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More businesses helped by WSU Vancouver program

More businesses helped by WSU Vancouver program

Since 2011, more than 100 small businesses in the Vancouver area have received c...

Workforce Development: A return to personnel investment

Workforce Development: A return to personnel investment

It is a common reaction to economic downturn: companies understandably tighten t...

Aerospace grant to fuel expansion of Clark College

Aerospace grant to fuel expansion of Clark College

Clark College is growing its presence in the Columbia River Gorge thanks to a st...

Local alliance ready to shape state health care reforms

Local alliance ready to shape state health care reforms

Backed by local industry leaders, members of the Southwest Washington Regional H...

Self-taught filmmakers driving local industry

Self-taught filmmakers driving local industry

Ask a local about the film scene in Southwest Washington, and you’re likely to b...

Legal marijuana sales underway in Washington state

Legal marijuana sales underway in Washington state

A year and a half after voters legalized recreational marijuana in Washington st...

Banking & Money Management

Challenges & successes in local lending

Challenges & successes in local lending

Reaching the two-year mark is a milestone for small businesses. Not only can owners celebrate the survival of their life’s work, but doors to one of the most vital resources – capital – also begin to open up.

G6 Airpark in Vancouver recently reached this milestone. The local business is a trampoline park, a place where children and adults alike can play on wall-to-wall trampolines. But for owner ...

Education & Workforce Development

Workforce Development: A return to personnel investment

Workforce Development: A return to personnel investment

It is a common reaction to economic downturn: companies understandably tighten their budgets; non-essential or slow-to-return investments get nixed pretty quickly. During the Great Recession, this was the case not only in Southwest Washington, but throughout much of the nation, as investing in a company’s most valuable asset – their employees – fell victim to the reigning in of purse strings.


News Briefs

Subaru delivers one-millionth car to Port of Vancouver

Subaru of America and the Port of Vancouver recently celebrated a milestone as a red 2015 Forester became the one-millionth Subaru vehicle to cross the port’s docks.


Wacom eyes continued growth of product lines

Wacom eyes continued growth of product lines

As Doug Little is being interviewed, he motions to the ball-point pen taking notes in my hand.

“You’re using a pen [and paper] right now, but you could be doing that with our tablet,” he said. Little is the senior public relations manager for Wacom Technology Services, a Tokyo-based company whose headquarters for the Americas are located in Vancouver.

Wacom specializes in creating a more intuiti...

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.


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.”


Focus Column

Improve payment processes by making them more integrated

Improve payment processes by making them more integrated

You’ve probably heard the saying that there’s nothing good that cannot be improved on. In the changing world of payables...

Don’t let your business become a victim of bank fraud

Don’t let your business become a victim of bank fraud

Your bank or credit union is the lifeblood of your business and critical spoke in the wheel of daily commerce. To their ...

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