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Health and Wellness 2011/12
Health and Wellness 2011/12
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Contents
Methow Valley
Health & Wellness
Off the charts Medical records go private................p.
The right SPOT
2011/2012 Don Nelson, publisher/editor Sue Misao, design Robin Doggett, ad sales Callie Fink, ad sales Dana Sphar, ad design/production Linda Day, ad design Marilyn Bardin, office manager Janet Mehus, office assistant
Contributors Ann McCreary Dashal Moore Marcy Stamper Laurelle Walsh
A publication of the Methow Valley News PO Box 97, Twisp, WA 98856 509.997.7011 Fax 509.997.3277 editor@methowvalleynews.com www.methowvalleynews.com
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Emergency locaters can save lives.......p.
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Creative counseling Mental health help is available...........p.
Healthy attitudes As an issue, the prevailing discussion about the future of health care is national and political. But in our individual lives, health care is personal and local. In our communities, we rely on a relatively small group of health care professionals who choose to live here for many of the same reasons the rest of us do. Primary care becomes more important because beyond-primary care may require hours of travel. We build connections with our health care providers that sometimes go beyond the patient-provider relationship, and those bonds may last for years. While we value that old-fashioned concept of care, we also benefit from the determination of our health care providers to keep up with the latest treatments and technologies. Living away from the big cities doesn’t have to mean falling behind them. In our annual Health & Wellness special publication, we take a look at some of the local resources available as well as the challenges providers face. We hope you’ll find the articles valuable – the information in them comes, for the most part, from people you probably already know as your providers and neighbors.
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Improved diagnosis Brewster hospital sets goals............p.
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Help for those who need it Resources for the uninsured............p.
Directory of advertisers
Supporters of this guide....................p.
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Cover photo by Sue Misao: Owen and Jasper Bard sell their healthy wares at the Farmers Market
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Health and Wellness 2010/112
Photo by Sue Misao
Integrated computer systems are commonplace now in medical facilities, as doctors and hospitals move toward a nearly paper-free system.
Off the charts
Electronic medical records are replacing piles of paper, but providers worry about privacy and loss of patient contact By Dashal Moore
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Not so long ago, a typical hospital scene might look like this: A patient just admitted to the emergency room lies in bed while a nurse lays two fingers across his wrist, eyes glued to the second hand of the clock. At hospitals like Mid-Valley in Omak, that scene is long gone. A machine now touches the patient where a nurse once did, reading the vital stats and entering them into the patient’s electronic medical record on a nearby computer. A computer accompanies every bed at Mid-Valley, and occupies every exam room in the hospital’s clinic. In fact, according to Kelly Cariker, manager of information systems at Mid-Valley, there are fewer than 120 total staff on site at the hospital at any given time, but more than 200 computers. Mid-Valley Hospital was early to adopt an electronic medical record (EMR) system, beginning the conversion in 1997, before the term EMR
meant much to anyone. Now the term is commonplace in the medical world. In 2009, the federal government introduced rules that effectively mandate adoption of EMR systems in all hospitals and clinics by 2015, and Congress earmarked up to $27 billion of stimulus funding to support the transition. National implementation of EMRs is supposed to happen in three stages. First, all hospitals and clinics are required to install a software system and the hardware to run it. Second, the federal government will set up regional centers to collect and store all the EMRs from that area. Third, a national network will be formed to stitch together the regional centers. The goal is to make patients’ medical records instantly available anywhere, even online in their own homes.
