Vancouver Business Journal


Last update12:18:59 PM

Font Size

CenturyLink strengthens commitment to Clark County with gigabit service

CenturyLink strengthens commitment to Clark County with gigabit service

CenturyLink announced this week that broadband speeds up to 1 gigabit per second...

Marketing & the human element

Marketing & the human element

The world of marketing is abuzz with talk of metrics. A typical campaign might i...

Fort Vancouver National Trust announces “Dancing with the Local Stars” participants

Fort Vancouver National Trust announces “Dancing with the Local Stars” participants

The Fort Vancouver National Trust has unveiled the nine local community leaders ...

10 Things: Julie Kuni, Village Vineyard

10 Things: Julie Kuni, Village Vineyard

Here are 10 things we learned from our discussion with Julie Kuni of Village Vin...

Clark County rolls out video option for building inspections

Clark County rolls out video option for building inspections

Contractors, business owners, landlords and private homeowners now have the opti...

Women shaping Clark County’s law industry

Women shaping Clark County’s law industry

In an industry that has been historically male-dominated, Clark County has seen ...

Design & Construction

Tracking Vancouver’s new waterfront park

Tracking Vancouver’s new waterfront park

The redevelopment of the old Boise-Cascade Mill site in downtown Vancouver has long been a top priority for city leaders. And while the mixed-use project has the potential to be a game-changer for the city, the key to its success may very well lie at the water’s edge.

The 32-acre project will include one million square feet of office space and 250,000 square feet of retail space, including propos...

Marketing & Strategic Communication

Marketing & the human element

Marketing & the human element

The world of marketing is abuzz with talk of metrics. A typical campaign might incorporate search-engine optimization (SEO), automated lead generation and a quantified return-on-investment. The thought of people – not computers – designing all the elements of a publicity push can start to sound like a dream of the Mad Men era.

But in this age of analytics, the human element is still vital to even...

News Briefs

Clark County taxable retail sales up 7.8 percent

Taxable retail sales in Clark County increased 7.8 percent to $1.2 billion during the first quarter of 2014 compared to the same period in 2013, according to the Washington State Department of Revenue.


Wall to Wall Stone Corp enjoying extraordinary growth

Wall to Wall Stone Corp enjoying extraordinary growth

Most business owners would be ecstatic if their companies grew 30 or 40 percent a year. One Vancouver company says it is growing at a rate of 100 percent a year and has been since 2008 when it was founded.

Wall to Wall Stone Corp., which began with four employees, is up to 93 now and hopes to employ more than 200 by next year. The fabricator and installer of stone for residential and commercial c...

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

How NOT to select a building design consultant

How NOT to select a building design consultant

A building construction project, whether for a new building, renovation, addition or repair, represents a significant fi...

Building “failures” and how to avoid them

Building “failures” and how to avoid them

The recent collapses of the I-5 Bridge over the Skagit River and the floor of the Vancouver Warehouse and Distribution C...

Special Editions

Business Growth Awards

Print Edition

JA Teline IV

Inside Track

JA Teline IV



North Bank Magazine

JA Teline IV