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County, wine industry approaching smoother waters

County, wine industry approaching smoother waters

A learning experience. That is how both vineyard/winery owners and county offici...

Banner Bank to open Salmon Creek branch

Banner Bank to open Salmon Creek branch

Banner Bank, a Walla Walla-based financial institution with a branch in East Van...

Study: $7 billion investment in state transportation would yield $42 billion in benefits

Study: $7 billion investment in state transportation would yield $42 billion in benefits

A healthy ROI awaits the state of Washington if its leaders are willing to make ...

Downtown Vancouver cocktail bar readies for opening

Downtown Vancouver cocktail bar readies for opening

The owners of Grocery Cocktail and Social, a new cocktail bar/restaurant located...

WSU Vancouver: Enhancing the business community for 25 years

WSU Vancouver: Enhancing the business community for 25 years

25 years ago, Washington State University opened its Vancouver branch on the Cla...

Maruichi Northwest to invest $30 million in port steel mill

Maruichi Northwest to invest $30 million in port steel mill

A new steel mill is coming to the Port of Vancouver USA’s Centennial Industrial ...

Health Care & Hospitals

Healthiest Companies of Southwest Washington 2014

Healthiest Companies of Southwest Washington 2014

Recognizing the employers who go above and beyond to create a healthy workforce

Studies continue to show that good health practices at work create a more productive and efficient environment with less absenteeism, proving that the “daily grind” doesn’t have to be a grind. From a Vancouver-based manufacturer to a regional law firm, these four workplaces are making the 9-to-5 a happier and healthie...

Food & Agriculture

County, wine industry approaching smoother waters

County, wine industry approaching smoother waters

A learning experience. That is how both vineyard/winery owners and county officials seem to view the past few years, as they sought solutions that would encourage the development of wineries in the county while mitigating impacts to neighboring parcels. And, like many learning experiences, it was sometimes fraught with mistakes, misunderstandings and frustration. But Marty Snell, Clark County comm...

News Briefs

Riverview Community Bank posts $1.1 million in second quarter earnings

Riverview Bancorp Inc. reported this week that it earned $1.1 million, or $0.05 per diluted share, in the second fiscal quarter ended September 30, 2014. The second quarter results also included a $3.5 million reduction in nonperforming assets, an 18.6 percent decline.

Spotlight

ExecuTech Lease Group: Putting the personal touch into equipment leasing

ExecuTech Lease Group: Putting the personal touch into equipment leasing

Many restaurants and small businesses use a cash register and a separate terminal to handle sales, while another PC handles timecards and inventory management. But as the business grows, so does the need for a full-scale point of sale (POS) system. Such a system in a restaurant, for example, integrates everything from placing an order to a credit card swipe into one piece of equipment. But this ty...

Private practices face uphill battle, uncertain future

Dr. Sheila Mitchell
Don Benz, M.D.
Medical office entrance

Economic pressures from all sides are squeezing the lifeblood out of Clark County’s small, independent health clinics and physicians’ offices. Several have already closed their doors, and the ones that remain open are questioning how long they can survive.

Feeling the squeeze

“I ask myself, ‘how long can I keep this up?’” said Don Benz, M.D., who owns a physician’s office on 164th Avenue in Vancouver.

Sheila Mitchell, M.D., owner of the Spirit of Health Wellness Clinic in Salmon Creek, reported that in just the last few months, a physician just down the street went out of business, as did Dr. Hehn, an independent urologist who had served the Vancouver area for 40 years.

Mitchell cited Medicare and Medicaid payment reductions and increasingly onerous paperwork as primary reasons for the economic challenges facing independents today. When she talks with colleagues, she said, “overhead is the biggest complaint.”

For example, she said, insurance companies require more paperwork. In addition to that, Benz explained, Regulations pertaining to HIPPA, electronic health records and updates to the International Classification of Diseases (ICD) codes are continuing to drive up overhead and administrative costs. For example, he said, it costs $50,000 to install an electronic records system and $15,000 per year to upgrade it.

Local regulations aren’t helping, according to Benz, who said that when he opened his office on 164th, all he needed to do was remodel – the infrastructure such as streets and parking existed for 12 years. But, he said, the city of Vancouver charged him an $18,000 traffic impact fee.

Bigger clinics, Mitchell pointed out, have bigger budgets and more administrative help than smaller offices, which can help absorb overhead increases.

Benz cited a recent American Medical News (AMN) article stating that the annual physician services inflation rate rose just 1.3 percent over the last year, compared to the overall Consumer Price Index gain of 2.7 percent. According to the American Medical Association, there is a 20 percent gap between Medicare payments and physician costs – and the governing body for Medicare and Medicaid is calling for a 30 percent reduction in Medicare payment reduction beginning in 2013.

Finding the dollars

“There are fewer dollars to pay for health care,” explained Kurt Litvin, executive director of PeaceHealth Medical Group Vancouver, whether those dollars are coming from the federal government, commercial payers, or the patients themselves.

For both large and small organizations, said Litvin, it means “doing more with less.” But larger systems, he said, can spread the risk out more. For smaller organizations, “there’s only so much you can adjust,” he said.

“Too much overhead, not enough payment,” summarized Mitchell.

Competing with hospitals

Competition from hospital systems is another survival factor for smaller doctors’ offices. Benz said that hospital systems get paid two to three times more by Medicare than small offices, and they can negotiate more favorable contracts with insurers.

The AMN article referenced earlier said that in 2001, only three percent of hospital residents wanted work as hospital employees. In 2011, that number was 32 percent. The number of full-time physicians and dentists employed at community hospitals jumped 47 percent between 2001 and 2010, according to the American Hospital Association. In contrast to the below-inflation rate payment increase for physicians, the cost of inpatient hospital services rose 5.3 percent for the past year – roughly double the overall inflation rate.

“We have a difficult time recruiting people to work with us,” said Mitchell. “We can’t pay as much as hospitals pay.” Mitchell is currently writing a book, tentatively titled “The Fall of Medicine in America,” chronicling the problems she sees with the medical insurance industry and her own struggles to keep her practice open.

Alternatives

To survive, physicians are looking for alternatives to owning their own practice. Mitchell said that some doctors are choosing to practice “boutique medicine,” which is cash-based, and targeted to patients who can afford to pay for extras. Many doctors are restricting or eliminating Medicare and Medicaid patients. Others are closing their doors, such as Mitchell’s colleague, who now works for Kaiser Permanente.

Another alternative, said Litvin, is a growing trend of partnerships, called clinical integration networks. This trend, said Litvin, is driven not only by economic pressures, but also by the concept of “population-based management of health care,” part of the Obama administration’s health care reform package. In this model, said Litvin, there is the expectation that instead of competing, care providers will collaborate. However, he cautioned that practices with only one or two doctors have more difficulty joining such partnerships because they don’t have as much reach in the population as mid and larger sized groups, who are generally more geographically dispersed.

Litvin said “grouping up” is already starting to happen in Portland and Seattle, and will be “coming to Vancouver soon as well.”

Opinion

Focus Column

How fitness makes you better at work

How fitness makes you better at work

In August of this year I had the opportunity to submit an article to the Vancouver Business Journal entitled “Healthcare...

5 Ways to win in workplace wellness

5 Ways to win in workplace wellness

In the building industry, you might not expect to need a fast horse in the race to win in wellness. Construction workers...

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