Skeptical but hopeful Many health providers in and near the Methow Valley
regard the federal EMR mandate with both skepticism and frustration. Providers worry about impersonalization of patient care, loss of privacy and the motivations behind the mandate. Yet most hope that switching to EMRs will have some long-term benefits, such as reduced medical errors and faster communication between medical institutions. Like it or not, local providers know that resistance to change will have its own costs. Health care providers that fail to implement an EMR system by 2015 will not only face significant penalties, but also miss out on federal money earmarked to reimburse providers for some of their implementation costs. Providers who want to qualify for reimbursement must meet a series of deadlines, the first of which will pass this year. Because implementation costs can run into the millions
Health and Wellness 2011/12 for hospitals and hundreds of thousands for clinics, many providers are frantically (but unenthusiastically) racing to catch up with the likes of Mid-Valley. At the Country Clinic in Winthrop, Dr. Ann Diamond doubts that quality-of-care concerns are driving EMR adoption. “The push behind EMRs is for billing,� she said. Echoing that skepticism, Dr. Joe Jensen of Methow Valley Family Practice in Twisp said, “Half [the reason for EMRs] is for patient benefit, maybe even a third, and the rest is for insurance companies.� A physician writing for the New York Times described it this way: “Currently, most systems have been designed not with clinical needs in mind but to meet the demands of the feefor-service payment system. The software rapidly codifies diagnosis and symptoms, thus facilitating billing. But that shorthand also encourages clinical short-cuts and less faceto-face time with patients.� Unease about the loss of face-to-face time, and particularly eye contact, tops the list of many practitioners’ worries. “It impersonalizes your patient care,� said Lori Sawyer, obstetrics supervisor at North Valley Hospital in Tonasket, and one of several staff overseeing EMR implementation there. Sawyer said the doctors and nurses she works with are loathe to spend the precious little time they have with each patient going between patient and computer. In Twisp, Dr. Jensen expresses similar concerns. “We don’t want to lose that personal touch,� he said. Undivided attention and good eye contact do more than put the patient at ease, he said. They are also crucial diagnostic techniques. “At least 75 percent of diagnoses are handed to you by talking with the patient,� he said. “If you blow that with technology, that’s bad medicine.� Dr. Jensen expressed another common concern: “I think this is going to decrease privacy down the road.�
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Photo by Sue Misao
Say goodbye to folders: The federal government has adopted rules that require adoption of electronic medical records systems in all hospitals and clinics by 2015. Government data show that the personal medical records of at least 7.8 million people have been improperly exposed in the past two years alone. According to privacy experts, the initial EMR mandate included inadequate security rules, and the government is now struggling to get those in place.
EMR systems “need to have bank-level security,� said Kelly Cariker at Mid-Valley. Yet, it may be some time before the legal and logistical reality catches up to that ideal. Though Cariker has fears about impersonalization and privacy, his perspective is also several shades rosier than
many providers, perhaps because Mid-Valley has been using EMRs for long enough to work out many of the kinks (and concerns) that arise during implementation. Cariker said that Mid-Valley physicians were initially apprehensive, “but they have been pleasantly surprised.� Thoughtful use of EMR systems there has fostered the caregiver-patient relationship in some ways. Computer monitors are situated so that patients can see their records as they are being created, and Cariker said this gives them a sense of empowerment. Moreover, patients enjoy the benefits of less paper, he said. “I’ve seen patient charts for people with chronic illnesses that are a foot thick. Now, those patients no longer have to carry that around with them,� Cariker said. Speaking from a patient’s perspective, Jeff Ulmer, a psychologist in Winthrop, said, “As a patient, it’s quite handy. If I have a special test such as an MRI in one building, it’s sent to another immediately. You used to have to wait for
your scans, wait for them to be developed, and lug them from one appointment to the next.� Indeed, greater efficiency is one of the most heralded benefits of EMR systems. Information can be shared rapidly, a critical advantage in emergency situations when a patient is transferred from one facility to another. “When a rural patient has an issue and they need to go to a hospital in a city, there will be no more of this silly faxing,� said Joe Wivoda, technology consultant for the National Rural Health Resource Center. “This whole mobile health revolution is just getting off the ground. ... Patients are going to have to get used to moments when the physician is going to be on the computer and not looking at you.� Still, Wivoda said, the old rules apply: When visiting a doctor, bring a notebook, write down questions beforehand, keep notes during your visit, and be part of the process of building your electronic record. “Feel free to ask, ‘Can I watch you enter information?’’’
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Health and Wellness 2011/12
Photo courtesy of Tim Terpstra
Navy rescuer, Brent Mcintyre, rappels from Nighthawk helicopter into the Beckey Gully.
The right SPOT Taking an emergency locater device into the wilderness could save your life By Laurelle Walsh “I stepped, slipped, corrected, then ‘CRACK!’ and I went down. I knew my leg was broken before I even hit the ground.” That’s Jason Wheeler reliving his Aug. 13 climbing accident on Liberty Bell. Wheeler, 41, of Vancouver, B.C., was on an exploratory weekend climbing trip in the Early Winters Spires with his climbing partner Crystal Martell, planning to return in the next few weeks to attempt to climb all the Spires in one day. It was 12:30 p.m. on a beautiful summer afternoon. Wheeler lay among the loose rock of the Beckey Gully with his leg “completely flexible between the ankle and the knee.” A highly experienced climber whose skill set includes rescue and first aid, Wheeler knew he would need assistance to get out of his predicament. The Beckey Gully that day was full of other climbing teams, including climber Todd Mackenzie, who descended to help Wheeler. Mackenzie activated his SPOT satellite
GPS messenger, which sent out an immediate SOS call to Okanogan County Search and Rescue (SAR). At the same time, Martell hiked out to Highway 20 and drove down into the valley, eventually reaching 911 dispatch with detailed information on Wheeler ’s condition and location nearly two hours later. “Search and rescue was already mobilizing people and equipment in Twisp by that time,” said Wheeler. “Jason is a world-class climber and was relatively well prepared,” said Ottis Buzzard of Okanogan County SAR, who assisted in Wheeler’s helicopter evacuation at 6:30 p.m. – around two hours before dark. “His was a legitimate use of the SPOT beacon [which] shortened the rescue response by an hour and 45 minutes,” Buzzard said. “If it had been different weather or time of day, it would have been a different outcome.” “I was lucky on a lot of levels,” said Wheeler of his
rescue. Although he hasn’t carried an emergency locater beacon before, he now says, “I would not consider going back out into a remote area without carrying a SPOT.”
