Vancouver Business Journal


Last update04:47:32 PM

Font Size

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...

New apartment complex breaking ground in downtown Vancouver

New apartment complex breaking ground in downtown Vancouver

Portland-based DBG Properties LLC will break ground next week on a new $17.4 mil...

Southwest Washington’s Innovation Advantage

Southwest Washington’s Innovation Advantage

What enables Southwest Washington to attract innovation giants such as Hewlett P...

Clark College introduces new technical program

Clark College introduces new technical program

Clark College has introduced a new technical program while adjusting some existi...

Q&A: Commissioner Barnes talks business

Q&A: Commissioner Barnes talks business

We recently sat down with newly-appointed Clark County Commissioner Ed Barnes to...

Buy Local

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 be met with a blank stare. We have a few movie theaters, and there are some places that make videos, but a real film industry? If we do have one, where is it?

Well, if we’re looking for a real film “industry,” we’re going to have to keep looking for a while. However, there are many more hobbyists making their own movie...

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

DiscoverOrg achieves record revenue growth in first half of 2014

DiscoverOrg, a Vancouver-based provider of IT sales leads intelligence, announced that it has achieved record revenue growth (+62 percent) in the first half of this year, compared to the same period in 2013.


Teamwork & training driving growth at Premiere Property Group

Teamwork & training driving growth at Premiere Property Group

Four years ago, Steve Borwieck, owner of Premiere Property Group LLC, (PPG) decided to launch his own brokerage.

“When you know something you should teach it, because when you teach it you master it,” said Borwieck.

But when he approached his boss with the idea of teaching some classes to brokers, they “brushed him off.” So, he said, “I rocked back in my chair and thought ‘I can do this as well’...

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

A long-term win for all

A long-term win for all

Becoming involved with workforce development is an opportunity for businesses to contribute to the economic health of ou...

Outstanding employees are standing by

Outstanding employees are standing by

In today’s competitive marketplace every employer wants to hire outstanding employees. While there continues to be a hig...

Special Editions

Business Growth Awards

Print Edition

JA Teline IV

Inside Track

JA Teline IV



North Bank Magazine

JA Teline IV