $500,000.
“It’s a huge investment for us,” Simcosky said. “But we cannot be a clinic this size and not do it.”
In addition to providing a number tools needed improve health care and make it more efficient, Simcosky feels Epic will help Jamestown Family Health Clinic streamline access to patient records because patient data from hospitals and specialists using Epic will be available to Jamestown medical providers.
“Providence Health and Services just in the Northwest has put $750 million into Epic Community Connect implementation in order to connect the medical community,” Simcosky said. “Just to name a few, the University of Washington is on Epic, GroupHealth, Swedish Medical Center, Providence Health and Services and the Franciscan Health System are on Epic.”
For now Epic will not alleviate the immediate patient influx the Jamestown Family Health Clinic is experiencing, but by June or July Simcosky and Burwell hope to determine the conditions and needs of their new patients and thus begin accepting non-Medicaid patients again.
The clinic is better off to be realistic and slow its acceptance of new patients than continue to accept patients and not be able to schedule appointments for another two months, Burwell explained.
“Every now and again when you have a large influx of new patients like this you have to take a couple steps back and take a deep breath and see where we’re at and what can we do moving forward and we just don’t know yet,” Simcosky said.
In the meantime, Jamestown Family Health Clinic staff is continually calling local clinics to determine who is taking new patients in order to provide people with alternatives, but the clinics accepting new patients are constantly changing. For patients that need more urgent, but not emergency room attention, the clinic recommends Olympic Medical Center’s Walk-in Clinic.
Reach Alana Linderoth at alinderoth@sequimgazette.com.