More calls generated Globalstar Inc. manufactures SPOT products, including two hand-held devices and a cell phone application. They utilize the Globalstar satellite network – also used by its satellite phones – which has suffered from periodic outages and no coverage in some parts of the world. SPOT requires an annual subscription fee of $100 and uses a private dispatch service that coordinates with local search and rescue operations. The units start around $150. Another successful rescue involving a SPOT device occurred in the Pasayten Wilderness a week later on Aug. 21. Kaye Clayton, 72, of Lacey, Wash., had become separated from her hiking group near the Boundary Trail, and after searching for several hours,
Health and Wellness 2011/12 the group decided to activate a SPOT beacon. That signal set into motion a search and rescue operation that involved Okanogan County SAR as well as the U.S. and Canadian Border Patrol. “They found [Clayton] alive because of the SPOT,” said Buzzard. “It was definitely a better outcome for the victim because it could have been days for her group to get help otherwise.” Buzzard said whereas Okanogan County SAR responded to five SPOT calls in
Page 7 the last 18 months, only the two described above were legitimate. The others involved upwards of 50 hours of volunteer time and were a result of misuse or malfunction of the locator device. “This device has definitely increased the volume of callouts for search and rescue and puts a strain on agencies,” Buzzard said. On the other hand, Dave Rodriguez, chief deputy of field operations for Okanogan County said he would rather have some false alarms be-
cause, “searching is hard. Thanks to these devices we’re able to do less search and focus on the rescue.” Rodriguez credits recent technology with improving backcountry rescue outcomes. “Four devices – GPS, FRS radio, cell phones and the SPOT locator – have changed search and rescue,” he said.
Other devices available Besides the SPOT, a related class of hand-held locater devices called Personal Locater Continued on P. 8
Photo courtesy of Tim Terpstra
Jason Wheeler with a splinted broken right leg waits for rescue from the Beckey Gully on Liberty Bell, Aug. 13.
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Beacons (PLBs) uses the 406 Megahertz frequency monitored by the National Oceanographic and Atmospheric Administration (NOAA). NOAA’s search and rescue satellite aided tracking is backed up by the Air Force Rescue Coordination Center, which coordinates with local search and rescue. According to NOAA’s website, in 2010 there were 43 PLB-initiated rescues in the United States, assisting 72 people. Unfortunately, the Air Force also reports a 90 percent false alarm rate overall for 406 MHz beacons which include EPIRBs at sea and ELTs on airplanes. PLBs do not require a license or annual fee, but the user must register the device with NOAA. Several manufacturers offer PLBs, starting around $250. Rodriguez said that two-way radios in the FRS or GMRS class are impacting searches that his agency doesn’t go on. “We used to have a lot of lost hikers and hunters who got separated from their group,” Rodriguez said. “Now, if everyone in the group has a radio, they can communicate with each other and we never get called.” Similarly, a GPS unit can help backcountry travelers stay found if they know how to use it and it is programmed correctly. “GPS is very powerful when
Health and Wellness 2011/12 used for what it’s intended for, but it doesn’t replace careful route planning or a map and compass,” said Buzzard. And phones? “Having a cell phone does help on occasion,” said Rodriguez, “but coverage shouldn’t be counted on in the backcountry.” Of cell reception in the Methow, Pasayten or North Cascades Buzzard said, “It’s probably not worth carrying around a cell phone. You would need to be prepared to climb the highest mountain around and even then you may not get coverage.” Paul Butler of North Cascades Mountain Guides said that satellite phones are now becoming more prevalent since recent models are not much bigger than a cell phone, and they’re advantageous because the signal only requires a clear view of the sky. Butler said both his guide service and heli ski operations carry a satellite phone on trips. For those backcountry enthusiasts interested in safe winter travel, it is important to carry and be trained in the use of avalanche transceivers, according to Butler. Each person carrying a transceiver (or beacon) sends and receives a signal on the 457 MHz frequency – the standard for beacons worldwide. All models and brands work together, so compatibility is not an issue, said Butler. Avalanche safety
Photo courtesy of Tim Terpstra
Jason Wheeler evacuated from Liberty Bell via short haul helicopter rescue with Navy rescuer, Brent Mcintyre.
