Hospital District needed to sustain island health care

A hospital district is our best shot at achieving sustainable primary medical care on the island.

I am writing to express my enthusiastic support for the proposed Vashon-Maury Island hospital district. I worked as a physician at the Vashon clinic for over 38 years and witnessed first-hand the financial problems associated with delivering primary medical care under various models.

The economic difficulty facing primary care is that it is labor- and cost-intensive, but is not adequately reimbursed under the current payment systems. This is not unique to the island. Primary care physicians throughout the country struggle to remain in independent practices with an increasing majority employed by hospital-based systems. These large organizations subsidize the losses of their primary care clinics and offset those losses by generating income from expensive admissions and procedures (such as cardiovascular surgery, orthopedic joint replacements and MRI scans.)

Attempts at hospital-based systems did not work here on Vashon for multiple reasons, including demographics, a mixed insurance base and island patients splitting their choices for care among multiple hospital systems. Without the potential for more overall growth and without the likelihood of acquiring a major market share on the island, those systems turned away from Vashon. The current federally-qualified system, Neighborcare Health, struggles because of the low percentage of our island population meeting their subsidization requirements, i.e. being on Medicaid or uninsured.

Other voices in this public forum have discussed some of these issues in admirable detail. I applaud their efforts.

Some islanders focus on the current lack of emergency or urgent primary care access, and, yes, acute care has historically been a significant part of local medical care and should remain so. In my view, the larger goal of local primary care is to work with patients to prevent life-threatening conditions from developing in the first place by carefully evaluating risk and advising people on pathways to optimal health. This means having a long term, longitudinal relationship with a local health care provider.

The major burden of outpatient medicine is actually not acute care, but chronic disease management. With our aging population, this burden is going to increase. Diabetes, cardiovascular disease, chronic lung disease and dementia are all labor-intensive conditions best served by the coordinating efforts of a primary care provider. The 21st-century label for this model is called the medical home. For a large portion of my tenure at the Vashon clinic, we fulfilled many of the goals of the medical home concept. By doing so, we also provided care that was very cost-effective, as documented by independent analysis.

While this type of care may be available off-island, in my opinion, on-island care is not just a convenience, but a true necessity. The impracticality and cost of transporting our aging population off-island for care that could be obtained locally simply do not make sense.

Medicine is evolving and technical advances in the area of telemedicine show great promise. However, face-to-face encounters are still mandatory to adequately evaluate and treat diabetic foot ulcers, listen to lungs for possible pneumonia and repair lacerations — to name just a few examples.

A hospital district is our best shot at achieving sustainable primary medical care on the island. I want to emphasize that a medical practice operating under that district would still be generating revenue from insurance billing and patient payments. Adding financial support through a hospital district would provide much-needed stability now and offer a viable future for health care on Vashon Island.

— Gary Koch practiced at the clinic formerly known as the Vashon Health Center for 38 years.