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1. effect of the ACA on HMC’s function — Depending on which expert one consults, one will receive a spectrum of predictions, ranging from ‘HMC’s mission population will shrink’ as they take their new Medicaid or health insurance exchange funding to other clinics in the city that previously rebuffed them because they were ‘self-pay’ (i.e., no-pay) … to “HMCs mission population will increase’ as these other clinics now actively recruit newly insured patients (e.g., the state exchange) while further rebuffing self-pay patients. The bottom line is that no one knows what will happen to the size of HMC’s mission population until the ACA plays out for several years — thus, the the urgent closing of HMC on-site clinics on July 1, 2014 (including no concrete plans of where they would move to in the city) is premature, with respect to this rationale. The HMC administration has clearly stated that this intended move will not significantly impact the fiscal health of HMC in a posi! tive way … so what is the real rationale?
2. complex needs of HMC’s mission population — As noted in Scott’s op-ed and my comments, HMC’s mission population patients have physical, mental, psychosocial, sub-specialty referral, and language/interpreter needs that are currently met in the on-site clinics at HMC, and are simply not available in other clinics in the city. Because the HMC administration has made it clear that they will not provide resources for HMC to build/acquire new clinics in the community, the only option is for these patients to receive care in existing clinics whose infrastructure and personnel are not able to provide the comprehensive care that the mission population requires.
3. where do HMC’s clinic patients live? — Depending on the specific primary care clinic, between 20-50% of the clinic population lives in the ‘urban core’ of Seattle — primarily downtown (e.g., homeless, low-income housing provided by DESC) and in the Rainier valley, with much of the remaining population living further south in White Center, Renton, Tukwila. Thus, moving the primary care clinics away from HMC would displace the care for 20-50% of the clinic population — that’s not a small number, and such a move would violate HMC’s obligation to King County. Furthermore, those patients living further away in the city still often require the various support services I refer to in #2 above, which cannot be provided in existing clinics run by other providers or health care systems.
4. impact on faculty/staff and education — Based on recent experience from the only other recent decentralizing move of a UW Medicine primary care into the community, such a large-scale move of the HMC primary care clinics would negatively impact faculty (e.g., time and transportation inconvenience/inefficiency required to work at both HMC and another community clinic, possible loss of faculty positions), staff (e.g., loss of seniority and benefits associated with moving to a new employer, possible loss of staff positions), and education of medical students and residents (e.g., time and transportation inconvenience/inefficiency required to work at both HMC and another community clinic, loss of exposure to and experience gained by caring for these most difficult patients).
In summary, on many levels the HMC announcement is premature, not fiscally or morally justified, and will create formidable new obstacles that negatively impact HMC’s faculty and staff, and limit medical education across multiple trainee groups.
Sam
2. complex needs of HMC’s mission population — As noted in Scott’s op-ed and my comments, HMC’s mission population patients have physical, mental, psychosocial, sub-specialty referral, and language/interpreter needs that are currently met in the on-site clinics at HMC, and are simply not available in other clinics in the city. Because the HMC administration has made it clear that they will not provide resources for HMC to build/acquire new clinics in the community, the only option is for these patients to receive care in existing clinics whose infrastructure and personnel are not able to provide the comprehensive care that the mission population requires.
3. where do HMC’s clinic patients live? — Depending on the specific primary care clinic, between 20-50% of the clinic population lives in the ‘urban core’ of Seattle — primarily downtown (e.g., homeless, low-income housing provided by DESC) and in the Rainier valley, with much of the remaining population living further south in White Center, Renton, Tukwila. Thus, moving the primary care clinics away from HMC would displace the care for 20-50% of the clinic population — that’s not a small number, and such a move would violate HMC’s obligation to King County. Furthermore, those patients living further away in the city still often require the various support services I refer to in #2 above, which cannot be provided in existing clinics run by other providers or health care systems.
4. impact on faculty/staff and education — Based on recent experience from the only other recent decentralizing move of a UW Medicine primary care into the community, such a large-scale move of the HMC primary care clinics would negatively impact faculty (e.g., time and transportation inconvenience/inefficiency required to work at both HMC and another community clinic, possible loss of faculty positions), staff (e.g., loss of seniority and benefits associated with moving to a new employer, possible loss of staff positions), and education of medical students and residents (e.g., time and transportation inconvenience/inefficiency required to work at both HMC and another community clinic, loss of exposure to and experience gained by caring for these most difficult patients).
In summary, on many levels the HMC announcement is premature, not fiscally or morally justified, and will create formidable new obstacles that negatively impact HMC’s faculty and staff, and limit medical education across multiple trainee groups.
Sam