courses are offered locally by North Cascades Mountain Guides. On any device Butler stressed, “Technology can’t replace self reliance and common sense.” Ultimately Jason Wheeler said, “When you go into the backcountry, your first responsibility is to get your-
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self out.” Wheeler is rethinking his trip planning in anticipation of climbing again once he’s fully recovered. Read Wheeler’s rescue in his own words online at outdoorreasearchverticulture. com, “Accidents happen: rescue on Washington Pass.”
Health and Wellness 2011/12
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Creative counseling
Mental health care providers use a variety of approaches to make help available to all By Marcy Stamper A source of pride and – often – necessity in our rural lifestyle is a spirit of self-sufficiency and willingness to watch out for one other. But when stresses pile up or people try to cope with serious depression or mental illness, that is not always enough. And while mental health care is an integral part of a full, healthy existence, as important as treatment for physical conditions, it is sometimes overlooked or dismissed. Despite some hurdles, local counselors believe people needing mental health care in the Methow Valley are better served than they were a few years ago. Today the Methow has counselors who specialize in all age groups and needs – children, families, adults and couples – and who offer a variety of clinical approaches to address those needs. Clinical psychologist Megan Schmidt blends several therapeutic techniques and concepts to help her
clients build new skills. She draws on cognitive behavioral therapy to help them recognize patterns and develop coping skills, and on mindfulness practices to make them more acute observers of their own thoughts and feelings. Schmidt works with children, adolescents and adults. In fact, having a practice in a small town has helped her build specialties that address particular needs, such as working with women suffering from pre- and post-partum depression, she said. Jeff Ulmer, a clinical psychologist with a practice in Winthrop, explores patients’ approach to relationships, both with him and others, to help build understanding and compassion. “Then it’s no longer just head-knowledge for them – they see they really do this, and can make decisions to do it differently,” he said. While the Methow has professionals with a wide range of expertise, financial hurdles can be a barrier for
many people who need care. “From my perspective, if you have money, you’re OK, but if you don’t have money, mental health care in this area is tough,” said Ulmer. Many local counselors set aside some appointments for patients without insurance and offer a sliding scale or accept Medicare or Medicaid, but options for long-term counseling – even for people with private insurance – can be frustrating. Insurance companies typically limit visits to 12 or 18 a year, which can be inadequate for someone struggling to deal with recurring crises, according to Lisa Spitzmiller, a counselor who specializes in children and families. “Short-term treatment is the signature of managed care,” she said.
Showing resiliency Until recently, Okanogan County was one of the few counties in the state to offer subsidized mental health care, through Okanogan Behavioral Health-
R
A DIFFERENT CO E OF LO RS O H
Photo by Marcy Stamper
Therapy dog Stellar helps clinical psychologist Megan Schmidt connect with students at Methow Valley Elementary School, and with clients in her practice. care (OBHC) in Omak. But after major state budget cuts at the end of last year, the agency was forced to discontinue the program. It has since been replaced with group counseling that emphasizes Continued on P. 10
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skills for resiliency. The group is available to people who cannot pay for private counseling, who have a likelihood of a crisis without help, and who commit to attending the eight weekly sessions, according to Priscilla Hone, the mental health professional who facilitates the program. Hone acknowledged that groups are not for everyone, but said the results had been impressive. “I’m very proud of this agency because it’s a response to an economic crisis in our field. It’s turning out to be very effective for the people served,” she said, noting that participants have benefited greatly from the social interactions, from seeing others overcome serious issues, and from feeling accepted and valued by the other group members. “We’re seeing incredible changes – people going back to work, volunteering, being more involved with their community or family,” she said. While the groups have proven valuable, they can be impractical for people in the Methow, many of whom do not have the resources or flexibility in their schedules to travel to Omak. And, while earning little or no money is not necessarily a trigger for mental health issues, it in itself is a risk factor because it increases the number of stressors, said Spitzmiller.
Health and Wellness 2011/12
New option in Methow This fall, low-income people in the valley who need mental health care will have another option. Room One, the social-service agency in Twisp, recently received a grant to fund a counselor, restoring a service that had to be eliminated last year after state budget cuts. The arrangement is a collaboration between Family Health Centers in Okanogan, which is supplying the therapist, OBHC and Room One, according to Karissa McLane, Room One’s executive director. The three organizations are still working out details, but McLane expects it will provide counseling services one day a week in Twisp. “What this means to the community is we’re going to have resources for people who are uninsured and underinsured,” she said. McLane said it will begin to fill a big need, since Room One often works with individuals with severe mental health needs but has no counselors to treat them. While some therapists have heard – anecdotally – that being in a small town presents another hurdle for people who need counseling but feel uneasy with the prospect of running into a therapist at the grocery store or library, most find it is not an issue, particularly once they address it explicitly with clients. They go over professional
obligations of confidentiality and set clear boundaries in consultation with patients. Spitzmiller finds that the opportunity to see people in different contexts can be an asset, because it demystifies both the process and the therapist. “If they see me interacting with my child, for instance, they understand that we all face the same issues – everyone’s child has meltdowns,” she said. Family medicine doctors also have specific training as counselors, and provide talk therapy, basic diagnoses and medications such as anti-depressants and anti-psychotics, said physician Ann Diamond at the Country Clinic in Winthrop. “It happens on a daily basis – it’s a huge part of what we do,” said Diamond. In fact, some people seem more comfortable seeing a family medicine doctor because they perceive that going to a counselor implies a different level of illness, she said. While there may be some resistance to counseling, some local programs help people become more comfortable with the concept. Schmidt, in addition to her private practice, spends two days a week as a counselor at Methow Valley Elementary School, where she works with students with social and behavioral problems. One aspect of her approach includes a counseling
dog, who helps Schmidt interact casually with students, many of whom visit her simply to play with the dog, she said. Ulmer said some mental health needs in the Methow may be linked to limited social options or less tolerance for people outside the mainstream, although he finds that schools and community are increasingly supportive of people who don’t fit in as easily. While male adolescents and men may be reluctant to go to a psychologist, believing it is a sign of weakness, they are often those with the greatest need for support, said Ulmer. “When they do get help, they’re like thirsty people in the desert,” he said. People with serious needs can also consult with a psychiatrist through OBHC, but medications are typically overseen by a primary care physician, according to the agency. The remoteness of the valley does present a problem for people with chronic, severe problems because of the distance to an in-patient hospital, said Ulmer. OBHC maintains a 24-hour crisis line, with a counselor on call for a phone consultation or in-person support at an emergency room. They also offer walk-in crisis appointments during open hours. “We don’t turn anyone away,” said Hone.
Health and Wellness 2011/12
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Hoping for an improved diagnosis Under a new CEO, financially challenged Okanogan Douglas District Hospital plans to raise its profile in the Methow Valley By Ann McCreary Surviving dire – people who don’t financial straits is have adequate (or nothing new for any) medical insurOkanogan Douglas ance, and can’t afDistrict Hospital ford to pay their (ODDH). Shortly hospital bills in full, after construction or at all. began in 1947 on a In recent years, 12-bed hospital in as the nation’s econBrewster, the projomy has faltered, the ect ran into finanhospital has been cial problems. Photo by Sue Misao hit by two trends The hospital Checking in at Okanogan Douglas District that contribute to its began as a commu- Hospital: A recently approved levy hike will help financial woes – an nity action project, with but not solve the fiscal challenges. increase in bad debt but donations and and a decrease in the community fundraising fell As a public hospital, number of paying patients. short of the construction costs. ODDH is required by law to “We’ve had a steady inThe board of directors decided provide charity care to patients crease in bad debt and charity that creating a hospital district who come to the facility, regard- care,” said Jan May, a nurse was the only way to complete less of their ability to pay. The anesthetist who chaired the the project, and a hospital dis- hospital also provides care hospital’s campaign for an trict bounded by Duley Lake, to many “self-pay”patients Continued on P. 12 Monse, Brewster, Pateros and the lower Methow Valley was established. Tax monies made it possible to open the hospital in 1949. Today, 62 years later, the hospital is once again struggling to get on its financial feet. With the hiring of a new chief executive officer who specializes in hospital “turnarounds,” and a voter-approved increase in the district’s tax levy increase to provide more funding, hospital officials are hoping to guide ODDH out of its current economic dilemma.
Charity, debt take toll It’s not likely to be an easy journey, because many of the issues the hospital faces are a result of the larger economic picture, the demographics of the population it serves, and the problems associated with providing health care in a rural area. “It’s taken a long time to get into the position we’re in, and will take a whole lot of work to get ourselves financially squared away,” said O.E. “Bud” Hufnagel, the new chief executive officer hired in early September.
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increase in the tax levy. At the same time, May said, “the volume of patients dropped dramatically and use of the hospital went down dramatically.” According to hospital figures, ODDH provided $484,110 in charity care and had a bad debt caseload of $777,571 in 2009. Last year the cost of charity care increased to $535,799, and bad debt cases totaled $1,010,155. As of September this year, charity care was $324,267 and bad debt from unpaid bills was $744,097. In his 30-plus years as a health care consultant, Hufnagel said the proportion of selfpaying patients at ODDH is “way higher” than any hospital he’s worked with. “Forty-five percent of the patients who come to the hospital are selfpay patients ... people who aren’t making enough money to buy insurance. At the end of the day if you are looking at 45 percent, we’ve got to figure out other ways of doing business,” Hufnagel said. “A substantial part of the population (served by the hos-
Health and Wellness 2011/12 pital) is transient and frequently do not have health insurance, and we’ve obviously got to take care of these patients. If you’re going to take care of them you have to have a revenue source that allows you to take care of them,” said Hufnagel.
It’s an extremely painful medical condition to have but it’s not an emergency. You’re going to see our financial counselor and she says surgery is going to cost this much money. You have to save up for a down payment on the surgery. “Say your gallstones become gangrenous, which isn’t that unusual – now you’re in the emergency room and they’re calling in the surgeon, and now you’re laid up for 12 weeks instead of two weeks, and you’re out of work because you lost your job. And we’re not going to get paid.”
Surgeries delayed About eight years ago, the hospital’s reserves were depleted and ODDH began operating on warrants from Okanogan County – essentially low-interest loans – to provide working capital. During that same year ODDH was designated a “critical access hospital” under a federal program that provides slightly higher Medicare and Medicaid reimbursement to rural hospitals to help them avoid going out of business. Cutbacks in Medicare and Medicaid reimbursements, however, are taking a toll on health care facilities. ODDH, with a large population of transient, agricultural workers in the district, has been hit hard by a recent change that ended Medicaid reimbursement for care provided to undocument-
Targeting the Methow
Photo by Sue Misao
Many ambulance rides that originate in the Methow take patients to the Brewster hospital. ed patients, Hufnagel said. The hospital’s chief financial officer, Sandy Sylvester, said the economy is causing people to delay elective surgeries, which means more
people are likely to end up in emergency rooms and undergo more expensive and invasive procedures. For instance, Sylvester said, “Say you have gallstones.
ODDH has made changes in administration, staffing and services to try to get a handle on its financial problems. The hospital’s CEO for the past seven years, Dale Polla, resigned in April after the board of directors pressured him to come up with new strategies, according to Dan Webster, a board member. The hospital also cut staff by about 20 full-time-equivalent positions during the last year and a half, Webster said. Many
Health and Wellness 2011/12 have been in ancillary services, such as the hospital laundry, record keeping and maintenance, said Sylvester. The hospital also closed an assisted living facility last June. Licensed for 25 residents, it had nine when it closed. An outreach clinic in Mansfield was also shut down in mid-September as a cost-saving measure. ODDH’s new CEO said the hospital needs to focus not only on budget cuts, but also “be very aggressive” about developing new revenues. To do that, Hufnagel said, he’ll be meeting with physicians throughout the district to “find out what we can do to encourage them to use the facility.” He said he hopes to attract more patients and physician referrals from the Methow Valley in particular. Many residents of the valley aren’t aware that they are part of the hospital district and support ODDH through their taxes, said Hufnagel, who owns a second home in Mazama. “We are all grown accustomed to referring to the hospital as the ‘Brewster hospital,’ but it’s not the Brewster Hospital, it’s the district hospital,” Hufnagel said. “A part of that is our own fault. Historically we haven’t done as much as we might to be visible to the community and let them know all the services we provide. “We intend to do a better job being visible in the district and let them know we’re here to take care of them. Over coming months and years we’re going to be a lot more visible than you’re used to.” Residents in the hospital district demonstrated their support for the hospital by
Page 13 voting in August to approve an increase in the district’s tax levy. By a 56 percent margin, voters agreed to boost the amount they pay to support the hospital from 28 cents per $1,000 of taxable property to 63 cents per $1,000, effective in January 2012. That increase is expected to raise an additional $600,000 for the hospital. Sylvester said ODDH has moved into “creative revenuegenerating services” such as a cardiac rehabilitation facility, a durable medical equipment department where patients can
rent or buy home health care products, and a sleep medicine center where sleep disorders are diagnosed. The hospital has also achieved “Baby Friendly” status through a global program sponsored by the World Health Organization and the United Nations Children’s Fund. Hospitals with that designation are recognized for the care they provide to breastfeeding mothers and their babies. ODDH is one of only 42 hospitals in the country to achieve the Baby Friendly designation.
“I’m definitely a fan of their obstetric policies,” said Blue Bradley, a certified nursemidwife in the Methow Valley. Bradley said when her patients want or need to give birth in a hospital, she delivers their babies at ODDH because she likes its “progressive” approach to childbirth. The hospital has two newly remodeled birthing suites equipped with a specially designed tub, where women are able to labor and deliver if they desire, Bradley said. As he has assessed ODDH’s strengths and weaknesses,
Hufnagel said the hospital staff is one of its strong points. “We’ve got really good people here. Not only really good technically and professionally, but their hearts are in the right place. They’re here because they want to be here,” he said. Hufnagel said he’ll be calling on the entire staff to help him make the changes that the hospital needs to prosper. “This is a team sport, doing turnarounds. Everybody in the organization has to be involved.”
Twisp River Wellness Acupuncture & Nutritional Therapy Are you looking for support with your: Chronic/Acute Pain Digestion Allergies
Headaches Fatigue Diet & Nutrition
Call today to learn how Acupuncture & Nutritional Therapy can support your health! Chaya Kudla MS, LAc, NTP
9 97.2488
125. N. Methow Valley Hwy Room 9 TWISP, WA 98856
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Health and Wellness 2011/12
Help for those who need it Valley offers resources for the uninsured By Ann McCreary As more people in the Methow Valley and around the nation find themselves unable to afford health insurance, the need for access to affordable medical care becomes more acute. According to the U.S. Census Bureau, more than 50 million people were uninsured in 2009, almost one in six U.S. residents. The percentage with private insurance was the lowest since the government began keeping data in 1987. The increase in uninsured people is attributed to workers losing their jobs in the recession, companies dropping employee health insurance benefits and families going without coverage to cut costs. Free and reduced-cost medical care is available in and around the Methow Valley for people with limited resources. Both family practice clinics in the valley have arrangements for helping people who are unable to pay in full for medical care. One longstanding local program offers free care for uninsured children on Fridays at The Country Clinic in Winthrop. About a decade ago, family physician Ann Diamond decided to begin offering free care to patients under 18 “when it looked like the state was going to shrink uninsured enrollment” for children. “It’s a vulnerable population, kids who don’t have insurance,” Diamond said. The free Friday clinic helps patients with acute illness, chronic conditions that need management, and preventive care such as well-child checkups. The free appointments are scheduled among the other paying clinic patients on Fridays. For many years Diamond was the primary care provider, but in recent years the care has been provided by family practitioner Chris Hogness. Diamond emphasized that the clinic is strictly for children who lack any insurance, not for
families who have insurance with high deductibles. “People who have large deductibles have chosen to have large deductibles,” she said. In cases where patients may need lab work done, Diamond said, the clinic has a cooperative arrangement with Quest Labs in Seattle. “We’ve
Photo by Sue Misao
Dr. Chris Hogness at Winthrop’s Country Clinic. arranged with the lab that if we don’t charge for the care, they won’t charge for the lab work,” she said. Similarly, Wenatchee Valley Clinic has agreed in some cases to provide free follow-up with specialists for patients who need it. “If we see someone who has a heart murmur, we can apply to a cardiologist at Wenatchee Valley Clinic and at times they’ve said yes to doing an echocardiogram,” Diamond said. At Methow Valley Family Practice in Twisp “we’ve always given away free and reduced medical care to indigent patients,” said family practitioner Joe Jensen. He said the care is provided on a sliding scale, based on documented income. He has cooperative arrangements with laboratories for free lab work for indigent patients. Jensen said his office also helps patients who qualify to apply for assistance through the state Department of Social
and Health Services. Methow Valley Family Practice is federally certified as a Rural Health Clinic, a program designed to improve access to primary care in underserved rural areas. The program helps rural medical clinics stay in business by providing special Medicare and Medicaid reimbursement. Rural Health Clinics are required to follow a variety of policies and protocols, said Jensen. Guidelines require that the designated rural clinics use a team approach of physicians and midlevel practitioners, such as nurse practitioners and physician assistants. Jensen said the additional reimbursement his clinic receives through the Rural Health Clinic certification has allowed him to survive in an area with a significant population of lowincome residents. “We would have to lose money to see Medicaid patients without the Rural Health Clinic designation,” Jensen said. Another regional source of low-cost medical care is Family Health Centers, which has clinics in Okanogan, Brewster and Tonasket. Family Health Centers is partially federally funded, and offers care on a sliding scale. The clinics provide primary and preventive health care for children and adults, as well as dental care and laboratory services. Karissa McLane, director of Room One, said transportation to the clinics from the Methow Valley “is almost always a problem,” but Room One works with clients to try to help them find a ride if they need one. In addition, Room One hosts a free Women, Infants and Children program on the first and third Thursdays of each month. WIC is a federally funded program designed to promote good nutrition and information on healthy eating to low-income pregnant, postpartum, and breastfeeding women and children up to age 5.
Health and Wellness 2011/12
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Directory of advertisers Acupuncture Methow Valley Wellness Center.... 6, 11 Twisp River Wellness ........................13 Adult Care Aging and Adult Care ......................12 Amedisys Hospice ............................14 Harmony House Health Care.......... 11 Ayurvedic Practitioners Methow Valley Wellness Center.... 6, 11 Bodywork Circle M Massage ...............................9 Methow Valley Wellness Center.... 6, 11 North Glover Healing Center............5 Spirals .................................................12 Sun Mountain Lodge .......................... 4 Cardiopulmonary Rehabilitation Okanogan Douglas District Hospital ... 7
Dentistry/Orthodontics, Cont. Family Health Centers......................10 Steven Harrop, DDS .........................10 Sawtooth Dental Care .......................13 Emergency Services Aero Methow Rescue........................13 Health Food Stores Glover Street Market...........................8 Main Street Market Natural Foods ...10 Hearing Aids & Services Eye & Ear Clinic ................................12 Micron Audiology ...............................5 Herbalists Horse of a Different Color..................9 Methow Valley Wellness Center.... 6, 11
Chiropractic Services Methow Valley Chiropractic Clinic.... 9
Home Care Suppliers Okanogan Douglas District Hospital ....7 Ulrich’s Valley Pharmacy ...................7 Webster Furniture ...............................6
Counseling Ann Douglas ........................................8
Hospice Services Amedisys Hospice ............................14
Dentistry/Orthodontics Caring Dental Center .......................... 3 Family Dentistry, Dr. John L. Nickell, DDS ...............10
Hospitals Okanogan Douglas District Hospital ... 7 Mid-Valley Hospital ......................... 15
Human Resources Room One.............................................7 The Support Center........................... 11 Hypnotherapy Inner Heights Hypnotherapy ..........14 Insurance Services Gayen Willett Insurance ...................14 Laundromats/Showers The Washworks ................................. 11 Life Improvement, Coaching Mindfullness Based Stress Reduction ...............................4 Medical Clinics Caribou Trail Orthopedics & Sports Medicine ............................3 The Country Clinic..............................4 Eye & Ear Clinic ................................12 Family Health Centers......................10 Main Street Health Associates .........10 Omak Clinic .......................................16 Midwifery North Glover Healing Center............5 Naturopathy Methow Valley Wellness Center.... 6, 11
Nutritional Therapists Twisp River Wellness ........................13 Optometrists Eye & Ear Clinic ................................12 Spectrum Eye Care ............................12 Pharmacies Family Health Centers......................10 Ulrich’s Valley Pharmacy ...................7 Pregnancy/Birth Control North Glover Healing Center............5 Okanogan Family Planning .............13 Retail/Gifts Bluebird Grain Farms .........................8 Spirals .................................................12 Ulrich’s Valley Pharmacy ...................7 Schools Little Star Montessori .........................6 Spa Services Nectar Skin Therapy ...........................9 Sun Mountain Lodge ..........................4 Fitness, Yoga and Dance Classes The Studio ............................................9
We care about you! Ever since the beginning of Omak’s Family Medical Center in 1958, the clinic has experienced a lot of change, including the merge with Wenatchee Valley Medical Center (WVMC) in 1985. One thing that has not changed is the strong commitment we have to the communities of Okanogan County. You are our friends, family and neighbors and we want to make sure you are receiving quality health care in a friendly and caring atmosphere close to home. With our association with WVMC, we have been able to host 33 different physicians and mid-levels representing 15 different specialty depar tments in Omak so that our patients do not have to travel to Wenatchee for their specialty visits. We’re proud of our association with WVMC and we’re honored to ser ve your medical needs together.